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PubMed1990

Cholelithiasis in owl monkeys: seven cases.

Spontaneous cholelithiasis was found in seven owl monkeys (Aotus spp.) at necropsy. There were four male and three female animals. Antemortem clinicopathologic findings included weight loss, anemia, increased alanine aminotransferase and gamma glutamyl transpeptidase, and hyperbilirubinemia in several animals. Choleliths ranged in size from sand-like particles to 5 mm in diameter. Gallstones from five animals were analyzed by accepted analytical methods. Results showed the gallstones to be composed primarily of cholesterol (89%). The gallbladder was histologically normal in all cases examined. The etiopathogenesis of cholelithiasis in the owl monkey is unknown.

Animals↗
PubMed1990

Nonsurgical management of cholelithiasis.

Cholecystectomy is accepted and effective therapy for symptomatic cholelithiasis; until recently, it was the only therapeutic option for patients with gallstones. Recently available alternative therapy for cholelithiasis includes oral dissolution therapy with the bile salts ursodeoxycholic acid and chenodeoxycholic acid, extracorporeal shock wave lithotripsy, and instillation of methyl tert-butyl ether directly into the gallbladder. The role of each of these methods in the treatment of patients with gallstones will be reviewed, as well as the epidemiology, pathogenesis, natural history, and roentgenographic characteristics of gallstones, all of which are relevant when choosing appropriate therapy for the individual patient.

Aged↗
PubMed1990

Ultrasonographic findings in horses with cholelithiasis: eight cases (1985-1987).

Cholelithiasis and/or obstructive biliary tract disease was diagnosed ultrasonographically in 8 horses, 5 to 15 years old. Ultrasonographic findings revealed greater than normal amount of hepatic parenchyma in the right side of the abdomen in 8 horses and in the left side in 3 horses. The echogenicity of the liver was greater than normal, and thick distended bile ducts were seen in all horses. Choleliths were imaged ultrasonographically in 6 horses. Subsequently, postmortem findings in 6 horses revealed periportal and intralobular fibrosis, moderate bile duct dilatation, proliferation, and cholestasis. One or more choleliths were found in all horses. Ultrasonographic findings accurately depicted the histologic changes in the hepatic parenchyma in horses with cholelithiasis.

Animals↗
PubMed1990

Cholelithiasis in the western region of Saudi Arabia.

This is a prospective study of 454 patients with cholelithiasis treated surgically in the University Hospital at Jeddah admitted to surgical department of K.A.U.H. from 1979 until the end of 1987. Biliary surgery constituted 4.7% of all major operations reviewed in our Hospital. The disease affected females 4.5 times more than males. Right hypochondrial pain was present in 74.2% of cases, biliary colic in 60% and obstructive jaundice occurred in 14.09% of patients. The clinical diagnosis of cholelithiasis was confirmed by radiological examinations by laboratory, oral and I.V. Cholangiogram, and Ultrasound. These included liver function tests. All cases had cholecystectomy. This was carried out electively in 95.34% of patients, and as an emergency in only 4.63% of cases. Exploration of the CBD was performed in 14.09% of patients. Choledochoduodenostomy in 0.44% and sphincterotomy. Sphincteroplasty in another 0.44% of cases. There was no operative mortality, and post op complications occurred in 14.53% of patients.

Adolescent↗
PubMed1990

[Cholelithiasis in patients with primary extrahepatic portal hypertension].

The results of treatment of 17 patients who had primary extrahepatic portal hypertension in combination with cholelithiasis are analysed. Of them 13, were operated on. In presence of the extended strictures of the bile ducts, the performance of hepaticojejunostomy is mandatory. In dominating involvement of the extrahepatic bile ducts, the endoscopic papillotomy as a definitive intervention is expedient. In asymptomatic course of cholelithiasis, the operation is not expedient.

Adult↗
PubMed1990

Modern standards for comparison of cholecystectomy with alternative treatments for symptomatic cholelithiasis with emphasis on long-term relief of symptoms.

Cholecystectomy is standard treatment for symptomatic cholelithiasis. Long term relief from symptoms, however, has not been reported. We reviewed 671 elective cholecystectomies performed between 1982 and 1987 for biliary colic (group 1, 91 per cent), dyspepsia associated with gallstones (group 2, 5 per cent) and atypical pain syndromes (group 3, 4 per cent), to define precisely important variables for comparison with alternate methods of gallstone treatment. Cholecystectomy resulted in a mortality rate of zero per cent and an over-all morbidity rate of 4.5 per cent. The procedure-related morbidity rate was 2.2 per cent. Long term follow-up period for 81 per cent of these patients (mean of 45 months) showed that 88 per cent were free of symptoms. Patients in groups 1 and 3 were more likely to obtain relief from symptoms than those in group 2 (p = 0.10). We concluded that cholecystectomy is a definitive treatment for symptomatic cholelithiasis with minimal risk to the patient and a high degree of relief from symptoms. Alternative treatments for gallstones must compare favorably with these results of modern cholecystectomy prior to acceptance and widespread use.

Cholecystectomy↗
PubMed1990

[The correction of disorders of lipid-mineral composition of the bile as a method for preventing cholelithiasis].

A study is presented of the lipid and mineral metabolism composition in 60 patients with diseases of the biliary tract (dyskinesias, chronic noncalculous cholecystitis, cholelithiasis) before and after treatment with a hepatoprotective agent silibor, with a dry protein mixture containing amino acids and minerals and a vitamin-mineral agent quadevit. It was established that the patients showed disorders of the mineral and lipid composition of monotypical character but of different degrees of severity in those suffering of dyskinesias, cholecystitis and cholelithiasis. Silibor treatment furthered normalization of the lipid composition of bile, while treatment with dry protein mixture--of the mineral, with quadevit--of the lipid and mineral.

Amino Acids↗
PubMed1990

[Lipid metabolism in cholelithiasis].

The results of studies of the blood and bile lipid metabolism in normal subjects and cholelithiasis patients and the findings of guinea pig experiments indicate that lipid levels decrease with age. The time course of the blood and bile lipids and the relationship thereof reflect the depression of cholesterol hydroxylation processes and reduction with age of cholic and deoxycholic acids synthesis and conjugation intensities in the patients with cholelithiasis, as well as a reduction of deoxycholic acid synthesis in normal subjects.

Adult↗
PubMedDate not supplied

Increased incidence of cholelithiasis in heart transplant recipients receiving cyclosporine therapy.

The introduction of cyclosporine to immunosuppressive therapy greatly improved the results of organ transplantation. The clinical use of cyclosporine, however, is associated with several serious side effects. Because the drug is primarily eliminated via biliary secretion and thus probably alters bile composition, we investigated the incidence of gallstones in 29 heart transplant recipients receiving immunosuppressive therapy with cyclosporine. Two of three female patients and none of the male patients had gallstones before heart transplantation. After operation, in nine of the 26 male patients cholelithiasis developed during cyclosporine therapy; seven cases of gallstones occurred within the first postoperative year. High cyclosporine blood levels, obesity, and diabetes mellitus in the early postoperative period appeared to be predisposing factors for formation of gallstones. Prevention of biliary calculous disease in heart transplant recipients is especially important because immunosuppressive therapy poses an additional risk on potential complications of cholelithiasis. An immunosuppressive regimen aimed at lower cyclosporine blood levels may help to avoid hepatobiliary complications.

Adult↗
PubMed1989

[The content of cholylglycine in the blood serum in cholelithiasis during treatment with litholytic preparations of bile acids].

Liver function has been assessed on the basis of radioimmunoassays of the primary conjugated cholic acid, cholylglycine, in the blood sera of cholelithiasis patients treated with cheno- and ursodeoxycholic acid drugs for a long time. The findings indicate that the blood serum cholylglycine levels may be regarded, among other things, as a prognostic criterion of the efficacy of cholelithiasis therapy with bile acid preparations for litholysis.

Adult↗
PubMed1989

[Free fatty acids in the bile and blood serum in cholelithiasis].

The content of some lipid fractions of the bile and blood serum in calculous and acalculous cholecystitis has been studied by thin-layer chromatography. The findings evidence that a significant reduction of the free fatty acid concentrations and of the ratio of these acids and bile cholesterol is a characteristic feature of cholelithiasis. It has been also revealed that the activity of the serum lipolytic processes does not answer the hypertriglyceridemia level. The detected shifts may be used to characterize the bile lithogenicity and to diagnose cholelithiasis.

Adult↗
PubMedDate not supplied

[Biliary calculi in th golden hamster (M. a. auratus). XXXV. Effect of the hydrogenation of Polifat KA-02 on its preventive activity against pigment cholelithiasis].

It has been previously reported that Polifat KA-02 (fatty acids derived from safflower oil) prevents the pigment cholelithiasis produced by vitamin A in the golden hamster. In order to establish whether the saturation or the unsaturation of Polifat is directly related with its preventive action, in the present study the effect of the hydrogenation of the derivative on this preventive action was tested. Two experiments were carried out in which the animals received the different experimental diets ad libitum during 70 days. In the 1st. experiment the effect of the additions to the lithogenic diet (Rodents Chow + 25,000 UI% of retinol acetate) of 18% of crude safflower oil, or 15% Polifat, or 15% hydrogenated Polifat (approx. 80% saturation) were assayed. In the 2nd. experiment the effect of a more hydrogenated Polifat KA-02 (greater than 99%) was tested. The results of the 1st. experiment showed that the lithogenic diet produced a high incidence (90.5%) of animals with gallstones, which was very similar (100%) to that produced by the crude safflower oil, whereas the additions of normal and hydrogenated Polifat completely prevented the formation of gallstones. The 2 forms of Polifat produced a considerable hepatomegaly. The absorption of vitamin A, measured as total hepatic vitamin A, was higher in the 3 groups that received extra lipids in their diets. The results of the 2nd. experiment fully confirmed the findings related to the hydrogenated Polifat. It is concluded that hydrogenated Polifat KA-02 prevents, as normal Polifat does it, the pigment cholelithiasis in the golden hamster produced by vitamin A.

Animals↗
PubMed1989

[Combined operations in cholelithiasis].

Experience in combined operations for cholelithiasis on 162 patients is discussed. In 98 patients, cholecystectomy was performed as a simultaneous stage of surgical treatment, the main stage of the operation was gastrectomy or resection of the stomach for cancer in 26 patients, formation of a small stomach for alimentary-constitutional obesity in 19, various types of vagotomy in 33, hemicolectomy, resection of the colon and sigmoid intestine for malignant tumors in 10, and reconstructive manipulations on the stomach, correction of intestinal obstruction, and other operations in 10 patients. Cholecystectomy was the main stage of the operation in 48 patients with hernias, benign tumors of the uterine appendages, breasts, and soft tissues. The authors insist that cholecystectomy must be carried out when cholelithiasis is a concurrent disease; they showed that increase in the extent of the operative intervention had no essential effect on mortality and frequency of postoperative complications (mortality rate, 1.2%). The authors substantiate the expediency of performing combined operations from economical considerations--the economical effect of the operations conducted by the authors came to some 51,000 roubles.

Adenocarcinoma↗
PubMed1989

[Esophageal, gastric and duodenal motility in patients with cholelithiasis].

Disturbed motility of the upper gastrointestinal tract presenting with phasic derangement (the absence of all motor phases or peristaltic duodenal contraction, abnormal duration of phases) has been found out in all cholelithiasis patients examined. The findings should in no way be viewed as isolated chronic duodenal insufficiency. Impairment of esophageal, gastric and duodenal motility needs identification and correction in combined treatment, rehabilitation and prevention of cholelithiasis.

Adult↗
PubMed1989

[New aspects of surgical treatment of cholelithiasis].

The interventional endoscopy and new knowledge about the spontaneous course of the cholelithiasis have obtained a far-reaching influence on the indication for operation and the surgical approach. Now as ever the adequate therapy of the symptomatic cholecystolithiasis consists in the early cholecystectomy. Since in the natural course the risk of lethality is small the operation for indication depending on the age and the risk factors given must be made cautiously. This in a still higher degree concerns the asymptomatic cholelithiasis in which at present no general indication for operation is regarded necessary. Due to the low lethality of circa 1% the endoscopic papillotomy has become the therapeutic method of choice in residual and recurrent calculi after cholecystectomy, but also in risk patients with cholecystocholedocholithiasis. The endoscopic papillotomy with stone extraction before the operation suggests a decrease of the operation lethality of 3 to 5% after cholecystectomy with revision of the choledochus.

Ampulla of Vater↗
PubMed1989

[Comparative evaluation of various approaches to the surgical treatment of cholelithiasis in patients of a high-risk group].

The authors undertook comparative analysis of the results of surgical treatment of 247 patients with cholelithiasis who were referred to the high risk group on the basis of consideration for the various complications and concomitant diseases. The control group consisted of 160 patients treated by the routine methods. The main group was made up of 87 patients, 28 of them were subjected to various endoscopic interventions on the major duodenal papilla and terminal part of the choledochus. The number of operations on the choledochus and major duodenal papilla using endoscopic interventions has increased from 27.5% to 48.3%, while the number of complications reduced from 27.4% to 15.2% and mortality--from 6.3% to 1.1%. Endoscopic operations, which cause little injury, considerably improve the results of treatment of cholelithiasis in patients of the high risk group.

Age Factors↗
PubMed1989

Cholelithiasis and urolithiasis in ileostomy patients.

Terminal ileostomy is at present less frequently performed in favour of the use of surgical techniques which allow for the maintenance of continence. The problem of long-term metabolic complications is still open, though it has been stated that 1 year postoperatively, the life expectancy of ileostomy patients is similar to that of the general population. The series here reported consists of 13 patients only, however the increased risk of cholelithiasis and urolithiasis in ileostomy patients can be confirmed (15.4% in this study). These complications should be carefully examined in the follow-up of patients: while cholelithiasis cannot be prevented, for early diagnosis liver scanning every 24-36 months is advisable. As for urolithiasis, the patients should be encouraged to drink large amounts of water daily. Water does not cause an increase in ileostomy output while allowing a satisfactory renal flow. For early diagnosis direct abdominal X-ray with renal tomography every 24-36 months is suggested. In case of suspected kidney or ureteral stones, perfusion urography should be performed.

Adult↗
PubMed1989

Fate of the gallbladder with cholelithiasis after endoscopic sphincterotomy for choledocholithiasis.

Endoscopic sphincterotomy is the treatment of choice for choledocholithiasis after cholecystectomy. Its role has been expanded to treat choledocholithiasis in patients with gallbladders still in place. The authors report their experience with endoscopic sphincterotomy, with emphasis on the safety of the procedure, in high-operative-risk patients with choledocholithiasis and gallbladder in situ. Stones were successfully removed in 72 of 75 patients (96%); 1 required an emergency operation and 2 an elective one. Complications included bleeding, pancreatitis and cholangitis; there were no associated deaths. Follow-up of 54 of the patients, who had associated cholelithiasis at the time of endoscopic sphincterotomy, showed that 14 died of causes unrelated to the biliary tract. Of the others, 14 underwent cholecystectomy for failure of endoscopic sphincterotomy (2), acute cholecystitis (4) or persistent biliary tract symptoms (8). The other 26 patients were well after a mean follow-up of 30.4 months; 1 had mild biliary tract symptoms. Ultrasonography in 16 of the 26 patients showed persistent cholelithiasis in 12. Life-table analysis revealed a 15% probability of acute cholecystitis within 5 years of endoscopic sphincterotomy.

Adult↗