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PubMed1991

[Cholelithiasis, cholecystectomy and colorectal cancer--a retrospective analysis].

The authors analyzed a series of 421 patients with colorectal cancer after preliminary review of the current literature and the modern theories of the origin of the disease. The patients have been treated at the Department of Propedeutics of Surgical Diseases, Research Institute of Surgery, for the period 1984-1990, and special accent was placed on the study of the relation of colorectal cancer to cholelithiasis and cholecystectomy. It was shown that 1.19 per cent of all patients had been cholecystectomized at mean 10.6 years back and 6.65 per cent had pre-existing or accompanying biliary calculosis with mean duration of symptoms 16.4 years. A major relationship was found between morbidity from colorectal cancer, on the one hand, and patient sex and biliary calculosis, on the other. Eighty nine per cent of the patients with colorectal cancer and with biliary calculosis treated by cholecystectomy were women and 20.3 per cent of the women with colorectal cancer had biliary calculosis and had been cholecystectomized. Attention is focused on the current practical requirements of the prophylaxis of colorectal cancer--adequate attitude to biliary calculosis, feeding habits, specifying cases at risk and their observation.

Age Factors↗
PubMed1991

Cholelithiasis: diagnosis and current therapeutic options.

More than 20 million people in the United States have gallstones and some 500,000 cholecystectomies are done annually. The cost to the American public is approximately 1.5 billion dollars per year. Biliary pain or "colic" is the classic presenting symptom in gallstone disease, occurring in 5 to 10 percent of symptomatic patients. Of significance is that 10 to 30 percent of symptomatic patients will present with atypical complaints, while 80 percent of people with gallstones are asymptomatic. It is crucial that a detailed history of clients' symptoms be ascertained to ensure an accurate diagnosis. New treatment modalities for cholelithiasis recently have been developed. These include oral bile salt therapy and gallstone lithotripsy. Knowledge of these options and their applications to symptomatic clients will enable health care providers to better formulate plans of education and intervention for clients with gallstone disease.

Cholelithiasis↗
PubMed1991

[Surgical treatment for the association of cardiovascular disease and cholelithiasis].

Six cases of the association of cardiovascular disease and cholelithiasis were treated in our surgical ward. Simultaneous operation was carried out for four of them, and two-stage operation was performed in the remaining two cases. As the time of the simultaneous operation, reconstruction of the abdominal aorta and cardiac surgery was firstly done, and cholecystectomy was secondly performed after closing the retroperitoneum or the median sternotomy. All of these cases were discharged from hospital uneventful. In conclusion, cholecystectomy could be safely performed at the same time of the aortic reconstruction and cardiac surgery without any high risk for the patients.

Adult↗
PubMed1990

[Bacteriocholia and cholic acid level in the bile in cholelithiasis].

Infection of the biliferous system in patients with cholelithiasis was shown to be the most frequent when the levels of cholic acid in bile were low. Physiological concentrations of cholic and deoxycholic acids have antimicrobial activity against organisms not adapted to the presence in bile. Outer drainage of the bile ducts was accompanied by an increase in the levels of cholic acid when at the background of outer decompression bacteria were eliminated from the biliferous system. In vitro studies revealed a synergistic antibacterial effect of cholic and deoxycholic acid combinations with cefazolin.

Bile↗
PubMed1990

[A method of individual selection of cholelitholytic drugs for the treatment of cholelithiasis].

A method of individual selection of cholelitholytic agents was developed and tested in the clinic on the grounds of the findings of polarizing microscopy of bile and the results of study of gallstones by scanning electron microscopy. Its essence consists in visual appraisal of the effect of various solvents, used in the clinic, on the crystal structures of the patient's bile. The use of the developed method makes it possible to raise significantly the efficacy of contact solution of gallstones in combined treatment of cholelithiasis.

Aged↗
PubMed1990

[Special methods of examination in the diagnosis of cholelithiasis].

Rational combination of special methods of examination yields exact, objective, and detailed information for the diagnosis of cholelithiasis. Ultrasonic examination (USE) is an absolutely noninvasive method and therefore precedes all the other methods. USE suffices for the diagnosis of uncomplicated calculous cholecystitis. USE and intravenous cholegraphy are indicated in complicated cholecystitis without jaundice, USE and percutaneous transhepatic cholegraphy--in the presence of jaundice. These methods of examination are supplemented with endoscopic retrograde cholangiopancreatography in cases which are difficult for differential diagnosis and in those with cicatricial strictures of the bile ducts. Laparoscopy and aspiration biopsy of the liver usually complete the examination. In emergencies diagnostic laparoscopy, despite its definite invasive character, is conducted after USE.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1990

Comparison of oral cholecystography (OCG) with real time ultrasonography in the diagnosis of cholelithiasis at the Tikur Anbessa Hospital, Addis Ababa, Ethiopia.

A prospective study of the accuracy of real time ultrasonography in the detection of gallstones was undertaken in 180 patients from February 1987 to February 1988. The ultrasound findings were compared with single dose oral cholecystography (OCG), and with the surgical findings where surgery was undertaken. Ultrasonography gave more accurate results than OCG, with an overall accuracy in the surgically proven patients of 97.1%, no false positive findings and a 2.9% false negative rate. OCG gave an accuracy of 80% with no false positive findings and a 20% false negative rate. Ultrasound was particularly valuable where there was non visualisation of the gall bladder at OCG, giving an overall accuracy of 93.3% in such patients. Ultrasonography is a non invasive, simple, safe and economic diagnostic test of high accuracy in the diagnosis of cholelithiasis and of particular benefit in those patients unsuited for OCG.

Cholecystography↗
PubMed1990

[Medical treatment of cholelithiasis (II)].

In the second part of this paper we review the potential side effects of orally administrated bile acids as well as recurrences after dissolution. We also discuss two new methods of medical treatment for cholelithiasis: the percutaneous instillation of contact solvents, particularly methyl-tert-butyl-ether and lithotripsy with external shock waves.

Bile Acids and Salts↗
PubMed1990

Cholelithiasis in a 5-year-old girl--case report.

A case of cholelithiasis in a 5-year-old girl is presented in which the main symptom was recurrent pain of the upper abdomen. The diagnosis was made by ultrasound examination of the abdomen and confirmed at surgery. Possible etiological factors of gallstones in children are discussed and the role of abdominal ultrasound examination is emphasized.

Abdominal Pain↗
PubMedDate not supplied

[A clinical survey on 17 cases of cholelithiasis in childhood (author's transl)].

A series of 17 cases of gallstones in children observed over a period of 10 years in the area of Marseilles is described and the literature reviewed. The majority of children were girls over 10 years old. Symptoms were constantly present and the disease revealed nine times by acute "mechanical" cholecystitis, compared to 16 infectious cholecystitis followed during the same period, three times by an accident of migration (cholangitis in a 14 years old girl, bile ascitis in two infants). A cholecystography should be performed in acute recurrent abdominal pain of unknown origin in children, gallstones appearing to be radiotransparent in six patients. Among causes of gallstone formation, the authors dig out only 6 hemolytic anemias, related to hemoglobinopathies in three patients, and they emphasize the frequency of idiopathic cholelithiasis which should lead to a more complete investigation of the enterohepatic cycle and chemical constitution of bile in such patients.

Adolescent↗
PubMed1990

[Effect of yiqi-yangyin prescription on bile composition of cholelithiasis patients].

There were 41 postoperative patients of cholelithiasis with manifestation of Qi-Yin deficiency, had treated with Yiqi Yangyin Prescription. The regimens was 2 weeks as a course, thereafter bile specimens were taken through T tube drainage, and biochemical analysis were performed in order to determine the composition in consequence of the comparison of the treated patients with the control groups. There were 19 patients of bile pigment stone in whom 10 treated with the prescription and 9 were served as control. The results showed that the total bilirubin, unconjugated bilirubin, the concentration of calcium ion and the activity of beta-glucuronidase were markedly decreased as compared to those in the control group (P less than 0.05), the concentration of bile acid markedly increased than that in the control group (P less than 0.05). There were 22 patients of cholesterol stone, 11 treated with the prescription and 11 were served as control group. The results were the same as in bile pigment stone group except decreased in conjugated bilirubin (P less than 0.05), and the unconjugated bilirubin were remained unchanged (P greater than 0.05) as compared to the control group. The ratio of unconjugated bilirubin to total bilirubin and the ratio of bile acid to bilirubin were markedly decreased as compared to those in the control group. The above observation showed promptly that Yiqi-Yangyin Prescription gave a promise influence on lithogenic bile of cholelithiasitic patients, and also investigated the mechanism of the prescription used for deficiency patients with biliary troubles.

Adult↗
PubMed1990

[Internal fistulas of bile ducts caused by cholelithiasis].

Operative treatment of 41 patients is analysed. It is shown that internal fistulas of the bile tract are severe complications of cholelithiasis. Late detection and treatment of diseases of the biliary system is the main cause of formation of the fistulas. Removal of the internal biliary fistula as well as correction of abnormal changes in the bile ducts is the object of the operative intervention. The postoperative fatality was 12.2%.

Adult↗
PubMed1990

Oral dissolution therapy for cholelithiasis: mix and match.

The authors conducted a prospective, randomized trial of chenodeoxycholic and ursodeoxycholic acid versus ursodeoxycholic acid alone in patients with cholelithiasis to determine their efficacy for dissolution of gallstones. One hundred and twenty patients with radiolucent gallstones, less than or equal to 15 mm and who had a functioning gallbladder were enrolled. The patients were divided into two groups based on the diameter of their largest stones. Seventy patients had stones larger than 5 mm but less than 15 mm, whereas 50 patients had stones that measured 5 mm or less. The patients were randomly assigned to treatment with chenodeoxycholic acid plus ursodeoxycholic acid (5 mm/kg of each) or ursodeoxycholic acid (10 mm/kg) alone. Oral cholecystography, plain abdominal x-rays, and ultrasonography of the gallbladder were done at 6, 12, and 24 months. Dissolution was deemed to be complete if not stones were visualized on two examinations. partial dissolution was defined as a 50% reduction in stone size and/or number. Stones that were not detected by cholecystography but still detected during ultrasonography were considered to be partially dissolved. Plasma triglycerides, serum cholesterol, HDL, and serologic liver function tests were determined at 1, 3, 6, 12, 18, and 24 months. In a select group of patients, bile-rich duodenal aspirates were aspirated and analyzed for biliary lipid contents. In the group with small stones, defined as less than or equal to 5 mm, complete stone dissolution occurred significantly more often utilizing combination therapy at 6 months (52% vs 24%), and this trend persisted, although no longer significant, at 12 and 24 months. Combination therapy also achieved an improved rate of dissolution for large stones within 6 months; however, this did not persist at 12 and 24 months. Although not statistically significant, stone calcification occurred less often with combined therapy. All treatment regimens were well tolerated, with only minor changes in bowel habits and mild elevations in serum transaminase levels. Serum lipid levels did not change with either therapy. The authors concluded that the combination of chenodeoxycholic acid and ursodeoxycholic acid was the preferred therapy for gallstone dissolution, because it dissolves stones more rapidly, with a lower incidence of stone calcifications, and thus might reduce the long-term cost of treatment.

Chenodeoxycholic Acid↗
PubMed1990

Cholelithiasis in the Kenyan African.

A prospective and retrospective review of 20 cases of cholelithiasis diagnosed at Kenyatta National Hospital (KNH) between June 1987 and June 1989 was done. Females were more often affected (6 times) than their male counterparts. 94% of the females were parous with a mean parity of 5.6. Most patients were in the 4th decade at the time of diagnosis. Qualitative analysis for gall-stones showed evidence of cholesterol in all stones analysed with calcium being detected in only one female patient.

Adult↗
PubMed1990

[Surgical treatment of patients with cholelithiasis].

The article analyses the results of treatment of 1,506 patients with cholelithiasis in the period between 1977 and 1986. On the grounds of the results four groups of risk were set apart. The lethality rate was 6.6% in the group of patient over 60 years of age. Performance of the operation in jaundice worsens the results 3.5 times, while conduction of choledochotomy in calculous cholecystitis leads to 3-4 fold increase in lethality depending on the patient's age. Diagnostic endoscopic retrograde cholangiopancreatography in patients with complicated forms of the disease helps in identifying the cause of jaundice before the operation. It is shown that the use of endoscopic papillosphincterotomy, both as the first and, in some cases, as the final stage of the treatment of the most severe patients with choledocholithiasis is promising.

Adult↗
PubMed1990

[Epidural block in the surgical treatment of cholelithiasis].

The article analyses surgical treatment of patients with cholelithiasis (231 persons) who were operated on with the use of a "pure" epidural block (59 patients), epidural block in combination with surface endotracheal nitrous oxide anaesthesia (100 patients), and general many--component anaesthesia (72 patients). The results show that epidural block is an effective method of neurovegetative protection of the organism from an operative trauma, provides rapid recovery of the organism for a state of operative stress, and is conducive to reduction of the number of postoperative complications. Administration of hydrocortisone and ephedrine is expedient for the prevention of arterial hypotension and its correction.

Adult↗
PubMed1990

[Muciparous cells and endocrine cells of the gallbladder epithelium in patients with uncomplicated cholelithiasis].

In this study the authors have investigated the different morphofunctional features of the gallbladder mucosa in patients with uncomplicated cholelithiasis. Histological changes, type and distribution of endocrine and mucin-producing cells were characterized by immunocytochemistry and mucin histochemistry. The authors attempted to correlate these findings to the number and size of gallbladder stones as well as type of bacteria present in the bile. The results indicate that, despite similar clinical parameters, a wide range of histological changes may occur in the gallbladder mucosa of these patients. Moreover, the presence of some endocrine and mucin-producing cell types in the so called "pyloric metaplasia" led the Authors to hypothesize that the latter may be a trivial event.

Cholelithiasis↗
PubMedDate not supplied

HLA antigens in Greek patients with cholelithiasis.

The distribution of HLA-A and B antigens was studied in 100 patients with cholelithiasis and in 202 healthy individuals all of Greek origin. An increased frequency of HLA-Aw19 was found in patients (33 per cent) compared with controls (22 per cent) (p less than 0.05, RR 1.7). The increase of Aw19 was even higher for patients with a family history of the disease (44 per cent, vs 22 per cent, p less than 0.01, RR 2.7) and for patients with cholesterol gall stones (44 per cent vs 22 per cent, p less than 0.01, RR 2.5). No difference was seen in patients without a family history of disease or with mixed gall stones. These results suggest a genetic basis for the development of cholesterol gall stone disease.

Adult↗