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PubMed1989

[Characteristics and results of the treatment of cholelithiasis in elderly patients].

The results of surgical treatment of cholelithiasis in 708 patients over 65 years of age are discussed and compared with those obtained in a group of 2.021 younger patients who underwent operation in 1975-86 for stones in the gallbladder and bile ducts. The authors discuss the morbidity according to the patient's age, frequency of combination of stones in the bile ducts and acute inflammation of the gallbladder, and mortality depending on the age and the type of the operation. It was found that the incidence of acute inflammation of the gallbladder, choledocholithiasis, obstructive jaundice, and cholangitis increased progressively with age.

Age Factors↗
PubMed1989

Acute abdominal pain: the value of liver function tests in suspected cholelithiasis.

Over a 4-year period, prospective data were collected on 311 patients with suspected acute cholecystitis. By identifying the diversity of conditions which can masquerade as acute cholecystitis, we have examined the role of biochemical liver function tests in the diagnosis and management of these patients. The initial clinical diagnosis of acute cholecystitis was confirmed in 229 patients (73.6%). Of those patients on whom liver function tests were performed, 76.3% (206/270) were confirmed to have cholecystitis and 69.9% (144/206) of these had some evidence of liver dysfunction. In the group of patients (64/270) with other diagnoses on whom liver function tests were performed, significantly fewer (57.8%, 37/64) had abnormal liver function tests (P less than 0.05). This is of little clinical value since normal liver function does not exclude cholecystitis (predictive value of negative test = 30.3%). In proven cases of cholecystitis, there was a significantly increased incidence of liver dysfunction when ductal calculi were present. Using the information obtained from this study, an investigative protocol is proposed which may substantially reduce the rate of misdiagnosis of patients with abdominal pain suggestive of cholelithiasis.

Abdomen, Acute↗
PubMed1989

Massive hemoperitoneum from transhepatic perforation of the gallbladder: a rare complication of cholelithiasis.

A 74-year-old woman with known cholelithiasis arrived at our emergency department with mild abdominal pain. During investigation she collapsed with abrupt hypotension. A peritoneal tap revealed frank blood. At urgent laparotomy, there were several liters of blood in the peritoneal cavity and two free gallstones, despite an apparently intact gallbladder. We report the second recorded instance of transhepatic perforation of the gallbladder presenting as massive hemoperitoneum.

Aged↗
PubMed1979

ABO bloodgroups in cholelithiasis.

In order to search for a probable association between ABO bloodgroups and cholelithiasis, a study was undertaken on 321 patients and 688 controls. It appears that group A subjects are having somewhat higher risk to be affected with the disease than those of groups B or O.

ABO Blood-Group System↗
PubMed1988

[Chronic gastritis and serum lipids, hypertension and cholelithiasis].

In 217 patients after gastric biopsies from corpus and antrum we looked for statistic correlations with lipids in serum, blood pressure, and gallstones. In patients with hypercholesterolemia we more often observed atrophic gastritis in antrum whereas in patients with hypertriglyceridemia or hypertension we more frequent found atrophic gastritis in corpus (significance on 5 per cent level). These results allow us to discuss the possibility, that arterial diseases may play a role in pathogenesis of atrophic gastritis. - In agreement with literature in cholelithiasis we found more often atrophic gastritis, but the difference was not statistically significant.

Adolescent↗
PubMed1988

Cholelithiasis in children. A report of 3 cases.

Three cases of gallstone in children with no apparent predisposing condition are reported. The importance of considering cholelithiasis in the child with abdominal pain is described and the use of ultrasonography in its efficient diagnosis is stressed.

Adolescent↗
PubMedDate not supplied

The epidemiology of gallstone disease in Rome, Italy. Part II. Factors associated with the disease. The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO).

The epidemiological associations of gallstone disease were evaluated in a population of 2,325 civil servants (1,244 men and 1,081 women) in Rome, Italy, which was enrolled in a cross-sectional survey on cholelithiasis. Participants were screened for the presence of gallstones by gallbladder ultrasonography, completed a questionnaire on family and personal history and underwent a physical examination and blood chemistry. Statistically significant associations were established by univariate analysis of the age-standardized data and by step-wise multiple logistic regression. At univariate analysis, increasing age, serum triglycerides and number of cigarettes smoked per day, and decreasing high-density lipoprotein-cholesterol were the conditions associated with the presence of gallstones in men. Age and parity were the correspondent associations in women. After controlling by multiple logistic regression, a different pattern of associated conditions emerged. In men, only age and serum triglycerides showed a significant positive association with gallstones, which was independent of other variables. In women, the presence of gallstones was independently associated with increasing age, number of pregnancies, body mass index and serum triglycerides, and with decreasing total (and low-density lipoprotein) cholesterol. The latter association was curvilinear in shape. The conditions associated with a history of cholecystectomy differed from those observed in subjects with gallstones, with the exceptions of age, in both sexes, and high serum triglycerides, in women. Fasting blood glucose levels were higher in women with a history of cholecystectomy than in those with or without gallstones, both at univariate and multiple logistic regression analyses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Operative therapy for cholecystitis and cholelithiasis: trends over three decades.

Gallstones constitute a major health problem. In the United States there are approximately 800,000 new cases of cholelithiasis each year. Several developments within the last 20 years are likely to have altered the profile of patients requiring cholecystectomy. All patients undergoing cholecystectomy at three hospitals during 1 year of the last 3 decades were reviewed. The results demonstrate a relative increase in the proportion of elderly patients undergoing cholecystectomy. The incidence of gallstones in blacks appears to be rising. Cholangiography significantly decreased the number of negative common duct explorations throughout this 20-year period. The percentage of patients with choledocholithiasis was stable from 1964 to 1984.

Adult↗
PubMed1986

[A case of inferior vena cava thrombosis associated with cholelithiasis demonstrated by ultrasonic examination].

A case of a 44 year old female with inferior vena cava thrombosis associated with cholelithiasis was reported. The patient had chest and back pain due to pulmonary embolism. Ultrasonic examination showed stone echoes in the gallbladder and thrombus echoes in the inferior vena cava (IVC) at the height from renal veins to bifurcation of iliac veins, but iliofemoral thrombosis was not found by RI angiography and venography. Anticoagulant and urokinase were administered, then pulmonary embolus disappeared and IVC thrombus reduced. IVC thrombus was removed by incision of IVC. Thrombus was white thrombus. Etiology of thrombus was not clear. IVC ligation or plication for prevention of pulmonary emboli was not carried out. Etiology, diagnosis and treatment of IVC thrombosis were also discussed.

Adult↗
PubMed1987

Radiologic appearance of gallstones and its relationship with biliary symptoms and awareness of having gallstones. Observations during epidemiological studies. Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO).

In the course of two cross-sectional epidemiological surveys carried out by the Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO), cholecystography was performed in 82 of 126 subjects identified by means of ultrasonography as having gallstones. In four subjects gallstones were not detected by cholecystography. The x-ray characteristics of the gallbladder and gallstones of the remaining 78 subjects were related to age, sex, presence of biliary symptoms in the five years prior to the study, and awareness of having gallstones. Twenty-three of the 78 gallstone subjects (29.5%) showed a nonvisualized gallbladder. Among the 55 subjects with visualized gallbladder, 16 (29.1%) and 28 (50.9%) showed radiopaque and solitary stones, respectively. The mean diameter of the largest stone was 19.7 mm +/- 11.2 (SD). Age was related inversely to the number of stones. X-ray characteristics of gallstones did not differ between men and women. Presence of biliary symptoms in the five years prior to the study or awareness of having gallstones were not related to any radiologic feature, either in univariate or multivariate statistical analysis which included age, sex, weight, and height as possible confounding variables. Nineteen (24.3%) of the 78 subjects showed gallstones which would have been suitable for medical therapy with bile acids (ie, radiolucent, with a diameter of less than 20 mm, and in a visualized gallbladder).

Adult↗
PubMed1987

[Morphogenesis of hepatocellular necrosis in patients with cholelithiasis complicated by gangrenous cholecystitis].

Morphogenesis of hepatocellular necrosis was studied on liver biopsy samples from patients with cholelithiasis complicated with gangrenous cholecystitis. In patients operated on 5-7 days after the onset on the disease there were foci of hepatic parenchyma necrosis infiltrated with polymorphonuclear leukocytes (PNL) with relevant introduction into the hepatocytes. In patients operated on in 10-15 days disintegration of cellular structures, removal of necrotic masses and reparation proceed with participation of PNL in line with tissue macrophages and stellate reticuloendotheliocytes, poorly differentiated and mature fibroblast-like cells. Finally, bundles of collagen fibres are forming and introduced at the sites of hepatocellular necrosis.

Adult↗
PubMed1987

[Comparative study of bile sedimentation rate and pH normally and in cholelithiasis patients].

The paper is concerned with the results of a study of the time of appearance of bile sediment and change in pH in patients with cholelithiasis (CL) and in healthy persons. In CL patients the rate of bile sediment in vitro was 3-4 times higher than in healthy persons, bile coagulation took place in a weak alkaline medium. In the course of chenoursotherapy one could control dissolution determining bile pH and the time of sedimentation.

Bile↗
PubMed1987

[Gallbladder cancer as unexpected histologic diagnosis following cholecystectomy for cholelithiasis and cholecystitis].

Uncharacteristic symptoms, inadequate early diagnosis, and high malignancy are the major reasons why most of the patients with carcinoma of gallbladder are not admitted for clinical examination until metastasation had begun to involve the liver. So, the majority of authors who have made contributions to the literature are in agreement to the effect that the prognosis is extremely poor for patients with gallbladder carcinoma and that curative therapy is possible only in rare cases. There are only few reports on cases on whom operations could be performed in good time. Curable gallbladder carcinoma is more often than not an absolutely accidental finding obtained in the course of surgical treatment for cholelithiasis. Reported in this paper are four cases in which malignant lesions to mucosa were accidentally discovered by pathologists in histological examination of specimens obtained from cholecystectomy for cholecystolithiasis and cholecystitis. Problems involved in therapeutic action are discussed.

Adenocarcinoma↗
PubMedDate not supplied

A necroptic study of the prevalence of cholelithiasis in liver cirrhosis.

The prevalence of cholelithiasis in liver cirrhosis was analyzed on 1320 consecutive necropsies which included 245 subjects with gallstones and 133 with liver cirrhosis. Gallstones were found in 24.8% of the cirrhotics, a prevalence significantly higher than in noncirrhotic subjects (17.8%) (p less than 0.05), and were more frequent in cirrhosis for all age-groups. The mean age of death was lower in cirrhotic than in noncirrhotic subjects (p less than 0.05). It was also lower, but without statistical significance, in cirrhotics without gallstones than in cirrhotics having gallstones. The ratio between lithiasic women and men was 0.8/1 in liver cirrhosis, as compared to 1.6/1 in noncirrhotic subjects. The proportion of pigment stones was significantly increased in liver cirrhosis (47.5%) (p less than 0.02). Chronic hemolysis secondary to hypersplenism, a know lithogenic factor in liver cirrhosis, might account for the predominance of pigment stones in this disease. Other lithogenic factors could be hyperestrogenism, changes in the proportion of biliary lipids etc. Complications of gallstones occurred less frequently in cirrhotic than in noncirrhotic patients, but complications of cholecystectomy represented the cause of death in 27.2% of cirrhotics as compared to 14.0% of noncirrhotic patients (p less than 0.02). These observations argue for a conservative, non-surgical attitude towards silent or uncomplicated gallstones in cirrhotic patient.

Adolescent↗
PubMed1986

The benefit of emergency nasobiliary drain in cholelithiasis with ascending cholangitis, coagulopathy, and thrombocytopenia.

Severe coagulopathy in a male patient with septicemia, renal failure, and obstructive jaundice secondary to cholelithiasis precluded safe endoscopic sphincterotomy. A temporary nasobiliary drain, inserted at endoscopic retrograde cholangiopancreatography, decompressed the biliary tree, allowing eventual safe sphincterotomy and bile duct clearance after correction of coagulopathy and improvement in his clinical condition.

Blood Coagulation Disorders↗
PubMed1986

Cholelithiasis and aortic reconstruction: the problem of simultaneous surgical therapy. Conclusions from a personal series.

From 1976 to 1983, 682 patients have undergone aortic reconstruction at Parkland Memorial Hospital and the Veterans Administration Hospital in Dallas, Texas. Thirty-five patients (5.1%) had a biliary tract operation performed before, during, or after their aortic procedure. Fourteen percent of patients had bacteria in the bile and 11.4% needed common bile duct exploration. Twelve patients had their aortic reconstruction first. Biliary pancreatitis developed postoperatively in one patient. Two patients who had infected prostheses removed had acalculous cholecystitis after operation and one had jaundice and fever 3 years after operation, but no biliary disease was found. Twenty-one patients had the biliary procedure first. Four patients were operated on for suspected aneurysm rupture an average of 18 months after operation. There was one true rupture; this patient had no gallstones. One patient had acute aortic thrombosis 10 days after emergency operation for acute cholecystitis. Only two patients underwent combined operative procedures; both were patients with acute aortic problems in whom chronic and subacute biliary disease was found. Eight operative deaths occurred, all in the patients undergoing aortic procedures. There were no ruptured aneurysms or acute biliary problems needing emergency operation in any patient with cholelithiasis. On the basis of our experience, we believe that concomitant cholecystectomy and aortic reconstructions rarely need to be performed and then only in those patients in whom the risk of not treating both biliary and aortic conditions is greater than the operative risks. In these circumstances, cholecystostomy should be considered to decrease operative time and the risk of graft contamination.

Adult↗
PubMed1986

Pediatric pancreatic pseudocyst associated with cholelithiasis.

Pseudocyst of the pancreas is an uncommon problem in pediatric practice, and when related to gallstones, it is rare. A 13-year-old male adolescent with pseudocyst of the pancreas associated with cholelithiasis and chronic cholecystitis presented with a peculiar clinical picture. The etiology, pathophysiology, diagnosis, and treatment of pancreatic pseudocysts and gallstone pancreatitis in children are discussed.

Adolescent↗
PubMed1986

Cholecystitis and cholelithiasis in children and adolescents.

One hundred patients aged 20 years and younger, admitted to Hurley Medical Center during a ten-year period for treatment of acute or chronic cholecystitis with or without cholelithiasis, were reviewed. Results demonstrated an increasing incidence of pediatric cases compared with previous reports, a predominance in parous teenagers, and only an 8 percent association with hemolytic diseases. The clinical presentation is very similar to that of adults. Maintaining a high index of suspicion in addition to the use of diagnostic aids such as cholecystogram, ultrasonography, and hepatobiliary imaging with technetium 99m PIPIDA (paraisopropylacetanilide iminoacetate) should lead to the diagnosis of gallbladder disease even at a very early age. Elective cholecystectomy in the stable patient is the treatment of choice, and any delays in the diagnosis and treatment will increase morbidity and mortality considerably.

Adolescent↗