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PubMed1987

Experimental cholelithiasis in the ground squirrel.

Richardson's ground squirrels of both sexes were fed a 2% cholesterol-enriched rat chow diet for various intervals from 6 hours through 20 weeks. Bile was withdrawn from the organs and analyzed biochemically to obtain a lithogenic index. The remaining luminal contents were rinsed from the resected organs and examined by light and scanning electron microscopy. Gallbladder tissue was fixed and examined in a similar fashion to observe the luminal aspect of the epithelial sheet. Scanning electron microscopy revealed increased mucus secretion before precipitation of rhomboidal cholesterol monohydrate crystals from the lithogenic bile. The crystals grew by appositional layering into microliths and then by aggregation into mulberry-shaped stones. Mucus hypersecretion continued to be a common epithelial observation throughout the study. Five days after introduction of the diet, a thick discontinuous sludge-like layer was observed overlying large regions of the epithelial sheet. In later stages, this material was observed embedding cholesterol crystals into the surface aspect of the stone. By 20 weeks many stones were approximately 2 mm in diameter and were accompanied by large numbers of various sized concrements. The nature of the cholesterol crystals and stone formation pattern closely resembled that reported for humans. The ground squirrel fulfills all criteria required to be regarded as an excellent animal model and is well suited for continued study into the role of the epithelial cell during cholesterol cholelithiasis.

Animals↗
PubMed1985

[Choleretic test in the ultrasonic diagnosis of cholelithiasis].

The authors provide the results of repeated echography of the gall bladder after the use of choleretics in cases presenting difficulties for echographic diagnosis of concrements inside the organ. Describe the technique of making the choleretic test, define indications and contraindications as to its use. Ultrasonic exploration of the gall bladder after choleretic intake raises the accuracy of echographic diagnosis of cholelithiasis, reduces the time required for echocholecystography, helps make differential diagnosis of the gall bladder diseases.

Adolescent↗
PubMed1985

Ultrasonographic diagnosis of asymptomatic cholelithiasis in pregnancy.

Using a static B scanner, 203 pregnant patients underwent cholecystosonography at the time of a routine 24-week ultrasound study. The incidence of asymptomatic cholelithiasis, 2.5%, was less than that reported by others. This low incidence and the increased time needed for cholecystosonography suggest that studies should be done on symptomatic patients only.

Adolescent↗
PubMedDate not supplied

[Prevalence of cholelithiasis in necropsies of patients with chronic Chagas' disease in the mining triangle--correlation with megaesophagus, megacolon and cardiac insufficiency].

Retrospective analysis of the diagnosis of 2.517 autopsies performed in the western region of the State of Minas Gerais, Brazil, showed that cholelithiasis has significant association with megaesophagus and megacolon but not with Chagas' disease (when considered in all of its anatomo-clinic presentations) or with heart failure due to chronic chagasic cardiopathy. Possible explanations to these findings are discussed and the scanty pertinent literature is commented.

Adolescent↗
PubMed1986

Elective cholecystectomy for the patient with sickle cell disease and asymptomatic cholelithiasis.

Experience with elective cholecystectomy in ten patients with sickle cell disease and one patient with sickle-thalassemia from 1977-1984 was reviewed. In contrast to an earlier review from our institution, the current series had a low morbidity. This improvement is attributed to careful perioperative care, especially preoperative transfusion, hydration, and oxygenation. Because of the increasing longevity of sickle cell patients, because of the incidence of eventual significant complications of even asymptomatic cholelithiasis, and in order to simplify medical management by eliminating the diagnostic confusion between acute cholecystitis and sickle cell hepatobiliary crisis, the authors believe that elective cholecystectomy is to be recommended for the sickle cell patient with asymptomatic gall stones.

Adolescent↗
PubMed1986

[Changes in the structure of the plasmalemma of hepatocytes and its specialized portions--intercellular junctions in man in complicated forms of cholelithiasis].

As demonstrates the electron microscopic investigation of the human liver at complicated forms of cholelithiasis, there is a stage-by-stage destruction of intercellular junctions and a change in the plasmolemma structure of hepatocytes depending on the degree of the disease. The greatest disorder in the plasmolemma structure is observed at gangrenous calculous cholecystitis, as well as at mechanical jaundice and suppurative cholangitis, dependent on choledocholithiasis. The most sensitive are the gap junctions; desmosomes and intermediate junctions are the second to suffer. The structure of the tight junctions is the last to be disturbed. This results in loss of specificity by different areas of plasmolemma in the hepatocytes, and the hepatocytes themselves loose their polarity. These alterations are evidently irriversible and result in death of the cells.

Cell Membrane↗
PubMed1985

Cholelithiasis in a cat.

A 4-year-old cat was examined because of anorexia and lethargy. The cat became icteric within 3 days of admission. Values for aspartate transaminase, alanine transaminase, total bilirubin, alkaline phosphatase, and cholesterol were higher than normal. Radiography revealed hepatomegaly, with loss of detail in the cranioventral portion of the abdomen. Further diagnostic procedures were not permitted, and the cat was euthanatized. At necropsy, cholecystitis, cholangitis, and numerous choleliths were found. Cholelithiasis is a rare cause of obstructive jaundice in the cat.

Animals↗
PubMed1985

[Cholelithiasis and carcinoma of the colon].

It results cholelithiasis is very frequently associated to colorectal cancer. Clinical and autoptic studies thereabout result to be doubtful. In the present research, the Authors evaluated the proliferative activity of colonic mucous membrane, through the mitotic index, and the secretion of mucins, with histochemical methods, in control subjects and cholelithiasic patients. The results show no significant differences in both groups; the data obtained are discussed in the light of the importance of the biologic parameter considered in the evaluation of risk groups for colorectal neoplasms and, moreover, as morphologic support to the clinical question.

Adult↗
PubMed1985

[Was the prognosis of gallstone disease improved? Analysis of 9,489 cholelithiasis sections].

Among 9,489 cholelithiasis autopsies the cases with cholecystectomy after 1970 significantly increased. At the same time the inflammatory complications with calculi (peritonitis, abscess, phlegmon, pylephlebitis, sepsis) became significantly more infrequent. But the remaining sequelae of calculi scarcely decreased, particularly not the lithogenic necroses of the pancreas and the non-suppurative cholangitis. After successful operation or conservative treatment many patients resume their old habits: but they are more endangered by dietary lapses and alcohol.

Aged↗
PubMed1985

[Pathophysiology of duodenal papillitis in cholelithiasis].

Pathological features of duodenal papillitis relative to cholelithiasis were analyzed in terms of dilatation of the bile duct, intracholedochal pressure, and histopathological pictures of papillitis, and the following conclusions were drawn: The principal causes of bile duct dilatation appeared to be pathological changes in the papilla per se; Papillitis accompanying choledocholithiasis with cholesterol stone were secondary to those gallstones evacuated from the gallbladder; Calcium bilirubinate stones seemed to be formed primarily as the result of papillitis. In some cases, ascariasis in their past history was thought responsible for the papillitis; and 4. It is suggested that as the papillitis advances, papillary incompetence will emerge.

Adult↗
PubMed1985

[Case of bile duct anomalies and cholelithiasis].

A case is reported with a rare anomaly of biliary ducts--lengthened hepatic ducts, that are connected right above papilla of Vater--established by endoscopic retrograde cholangiography and confirmed at operation. The patient was twice operated on the occasion of cholelithiasis: cholecystectomy was performed with the first operation, the gall bladder being connected to the right hepatic duct, but the second biliary duct was not established. The other biliary duct--the left hepatic duct was obstructed by a calculus and dilated, established at the second operation.

Aged↗
PubMed1979

Scanning electron microscopic study of human gallbladder mucosa in cholelithiasis.

The mucosa of 17 gallbladders removed because of cholelithiasis was examined by means of transmission and scanning electron microscopy. Scanning electron micrographs revealed a mulberry-like organization of the normal human gallbladder mucosa. In acute inflammation, circumscribed ulcers were often seen; along their margins the epithelial cells were swollen and isolated from the surrounding cells. In chronic cholecystitis there was an extensive lack of epithelium on the irregularly oriented folds of the mucosa and the characteristic mulberry-like organization was preserved only in islets.

Cholecystitis↗
PubMedDate not supplied

[Prevention of cholelithiasis with ascorbic acid. Experimental study in hamsters].

Cholesterol lithogenesis is the end result of hepatic microsomal enzymatic alterations which determine an increase in cholesterol synthesis (HMG CoA reductase) and a decrease in its transformation into bile salts (7 alpha hydroxylase). Therefore biliary cholesterol excretion is increased while bile salt excretion is diminished. Ascorbic Acid (A.A.) seems capable of reversing those enzymatic derrangements in scorbutic animals. Since hamsters are able to synthesize A.A., we evaluated its effect used in high doses during diet induced lithogenesis. Two groups of 6 weeks old, male hamsters, were fed with a lithogenic diet for 30 days. Group A received the usual amount of A.A. contained in the diet (0.25 mg/day/manster) while group B had supplementary A.A. added to drinking water (5 mg/day/hamster). Thirteen out of twenty of group A (65%) and 5 out of 20 of group B (25%) developed cholesterol calculi (p 0.05). Less stones were found in the gallbladders of hamsters fed with supplementary A.A. It is concluded that A.A. in this model, has an inhibitory effect on lithogenesis. The possible mechanism seems to be related to A.A. influence on the microsomal enzymes involved in lithogenesis. These findings, plus the lack of undesirable secondary effects of supplementary A.A. suggest a potential therapeutic role in human cholelithiasis.

Animals↗
PubMed1968

Experimental cholelithiasis in the rabbit induced by cholestanol feeding: effect of neomycin treatment on bile composition and gallstone formation.

Fed cholestanol is converted by the rabbit to 5alpha-bile acids which coprecipitate with the normally occurring 5beta-bile acids to form gallstones composed of calcium and sodium glycoallodeoxycholate and glycodeoxycholate. The present study shows that oral administration of large doses of neomycin prevents gallstone formation in the cholestanol-fed rabbit and reduces the elevated concentration of allodeoxycholic acid in bile, with a reciprocal increase in allocholic acid concentration. The reduction in the concentration of allodeoxycholic acid and in the incidence of gallstones is proportional to the dose of neomycin; at a concentration of allodeoxycholic acid below about 20% of total bile acids, gallstone formation does not occur. Neomycin probably exerts its action by modifying the anerobic intestinal flora which dehydroxylate allocholic acid to allodeoxycholic acid; if so, this suggests that both hepatic and bacterial transformations are essential steps in the pathogenesis of cholestanol-induced cholelithiasis. The bile of rabbits on a normal diet contains allodeoxycholic acid (5% of total bile acids). A similar decrease in allodeoxycholic acid concentration and reciprocal increase in allocholic acid concentration is observed when neomycin is administered to rabbits on a normal diet.

Animals↗
PubMed1978

Mucosa of the Heister valve in cholelithiasis: transmission and scanning electron microscopic study.

Light, transmission, and scanning electron microscopic studies were performed on 24 gallbladders with thin walls, without inflammation, extirpated by cholecystectomy because of gallstones and on five, free from biliary diseases, obtained by autopsies. Examination of gallbladders and epithelium covering the valvula spiralis (Heister) of the ductus cysticus showed the surface structure of the epithelium covering the Heister valve to be mulberry-like and characteristically pleated, similar to the epithelial lining of the gallbladder. In cases of cholelithiasis, several denuded areas were detectable on the valves. The epithelial lining of the gallbladder was intact. As a new observation, we describe the appearance of worm-like processes on the lateral surface of detached epithelial cells, seen during the course of scanning electron microscopic study. These probably correspond to interdigitating cell junctions observed by transmission electron microscopy.

Cholelithiasis↗
PubMed1980

Optimal timing of surgical intervention in patients with acute pancreatitis associated with cholelithiasis.

In evaluating patients with acute pancreatitis, disproportionately high serum amylase values in comparison to physical findings of peritonitis of the upper part of the abdomen and the rapid return to normal values and the lack of a history of alcohol ingestion should be viewed as findings highly indicative of pancreatitis associated with cholelithiasis. Diagnostic roentgenologic procedures can be initiated soon after admission of the patient, with an intravenous cholangiogram or oral cholecystogram, depending upon the feasibility of oral intake, in patients without jaundice. Expectant treatment is both safe and preferable, so that surgical treatment for disease of the biliary tract is performed after the diagnosis is established in the same hospitalization period.

Acute Disease↗
PubMed1981

P3 amylase isoenzyme in patients with cholelithiasis.

The plasma P3 amylase isoenzyme was determined in 25 patients with proven cholelithiasis. In six patients who had a single gallstone and normal pancreas at operation, the total plasma amylase was within normal limits and the P3 amylase isoenzyme was absent. In the remaining 19 patients who had multiple gallstones, pancreatitis was found at surgery in 10. In this group of 10 patients, the total plasma amylase was above the reference range for healthy individuals in only five (50%), while the P3 amylase isoenzyme band was detected in all 10 (100%). It is concluded that P3 amylase isoenzyme is superior to the total plasma amylase in the diagnosis of pancreatitis in patients with gallstone.

Amylases↗