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PubMed1998

[PCR in detecting the correlation between infection of HBV and cholelithiasis].

OBJECTIVE: To study the correlation between cholelithiasis and the infection of HBV. METHOD: 32 formalin-fixed and paraffin-embedded gallbladder samples of cholelithiasis patients and 20 gallbladder samples of non-cholelithiasis patients were investigated using the polymerase chain reaction-Ethidium bromide (PCR-EB) assay. The 52 patients were positive to HBV serologic markers. RESULT: The results showed that HBV-DNA was found in 13 gallbladder samples of 32 cholelithiasis patients (40.63%), significantly higher than that in 3 gallbladder samples of 20 non-cholelithiasis patients (15%). CONCLUSION: The infection of HBV and the formation of cholelithiasis are correlated.

Adult↗
PubMedDate not supplied

[Cholelithiasis after total gastrectomy for gastric cancer].

After gastric resection for peptic ulcer and total gastrectomy for Zollinger-Ellison syndrome, there is an increased prevalence of cholelithiasis. In order to assess whether this increased prevalence also exists after total gastrectomy for cancer, we evaluated the rate of cholelithiasis (echographic diagnosis) both before and after this operation. Between 1980 and 1990, 89 patients underwent total gastrectomy for cancer in the Surgical Department of our Institute. The pre-operative prevalence of gallstones was 5% in the males and 13.8% in the females. Seventy-four of the eighty-nine patients (83%) were examined post-operatively (7 patients with pre-operative cholelithiasis, 3 who died during the post-operative stay and 5 lost to follow-up were excluded from the study). The median post-operative follow-up was 24 months (range 3-115 months). The post-operative prevalence of cholelithiasis in the 74 patients was 39.6% in the males and 19% in the females. We also calculated the expected frequency of gallstones in both the pre- and post-operative groups from prevalence data in the population of the city where our Institute is based (taken from an echographic survey). We then compared the observed frequency of cholelithiasis with the expected frequency and we found that the difference in pre-operative frequencies, both in the males and females, was not statistically significant (p > 0.05). The same was true of the post-operative frequencies in the females (p = 0.48), but in the males there was a statistically significant difference between the observed frequency of cholelithiasis and that expected after total gastrectomy (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Incidence of cholelithiasis after its experimental induction by various methods].

The incidence rate of cholelithiasis was studied in varying methods of lithogenic stimulation: a diet enriched with cholesterol and chenodesoxycholic acid, induction of acute aseptic inflammation of the gallbladder by thermal damage, and the use of ++anti-gallbladder sera. The results of the study have shown almost similar (44-52%) reproducibility of cholelithiasis in guinea pigs, the development of pigment concrements was recorded in the absolute majority of cases. Correlation of the cholelithiasis incidence rate with inflammatory disorders in the gallbladder has evidenced the importance of the immunoallergic component in the determination of acute cholelithiasis and cholelithiasis, where cholelithiasis shows its secondary character.

Acute Disease↗
PubMed1980

The incidence of cholelithiasis after jejunoileal bypass.

In a prospective study of morbid obesity at the University of Florida, 225 consecutive patients with medical complication of obesity underwent intestinal bypass during a ten-year period from 1967 to 1977. The average age was 35 years, with the average weight being 322 lb (145 kg). Oral cholecystograms were obtained preoperatively in all patients, and repeated at one and five years postoperatively. If a patient developed symptoms, ultrasonography or a cholecystogram was performed at that time. The cumulative preoperative prevalence of cholelithiasis was 30.7 percent. The 156 patients with an intact gallbladder made up the study group. These patients have been followed for an average of 36 months, and 16 have subsequently demonstrated cholelithiasis. The post intestinal bypass incidence of cholelithiasis from surgery to the time of their last oral cholecystogram was 7.2 percent per year. Analysis of variance demonstrated no significant differences between patients, with and without cholelithiasis, with respect to serum triglycerides, cholesterol, or percent weight loss. The incidence of cholelithiasis in the morbidly obese increases further with the metabolic derangements induced by jejunoileal bypass. The increased incidence of cholelithiasis after intestinal bypass, along with the other serious metabolic sequelae that follow this procedure, suggests that the continued long-term followup of these patients is mandatory.

Adolescent↗
PubMedDate not supplied

[Morbidity after video-laparoscopic cholecystectomy in cholelithiasis associated with liver cirrhosis. A case-control study].

At present laparoscopic cholecystectomy represents the treatment of choice for symptomatic cholelithiasis. Authors performed a retrospective case-control study to evaluate whether cirrhosis associated with cholelithiasis increases the risk for morbidity of laparoscopic cholecystectomy. Twenty-one patients with cholelithiasis and cirrhosis (Child-Pugh class A or B) (group A) and 21 controls with cholelithiasis without cirrhosis (group B) entered the study. Controls were paired with cases for age, sex, and indication for cholecystectomy (simple cholelithiasis, acute cholecystitis). The two groups were compared for rate of conversion to open cholecystectomy (19% group A vs 9.5% group B; p = 0.31), morbidity (29.5% group A vs 5.3% group B; p = 0.17), median length of surgery (80 m in the two groups), and median time of postoperative hospitalization (5 days group A vs 3 days group B; p = 0.21). No difference among variables resulted to be statistically significant. Besides, neither common bile duct injuries nor intra or postoperative hemorrhages occurred in patients with cirrhosis. Authors conclude that the laparoscopic cholecystectomy can be considered a safe and effective surgical procedure also for patients with cholelithiasis associated with cirrhosis with a good residual hepatic function.

Aged↗
PubMed1977

Cholelithiasis in Jamaican patients with homozygous sickle cell disease.

The prevalence of cholelithiasis in Jamaican adults with SS disease was studied by plain abdominal radiograph in 206 patients and by oral cholecystogram in 126 (61%) of these patients. Gallstones were found in 57 (28%) of patients, were more common in females than males, and increased with age and hemolytic rate. The majority of gallstones were visible on the plain abdominal radiograph, only 17% of patients with gallstones having only radiolucent stones. Nonfunctioning oral cholecystograms were common (10%) in agreement with observations by previous workers. Gallstones were noted in the common bile duct in 2 patients. In general there was no clear relationship between the presence of cholelithiasis and clinical symptomatology. Complications, such as pancreatitis and malignant change in the gall bladder, recognized to be associated with cholelithiasis in the general population, have not been clearly related to cholelithiasis in SS disease. More information is needed before a logical policy can be evolved for surgical intervention in cholelithiasis in SS disease.

Aging↗
PubMed1988

Cholelithiasis: a serious complication after total gastrectomy.

To establish the incidence of cholelithiasis after total gastrectomy, patients operated on between 1979 and 1985 were reviewed. The study group consisted of 30 patients, all free of gallstones at the time of their gastrectomy. The median age of the patients was 56 years, the average follow-up 40 months. Cholelithiasis developed in 47 per cent of patients (14/30) and always within 2 years of total gastrectomy. The incidence of cholelithiasis was not related significantly to the sex or age of the patients. Morbidity from cholelithiasis was not negligible. Three of the fourteen patients presenting with gallstones required medical treatment in hospital and later came to cholecystectomy because of specific biliary symptoms. Cholelithiasis appears to be a significant complication after total gastrectomy. It may be related to the vagotomy which is performed at the time of gastrectomy.

Adult↗
PubMed2004

Risk factors for cholelithiasis in pregnancy.

This study was designed to examine the relationships of demographics, anthropometrics, prenatal physical activity, serum cholesterol, and nutrient intakes to symptomatic cholelithiasis (gallstone) occurrence in 128 northern plains pregnant women. Data collected at 14 and 26 weeks of pregnancy and 4 weeks after delivery, indicated 25.8% of the Native American and 8.3% of the Caucasian pregnant women experienced symptoms of cholelithiasis. Body mass indices (BMIs) were significantly higher in the pregnant women who experienced cholelithiasis than in those who did not have cholelithiasis, and prenatal physical activity was significantly lower in those same women. History of gallbladder disease (beta=.73; p=.001), BMI (beta=.33; p=.01), and prenatal physical activity (beta=-.20; p=.04) were predictive of increased occurrence of cholelithiasis during pregnancy.

Adult↗
PubMed2002

Male gender: risk factor for severe symptomatic cholelithiasis.

The aim of this study was to determine the effect of male gender on the clinical presentation of symptomatic cholelithiasis. Laparoscopic cholecystectomy (LC) has been accepted as standard procedure for the management of symptomatic cholelithiasis even when the gallbladder is acutely inflamed. With the accumulated experience in the management of acute cholecystitis, some factors including male gender were recognized to influence the clinical presentation of symptomatic cholelithiasis and increase the conversion rate during LC. This retrospective study tried to clarify the correlation between male gender and the clinical presentation of symptomatic cholelithiasis. The medical records of all patients presenting with symptomatic cholelithiasis from January 1994 to August 1999 were evaluated. These cases were divided into four groups as follows: (1) elective LC group: patients with a history of biliary colic or acute attack of cholecystitis but whose LC was performed electively without any inflammatory change in the gallbladder during operation; (2) acute LC group: patients presenting with acute cholecystitis, and LC was performed successfully without conversion; (3) acute conversion group: patients who underwent LC during the course of acute cholecystitis but the procedure were disturbed by severe inflammatory change so they were converted to open surgery; (4) acute open group: patients whose acute cholecystitis was managed by direct open surgery due to the preoperative prediction that LC would not succeed. The correlation of gender, age, and operating time were assessed among these four groups. We found that: (1) the male/female ratio increased (in the patient group sequence of simple LC, acute LC, acute open, and acute conversion group); (2) in the acute LC group male patients had significantly (p = 0.04, t-test) longer operating time than females; (3) although there was no significant difference between the mean age of male (55.7 +/- 13.4) and female (56.3 +/- 15.7) patients in the acute cholecystitis groups (i.e., all patients in the acute LC, acute conversion, and acute open groups), the distribution curve by age in male patients showed a significantly shift to a younger age compared with female patients (p = 0.009, Fisher's exact test).

Adolescent↗
PubMed1989

Changing spectrum of cholelithiasis and cholecystitis in infants and children.

Cholecystitis and cholelithiasis are infrequent in children and have been historically associated with adolescent pregnancy or hemolytic disorders; however, the incidence and spectrum of cholelithiasis seem to be changing. Between 1970 and 1988, 47 children 17 years of age or less underwent cholecystectomy for cholecystitis or cholelithiasis in our hospital. The patients were divided into chronologic groups: Group 1 encompassed 1970 through 1979 (15 patients) and group 2, 1980 through 1988 (32 patients). The groups were compared for age, sex, pregnancy, blood dyscrasia, family history, obesity, use of total parenteral nutrition (TPN), and incidence of choledocholithiasis with its sequelae. A significant increase in the number of patients with cholelithiasis was found. Infants and young children were affected more frequently in group 2, and many of these young patients had a history of TPN. Choledocholithiasis was also more common in group 2 and presented with life-threatening sequelae. Calculous biliary tract disease should be considered as a possible cause of abdominal pain in children. Timely operative intervention can prevent the increasingly common sequelae of childhood cholelithiasis.

Adolescent↗
PubMed2006

Expectant management is safe for cholelithiasis after heart transplant.

BACKGROUND: The optimal management of cholelithiasis after heart transplant remains unclear. We use expectant management based on symptoms, without screening studies or prophylactic treatment. We hypothesized that expectant management for cholelithiasis after heart transplant does not result in significant mortality or morbidity from gallstone-associated disease. METHODS: Between November 1985 and August 2004, 409 heart transplants were performed in 402 recipients at the University of Washington. This is a non-concurrent cohort study of these recipients. RESULTS: Among recipients, 24 underwent cholecystectomy before heart transplant. After transplant, in the remaining 378 patients, 34 were found to have gallstones during the observation period. There was no mortality from gallstone-associated disease. Thirty patients developed morbidity from gallstones, including 25 cases of biliary colic, 3 of acute cholecystitis and 2 of pancreatitis, and there was 1 abnormal liver function test. Acute cholecystitis and pancreatitis were treated with conservative management followed by cholecystectomy. Cholecystectomy was performed in 32 patients after transplant. Indications included symptomatic cholelithiasis in 31, and prophylactic cholecystectomy prior to kidney transplant in 1. The laparoscopic approach was performed in 25 of these 32 patients. There was no mortality from cholecystectomy, but there were 4 complications: surgical site infections (n = 2); wound dehiscence (n = 1); and bile duct injury (n = 1). Median hospital stay was 1 day. CONCLUSIONS: Our expectant management for cholelithiasis after heart transplant resulted in no mortality or significant morbidity related to delay in treatment. Symptomatic cholelithiasis was successfully treated with cholecystectomy, mostly with the laparoscopic approach. We believe expectant management is safe for patients after heart transplant.

Adult↗
PubMed2006

Incidence, risk factors, and complications of cholelithiasis in patients with home parenteral nutrition.

BACKGROUND: Previous studies showed high prevalence rates of cholelithiasis in patients with home parenteral nutrition (HPN). Our aim was to determine, in an HPN population, the incidence and risk factors for gallstones and sludge and their complications. STUDY DESIGN: Retrospective chart review was conducted in a tertiary care center. One hundred fifty-three consecutive patients who received HPN for longer than 2 months (range 2 to 204 months; median 15 months) between 1985 and 1997 were followed with ultrasonography. Kaplan-Meier curves and log-rank tests were calculated to assess risk factors for gallbladder lithiasis and complications. RESULTS: Thirty-four patients (22%) underwent cholecystectomy before HPN. Of the 119 remaining patients with gallbladder in situ, cholelithiasis appeared during HPN in 45 (38%). The probability of cholelithiasis developing during HPN was estimated to be 6.2%, 21.2%, and 38.7% at 6, 12, and 24 months, respectively. Biliary complications developed in eight patients (7%) during followup. Therapy consisted of endoscopic sphincterotomy (three patients) or operation (five patients) with uncomplicated outcomes except for one patient; no death was observed. Incidence rates of biliary complication during HPN were estimated to be 0.0%, 4.7%, and 10.1% at 6, 12, and 24 months, respectively. Nil or negligible ingesta was the only factor notably associated with incidence of cholelithiasis (p < 0.01) or biliary complications (p < 0.01). CONCLUSIONS: This first incidence study shows a high rate of cholelithiasis and a low rate of complications during HPN. Both events were notably related to nil or negligible ingesta.

Adolescent↗
PubMed2003

ABCB4 gene mutation-associated cholelithiasis in adults.

BACKGROUND & AIMS: We recently put forward arguments in favor of ABCB4 gene (adenosine triphosphate-binding cassette, subfamily B, member 4) defects as a risk factor for symptomatic cholelithiasis in adults. In this study, we characterized ABCB4 gene mutations in a series of patients with symptomatic cholelithiasis to determine the genetic basis and the clinical phenotype of ABCB4 gene mutation-associated cholelithiasis. METHODS: We analyzed the entire ABCB4 gene coding sequences in a first group of 32 patients who had a clinical history compatible with the syndrome previously described, in a second group of 28 patients who presented with a classic gallstone disease that justified a cholecystectomy, and in a third group of 33 patients without a history of cholelithiasis. RESULTS: We identified both heterozygous and homozygous ABCB4 gene point mutations in 18 of 32 (56%) patients who presented with clinical criteria of the syndrome, whereas no mutation was detected in the 2 other groups of patients (P < 0.001). Three independent clinical features were strongly associated with point mutations: recurrence of symptoms after cholecystectomy (odds ratio, 8.5); intrahepatic hyperechoic foci, intrahepatic sludge, or microlithiasis (odds ratio, 6.1); and age <40 years at the onset of symptoms (odds ratio, 3.0). ABCB4 gene point mutations were detected exclusively in the patients who showed 2 or 3 of these clinical features. CONCLUSIONS: Our results show that ABCB4 gene mutations represent a major genetic risk factor in a symptomatic and recurring form of cholelithiasis in young adults.

ATP Binding Cassette Transporter, Subfamily B↗
PubMed1999

Prevalence of cholelithiasis: results of an epidemiologic investigation in Vidauban, southeast France. General Practitioner's Group of Vidauban.

Cholelithiasis leads to 80,000 cholecystectomies being performed every year in France, but its prevalence is still unknown. The aim of this study was to assess the prevalence and risk factors of cholelithiasis in a random population of 1027 women and 727 men over the age of 30 in a small town in the southeast of France. Detailed clinical history, dietary investigation, and gallbladder ultrasound were collected for each subject and assessed by univariate analysis. A regression model was used in the multivariate analysis to detect the relative risk of cholelithiasis. Cholelithiasis was found in 130 individuals (global prevalence 13.9%). The relative risk for lithiasis was higher in women compared to men (1.89). Age (P<0.0001) and body mass index (BMI) >25 (P = 0.013) were also significant risk factors. Neither pregnancy nor oral contraceptive use proved to be risk factors. Typical biliary colic pain was the only symptom significantly associated with cholelithiasis (P<0.0001). These results show that the prevalence of gallstones in France is similar to that in Denmark and Italy.

Adult↗
PubMedDate not supplied

[Ceftriaxone-induced cholelithiasis--a harmless side-effect?].

43 children suffering from borreliosis, meningitis and septicemia were treated with ceftriaxone. A six year old boy with acute jaundice due to ceftriaxone induced cholelithiasis encouraged us to reevaluate the frequency of ceftriaxone induced cholelithiasis and its' sequelae in children in a prospective study. Out of 43 children (age 6.3 years, 4 months to 16 years, male: female 25:18), 20 children (46.5%) showed sonographical evidence for ceftriaxone induced cholelithiasis after a treatment of at least 10 days. Two of them even had signs of intrahepatic cholestasis, 3 kids suffered from severe abdominal pain, non of them showed serologic abnormalities. Another 5 children (11.6%) had sludge in the gallbladder without evidence for cholelithiasis. In all patients the "pseudocholelithiasis" spontaneously resolved within at most 2 months. We suggest a sonographical examination of the gallbladder at the end of the ceftriaxone treatment in order to detect cholelithiasis, which might call for further monitoring and maybe dietary treatment.

Adolescent↗
PubMed1990

Clinical significance of cholelithiasis in patients with decompensated cirrhosis.

There is general agreement that the prevalence of gallstones in cirrhotics is high (at least twice that in the general population), but the pathogenetic link between cirrhosis and cholelithiasis is still uncertain. The influence of cholelithiasis on survival in cirrhotics is also unknown. During an 8-year period, we observed 90 patients affected by decompensated cirrhosis: 36 of them (40%) turned out by cholecystographic/cholangiographic or ultrasonographic examination to have cholelithiasis. We were not able to demonstrate any correlation between cholelithiasis and sex, age of patients, etiology of cirrhosis, severity of the illness, degree of portal hypertension, previous gastrointestinal bleeding, number of pregnancies, or levels of serum cholesterol, bilirubin, and triglycerides. During the follow-up observation, (range, 1-91 months), 30 patients died. Survival curves analyzed by the log-rank test did not show any difference between patients with or without gallstones. We therefore confirm that cirrhosis is a lithogenic condition, but we were not able to explain the reasons for the close relationship between cholelithiasis and cirrhosis. Gallstones, however, did not affect the survival of these patients.

Adult↗
PubMed2001

Incidence of cholelithiasis in 125 continent urinary diversions.

PURPOSE: Several studies in animals and humans have demonstrated that ileal resection has an increased association with gallstone formation. However, little reported data exist in regard to continent diversion, and the incidence and relative risk of gallstones. We describe a single institution, single surgeon (J. W. W.) experience with 125 modified Indiana pouch continent urinary diversions constructed in a 14-year period and the subsequent association with gallstones. MATERIALS AND METHODS: We retrospectively reviewed the charts of 129 patients who underwent continent urinary diversion from March 1985 to August 1998 at our institution to assess postoperative cholelithiasis. Complete information was available in 125 of the 129 charts. All patients were followed yearly with ultrasound combined with telephone followup to ensure complete data. RESULTS: Cholelithiasis was present in 32 of the 125 reviewable patients (25.6%), including 53 men and 72 women. Three men and 8 women who underwent previous or concomitant cholecystectomy for gallstones were excluded from study. Therefore, cholelithiasis developed in 21 of the 114 remaining patients (18.4%), including 5 males (4.3%) and 16 females (14%). Five of the 50 remaining men (10%) and 16 of the remaining 64 women (25%) had gallstones. Mean age at surgery was 43.5 years (range 19 to 73) and mean age at gallstone development was 45 years (range 23 to 77). Mean time from surgery to gallstone development was 3 years (range 1.1 to 5.5). Mean followup via chart review was 41 months (range 1 to 127). The recent telephone followup reached 83 of the 125 patients (66.4%). However, 20 of the 42 patients who were not reached by the telephone followup had had clinic appointments at our institution in the last 11/2 years for an overall 82.4% followup rate (103 of 125 patients). Of the 21 patients with cholelithiasis 17 were identified by chart review and 4 were identified by telephone followup. CONCLUSIONS: The recent literature indicates a 10% and 20% incidence of gallstones in American men and women, respectively. Previous reports support a potential increase in cholelithiasis in patients who undergo ileal resection. Our data indicate no increased risk of gallstones in patients who undergo modified Indiana pouch urinary diversion. However, longer followup is required to verify these findings.

Adult↗
PubMed1970

Cholelithiasis: a clinical and dietary survey.

Cholelithiasis among male and female patients at the Royal Melbourne Hospital was studied, and the incidence of the disease in relation to various clinical and dietary factors is discussed. The patients are distinguished by sex and country of origin, a distinction being made between patients born in Australia and those born in southern Europe and now living in Australia. Appropriate control groups were also studied.It was shown that the incidence of cholelithiasis is higher in women than in men (3.0% as opposed to 0.7% in the Melbourne Hospital group), and higher among patients born in southern Europe than in Australia. A correlation was also established between marriage and the disease, and, in women, between having had children and the disease. The dietary investigations showed that in Australia those patients with cholelithiasis were fatter than the control patients. Equally well there seemed to be a strong family tendency to develop gallstones. No association was found between cholelithiasis and blood grouping. In the comparison of the southern European group and the Australian-born group it was shown that the former group had a higher incidence of the disease (9.3% as opposed to 2.3%), and that the overall incidence of cholelithiasis increased with age in men and was constant in women. However, when taken separately, the incidence in Australian female patients did increase with age, the higher proportion of women from southern Europe with the disease where the incidence was, in fact, evenly distributed in all age groups, accounting for this apparent constancy. It was also shown that a woman born in southern Europe increased the risk to herself of developing gallstones within two to five years of moving to Australia, and the contributory factors are discussed.

Adolescent↗