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PubMed2000

Insulin and gall stones: a population case control study in southern Italy.

BACKGROUND: Hyperinsulinaemia has been associated with many common diseases in developed countries, such as ischaemic heart disease and colon cancer. Gall stones are also very prevalent in these countries but little is known about the association between insulin and gall stones. AIMS: To study the relationships between insulin and the incidence of gall stones in a sample of the general population. SUBJECTS AND METHODS: Between May 1985 and June 1986, systematic sampling from the electoral register of Castellana, a small town in southern Italy, yielded 2472 subjects who had their gall bladder checked for gall stones by ultrasonography. Between May 1992 and June 1993, 1962 of the 2235 subjects without gall stones at the first examination agreed to a further ultrasound examination. A total of 101 subjects with newly diagnosed gall stones and 303 randomly chosen controls entered the study. Serum insulin was determined by radioimmunoassay, and concentrations of cholesterol, cholesterol high density lipoprotein (HDL), glucose, and triglycerides by standard enzymatic colorimetric methods. Unconditional multiple logistic regression was used to study the association between insulin and gall stones, controlling for the most common confounding factors. RESULTS: In individuals with no clinical diagnosis of diabetes and serum glucose <7 mmol/l, insulin was associated with gall stones. This association persisted even after controlling for sex, age, body mass index, and serum glucose. The risk of gall stones in the highest quintile of serum insulin was 2.66 (95% confidence interval 1.04-6.72; chi(2) test for trend, p=0.03). The association of insulin with gall stones persisted when total and HDL cholesterol were entered in the logistic regression models, and only slightly decreased when serum triglycerides were included in the model. CONCLUSIONS: The results of the study indicate that hyperinsulinaemia may play an important role in the aetiology of gall stones even in individuals without diabetes and with normal serum glucose levels.

Adult↗
PubMed2005

Expression and subcellular localization of the AQP8 and AQP1 water channels in the mouse gall-bladder epithelium.

BACKGROUND INFORMATION: Transepithelial transport of water is one of the most distinctive functions by which the gall-bladder rearranges its bile content. Water is reabsorbed from the gall-bladder lumen during fasting, whereas it is secreted into the lumen following meal ingestion. Nevertheless, the molecular mechanism by which water is transported across the gall-bladder epithelium remains mostly unclear. RESULTS: In the present study, we investigate the presence and subcellular localization of AQP (aquaporin) water channels in the mouse gall-bladder epithelium. Considerable AQP8 mRNA was detected in the gall-bladder epithelium of mouse, calf, rabbit, guinea pig and man. Studies of subcellular localization were then addressed to the mouse gall-bladder where the transcript of a second AQP, AQP1, was also detected. Immunoblotting experiments confirmed the presence of AQP8 and AQP1 at a protein level. Immunohistochemistry showed intense expression of AQP8 and AQP1 in the gall-bladder epithelial cells where AQP8 was localized in the apical membrane, whereas AQP1 was seen both in the apical and basolateral membranes, and in vesicles located in the subapical cytoplasm. CONCLUSIONS: The pattern of subcellular distribution of AQP8 and AQP1 strongly corroborates the hypothesis of a transcellular route for the movement of water across the gall-bladder epithelium. Osmotic water would cross the apical membrane through AQP8 and AQP1, although AQP1 would be the facilitated pathway for the movement of water across the basolateral membrane. The presence of two distinct AQPs in the apical membrane is an unusual finding and may relate to the membrane's ability both to absorb and secrete fluid. It is tempting to hypothesize that AQP1 is hormonally translocated to the gall-bladder apical membrane to secrete water as in the bile duct epithelium, a functional homologue of the gall-bladder epithelium, whereas apical AQP8 may account for the absorption of water from gall-bladder bile.

Amino Acid Sequence↗
PubMed2003

Description of the soybean pod gall midge, Asphondylia yushimai sp. n. (Diptera: Cecidomyiidae), a major pest of soybean and findings of host alternation.

The soybean pod gall midge is an important pest of soybean in Japan and is known to occur also in Indonesia and China. This gall midge is described from Japan as Asphondylia yushimai sp. n. and is clearly distinguished from its congeners by the arrangement of the lower frontal horns of the pupa and the sequence of the mtDNA COI region. It is concluded that Prunus zippeliana Miquel is a winter host of the soybean pod gall midge since haplotypes of the soybean pod gall midge coincide with those of the Prunus fruit gall midge that produces fruit galls on P. zippeliana. In addition, phenological and distributional information on the two gall midges and on their host plants supports the identification of the winter host. In Japan, the soybean pod gall midge overwinters as a first instar in the fruit galls on P. zippeliana and emerges as an adult from the galls in May. In summer and autumn, the soybean pod gall midge has two or more generations in the pods of soybean, Glycine max (L.) Merrill or wild fabaceous and caesalpiniaceous plants. Thus host alternation by A. yushimai is confirmed. This is the second finding of host alternation by a species of Asphondylia, the first instance being that of Asphondylia gennadii (Marchal) in Cyprus.

Animals↗
PubMed2003

The influence of pruning on wasp inhabitants of galls induced by Hemadas nubilipennis Ashmead (Hymenoptera: Pteromalidae) on lowbush blueberry.

The efficacy of pruning methods for managing blueberry stem galls caused by the chalcid wasp, Hemadas nubilipennis (Ashmead), was studied in five commercial lowbush blueberry (Vaccinium angustifolium Aiton) fields in Nova Scotia, Canada, between October 1999 and May 2000. Blueberry fields were mowed in the fall, and burning treatments were subsequently applied either in the fall or the spring. Three treatments were compared: mowing only, mowing plus fall burning, and mowing plus spring burning. Galls collected from the mow plus spring-burn treatment had the least wasp emergence of the three treatments, while the total number of galls was not affected by treatment. Wasp mortality, not gall destruction, is why wasp emergence is reduced in burn treatments. More galls were located and, for the burn treatments, higher wasp emergence was seen from galls found within the leaf litter than those above it. Five co-inhabitants emerged from blueberry stem galls in this study. Three, Eurytoma solenozopheriae (Ashmead), Sycophila vacciniicola (Balduf), and Orymus vacciniicola (Ashmead) are commonly found associates. The other two, Eupelmus vesicularis (Ritzius) and Pteromalus spp., are new records for Nova Scotia. O. vacciniicola is likely an inquiline because it is the largest wasp emerging from galls, and there was a positive relationship between its emergence and that of H. nubilipennis. Larger gall size improved H. nubilipennis emergence from mow and spring-burn galls. After a field has been mowed in the fall, we recommend a spring burn to reduce gall populations and the threat of product contamination.

Agriculture↗
PubMed1998

Colour Doppler-guided spectral analysis of gall-bladder wall flow.

For the purpose of the present study to diagnose gall-bladder cancers, which cannot be detected or are only partly visible by conventional ultrasonography (US), we attempted differential diagnoses of 69 patients with gall-bladder diseases (12 with gall-bladder cancer, five with acute cholecystitis, 11 with chronic cholecystitis, 27 with cholesterol polyp and 14 with adenomyomatosis) using the evaluation of gall-bladder wall blood flow (GWBF). GWBF was evaluated by colour Doppler-guided spectral analysis (CDSA). Thirty-three healthy volunteers were selected as controls at random. Two parameters of GWBF, namely flow velocity and resistive index (RI), were compared between patients with gall-bladder diseases and healthy volunteers. GWBF could be ultrasonically evaluated in 92 (90%) of 102 subjects. All 12 patients with gall-bladder cancer had a significantly rapid blood flow value compared with other patients and healthy volunteers. There was no significant difference in RI among patients and healthy volunteers. When cut-off level of the flow velocity was set at 30 cm/s, gall-bladder cancer could be diagnosed by flow velocity with 100% sensitivity (12/12) and 96% specificity (50/52). Using the same cut-off level of the flow velocity, 17 patients were analysed prospectively. In four asymptomatic gall-bladder cancers and two acute cholecystitis cases with some symptoms, the flow velocity was over 30 cm/s. In two of four patients with gall-bladder cancer, only a part of the tumour was visualized on conventional abdominal US. In conclusion, CDSA was more useful for diagnosing gall-bladder lesions than the conventional abdominal US due to estimation of arterial flow velocity in the gall-bladder wall.

Blood Flow Velocity↗
PubMed1993

Erythromycin induces supranormal gall bladder contraction in diabetic autonomic neuropathy.

Gall bladder motor function is impaired in some patients with diabetes. It has been suggested that the abnormalities of gall bladder motility are confined to those patients with autonomic neuropathy. Erythromycin, a motilin receptor agonist, causes gall bladder contraction in both normal subjects and patients with gall stones with impaired gall bladder emptying. The effect of erythromycin on gall bladder motility in seven patients with diabetes with an autonomic neuropathy, six patients with diabetes without autonomic neuropathy, and 17 normal subjects was studied using ultrasound. There was no significant difference in gall bladder fasting volume between the three groups, but the patients with diabetes with autonomic neuropathy had impaired postprandial gall bladder emptying compared with normal subjects (percentage emptied (SEM) 40 (10.3)% v 64 (2.8)%, p < 0.01) and those with autonomic neuropathy (48 (7.7)%, NS). Erythromycin produced a dramatic reduction in gall bladder fasting volume in patients with diabetes with an autonomic neuropathy, compared with either normal subjects or patients with diabetes without autonomic neuropathy (percentage reduction 62 (4.6)% in patients with autonomic neuropathy, v 37 (17.6)% in those without autonomic neuropathy, and 26 (7.3)% in the normal subjects, (p < 0.02) and returned gall bladder emptying to normal in all patients with impaired emptying. The pronounced effect of erythromycin in diabetic autonomic neuropathy suggests denervation supersensitivity and that the action of erythromycin on the gall bladder is neurally modulated.

Adult↗
PubMed1994

Pathogenesis of gall stones in Crohn's disease: an alternative explanation.

The increased prevalence of gall stones in Crohn's disease is thought to be related to depletion of the bile salt pool due either to terminal ileal disease or after ileal resection. This study was designed to examine whether this hypothesis is correct and explore alternative explanations. Two hundred and fifty one randomly selected patients (156 females, 95 males, mean age 45 years) were interviewed and screened by ultrasonography to determine the prevalence of gall stones in a large population of patients with Crohn's disease. Sixty nine (28%) patients had gall stones proved by ultrasonography (n = 42), or had had cholecystectomy for gall stone disease (n = 27). The risk factors for the development of gall stones including sex, age, site, and duration of disease, and previous intestinal resection were examined by multivariate analysis. Age and duration of disease were positive risk factors for gall stones and were covariables. The site of disease and of previous intestinal resection did not predispose to gall stones. Previous surgery was an independent risk factor for the development of gall stones, the risk increasing with number of laparotomies. It is suggested that mechanisms other than ileal dysfunction may predispose to gall stones. Postoperative gall bladder hypomotility with biliary sludge formation may be precursors of gall stone formation in patients with Crohn's disease.

Adolescent↗
PubMed1997

Gastric and gall bladder emptying of a mixed meal are not coordinated in liver cirrhosis--a simultaneous sonographic study.

BACKGROUND AND AIM: An impaired contractility has been suggested as a contributor to the increased incidence of gallstones in liver cirrhosis, but the few studies on gall bladder emptying in cirrhotics offered contradictory results. Ingestion of a meal triggers the physiological pathway of gall bladder emptying; therefore, it was decided to analyse postprandial kinetics by investigating simultaneously the rates of gastric and gall bladder emptying of a mixed meal in patients with liver cirrhosis. METHODS: Gastric and gall bladder emptying were measured using ultrasound techniques after a solid-liquid meal (14 g fat, 425 kcal) in 24 patients with liver cirrhosis and in 12 controls. None of the subjects had gall bladder disease. Sequential changes in cross sectional area of the gastric antrum and in gall bladder volume were represented as a monoexponential process after the test meal. Cirrhotic patients were analysed according to the severity of disease (Child classes). The presence of portal gastropathy was assessed by endoscopy. Differences between groups were assessed using the two tailed Student's t test for unpaired observations and the correlations by linear regression (Pearson's coefficient). RESULTS: It was found that gastric emptying after the solid-liquid meal was delayed in cirrhotic patients compared with controls. Gall bladder emptying was significantly diminished in cirrhotic patients: the area under curve was greater in Child A (p = 0.01), Child B (p = 0.04), and Child C (p = 0.014) cirrhotics compared with controls. No correlation was found between the variables of gastric and gall bladder emptying. Gall bladder refilling began earlier in cirrhotics than in controls, before completion of gastric emptying. CONCLUSIONS: These results indicate the lack of coordination between gastric and gall bladder emptying in liver cirrhosis. They also support the hypothesis that diminished gall bladder contractility might contribute to the increased gallstone formation in liver cirrhosis.

Female↗
PubMed1998

Effect of the nitric oxide donor, glyceryl trinitrate, on human gall bladder motility.

BACKGROUND: Nitric oxide is a major neurotransmitter in non-adrenergic, non-cholinergic (NANC) pathways. NANC inhibitory innervation has been shown in human gall bladder muscle in vitro; the role of nitric oxide in human gall bladder emptying however is undefined. AIMS: To study the effect of glyceryl trinitrate, a nitric oxide donor, on gall bladder emptying in healthy subjects using a randomised, double blind, cross-over, placebo controlled design. METHODS: Ultrasonographic gall bladder volume was measured in the fasting state in eight healthy volunteers after randomised administration of either glyceryl trinitrate 1200 micrograms buccal spray or placebo spray. On two further occasions, after randomised administration of either glyceryl trinitrate 1200 micrograms buccal spray or placebo spray, gall bladder volumes were also measured after a liquid test meal. RESULTS: Glyceryl trinitrate significantly increased fasting gall bladder volume to a mean of 114% (SEM 5%) of pretreatment volume (p = 0.039). Glyceryl trinitrate also significantly impaired gall bladder emptying between five and 40 minutes postprandially. Gall bladder ejection fraction was also reduced after glyceryl trinitrate compared with placebo (43 (6.9)% versus 68.4 (6.5)%, p = 0.016). CONCLUSIONS: This study shows that glyceryl trinitrate produces gall bladder dilatation in the fasting state and reduces postprandial gall bladder emptying, suggesting that nitric oxide mechanisms may be operative in the human gall bladder in vivo.

Adult↗
PubMed1998

Motilin induces gall bladder emptying and antral contractions in the fasted state in humans.

BACKGROUND: Animal studies have shown that motilin affects gall bladder motility. In humans, no effect has been shown, but erythromycin, a motilin receptor agonist, induces gall bladder emptying. AIMS: To explore the effect of increasing doses of exogenous motilin on gall bladder volume and antral contractility in the fasted state in humans. METHODS: After an overnight fast, eight healthy men received increasing intravenous doses of Leu13-motilin (KW-5139) or 0.9% NaCl in a double blind, randomised fashion. Gall bladder volume and antral contraction frequency were determined by ultrasonography. RESULTS: Infusion of motilin increased plasma motilin levels. Motilin induced a reduction in gall bladder volume of 8.0 (5.0)%, 17.1 (5.0)%, 18.5 (4.7)%, and 16.1 (4.9)% of baseline volume at the end of infusion of 2, 4, 8, and 16 pmol/kg/min respectively, compared with mean stable gall bladder volumes during placebo infusion (p < 0.05). Antral contraction frequency increased during motilin infusion, but not during placebo infusion (p < 0.05). CONCLUSIONS: Exogenous motilin reducted fasting gall bladder volume and increased antral contractions. After reaching maximal reduction, the gall bladder volume did not decrease further during continuous motilin infusion at higher doses and stayed at the same reduced volume. The degree of gall bladder volume reduction during motilin infusion mimicked gall bladder emptying preceding antral phase III activity of the migrating motor complex in humans. This study indicates that motilin may play a physiological role in the regulation of gall bladder emptying in the fasted state.

Adult↗
PubMed2001

Inhibitory motor innervation of the gall bladder musculature by intrinsic neurones containing nitric oxide in the Australian brush-tailed possum (Trichosurus vulpecula).

BACKGROUND: Gall bladder functions are modulated by neurones intrinsic to the organ. Data are available on the neurochemical composition of intrinsic and extrinsic nerves innervating the gall bladder but are lacking on specific functional classes of gall bladder neurones. AIMS: To characterise the intrinsic motor neurones of the gall bladder and identify their roles using pharmacological techniques. METHODS: Retrograde tracing from the possum gall bladder muscle in vitro allowed identification of intrinsic motor neurones. Subsequently, their content of choline acetyltransferase and nitric oxide synthase, markers of acetylcholine and nitric oxide containing neurones, was established using immunohistochemical techniques. Organ bath pharmacology was used to evaluate neurotransmission by acetylcholine and nitric oxide in gall bladder muscle strips. RESULTS: Innervation of the gall bladder musculature by neurones of both the muscular and serosal plexuses was demonstrated. A large proportion (62%) of these motor neurones were immunoreactive for nitric oxide synthase. All gall bladder neurones showed immunoreactivity for choline acetyltransferase. Organ bath pharmacology confirmed the neuroanatomical data, showing acetylcholine and nitric oxide mediating neurotransmission to the gall bladder musculature. CONCLUSIONS: Neurones containing acetylcholine and nitric oxide, located within the muscular and serosal plexuses, provide excitatory and inhibitory motor innervation of the gall bladder, respectively. The large inhibitory innervation suggests active relaxation of the gall bladder during filling, mediated by intrinsic nerves.

Animals↗
PubMed1999

Differing effects on gall-bladder motility of lanreotide SR and octreotide LAR for treatment of acromegaly.

BACKGROUND: Octreotide treatment may be associated with gall stone development in up to 50% of patients with acromegaly. Two new sustained-release formulations of somatostatin analogue have been recently developed: lanreotide SR (Somatuline) and octreotide LAR (Sandostatin LAR). The incidence of gall-stone development in patients receiving these drugs has been shown to be less than 20%, but the duration of follow-up has been limited. OBJECTIVE: Prospectively to assess and compare the effects of the two new long-acting somatostatin agonists on gall bladder motility in patients with acromegaly. METHOD AND PATIENTS: Eleven patients with active acromegaly were studied. Three patients had asymptomatic gall stones at the start of the study. Ultrasound scans were performed before commencement of the treatment, and repeated during treatment with lanreotide SR and octreotide LAR. The presence of gall stones, fasting gall bladder volume (FV), residual volume (RV) and maximal percentage gall bladder emptying were measured. RESULTS: One patient developed asymptomatic small gall stones after treatment with octreotide LAR for 4 months. FV and RV were both significantly larger when patients received treatment with lanreotide SR or octreotide LAR compared with pretreatment values (P<0.05 for both). Maximal percentage gall bladder emptying was significantly reduced in patients receiving lanreotide SR or octreotide LAR compared with pretreatment (P<0.01), but was less impaired in patients receiving lanreotide SR than in those receiving octreotide LAR (P<0.01). CONCLUSIONS: Gall bladder motility is impaired in patients receiving either of these new long-acting preparations, and long-term follow-up will be needed to establish the true incidence of gall stones.

Acromegaly↗
PubMed2000

Dogwood borer (Lepidoptera: Sesiidae) infestation of horned oak galls.

Pin oak, Quercus palustris Muenchhausen, is the primary host for the gall wasp Callirhytis cornigera (Osten Sacken). Woody stem galls formed by C. cornigera may be infested by the dogwood borer, Synanthedon scitula (Harris), an important pest of flowering dogwood, Cornus florida L. Previous research has shown that S. scitula has a bimodal seasonal flight pattern, with peaks in late spring and midsummer. We tested the hypothesis that moths emerging from dogwoods largely account for the first flight pulse, whereas emergence from stem galls contributes disproportionately to the second pulse. Seasonal flight activity of S. scitula was monitored with pheromone traps baited with Z,Z-3,13-octadecadien-1-ol acetate. Traps were hung near plantings of dogwoods in suburban landscapes or near heavily galled pin oaks. Borer emergence from dogwood was monitored by sampling infested trees for pupal exuviae, and from galls that were collected and held in outdoor rearing cages. The impact of S. scitula on C. cornigera larvae was assessed by weighing, measuring, and dissecting galls. Flight activity of S. scitula began on 5 May and ended on 13 October 1999, with peaks in late May and in late July to early August. The flight pattern was similar for the two types of trapping sites, and moths emerged from both hosts during both flight periods. Proportionately more moths emerged from dogwoods during the first flight pulse than during the second, but emergence from galls was nearly evenly divided between the two flight peaks. We therefore reject the hypothesis that emergence of borers from galls contributes disproportionately to the second flight period. Approximately 12-15% of stem galls (2-3 yr old) contained S. scitula larvae. Feeding and tunneling by borers contributed to gall desiccation and reduced horn development, but rarely killed C. cornigera larvae. This study has implications for management of S. scitula because borers emerging from horned oak galls may represent a threat to dogwood.

Animals↗
PubMed1997

[The reception of Franz Joseph Gall's doctrine on phrenology in Holland shortly after 1800].

Between 1800 and 1810 Gall's 'Hersen-Schedelleer' [= doctrine on phrenology] received increasing attention in Holland, just as it did in Germany and France. Gall had tried to connect visible human skull marks with brain anatomy, brain functioning and behaviour, a relationship in which he also compared man and animal. Scientists as well as people in non-scientific circles tried to find an answer to the question to what extent Gall's ideas on human brain anatomy and the development of the skull in relation to behaviour were acceptable. Besides there was a growing interest in the possible consequences of Gall's theory for moral life. However, Gall's doctrine was largely based on unproved and unprovable assumptions. Gall's visit to Holland, in the early spring of 1806, had a polarizing effect on supporters and adversaries, as it had had in Germany. In Holland Gerard Vrolik, professor at the Amsterdam Athenaeum Illustre, published the first treatise on this subject, in which he revealed himself to be a hesitant and prudent supporter of Gall's theories. From early 1804 Jacob Eliza Doornik, physician and scientist, and Martinus Stuart, theologist and historian, played a leading part in the discussion on this subject. The former opposed all aspects of Gall's theory. The latter - contrary to what one would expect - supported Gall in every way, with both regard to his explanation of brain anatomy and physiology and to his views on the relationship between the shape of the brain and the development of the skull. Remarkably he accepted Gall's materialism and rejected his fatalism. We can only explain Stuart's defence of Gall's moral views supposing he considered these in a religious framework. In Stuart's conviction God had given man a certain tendency to evil which man has to accept as a necessity in the fight against evil and the search for good. ...

Brain↗
PubMed1993

Prenatal diagnosis of gall bladder anomalies--report of 17 cases.

We describe here 17 cases of fetal gall bladder anomalies, detected as early as the 14th week of gestation, out of 10,016 fetal systemic examinations performed by us in the last 6 years (0.15 per cent). In seven cases, agenesis of the fetal gall bladder was detected. The diagnosis was confirmed by post-abortal examination in five cases and in two post-partum. In six other cases, a left-sided gall bladder and in one case, a 'floating' gall bladder were detected at 15 weeks' gestation. In two cases, a septated or bilobed gall bladder was visualized. None of these 15 cases was dyskaryotic, but in five cases, two with agenesis and three left-sided gall bladders were associated with other fetal malformations. In two other cases, the gall bladder appeared dysmorphic on sonographic examination and in both of them intrauterine growth retardation and other anomalies were detected. Trisomy 18 was diagnosed by amniocentesis in one of them. According to our experience, failure to visualize the fetal gall bladder by the 15th gestational week is diagnostic of its absence and should raise the differential diagnosis between gall bladder atresia, which has a good prognosis, and external biliary atresia, which has a poor prognosis. Further experience is needed to characterize the various gall bladder malformations and their prognosis.

Female↗
PubMed2000

Review: low caloric intake and gall-bladder motor function.

Cholelithiasis is the primary expression of obesity in the hepatobiliary system. In obese subjects the risk of developing gallstones is increased due to a higher cholesterol saturation of gall-bladder bile. During weight reduction with very low calorie diets (VLCD) the incidence of gallstones increases, but the mechanism for gallstone formation is not completely understood and several pathogenetic mechanisms have been suggested: increased saturation of bile, increased gall-bladder secretion of mucin and calcium, increased presence of prostaglandins and arachidonic acid. Alterations in gall-bladder motility may contribute to gallstone formation, but few studies have addressed the issue of gall-bladder motility during rapid weight loss and its possible role in gallstone formation. VLCD have been associated with a gall-bladder stasis, as a consequence of reduced gall-bladder stimulation by low fat content of the diets. A threshold quantity of fat (10 g) has been documented to obtain efficient gall-bladder emptying. Ursodeoxycholic acid administered during VLCD seems to have a protective role in developing a biliary cholesterol crystals. Gall-bladder emptying was lower in response to low fat meals with respect to relative higher fat meals, before as well as during the VLCD. This may account the possibility of an adaptative response of the gall-bladder motility to a given diet regimen. Adequate fat content of the VLCD may prevent gallstone formation, maintaining adequate gall-bladder motility and may be more economic and physiologically acceptable than administration of a pharmacological agent.

Bile Acids and Salts↗
PubMed2003

Triangular cord sign and ultrasound features of the gall bladder in infants with biliary atresia.

The aim of this study was to reassess the accuracy of the triangular cord sign, the triangular cord sign coupled with abnormal gall-bladder length, and an irregular gall-bladder wall in the diagnosis of biliary atresia. The ultrasonograms of 46 infants with cholestatic jaundice were reviewed for the triangular cord sign, gall-bladder length and gall-bladder wall without knowledge of the clinical data. Of the 23 infants with biliary atresia, 22 had the triangular cord sign whereas 17 infants with other causes of cholestatic jaundice did not have the triangular cord sign. The sensitivity, specificity, accuracy and positive predictive value of the triangular cord sign in the diagnosis of biliary atresia were 95.7, 73.9, 84.8 and 78.6%, respectively. The sensitivity, specificity, accuracy and positive predictive value of the triangular cord sign coupled with abnormal gall-bladder length in the diagnosis of biliary atresia were all 95.7%. Gall-bladder wall irregularity was seen in seven of 14 infants (50%) with biliary atresia whose gall bladders contained bile on ultrasound and in two of 22 infants (9.1%) without biliary atresia whose gall bladders contained bile on ultrasound. At the medical centre where this study was performed and where infants present with cholestatic jaundice at an advanced stage, the ultrasonographic triangular cord sign coupled with abnormal gall-bladder length is more reliable than the ultrasonographic triangular cord sign alone or gall-bladder wall irregularity in the diagnosis of biliary atresia.

Biliary Atresia↗
PubMed2002

Gall bladder cancer, extrahepatic bile duct cancer and ampullary carcinoma in New Zealand: Demographics, pathology and survival.

INTRODUCTION: The aim of present paper was to document the incidence of gall bladder cancer, cancer of the extrahepatic bile ducts and ampullary carcinoma in New Zealand. METHODS: Data were collected from the New Zealand Cancer Registry from 1980 to 1997 and combined with national census statistics to give crude and age standardized incidence rates. RESULTS: Over the 18-year study period, 226 carcinomas of the ampulla of Vater, 608 gall bladder cancers, and 486 extrahepatic cholangiocarcinomas were registered. The age standardized incidence rates for gall bladder carcinoma in all New Zealanders were 0.41/100 000 in men and 0.74/100 000 in women. The age standardized incidence rates for gall bladder cancer in Maori were 1.49/100 000 in Maori men and 1.59/100 000 in Maori women. The corresponding age standardized incidence rates for extrahepatic bile duct cancers were 0.67/100 000 in men and 0.45/100 000 in women. There were insufficient cases to calculate an age standardized incidence in Maori or Pacific Islanders. For carcinoma of the ampulla, the age standardized rates were 0.34/100 000 in men and 0.25/100 000 in women. There were insufficient cases to calculate an age standardized incidence rate for Maori or Pacific Islanders. When histology was defined adenocarcinoma was the most common form of cancer occurring in 66% of gall bladder cancers, 91% of extrahepatic bile duct cancers and 70% of ampullary cancers. Most tumours were advanced at presentation with regional or distant metastases present in 72% of gall bladder cancers, 63% of extrahepatic bile duct cancers and 69% of ampullary tumours at diagnosis. Survival was poor with median survivals of 86 days, 151 days and 440 days recorded for gall bladder cancer, extrahepatic bile duct cancer and ampullary cancer, respectively. CONCLUSIONS: The demographic profile, pathology and survival of patients with gall bladder cancer, extrahepatic bile duct cancer and ampullary carcinoma are similar in New Zealand to that of other Western countries. However New Zealand Maori have a relatively high incidence of gall bladder cancer, and the incidence is equal in both Maori men and women, while cancers of the extra-hepatic bile duct and ampulla of Vater are rare in Maori. In comparison, cancers of the gall bladder, extrahepatic bile ducts and ampulla are rare in Pacific Islanders.

Adenocarcinoma↗