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PubMed1992

[Cholelithiasis in the region of Cartagena: an approximation to its real incidence based on the study of its symptomatic group].

We have studied the frequency of cholelithiasis in a group of patients who complained of clinical symptoms of cholelithiasis and lived in the region of Cartagena. This group of patients accounts for 40% of all the patients suffering from cholelithiasis this would account for 0.5% of the whole population and 1% of the exposed population over 30 year-of-age. Our results suggest that the population living in the region of Cartagena has a low-risk for cholelithiasis.

Adult↗
PubMed2005

Cholelithiasis and cholecystitis: changing prevalence in an African community.

BACKGROUND AND OBJECTIVES: Cholelithiasis and cholecystitis were thought to be rare in Africans. It is now seen more frequently than previously thought. The essence of this study is to determine the prevalence of cholelithiasis and cholecystitis in a Nigerian population, changing pattern and outcome. DESIGN: Descriptive study over a five-year period in an urban teaching hospital in Nigeria. MATERIALS AND METHODS: All cases of inflammatory gallbladder disease seen in the University of Ilorin Teaching Hospital, Ilorin, Nigeria, from January 1997 to December 2001 were studied prospectively. Only those who had a surgical operation and histological confirmation of cholelithiasis and cholecystitis were included in the study. The patients' demographic details, clinical presentation, findings at surgical operation and histological results of gallbladder specimens and outcome were studied. RESULTS: In this study, 46 patients had cholecystectomy for cholelithiasis and cholecystitis in five years. In the first three years, 18 (39.1%) cases were seen, but in the next two years 28 (60.9%) patients had cholecystectomy. The male:female ration was 1:4.8. Only four (8.7%) of these patients were obese. Thirty-two (69.6%) were multiparous. Only four (8.7%) of the patients had pigmented stones, the majority of which were mixed stones. Many of the patients have been on treatment for suspected peptic ulcer disease for a period ranging from four weeks to five years. One of the patients had Mirizzi syndrome type 1. Abdominal ultrasound was found useful in the diagnosis. All patients had open cholecystectomy. Outcome of treatment was satisfactory. CONCLUSION: We are beginning to have an increase in gallbladder disease probably as a result of changing dietary habits (increase in intake of calories and cholesterol/fats) of the population. A high index of suspicion and careful clinical judgment coupled with the use of simple ancillary investigation like ultrasound will make early diagnosis and treatment feasible.

Adult↗
PubMed1989

[Ultrasonic evaluation of the state of the abdominal vessels in cholelithiasis and chronic acalculous cholecystitis].

Ultrasound investigation of the abdominal vessels (the celiac artery and its branches, the hepatic veins and the portal veins) was performed in 30 patients with cholelithiasis, 20 patients with chronic acalculous cholecystitis and 100 healthy controls. Statistically significant increases in the calibers of the hepatic arteries and portal veins were detected in the patients with cholelithiasis. The diameters of these vessels in the patients with chronic acalculous cholecystitis did not differ considerably from those of the controls. Ascites, splenomegaly, vascular collaterals, varicosis of the esophageal or gastric veins were unobserved in the patients with cholelithiasis, neither was observed an increase in the calibers of the portal veins during the Valsalva test in this group as compared to the control group. It was assumed that an increase in the calibers of the hepatic vessels in cholelithiasis was caused by change in the hepatic blood flow rather than by the development of portal hypertension.

Abdomen↗
PubMed1979

The prevalence of cholelithiasis in sickle cell disease as diagnosed by ultrasound and cholecystography.

Gallbladder disease is known to be increased in sickle cell disease (SS). The prevalence of cholelithiasis in children with SS has been reported as 10% to 37%. Gallbladder ultrasound, cholecystography, and/or abdominal radiography were used to evaluate 31 patients aged 2 to 18 years with no systematic evidence of gallbladder disease for cholelithiasis, Overall prevalence of gallstones was found to be 29%. Cholelithiasis was detected in children as young as 4 years of age. Prevalence below the age of 10 years and above the age of 10 years was found to be 11% and 55% respectively. The increased prevalence of cholelithiasis in children with sickle cell disease suggests the use of diagnostic ultrasonography as a routine screening procedure.

Adolescent↗
PubMed1983

[Correlation of biliary cholesterol, phospholipids and bile acid compositions and the development of cholesterol cholelithiasis in mice].

A study was attempted to establish a screening method for detecting cholelitholytic ingredients from a wide variety of natural substances. Although mice were selected as a suitable pathological model of cholelithiasis to detect a small amount of the ingredients, all the conventional lithogenic diets caused unfavorable influence on the animals. Therefore, as the first step we formulated a new lithogenic diet consisting of butter, cholesterol, cholic acid, etc, which was adequate for mice. Subsequently, the pathological characteristics and persistence of cholelithiasis were examined in the animals; the changes in bile compositions including free and conjugated bile acids, cholesterol and phospholipids were observed before and at the onset of cholelithiasis. Following confirmation of the stone formation, a normal diet was substituted for the lithogenic diet to likewise assess the bile compositions 4 and 6 weeks later. An increasing tendency for deoxycholic acid, disappearance of chenodeoxycholic acid and decrease in ursodeoxycholic acid were seen under the condition of cholelithiasis. In addition, the cholic acid-glycine conjugate which should not exist in the normal state and the increase in free and tauring-conjugated cholic acid were noticed. The biliary cholesterol level in treated mice increased to about 4 times higher than that in untreated mice, while the biliary phospholipids and total bile acids levels increased to only about 1.5 and about 2 times the control levels, respectively. The incidence of stone formation rose sharply at an experimental period between 2 and 3 weeks after starting the lithogenic diet. Gallstones die not disappear even at the 6th week after substituting a normal diet for the lithogenic one. However, the cholic acid-glycine conjugate disappeared, and deoxycholic acid as well as chenodeoxycholic acid and ursodeoxycholic acid tended to recover to the normal levels in the bile.

Animals↗
PubMedDate not supplied

Ultrastructural evidence of intrahepatic cholestasis before and after chenodeoxycholic acid therapy in patients with cholelithiasis: the national cooperative gallstone study.

Electron microscopy was performed to assess potential hepatotoxicity before and after 9 and 24 months of chenodeoxycholic acid (CDCA) therapy (375 or 750 mg, daily) in 103 patients with cholelithiasis. Prior to treatment, 64% of the biopsies demonstrated ultrastructural evidence of intrahepatic cholestasis, manifested by abnormal bile canaliculi, thickened pericanalicular ectoplasm, and retention of biliary material within liver cells or pericellular spaces. After 9 months of CDCA therapy, several changes (including increased free cytoplasmic "biliary pigment," decreased canalicular microvilli, and increased pericanalicular ectoplasm) consistent with intrahepatic cholestasis became more prevalent (63% prior to therapy, 89% at 9 months, p less than 0.01) regardless of CDCA dose. After 24 months of therapy, canalicular microvilli and pericanalicular ectoplasm continued to be abnormal (p less than 0.01). This study indicates that ultrastructural evidence of intrahepatic cholestasis is a common subclinical abnormality in patients with cholelithiasis which increases during CDCA therapy, changes which could represent either the natural history of cholelithiasis or CDCA toxicity. A drug effect is suggested by the lack of correlation of these abnormalities with the duration of cholelithiasis prior to CDCA treatment and their "increasing" prevalence after only 9 months of therapy. In addition, canalicular membrane lesions developed in two patients which were similar to lithocholate toxicity in animals. It is not known whether these abnormalities would result in clinically significant hepatoxicity if therapy is continued for longer than 24 months.

Bile Canaliculi↗
PubMed1995

The role of extracorporeal shock-wave lithotripsy in the treatment of symptomatic cholelithiasis.

OBJECTIVES: To determine the effectiveness of extracorporeal shock-wave lithotripsy (ESWL) and adjuvant bile-salt therapy for the treatment of symptomatic cholelithiasis. DESIGN: A prospective case study. Follow-up ranged from 3 to 54 months. SETTING: A university teaching hospital. PATIENTS: Two hundred and twenty-three patients with symptomatic cholelithiasis, a gallbladder that opacified at oral cholecystography and three or fewer radiolucent stones with a maximum total dimension of 3 cm. Of these patients, 197 were given bile salts (ursodeoxycholic acid or chenodeoxycholic acid, 8 to 10 mg/kg daily) and underwent ESWL. Twenty-eight were excluded because of noncompliance with the protocol or treatment failure before termination of the ESWL procedure. INTERVENTION: ESWL with a piezoelectric lithotripter. MAIN OUTCOME MEASURES: The success rate of the intervention, the causes of failure, associated complications and the recurrence rate of cholelithiasis. RESULTS: Of the 197 patients who underwent ESWL, 85 (43%) were free of stones after treatment. Treatment failure was caused by the following: unsatisfactory fragmentation (9%), increase in fragment size during bile-salt therapy (8%), severe diarrhea due to bile salts (3%), nonvisualization of fragments after the first ESWL (3%), acute cholecystitis (2%), persistence of small fragments at the end of the treatment protocol (2%) and acute pancreatitis (0.5%). Complications included biliary colic (21%), diarrhea (15%), acute cholecystitis (2.5%), acute pancreatitis (2%), macroscopic hematuria (2%), perirenal hematoma (0.5%) and vagal shock (0.5%). The recurrence rate was 18%. Causes of noncompliance with treatment (26%) were the length of treatment, the occurrence of biliary colic during this period and the high cost of bile salts. CONCLUSION: ESWL with bile salts as treatment for symptomatic cholelithiasis is not recommended for routine use.

Adult↗
PubMed1994

Management of cholelithiasis in heart and kidney transplant patients: with review of laparoscopic cholecystectomy.

The purpose of this study was to determine the incidence of cholelithiasis among heart and kidney transplant recipients. Since recommendations for cholecystectomy in transplant recipients varies widely, we discuss guidelines for surgery including laparoscopic techniques. We reviewed the records of 114 patients who underwent heart transplantation from 1984 to 1993 and 539 kidney transplant patients from 1972 to 1993. Recipients of heart and kidney transplants were found to have an incidence of cholelithiasis of 12% and 3% respectively. Pretransplantation ultrasound surveillance was used in heart transplant recipients and 64% of these with asymptomatic cholelithiasis have not required surgery with close follow-up from six months to six years. Thirty-six percent of the heart patients underwent cholecystectomy. All symptomatic renal transplant patients undergoing ultrasound with the findings of cholelithiasis underwent cholecystectomy. Open cholecystectomies were performed prior to the advent of laparoscopic surgery in six of the first seven attempts. Laparoscopic cholecystectomy on heart and kidney transplant recipients was well tolerated with admission the same day of surgery, a one to two day hospital stay and maintenance of oral immunosuppression. There was a single complication of leg thrombophlebitis, no mortality, and allograft rejection did not occur.

Adult↗
PubMedDate not supplied

[Biliary calculi in the golden hamster. XXXVII. The prophylactic action of the creosote bush (Larrea tridentata) in pigmented cholelithiasis produced by vitamin A].

In the present work the results of an experiment performed in the golden hamster (Mesocricetus auratus), strain ChCM, are presented, in which the possible preventive action of pigment cholelithiasis by a powdered, desiccated, hydroalcoholic extract of leaves of "gobernadora" (Larrea tridentata) was studied. The extract was added to the lithogenic diet (basic diet + 25,000 I.U. of Vitamin A) at the 4% level; the hamsters were fed with the experimental diets during 70 days. The results showed that the group which received the diet with "gobernadora" did not develop pigment cholelithiasis, whereas the group that received the lithogenic diet alone developed cholelithiasis in 63% of cases. It is suggested that the active principle present in the leaves of "gobernadora", responsible for the prevention of the cholelithiasis is nordihydroguiaretic acid (NDGA), a potent antioxidant. On the other hand, the hamsters that received the diet containing "gobernadora" showed serious signs of toxicity and pathological changes, such as a marked reduction of growth, pronounced irritability and aggressiveness, and a marked hypoplasia both testicular and of the accessory sex glands.

Animals↗
PubMed1993

Biliary and serum immunoglobulin alterations in patients of cholelithiasis.

IgG, IgA and IgM were estimated in serum, common bile duct bile and gall bladder bile by single radial immunodiffusion technique in 30 patients of cholelithiasis, which included 22 patients of cholelithiasis with non functioning gall bladder (sub group A) and 8 patients of cholelithiasis with functioning gall bladder (sub group B). 30 age and sex matched controls were also included in the study. Serum IgG, IgA and IgM were significantly raised in patients of cholelithiasis as compared to controls. However, in gall bladder bile although IgA and IgM were significantly lower (more so in sub group A) than that of control group (p < 0.001 and p < 0.001 respectively but there was no change in IgG. While in common bile duct bile, rise in all the three immunoglobulins was statistically insignificant when compared to controls.

Bile↗
PubMed1993

[Definition, classification and clinical symptoms of cholelithiasis].

Generally, the cases with symptomatic biliary stone are diagnosed as cholelithiasis and asymptomatic cases are not defined as cholelithiasis in the strict sense. However, asymptomatic stones are often diagnosed and treated as cholelithiasis. In the diagnosis and treatment of cholelithiasis, it is important to study the localization and classification of biliary stones relation to clinical symptoms.

Cholelithiasis↗
PubMed1996

Clinical analysis of choledochoduodenal fistula with cholelithiasis in Taiwan: assessment by endoscopic retrograde cholangiopancreatography.

OBJECTIVES: Choledochoduodenal fistula (CDF) is occasionally found during endoscopic retrograde cholangiopancreatography (ERCP). Cholelithiasis is suspected to be the leading cause in some endemic areas. We focus on this cause of CDF to determine which clinical characteristics are relevant to formation of fistulas and to learn whether CDF of various types would imply different clinical significance. METHODS: In 1882 ERCP studies from 1988 to 1993, we found 27 CDF with cholelithiasis in 1066 patients. Their clinical backgrounds and ERCP findings were compared with those of 492 patients who had cholelithiasis but no CDF. RESULTS: The prevalence of CDF was 2.53%. A longer past history of biliary stones, recurrent biliary tract infection (BTI), and the presence of common bile duct stones (CBS) were factors relevant to the formation of fistula. In the case of 24 distal fistulas, including seven of type I and 17 of type II, there was concurrent distal CBS. Three cardinal features of fistula of the distal type were: 1) the length of CDF was less than 1.5 cm, 2) its orifice was just around or on the papillary fold, and 3) all cases of distal type II had prominent pneumobilia, less jaundice, and larger CBS than type I. Aggressive endoscopic or surgical treatment of distal type CDF decreased the recurrence of BTI, as indicated by surveillance for 1 yr. Three fistulas of the proximal type were longer and drained into the duodenum far from the papilla. All of these cases deserved early surgical intervention. CONCLUSIONS: CDF really serves as a chronic sequel of cholelithiasis. Different clinical features of CDF of various types help one to establish diagnosis and treatment. To avoid recurrence of BTI, aggressive therapy to correct CDF is mandatory.

Aged↗
PubMed1996

Endoscopic stenting of gallbladder for symptomatic cholelithiasis in patients with end-stage liver disease awaiting orthotopic liver transplantation.

Cholecystectomy in patients with advanced cirrhosis is associated with excessive morbidity and mortality. Symptomatic cholelithiasis in patients awaiting orthotopic liver transplantation poses unique management issues. Three patients with end-stage liver disease, severe enough to warrant hepatic transplantation, developed symptoms and complications of cholelithiasis requiring intervention. Each underwent placement of a biliary stent from gallbladder to duodenum at endoscopic retrograde cholangiopancreatogram. In each case, biliary symptoms and complications ceased after stent placement. Two patients remained symptom-free until they underwent successful liver transplantation, and the third awaits transplant and is currently free of symptoms of cholelithiasis. Endoscopic placement of gallbladder stents represents a temporizing alternative for the management of patients with symptomatic cholelithiasis awaiting hepatic transplantation.

Adult↗
PubMed1996

Development of intrahepatic cholelithiasis long after primary excision of choledochal cysts.

BACKGROUND: Biliary stricture with dilatation is a putative cause of intrahepatic bile duct stones. However, this hypothesis has never been proved. STUDY DESIGN: Fifty-six patients had operative cholangiography, underwent standard excision of a choledochal cyst, and were reviewed at follow-up clinics at a mean follow-up time of 13 years and 6 months. The incidence of complications such as intrahepatic cholelithiasis was analyzed according to the morphologic types of the intrahepatic bile ducts as observed at the initial operation. RESULTS: Group 1 patients (29 cases) did not show any dilatation of the intrahepatic bile ducts. Intrahepatic cholelithiasis developed in only one case (3 percent). In group 2 (24 cases), the intrahepatic bile ducts were dilated but not associated with any downstream stenosis. One patient (4 percent) suffered from intrahepatic cholelithiasis. Group 3 patients (3 cases) had dilatation of the intrahepatic bile ducts associated with downstream stenosis, and none of them was free from the development of intrahepatic biliary stones (3 cases). CONCLUSIONS: Patients with biliary dilatation with stricture of the intrahepatic bile ducts are most likely to develop intrahepatic cholelithiasis after surgical excision of a choledochal cyst, and their stenosis should be relieved by whatever means feasible at initial operation.

Bile Ducts, Intrahepatic↗
PubMed1997

[Antioxidants in the treatment of cholelithiasis patients].

Results of examination and treatment of 157 patients with cholelithiasis against the background of a liver pathology were summed up. The antioxidant system in such patients was studied. The degree of a decrease of catalase activity in the liver and blood serum as well as the ascorbic acid content were found to depend on the liver state of patients with cholelithiasis. Greatest changes were found in patients with cirrhosis of the liver and chronic active hepatitis. The method of complex treatment of cholelithiasis patients with non-enzymatic antioxidants alpha-tocopherol and ascorbic acid is proposed. Activity of organ specific liver enzymes urokaninase and histidase was used for the estimation of treatment efficiency. Complex administration of ascorbic acid and alpha-tocopherol was shown to improve the liver function in patients operated upon for cholelithiasis.

Antioxidants↗
PubMed1996

[Suitability of laparoscopic cholecystectomy in the asymptomatic cholelithiasis patient].

Cholelithiasis is a disease of high prevalence in the adult population. Prevalence increases with age; the incidence of complications, such as choledocholithiasis, acute pancreatitis, and cancer of gallbladder, also increase with age. Cholecystectomy has been considered as the gold standard in the treatment of symptomatic or complicated cholelithiasis. Laparoscopic cholecystectomy has become the new gold standard. Our Department of Surgery has adopted a policy of advising laparoscopic cholecystectomy in all patients with symptomatic cholelithiasis, but also subpopulation of high risk asymptomatic patients. This subgroup is made up by patients with long life expectancy, radioopaque stones, small calculus with patent cystic duct, nonfunctioning or calcified gall bladder, and patients with concomitant diabetes, cirrhosis, chronic hemolytic anemia, those that are candidates for kidney or heart transplantation, and those with underling degenerative diseases that are more likely to develop severe complication of cholelithiasis. Csendes of Chile has reported very high incidence of gallbladder cancer in Chile and Bolivia. He considers that cholecystectomy is indicated in asymptomatic patients as a "prophylactic" measure. Our group agrees that this is a valid indication in areas or populations groups where gallbladder cancer is of high prevalence.

Cholecystectomy, Laparoscopic↗
PubMed1996

[Long-term follow-up of non-operated patients with symptomatic and asymptomatic cholelithiasis].

BACKGROUND: In Chile, cholelithiasis is a serious public health problem and there are no studies about its natural history. AIM: To assess the long term evolution of patients with symptomatic and asymptomatic cholelithiasis. PATIENTS AND METHODS: Ninety two patients with cholelithiasis (57 female), aged 15 to 80 years old and that were not operated, were followed during a period of 9 to 14 years. RESULTS: Thirteen patients were initially asymptomatic. Of them, seven bad complications or symptoms during follow-up and two were operated. Among the 69 symptomatic patients, 38 (55%) were not operated during follow-up, and seventeen (25%) did not have symptoms again. Ten patients died during follow-up, four due to complications of biliary tract stones. CONCLUSIONS: The present finding suggest that the evolution of cholelithiasis in Chile is more aggressive than abroad, and an early surgical treatment is warranted.

Adolescent↗
PubMed1996

[The effect of diabetes and cholelithiasis on the course and consequences of acute viral hepatitis type B].

Course and consequences of acute hepatitis B on the group of 40 patients with diabetes mellitus and 21 patients with cholelithiasis were estimated with respect to the group has consisted of 82 person with acute hepatitis B without coexisting disorders. Hospitalization time has been longer on the group with diabetes mellitus or cholelithiasis and activity of serum alanine aminotransferase (AlAT) has brought back to normal longer than on the control group. Maximal activity of serum AlAT has been higher on the control group and maximal bilirubin concentration in serum the patients with diabetes mellitus or cholelithiasis has not differed from the control group. Acute hepatitis B passed into chronic hepatitis or cirrhosis of the liver on the group with diabetes mellitus or cholelithiasis frequently, has been observed.

Alanine Transaminase↗