[Current principles of cholelithiasis prophylaxis in the practice of district physician]

The key task of the district physician is staged diagnostic search and clinical detection of functional disorders--conduction of laboratory tests and device investigations (in cholelithiasis patients--ultramicroscopic investigation of bile, x-ray methods, ultrasonography) to initiate prophylactic-therapeutic measures (medico-social, pharmacological and therapeutic-dietary).

[Gallstone disease in children with obesity]

Based on the authors own research shown a relationship of metabolic disorders in children with GSD with the metabolic syndrome. Studied the parameters of lipid and carbohydrate metabolism in children with both abdominal and endocrine obesity. Was shown the Significance a high direct correlation in children with cholelithiasis on the background of obesity and metabolic syndrome. Obtained data enable us to assert that in children with cholelithiasis on the background of obesity forms classical clinical picture of metabolic syndrome.

Cytokeratin 8 and 18 tissue expression in gallbladder mucosa of patients with cholelithiasis

Cytokeratins (CKs) 8 and 18 are normally expressed in simple epithelia. This unique pair of CKs is believed to be involved in hepatic diseases and many human cancers. Little is known about the role of tissue expression of both CKs in patients with cholelithiasis (CH). The aim of the study was to analyse tissue expression of CK8 and 18 in the specimens of gallbladder mucosa in 35 young (up to 25 years of age) and 20 older patients (approximately 50 years of age) with CH. An immunocytochemical ABC method and the spatial visualization technique were conducted. Our study demonstrated significantly lower amounts of both CKs in young patients, as compared to older patients. The higher cellular expression of CK8 in older patients was linked to acute clinical course vs. chronic ones. Tissue expression of neither CK correlated with inflammatory activity (grading) of the gallbladder mucosa. A positive correlation between reciprocal expressions of the two CKs may confirm a cytoprotective role of the two proteins in both groups of patients with symptomatic CH. Significantly higher expression of CK18 than that of CK8 in younger patients suggests a different role of CK8 and 18 in lithogenesis in this group.

[Possibilities of using of crystal-optic qualities of bile in early diagnostic stage of cholelithiasis]

The aim of our investigation was to study the changes of bile morphology and possibilities of its using in early diagnostic stage of cholelithiasis. We spent the complex investigation of biochemical and crystal-optic qualities of bile in 207 patients with cholelithiasis stage I with different disease duration. The revealed crystal-optic morphotypes have selective morphology due to the bile lithogene level that allows to determine the disease duration and the bile instability to make in-time adequate profilactic.

Pathophysiological conditions in cholelithiasis formation in North Indian population: spectroscopic, biophysical, and biochemical study

Knowledge of the chemical, structural, and elemental composition of gallstones is essential for etiopathogenesis of gallstone disease. To identify the predisposing factors for gallstone formation, X-ray diffraction powder analysis, atomic absorption spectroscopy, and various biochemical estimations were carried out. In the present study, trace elemental analysis revealed calcium as the major constituent element in addition to the iron, magnesium, and zinc in the majority of the gallstones. Patients with gallstones exhibited increased serum total bilirubin and conjugated bilirubin levels and liver function parameters (serum glutamic pyruvic transaminase, serum glutamic oxaloacetic transaminase, and alkaline phosphatase). In patients with gallstones, higher concentrations of malondialdehyde, significantly higher glutathione disulfide/glutathione (GSH) ratio, reduced total GSH levels, and significantly decreased antioxidant enzymes activities (superoxide dismutase, catalase, and glutathione peroxidase) were found than in patients without gallstones. Further studies are needed to establish whether the observed differences are a cause or an effect of gallstone formation. Such studies could ultimately result in the development of new strategies for the treatment of gallstones and might provide clues for prevention of gallstones formation.

Prevalence of cholelithiasis in a Turkish population sample of postmenopausal women

BACKGROUND/AIMS

Gallstone disease is a global health problem worldwide. Potential risk factors for gallstone disease have not been well established except for age and gender. We aimed to investigate the prevalence and potential risk factors for gallstone disease in a population of postmenopausal women.

METHODS

A detailed Turkish questionnaire was prepared, and 474 of 502 postmenopausal women seen at the menopause clinic of Dr. Zekai Tahir Burak Hospital were included in the study. Sociodemographic, medical and reproductive characteristics were analyzed. Subjects were divided into two groups. The gallstone disease group (Group 1, n=73) was defined by both prior histories of gallstones diagnosis or cholecystectomy in the postmenopausal period and the presence of current sonographically diagnosed gallstones; Group 2 (n=401) included women with no gallstone disease.

RESULTS

The present study found a 15.4% prevalence rate of cholelithiasis in a Turkish population sample of postmenopausal women. The demographic characteristics were similar between the two groups. The mean gravidity was 5.25 in Group 1 and 4.9 in Group 2. The number of subjects with past oral contraceptive use was 17 (23.3%) in Group 1 and 56 (13.9%) in Group 2. The number of women who took hormone replacement therapy was 40 (54.8%) in Group 1 and 222 (55.3%) in Group 2. There was no significant difference related to mean total cholesterol levels (216.5±44.9 mg/dl versus 215.9±44.3 mg/dl; p=0.915) and mean triglycerides (134.5±54.8 mg/dl versus 143.2±77 mg/dl; p=0.202) between the two groups.

CONCLUSIONS

No risk factors for developing gallstones were determined among the evaluated parameters in postmenopausal women.

[Cholelitiasis and age: tactic of surgical treatment]

We examined the resultants of treatment of 268 old patients. RESULTATES: The global demographic transition to an older population effects developing as well as developed coutries. Cganges in mitochondria with age, in body composition, in biliary tract gives to start for many diseases such as cholelitiasis. It has recommended the special surgic tactict of treatment such situations.

[Disorders of bone mineral density in patients with cholelithiasis and postcholecystectomic syndrome]

to justify the role of biliary insufficiency (BI) in the development of disorders of bone mineral density (BMD) in patients with cholelithiasis and after cholecystectomy, to introduce with main methods of diagnosis, prevention and treatment of osteoporosis and osteopenia in biliary pathology. Recent literature data showed that development of BI in the CL and PS leads to malabsorption of vitamin D and thereby contribute to the development of osteoporosis and osteopenia. The main method of diagnosis of BMD is twoenergic X-ray densitometry.

Biliary proteins and their redox status changes in gallstone patients

BACKGROUND

Proteins might act as pronucleating agents of cholesterol crystallization in bile. However, little is known about the redox status of biliary proteins in humans and their interaction with crystallization of biliary cholesterol.

MATERIALS AND METHODS

Gallbladder biles were obtained at cholecystectomy from 86 symptomatic patients with either cholesterol gallstones (32 multiple and 32 solitary stones) or pigment stones (n = 22), and studied for protein redox status [carbonyl and sulfhydryl (PSH) concentrations], total lipid and protein levels and cholesterol saturation index (CSI). First appearance of cholesterol crystals in ultrafiltered bile (crystal observation time, COT) was studied with polarizing light microscopy during 21 days.

RESULTS

Patients with cholesterol stones had significantly shorter COT (3 days vs. >21 days, P < 0.05), higher CSI (149 +/- 10% vs. 97 +/- 7%, P < 0.05) and higher total biliary proteins (1.96 +/- 0.1 mg mL(-1) vs. 0.55 +/- 0.1 mg mL(-1), P < 0.05) than patients with pigment stones. Patients with cholesterol stones had significantly lower (P < 0.05) level of protein sulfhydryl concentrations (18 +/- 4 nmol mg(-1) protein vs. 49 +/- 16 nmol mg(-1) protein), while total lipid and carbonyl proteins concentrations were similar between cholesterol and pigment stone patients. Crystallization probability was influenced by the number/type of gallstones (multiple > solitary > pigment stones, P = 0.009) and total protein concentration (high > low levels, P = 0.004). COT was negatively correlated with total protein content (r = -0.45, P = 0.03).

CONCLUSIONS

Biles with cholesterol stones show high CSI and total protein concentration, and rapid COT, which is even faster in patients with multiple stones and high protein concentration. Low PSH levels in cholesterol stone patients point to a biochemical shift, potentially able to affect cholesterol crystallization.

[Expression and regulation of megalin in gallbladder mucosa associated with cholesterol gallstone disease]

OBJECTIVE

To explore the relationship between expression and regulation of Megalin in gallbladder mucosa and cholesterol gallstone disease.

METHODS

Gallbladder mucosa, gallbladder wall, bile, gallstone were collected from 29 patients with cholesterol gallstone disease (GS) and 12 patients with gallstone free (GSF). Lipids of bile and stone were measured by kits. Expression of Megalin and Cubilin was analyzed by Real-time PCR. GBC-SD cell line were treated with T0901317, 9-cis retinoic acid, chenodeoxycholic acid (CDCA), the agonists of LXR, RXR, FXR, respectively. Gene expressions were detected.

RESULTS

Biliary cholesterol % molar and CSI increased significantly in GS group [(7.98 +/- 0.44) mol% vs (4.87 +/- 0.39) mol%, P < 0.01]. Megalin expression in GS group was significantly higher than that in GSF group (P < 0.05) and cubilin expression was similar between two groups. In vitro experiments showed that CDCA markedly increased expression of megalin.

CONCLUSION

This study shows that the increased expression Megalin may help to increase cholesterol uptake in gallbladder and play a compensative role in GS. FXR may participate in the transcription regulating of Megalin.

Coagulation function in patients with pancreatic carcinoma

BACKGROUND

The coagulation function in patients with pancreatic carcinoma is abnormal and the reason is not very clear. In this study, we retrospectively analyzed the coagulation function in patients with pancreatic carcinoma.

METHODS

From June 2004 to December 2007, 132 patients received diagnosis and treatment in our hospital. The coagulative parameters including the prothrombin time, activated partial thromboplastin time, and fibrinogen levels were collected and studied retrospectively.

RESULTS

The average fibrinogen levels in patients with pancreatic carcinoma, (476.21 +/- 142.05) mg/dl, were significantly higher than in patients with cholangiolithiasis, (403.28 +/- 126.41) mg/dl (P < 0.05). In patients with pancreatic carcinoma, the levels of fibrinogen in the group with jaundice were significantly higher than in patients without jaundice (P < 0.05). In patients who received Pancreaticoduodenectomy, Whipple's operation, the level of fibrinogen in the group with local invasiveness was significantly higher than in the group without invasiveness. The group with lymphatic metastasis had higher levels than the group without lymphatic metastasis (P < 0.05). There was no significant difference of intraoperative blood loss between patients with vitamin K, (748.27 +/- 448.51) ml, and those without vitamin K, (767.31 +/- 547.89) ml (P > 0.05).

CONCLUSIONS

The level of fibrinogen in patients with pancreatic carcinoma was elevated. The elevated fibrinogen level may be associated with invasiveness and lymphatic metastasis. Using vitamin K in perioperation management did not reduce intraoperative blood loss.

[APOE gene polimorphism and lithogenicity of the bile in the women with cholelithiasis]

AIM

to study the frequency of alleles and genotypes of APOE gene in women with gallstone disease (GSD), and also to research the association of the APOE gene polymorphism and bile lithogenicity indices.

MATERIALS AND THE METHODS

were investigated 104 women after cholecystectomy about verified cholesterol gallstones, and 176 women from the female Novosibirsk population, they were control group for the comparison of the frequency of APOE alleles and genotypes. Gallbladder bile (bile cholesterol, common bile acids) was investigated in women with GSD. Blood serum lipids and APOEgene polymorphism were studied in all women.

RESULTS

APOE gene polymorphism in the women with GSD did not differ from those registered in control group from women population. At the presence of APOE4 allele at the women with GSD the significant increase of gallbladder biliary cholesterol level was marked. In the women with GSD with various APOE genotypes average levels of blood serum lipids, common bile acids and bile cholesterol indices were similar.

[The functional condition of the hepato-biliary system in fatty hepatosis with concomitant diabetes mellitus]

It was made an organized study of the functional condition of hepato-biliary system beside 200 patients with fatty hepatosis and fatty hepatosis with concomitant sugar diabetes. In verification of the diagnosis were used results of the biochemical blood's study, ultrasonography study, computer and MR tomography. All patients were conducted with duodenal tubing with following biochemical bile study. Breach of the functional condition liver was revealled beside majority sick fatty hepatosis, moreover degree of the breaches becomes above under accompanying sugar diabetes. Unidirectional change in biochemical bile characteristic wasn't noted beside patient fatty hepatosis and fatty hepatosis with accompanying sugar diabetes, corresponding to I stage cholelithiasis.

[Lipid peroxidation and antiradical defense in patients after endosurgical cholelithiasis]

The peroxide status was studied after cholecystectomy depending on the procedure of a surgical access and the duration of exposure to the pneumoperitoneum during laparoscopic operations. Endosurgical interventions, unlike open operations and miniaccess operations, were found to have the least impact on the values of lipid peroxidation (LPO) expirate. There was evidence that a marked imbalance occurred in the LPO-antioxidant system with longer exposure to the peritoneum.

[Lipoprotein(a)--a new independent cholelithiasis risk factor?]

AIM

To study the level of lipoprotein(a)--Lp(a) in the blood serum and incidence of isoforms of apolipoprotein(a)--apo(a) in males and females with cholelithiasis and free of it in population of Novosibirsk; to assess possible correlations between Lp(a) level in the blood, apo(a) isoforms and bile lithogenicity in females with cholesterol cholelithiasis.

MATERIAL AND METHODS

Examination of the representative samples of 870 females aged 25-64 years and 405 males aged 35-54 years has detected cholelithiasis in 91 females and 19 males.

RESULTS

Serum levels of Lp(a) are associated with cholelithiasis. Risk of the latter in males (Lp(a) > 28 mg/dl) and females (Lp(a) > 24 mg/dl) is estimated. It is confirmed that isoforms of apo(a) B, S1 and S2 in females and isoforms of apo(a) B, S2 in males with cholelithiasis occur much more frequently than in individuals free of cholelithiasis while isoform apo(a) S4 is rare. Females with cholesterol cholelithiasis have positive correlation between blood Lp(a) levels, the presence of isoforms apo(a) B, S1 and bile lithogenicity.

CONCLUSION

Males and females with cholelithiasis have more frequent high concentrations of Lp(a) (> 30 mg.dl) while low levels (0-5 mg/dl) are rare. There is a correlation between blood levels of Lp(a), apo(a) isoforms, bile lithogenicity in females with cholesterol cholelithiasis.

[Comparative assessment of bile and blood cholesterol, pigment, and protein metabolic parameters in patients with cholelithiasis in the presence and absence of opisthorchiasis]

AIM

to study the regularities of lithogenesis in patients with cholelithiasis (CL) and opisthorchiasis.

SUBJECTS AND METHODS

Fifty-one patients with CL and opisthorchiasis were examined. Comparison groups comprised 32 with CL without opisthorchiasis and 14 patients with opisthorchiasis without CL. All the patients underwent a comprehensive examination involving laboratory and ultrasound studies.

RESULTS

Opisthorchis invasion leads to increases in vesicular and hepatic bile cholesterol saturation and bile albumin levels due to intrahepatic ductal cholestasis, to a rise in bile unconjugated bilirubin concentration, which is caused by the activation of proliferative inflammation in the bile ducts and by the increased deposits of bilirubin complexes resulting from higher bile globulin levels.

CONCLUSION

In opisthorchiasis, bile lithogenic factors mostly activate in the development of CH in patients with significant manifestations of cholestasis, angiocholitis with the most preserved concentration function of the gallbladder.

[Differential analysis of protein profiles of vesicular phase and micellar phase of gallbladder bile from cholesterol gallstone patients]

OBJECTIVE

To identify the proteins which play key roles during the formation of cholesterol gallstone, differential analysis was carried out that the proteome of vesicular phase and micellar phase of gallbladder bile from cholesterol gallstone patients.

METHODS

Vesicular and micellar phases were isolated by the density gradient ultracentrifugation method. Total proteins from the two phases were extracted, and the protein expressional profiles were established by two-dimensional electrophoresis respectively. The differentially expressed protein spots analyzed by ImageMaster two-dimensional electrophoresis analysis software were identified with matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS).

RESULTS

The concentrations of proteins from vesicular phase and micellar phase of gallbladder bile from cholesterol gallstone patients were (1.5358 +/- 0.0682) mg/ml and (7.1222 +/- 0.2022) mg/ml (P < 0.01) respectively. The average matched protein spots were 120 +/- 24 and 198 +/- 37 in the two groups respectively. There were 72 +/- 16 matched spots in the two representative gels maps and the matched rate was 45.30%. Eight differentially expressed protein spots were identified from the two cholesterol-carrier phases. Among them, 6 were up-regulated with 2 down-regulated in vesicular phase compared with micellar phase. The abundance differentiation of RBP and HSA was confirmed by immunoblotting.

CONCLUSIONS

The differential protein profiles of vesicular phase and micellar phase of gallbladder bile from cholesterol gallstone patients were established and 8 differential protein spots were identified successfully. The data may be a basis for further screening the key regulators of formation of cholesterol gallstone.

Effect of ezetimibe on the prevention and dissolution of cholesterol gallstones

BACKGROUND & AIMS

Cholesterol cholelithiasis is one of the most prevalent and most costly digestive diseases in developed countries and its incidence has increased markedly in Asian countries owing to the adoption of Western-type dietary habits. Because animal experiments showed that high efficiency of intestinal cholesterol absorption contributes to gallstone formation, we explored whether the potent cholesterol absorption inhibitor ezetimibe could prevent gallstones and promote gallstone dissolution in mice and reduce biliary cholesterol content in human beings.

METHODS

Male gallstone-susceptible C57L mice were fed a lithogenic diet and concomitantly administered with ezetimibe at 0, 0.8, 4, or 8 mg/kg/day for 8 or 12 weeks. Gallbladder biles and gallstones were examined by microscopy. Gallbladder emptying in response to cholecystokinin octapeptide was measured gravimetrically. Biliary lipid outputs were analyzed by physical-chemical methods. Cholesterol absorption efficiency was determined by fecal dual-isotope ratio and mass balance methods. Lipid changes in gallbladder biles of gallstone patients vs overweight subjects without gallstones were examined before (day 0) and at 30 days after ezetimibe treatment (20 mg/day).

RESULTS

Ezetimibe prevented gallstones by effectively reducing intestinal cholesterol absorption and biliary cholesterol secretion, and protected gallbladder motility function by desaturating bile in mice. Treatment with ezetimibe promoted the dissolution of gallstones by forming an abundance of unsaturated micelles. Furthermore, ezetimibe significantly reduced biliary cholesterol saturation and retarded cholesterol crystallization in biles of patients with gallstones.

CONCLUSIONS

Ezetimibe is a novel approach to reduce biliary cholesterol content and a promising strategy for preventing or treating cholesterol gallstones by inhibiting intestinal cholesterol absorption.

[Association of fatty acid composition of blood serum with bile lipid composition in cholelithiasis patients]

AIM

To examine correlations between bile lipid composition and fatty acid composition of blood serum in cholelithiasis patients.

MATERIAL AND METHODS

Cholelithiasis prevalence in Khakasia Republic was studied in a clinico-epidemiological trial with participation of 1393 European people and 1060 mongoloid people--Khakasians. Bile lipids and serum fatty acids were measured.

RESULTS

Europeans had cholelithiasis in 7.3%, Khakasians--3.4% (p < 0.001). Total cholesterol in bile of cholelithiasis patients was higher than in healthy subjects (both in Europeans and Khakasians). Fatty acids content was higher in cholelithiasis patients of both populations.

CONCLUSION

Cholelithiasis was more prevalent in Europeans because of genetical differences in lipid metabolism. Rise in contents of saturated fatty acids and lowering of the proportion of unsaturated acids in blood is a universal aspect of lipid metabolism disturbance in cholelithiasis patients in genetically diferent populations.

[Using simvastatin in combination with chophytol at early stages of cholelithiasis in elderly patients]

In the treatment of 78 elderly patients with the gallstone disease were used chophytol and vasilip. To estimate the efficiency of treatment we used modern laboratory-instrumental, ultrasonic and biochemical methods of examinations. The examinations of indexs of fat exchange in bile and blood showed the communication of theirs disturbances. The application of chophytol and vasilip in the treatment of the first stage of gallstone disease is prove the positive changes of clinical symptoms of illness and lead to improvement of liver functional condition and biochemical composition of bile. These changes are cause to decrease of risk of formation the gallstones.

Role of bile bacteria in gallbladder carcinoma

BACKGROUND/AIMS

Long standing calculus disease has been observed to be a risk factor for gallbladder carcinoma. However it is possible that calculi may be incriminated by some means other than just chronic irritation. Calculi may induce an element of stasis, promoting chronic infection leading to increased turnover of primary bile acids to secondary bile acids, which are known tumor promoters and initiators. This study aimed to find the prevalence of biliary microflora in gallbladder carcinoma and association of gallbladder carcinoma with chronic bacterial infection and bile acid profile.

METHODOLOGY

Bile culture was done in 390 patients divided into 3 groups--gallbladder carcinoma 65 (17%), cholelithiasis 125 (32%) and control group 200 (51%). Serum samples were analyzed for presence of Vi antibody for chronic typhoid carrier state and bile acid analysis was done in 10 patients in each group.

RESULTS

116 (30%) patients had culture positive bile. Significantly higher number of patients with gallbladder carcinoma 40 (65%) had culture positive bile as compared to cholelithiasis 52 (42%) and control 24 (12%). Vi Antibodies suggestive of chronic typhoid carrier state were found to be significantly higher in the gallbladder carcinoma group 20 (31%) as compared to controls 22 (11%) (OR 3.596, p < 0.05) however, the difference was statistically insignificant in the cholelithiasis group 12 (11%) (OR 0.859, p > 0.05). There was a 6.84 times higher risk of developing gallbladder carcinoma in culture positive cholelithiasis patients and 5.14 times if both Vi antibody and cultures were positive. Bile analysis showed primary bile acids cholic acid and chenodeoxycholic acid to be lower while secondary bile acids deoxycholic acid and lithocholic acid to be more in the gallbladder carcinoma group (7.268 mg/mL, 9.183 mg/ mL, 14.468 mg/mL, 3.312 mg/mL respectively) than cholelithiasis (17.50 mg/mL, 13.80 mg/mL, 6.07 mg/ mL, 2.05 mg/mL) and control group (19.85 mg/mL, 16.53 mg/mL, 2.71 mg/mL, 1.128 mg/mL respectively). The difference was statistically significant.

CONCLUSIONS

Chronic bacterial infection of bile leading to production of carcinogenic precursors might be one of the etiological factors in the pathogenesis of gallbladder carcinoma and hence a target for its prevention.

A genome-wide association scan identifies the hepatic cholesterol transporter ABCG8 as a susceptibility factor for human gallstone disease

With an overall prevalence of 10-20%, gallstone disease (cholelithiasis) represents one of the most frequent and economically relevant health problems of industrialized countries. We performed an association scan of >500,000 SNPs in 280 individuals with gallstones and 360 controls. A follow-up study of the 235 most significant SNPs in 1,105 affected individuals and 873 controls replicated the disease association of SNP A-1791411 in ABCG8 (allelic P value P(CCA) = 4.1 x 10(-9)), which was subsequently attributed to coding variant rs11887534 (D19H). Additional replication was achieved in 728 German (P = 2.8 x 10(-7)) and 167 Chilean subjects (P = 0.02). The overall odds ratio for D19H carriership was 2.2 (95% confidence interval: 1.8-2.6, P = 1.4 x 10(-14)) in the full German sample. Association was stronger in subjects with cholesterol gallstones (odds ratio = 3.3), suggesting that His19 might be associated with a more efficient transport of cholesterol into the bile.