Associations between serum leptin levels, hyperlipidemia, and cholelithiasis in dogs

Leptin and its receptor play several physiological roles in the canine gallbladder, and the dysregulation of leptin might play a role in the pathogenesis of gallbladder diseases such as gallbladder mucocele. Previous studies revealed a positive association between hyperlipidemia and gallstones in humans. However, the latter is still unclear in dogs with cholelithiasis. In this study, we examined the differences in leptin, leptin receptor, total cholesterol, and triglyceride levels between healthy dogs and dogs with cholelithiasis, and evaluated the correlation between leptin and hyperlipidemia. Twenty-eight healthy dogs and 34 client-owned dogs with cholelithiasis were enrolled in the study. Leptin concentrations and lipid profiles were determined from sera, and leptin and leptin receptor expression levels were quantified in gallbladder tissue. In dogs with cholelithiasis, serum concentrations of leptin (p < 0.001), total cholesterol (p < 0.001), and triglycerides (p < 0.001) were significantly higher compared with those in healthy dogs. Positive correlations were observed between serum leptin and total cholesterol (95% confidence interval (CI) = 0.61–0.89, r = 0.725, p < 0.001), and between leptin and triglycerides (95% CI = 0.63–0.89, r = 0.782, p < 0.001) in the cholelithiasis group. Hypercholesterolemia (Odds Ratio (OR) = 9.720; 95% CI = 1.148–82.318) and hypertriglyceridemia (OR = 12.913; 95% CI = 1.548–107.722) were shown to be risk factors for gallstone disease. In cholelithiasis patients who underwent cholecystectomy, serum leptin levels were significantly higher than in patients that had not undergone surgery (p < 0.001). Leptin and leptin receptor expression was upregulated in the gallbladder tissues of cholelithiasis patients (p < 0.01 and p < 0.001, respectively). These results indicate that increased serum leptin concentrations and hyperlipidemia (hypercholesterolemia or hypertriglyceridemia) are associated with canine cholelithiasis and that homeostatic imbalance of these parameters might affect the pathogenesis of gallstones.

The effect of UGT1A1 promoter polymorphism in the development of hyperbilirubinemia and cholelithiasis in hemoglobinopathy patients

Present study was aimed to explore the effect of (TA)n UGT1A1 gene promoter polymorphism on bilirubin metabolism, bilirubinaemia, predisposition to cholelithiasis and subsequent cholecystectomy, in Sickle-Cell Anemia (SCA) and beta-Thalasemia major (bTH) in Kuwaiti subjects compared to other population. This polymorphism was analyzed and correlated to total bilirubin and cholelithiasis in 270 age, gender, ethnically matched subjects (92 bTH, 116 SCA and 62 Controls) using PCR, dHPLC, fragment analysis and direct sequencing. Four genotypes of UGT1A1 were detected in this study (TA6/6, TA6/7, TA6/8 and TA7/7). (TA)6/8 was found only in four individuals; hence it was not included in the analysis. There was a statistically significant association of genotypes with serum total bilirubin levels in both bTH and SCA groups (p<0.001). Subjects with (TA)7/7 had the highest total serum bilirubin level (178.7 ± 3.5 µmole/l). A significant association was observed between allele (TA)7 and cholelithiasis development (p = 0.0001). The 40%, 67.5% and 100% of SCA with (TA)6/6, (TA)6/7 and (TA)7/7 respectively developed cholelithiasis and were subsequently cholecystectomized. Our results confirm UGT1A1 (TA)7 allele as one of the factors accounting for the hyperbilirubinemia and cholelithiasis observed in SCA and bTH.

Evaluation of leptin and insulin resistance in patients with cholelithiasis

The association between insulin resistance, lipoproteins and leptin was evaluated in cholelithiasis. The study group included 55 women (68.8%) and 25 men (31.3%) with a mean age and SD of 50.56 +/- 14.28 yrs. The control group included 25 women (62.5%) and 15 men (37.5%) with a mean age of 50.93 +/- 11.73 yrs. Serum leptin levels were measured by the enzyme immunoassay method. HOMA-IR was determined by using fasting glucose and insulin levels. Insulin, total cholesterol (TC), LDL-C, HOMA-IR (p < 0.01) and leptin (p < 0.001) were significantly higher in the cholelithiasis group, compared to the controls. In patients with a HOMA-IR >2.2, age, body mass index (BMI), glucose, insulin, triglycerides (TG), TC and leptin levels were higher than in patients with a HOMA-IR < 2.2. In patients with glucose levels >100 mg/dl, mean BMI, HOMA-IR, insulin, TG, TC and leptin levels were significantly higher than in patients with glucose levels <100 mg/dl. In patients with TG levels >150 mg/dl, mean age, BMI, glucose, insulin, TC, leptin and HOMA-IR were significantly higher than in patients with TG levels < 150 mg/dl. In patients with BMI > 25 kg/m2, mean age, glucose, insulin, TG, TC, leptin, HOMA-IR were significantly higher than in patients with BMI < 25. In cholelithiasis group, there was a positive correlation between leptin and age, BMI, glucose, insulin, TG, TC, LDL-C or HOMA-IR. In conclusion, we found a positive association between increased leptin levels and abnormal lipoprotein metabolism in cholelithiasis. Cholelithiasis subjects with insulin resistance showed higher cardiometabolic risk factors than those without it.

[Effect of antihypoxant infusion on microbial endotoxin circulation in obstructive jaundice patients]

The dynamics of microbial endotoxemia in group of 149 patients with cholelithiasis complicated by obstructive jaundice has been studied as dependent on the perioperative tactics of infusion therapy. The perioperative period in obstructive jaundice patients is complicated by a significant increase in lipopolysaccharidemia caused by translocation mechanisms and disorders of the liver detoxification function. In Group 1, 47 patients received infusion therapy including Ringer's solution and 10% glucose solution at a 1:1 ratio. In group 2, 55 patients received infusion therapy with only Sterofundin G-5 solution. In Group 3, 47 patients received the infusion therapy with remaxol in a dose of 800 ml/day. It is established that the infusion of Sterofundin G-5, and to a greater extent the infusion of remaxol, reduces the early postoperative degree of decompensation and accelerates recovery of the detoxifying function of Kupffer cells with respect to microbial endotoxin.

Analysis of serum lipid profile in cholelithiasis patients

BACKGROUND

Gallstone diseases being common disorder, multiple studies have shown an association between gallstones and abnormal lipids. This study is to compare the serum lipid abnormalities in females who have cholelithiasis with controls.

METHODS

A retrospective study of females who underwent cholecystectomy for gallstone disease was carried out. A total of 133 patients were divided into two age groups ≤ 40 and >40 years. In age group ≤ 40 years, there were 72 cases with no controls, whereas, in >40 years, 61 cases were compared with 67 controls. The serum lipid profile were collected and compared according to the age groups. The groups were compared by using Student's t-test, p<0.05 was considered statistically significant.

RESULTS

In age group >40 years serum LDL of gallstone patients were statistically significantly raised (P<0.05) (95% CI -22.077; -850) compared with controls and serum total cholesterol and triglycerides were not statistically significantly high (P >0.05). Serum HDL and VLDL were lower in gallstone patients but not statistically significant (P >0.05) compared to control group.

CONCLUSIONS

The study showed that serum LDL level was statistically significant in females >40 years of age, whereas other parameters were not statistically significantly different.

A genome-wide association study of total bilirubin and cholelithiasis risk in sickle cell anemia

Serum bilirubin levels have been associated with polymorphisms in the UGT1A1 promoter in normal populations and in patients with hemolytic anemias, including sickle cell anemia. When hemolysis occurs circulating heme increases, leading to elevated bilirubin levels and an increased incidence of cholelithiasis. We performed the first genome-wide association study (GWAS) of bilirubin levels and cholelithiasis risk in a discovery cohort of 1,117 sickle cell anemia patients. We found 15 single nucleotide polymorphisms (SNPs) associated with total bilirubin levels at the genome-wide significance level (p value <5 × 10(-8)). SNPs in UGT1A1, UGT1A3, UGT1A6, UGT1A8 and UGT1A10, different isoforms within the UGT1A locus, were identified (most significant rs887829, p = 9.08 × 10(-25)). All of these associations were validated in 4 independent sets of sickle cell anemia patients. We tested the association of the 15 SNPs with cholelithiasis in the discovery cohort and found a significant association (most significant p value 1.15 × 10(-4)). These results confirm that the UGT1A region is the major regulator of bilirubin metabolism in African Americans with sickle cell anemia, similar to what is observed in other ethnicities.

[Wether cholescystectomy affects bile lithogenicity in cholelithiasis]

THE AIM

The studying of physical-chemical qualities of liver bile and lipid exchange before and after cholecystectomy.

MATERIALS AND METHODS

We spent the complex investigation of physical-chemical qualities of bile and lipid levels in 210 patients with cholelithiasis stage I (pre-stone) and in 90 patients with cholelithiasis stage II and III (with gallstones) after cholecystectomy.

THE RESULTS

In all examined patients we revealed disturbances of physical-chemical qualities of bile and lipid exchange. With correlation analysis it was found that bile lithogenity increases in high bile density, in progressing of inflammation process in bile ducts, in increasing of aterogene fractions of blood cholesterol.

CONCLUSION

After cholecystectomy in liver-cells dyscholia the ability to stones formation preserves. It means that patients after cholecystectomy need in following-up with using of prophylactic measures to restoring of bile-formation.

[Factors affecting contractile function of the gall blader in patients with cholelithiasis]

In article the data on interrelation between gallbladder contractility and a level of hormones of a thyroid gland (threeiodethyronine, thyroxine, thyrotropin hormone (TTH) and antibodies to thyreoperoxidase (AT to TPO)) in plasma of blood at 470 healthy persons and 540 patients with gallstone disease are submitted. The contractility function of a gallbladder on ultrasonic at persons with gallstone disease is authentic less, than at healthy persons. Dysfunction of a thyroid gland is found out in women with gallstone disease: increase TTH and AT to TPO. Among men hormonal shifts are not revealed. Contact chemical litholysis with methyl tert butyl ether of cholesterol stones in gallbladder except for their dissolution, improves its contractility activity.

[The role of metabolism disorders in genesis of gallstone disease in children]

Identified changes lipid metabolism in children with biliary disease, characteristic of the metabolic syndrome. The correlation between indices of lipid metabolism with body weight in children with cholelithiasis. However, the degree of impairment of carbohydrate metabolism was independent of body mass index. Obtained data allow us to state that obesity is not always a marker of the metabolic syndrome.

Comparison of primary octreotide-lar and surgical treatment in newly diagnosed patients with acromegaly

OBJECTIVE

The primary aim of the study was to compare the efficacy of Oct-LAR and surgery in terms of controlling IGF-1 and GH levels and tumour volumes. The second aim was to compare two primary treatment modalities in terms of side effects such as pituitary insufficiency, cholelithiasis, metabolic parameters and the effect on quality of life (QoL).

DESIGN

The study was a randomized, prospective study.

PATIENTS

The 22 patients were consecutively randomized to Oct-LAR and surgical treatment groups.

RESULTS

Baseline serum IGF-1 level, tumour volume and GH levels were comparable in the Oct-LAR and surgery groups. No significant differences were detected between the Oct-LAR and the surgery groups in terms of IGF-1 and GH levels at the 3rd and 6th months, but at 12th month, preglucose GH was found to be lower in the surgical treatment group. IGF-1 control and complete biochemical response rates were found to be 27% and 64%, in the Oct-LAR and surgical treatment groups, respectively. The mean percentage of tumour volume reduction was found to be 26%, 30% and 31% in the Oct-LAR group vs 64%, 74% and 79% in the surgery group at the 3rd, 6th and 12th months, respectively.

CONCLUSION

Primary surgical treatment seems to be slightly more effective than Oct-LAR in terms of biochemical response and IGF-1 control, besides tumour volume reduction, in patients with acromegaly with noninvasive tumours. Oct-LAR is associated with more side effects such as cholelithiasis and glucose metabolism disorders and is more expensive.

[Surgical strategy for the treatment of complicated cholelithiasis in elderly and senile patients]

The author summarizes results of the treatment of 140 elderly and senile patients with complicated cholelithiasis divided into 2 groups using scales for the assessment of their clinical condition and prognosis of treatment outcome. Patients of groups 1 and 2 were given single- and multistep treatment respectively. It is concluded that differential approach to the treatment of complicated forms of cholelithiasis in elderly and senile patients permits not only to evaluate their condition but also to use the least invasive procedures for resolution of the biliary obstruction and thereby to reduce the risk of complications and fatal outcome.

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.

[Role of hyperlipidemia in cholelithiasis]

THE PURPOSE OF THE REVIEW: Was analyzed basic data on the contribution of blood serum lipids in the development of gallstone disease (GSD) in the world as well as in northern Russia, as well as the association of cholelithiasis and coronary heart disease (CHD).

RECENT LITERATURE DATA

Worldwide, there is suffer from cholelithiasis 10 to 15% of the population. In Russia, about 60% of adults have a lipid metabolism. According to some epidemiological and clinical studies, serum lipid profile did not differ in patients with and without gallstone disease, in others with cholelithiasis observed hyperlipidemia. In an epidemiological study in the unorganized population of Novosibirsk cholelithiasis occurs more frequently among men and women with lipid disorders. Indigenous peoples of the North Asian Russia this disease is less common than among the aliens, which was accompanied by a more moderate hyperlipidemia. There was a positive association between gallstone disease and coronary heart disease. Despite the fact that hypertriglyceridemia and hypo by a majority of authors are recognized risk factors for gallstone disease, a consensus on the contribution of blood serum lipids in the pathogenesis of gallstone no. Since gallstone mostly composed of cholesterol, probably need to examine the level of serum lipids in a moment of gallstones after this time can be obscured link hyperlipidemia and holelitgenesis.

[Possibility of correction of the lipid disorders in patients with cholelithiasis and gallbladder cholesterosis]

OBJECTIVE

To evaluate the possibility of incorporating organic drugs Hepatosan and Entherosan in the complex therapy of patients with gallstone disease and gall bladder cholesterosis (reticulated polypus form) on the basis of literature data and own research.

RESULTS

It has been found that the physiological effect of drugs Entherosan and Hepatosan is directed on the improvement cavity and wall digestion processes, that leads to the reduction (disappearance) of dyspeptic symptoms (eliminating discomfort in the epigastrium, bloating, diarrhea) in most of the patients. The main features of Entherosan are: normalization of gastro-intestinal tract motor activity, intestinal microflora, enteroprotective effect of the drug and its influence on intestinal and cellular pools of cholesterol that leads to the activation of cavitary and parietal digestion. The essential point of Hepatosan is to stimulate 7alpha-hydroxylase, resulting in strengthening of cholesterol oxidation and to an increase the pool of LCD in enterohepatic circulation. This factor, coupled with hepatoprotective action of the drug, ensures the deletion of biliary insufficiency.

CONCLUSION

The incorporation of drugs Entherosan and Hepatosan in the complex conservative therapy of cholelithiasis and reticulated polypus forms of gall bladder cholesterosis is pathogenetically substantiated.

[Changes in concentration of cholecystokinin-pancreozymin in patients with cholelithiasis before and after cholecystectomy]

The level of cholecystokinin and secretin in 50 patients after cholecystectomy (from 1 to 10 years ago) was analyzed to study connection between cholecystectomy and gastrointestinal hormones concentration. 30 patients with gall bladder stone disease were included into the group of comparison. Cholecystokinin and secretin concentration in the groups of research was compared with indicated hormones concentration in the group of control formed of healthy volunteers. After anamnestical clinical and diagnostical features in every group had been studied we concluded, that cholecystokinin level changes depending on period after operation and outflow of bile conditions.

Gallstones and biliary sludge in Greek patients with complete high spinal cord injury: an ultrasonographical evaluation

INTRODUCTION

We used ultrasonography to detect the presence of biliary sludge or gallstones in Greek patients with complete high spinal cord injury (SCI) above the seventh thoracic segment (T7), within the first six months from injury onset, in order to evaluate the effects of neurological instability and dysfunction of the sympathetic nervous system (SNS) on the gallbladder function in the early post-SCI phase.

METHODS

We evaluated 78 asymptomatic patients (57 males, 21 females; mean age 34.8 (range 19-56) years) with complete high SCI located above the T7 segment, and 78 healthy subjects (59 males, 19 females; mean age 35.2 (range 21-59) years) matched for age, gender and race, for a total period of 39 months. All the participants underwent ultrasonographical examination of the gallbladder and common bile duct within the first six months from the injury, in order to investigate the development of biliary sludge and gallstones.

RESULTS

The incidence of biliary sludge was significantly higher in patients with SCI compared with the control group. The incidence of biliary sludge and gallstones was also significantly higher in patients with SCI patients in comparison with the healthy subjects. In male SCI patients, the incidence of biliary sludge was significantly increased in comparison with healthy subjects. No significant difference was revealed between the two groups in detection of gallstones.

CONCLUSION

Our study indicates that the detection of gallbladder sludge and gallstones are significantly higher in Greek patients with complete high SCI above the T7 segment, as compared with healthy control subjects within the first six months of the injury onset. The complete disruption of the SNS and the neurological instability in the early post-SCI phase is probably responsible for the biliary sludge and gallstone formation. Our results suggest that ultrasonography should be performed in these patients at the first 3-6 months from the injury for the early diagnosis of the lithogenic bile.

[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.

[Serum fatty acid and lipid spectrum in patients with cholelithiasis]

Caucasoids and mongoloids from different regions of Siberia were examined for the prevalence of cholelithiasis, serum lipid and fatty acid profiles. In Caucasoids, unlike Mongoloids, cholelithiasis was associated with increased serum cholesterol. This finding suggests that relative stability of lipid metabolism in Mongoloids protects them from biliary pathology. It was shown for the first time that elevated levels of saturated fatty acids and depletion of unsaturated fatty acids in the sera are a universal feature of disturbed lipid metabolism in patients with cholelithiasis in genetically different populations.

[Antioxidative defense parameters in acute and chronic cholecystitis]

A hundred and fifty-two patients cholelithiasis were examined. Among them, 69 and 83 patients were operated on for acute destructive and chronic cholecystitis, respectively. In destructive cholecystitis, there is a high lipid oxidation rate accompanied by the elevated levels of nonenzymatic antioxidant ceruloplasmin. The low activity of catalase and ceruloplasmin and the decreased content of ascorbic acid suggest the depletion of antioxidative defense in patients with cholelithiasis with significant liver disease. The magnitude of changes in the activity of antioxidative enzymes and the level of the nonenzymatic antioxidant ascorbic acid depend on the state of the liver.

[Predictive factors for cholelithiasis in the morbidly obese submitted to Roux-en-Y gastroplasty]

OBJECTIVE

This study intended to evaluate predictive factors for cholelithiasis in morbidly obese submitted to gastroplasty with "Y" de Roux reconstruction.

METHODS

The population under study was a group of obese patients enrolled in a program of surgical procedure for morbid obesity at the Department of Surgery, College of Medical Sciences, Santa Casa de São Paulo. The exclusion criteria were: patients previously cholecystectomized, patients with diagnosis of pre-operative cholelithiasis and patients with a questionable ultrasonography about existence of billiary stones. A total of 160 patients were operated, 29 with prior cholecystectomy, 23 with pre-operative biliar lithiasis , 5 with questionable ultrasonography about billiary stones and 103 with normal gallbladders at abdominal ultrasonography.

RESULTS

Results showed that (46.6%) of patients developed cholelithiasis, 22 of them symptomatic. When patients with or without cholelithiasis were compared, no significant difference related to age, gender and preoperative weight was observed. The body mass index, the triglycerides serum levels, total cholesterol and the fractions HDL-cholesterol and LDL-cholesterol were higher in the group who developed cholelithiasis compared to patients without gallstones and this difference was statistically significant. The percentage of weight loss in the 6th and 12th postoperative month was significantly higher in patients who developed billiary stones.

CONCLUSION

The study leads to conclude that body mass index, levels of triglycerides, total cholesterol and the fractions LDL and VLDL are predictive factors for cholelithiasis post-gastroplasty with the "Y" de Roux reconstruction.

Modifications of coagulation and fibrinolysis mechanism in laparoscopic vs. open cholecystectomy

BACKGROUND/AIMS

The incidence of thromboembolic complications following laparoscopic cholecystectomy as well as the indication for prophylactic thrombophylaxis is still controversially discussed. The aim of this study is to evaluate the alterations of the coagulation and fibrinolytic mechanism after laparoscopic vs. open cholecystectomy.

METHODOLOGY

Forty-five patients, who were submitted to laparoscopic (LC-group, n=30) or open cholecystectomy (OC-group, n=15) were included in the study. The following parameters were measured preoperatively and 24h and 48h postoperatively: platelet count (PLT), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen (FG), d-dimers (DD) and antithrombin III (AT-III).

RESULTS

The preoperative values were within the normal range and did not differ between the two groups. No significant alterations were noted concerning PT and PTT. FG and PLT were significantly increased in both groups at 24h and 48h compared to the baseline values, with no statistical significant difference between them at all time points. D-dimers were significantly elevated at 24h and 48h postoperatively in both groups. The LC-group showed significantly higher AT-III levels at 24h, and significantly lower DD levels at 24h and 48h compared to the OC-group (p < 0.05).

CONCLUSIONS

Laparoscopic cholecystectomy seems to induce a lower activation of the hemostatic mechanism compared to open cholecystectomy.

Genetic evidence that apolipoprotein E4 is not a relevant susceptibility factor for cholelithiasis in two high-risk populations

Apolipoprotein E (apoE) isoforms are genetic determinants of interindividual variations in lipid metabolism. To assess whether apoE is a genetic risk factor for cholesterol gallstone disease (GD), we analyzed apoE variants in populations from Chile and Germany, two countries with very high prevalence rates of this disease. ApoE genotypes were determined in Chilean gallstone patients (n = 117) and control subjects (n = 122) as well as in German gallstone patients (n = 184) and matched controls (n = 184). In addition, we studied apoE variants in subgroups of Chilean patients with strong differences in their susceptibility to acquire gallstones: 50 elderly subjects without gallstones in spite of well-known risk factors for this disease (gallstone-resistant) and 32 young individuals with gallstones but without risk factors (gallstone-susceptible). Furthermore, correlation analysis of apoE genotypes with cholesterol crystal formation times, biliary cholesterol saturation index (CSI), and gallstone cholesterol contents was performed in 81 cholecystectomized patients. In this study analyzing the largest sample set available, apoE4 genotype was not associated with an increased frequency of GD in either population. Moreover, in the Chilean population after adjusting for risk factors such as gender, age, body mass index, serum lipids, and glucose, the odds ratio for the association of the apoE4 allele and GD was significantly (P < 0.05) <1. Also, genotypes were not correlated with cholesterol crystal formation time, CSI, or gallstone cholesterol content. In contrast to previous smaller studies, apoE polymorphisms were not associated with susceptibility to cholesterol GD in high-risk populations.

[Clinical significance of the functional and structural changes in the intestines in chronic cholecystitis]

The aim of the study was to determine the clinical significance of intestinal functional and structural alterations in biliary pathology. Clinical, endoscopic, morphological, and morphometric methods were used. The subjects of the study were 62 patients with functional gall bladder disorder, 90 patients with chronic calculous cholecystitis, and 90 patients who had undergone cholecystectomy for cholelithiasis. The study found that biliary lithogenesis was associated with intestinal dysbiosis, changes in the qualitative density of erythrocytes immunopositive to motilin and substance P, and inflammatory changes in the intestines. After cholecystectomy, changes in intestinal microecology progressed, inflammatory and atrophic changes in the intestinal mucosa appeared or deepened, the qualitative density of erythrocytes immunopositive to motilin and substance P decreased, and colon polyps appeared more frequently.

[Effect of ursodeoxycholic acid on the characteristics of lipid metabolism in cholelithiasis and gall-bladder cholesterosis]

The article represents data demonstrating influence of ursodeoxicholic acid on the characteristics of lipidic interchange during cholesterin assosiated diseases of biliary tract. It has been shown that hypercholesterolemias occur in 64% of cases under cholelithiasis and in 56% of cases under gall-bladder cholesterosis. Slow rising of level of total cholesterol (within 5.3-6.1 mmole/l) is registered in 68% of cases under cholelithiasis and in 69% of cases under gall-bladder cholesterosis, higher hypercholesterolemia occurs rare and doesn't exceed 2-4% of cases. Disappearance of hypercholesterolemia after 3-month course of treatment with Ursosan has been registered in 45% of patients with cholelithiasis and in 49% of patients with gall-bladder cholesterosis. Other patients showed positive dynamics, and level of total cholesterol made up in general 5.6 mmoles/l under cholelithiasis and 5.4 mmoles/l uder gall-bladder cholesterosis.

Changes in coagulation and fibrinolysis during laparoscopic cholecystectomy

BACKGROUND

The influence of laparoscopic cholecystectomy on coagulation and fibrinolysis is debatable. There have been a few but controversial studies and the need for routine antithrombotic prophylaxis is unclear.

MATERIALS AND METHODS

In this prospective study we investigated changes in coagulation and fibrinolysis parameters in laparoscopic cholecystectomy. Blood samples taken before, during, and after surgery from 38 consecutive patients were analyzed. Measured parameters included the international normalized ratio, prothrombin time, partial thromboplastin time, antithrombin III activity, platelet count, mean platelet volume, fibrinogen, and D-dimers.

RESULTS

Statistically significant changes included increased perioperative international normalized ratio and D-dimers, and postoperative antithrombin III, fibrinogen, and D-dimers, as well as decreased perioperative antithrombin III and fibrinogen and postoperative international normalized ratio, platelet count, and mean platelet volume. Values of partial thromboplastin time had no statistically significant changes.

CONCLUSION

Reduced coagulation activity and increased fibrinolytic activity occur during and after laparoscopic cholecystectomy.

Obstructive cholelithiasis and cholecystitis in a keeshond

A 10-year-old, neutered male, keeshond was presented for vomiting, lethargy, icterus, and anorexia. Obstructive cholelithiasis was diagnosed based on analysis of a serum biochemical profile, abdominal radiographs, and ultrasonography. Choleliths were removed from the gall bladder and common bile duct via a cholecystotomy.

Admission serum glucose level: an accurate predictor of outcome in gallstone pancreatitis

OBJECTIVES

Early identification of patients at high risk of complications from acute pancreatitis is important; as yet, no simple and accurate method has been identified. The aim was to evaluate admission serum glucose as a prognostic marker in gallstone pancreatitis.

METHODS

Retrospective review of consecutive admissions with gallstone pancreatitis to a large urban hospital was made. Serum glucose levels, Glasgow scores, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were recorded. Outcomes considered were death, intensive care requirement, local complications, and length of hospital stay.

RESULTS

There was a total of 184 admissions (122 women and 62 men; mean age, 55.4 years). Serum glucose of 8.3 mmol/L or higher was as good as APACHE II score of 8 or above (likelihood ratios [LRs] of 2.51 and 2.84, respectively) in predicting mortality (overall probability, 4.3%). Overall, 9.2% of the patients were admitted to intensive care units, and risk was significantly higher in patients with glucose of 8.3 mmol/L or higher (LR, 3.23; P < 0.001) or APACHE II score of 8 or above (LR, 1.9; P < 0.02). Local complications occurred in 12.0% of the patients, and the risk significantly increased in patients with glucose of 8.3 mmol/L or higher (LR, 2.61; P < 0.001) but not for APACHE II or Glasgow scores. Patients with admission serum glucose of 8.3 mmol/L or higher had a mean length of stay of 17.9 days as compared with 7.1 days for patients with admission serum glucose of less than 8.3 mmol/L (P < 0.001).

CONCLUSIONS

In gallstone pancreatitis, an elevated admission serum glucose level offers more prognostic information than Glasgow and APACHE II scores.

Serum adiponectin levels in cholesterol and pigment cholelithiasis

Background

Altered adiponectin levels are associated with metabolic abnormalities. The aim of this study was to explore the role of adiponectin in cholelithiasis.

Methods

A radioimmunoassay was used to determine serum adiponectin levels in 58 patients with cholesterol gallstones and 47 with pigment gallstones, and 101 healthy controls. The chemical composition of extracted gallstones was determined by Fourier transform infrared spectroscopy.

Results

The mean(s.d.) adiponectin level was decreased in patients with cholesterol gallstones (7·6(4·1) µg/ml; P &lt; 0·001) but raised in patients with pigment gallstones (17·9(9·0) µg/ml; P &lt; 0·001) in comparison with healthy controls (11·7(6·5) µg/ml). Decreased adiponectin levels (odds ratio (OR) 0·85 (95 per cent confidence interval (c.i.) 0·76 to 0·96); P = 0·008) and female sex (OR 6·06 (95 per cent c.i. 2·10 to 17·46); P = 0·001) were associated with cholesterol gallstone formation. Increased adiponectin levels (OR 1·11 (95 per cent c.i. 1·01 to 1·22); P = 0·025) and increased age (OR 1·06 (95 per cent c.i. 1·01 to 1·12); P = 0·029) were associated with pigment gallstone formation. Raised serum aspartate aminotransferase concentration was a risk factor for both cholesterol (OR 1·16 (95 per cent c.i. 1·03 to 1·30); P = 0·013) and pigment (OR 1·23 (95 per cent c.i. 1·10 to 1·38); P &lt; 0·001) gallstones.

Conclusion

Gallstone formation is associated with altered serum adiponectin levels. Serum adiponectin might serve as a novel marker for cholesterol and pigment cholelithiasis.

UGT1A1 polymorphism outweighs the modest effect of deletional (-3.7 kb) alpha-thalassemia on cholelithogenesis in sickle cell anemia

Enhanced erythrocyte destruction in sickle cell anemia results in chronic hyperbilirubinemia. Only a subset of patients develop cholelithiasis. UGT1A1 promoter polymorphism is associated both with unconjugated bilirubin level and elevated risk for cholelithiasis in such subset. Here, we investigated the role of alpha-thalassemia, yet another genetic factor that modulates hemolysis, in conferring protection from cholelithiasis. We show that, although alpha-thalassemia is associated with modest reduction in hemolysis and unconjugated bilirubin level, UGT1A1 polymorphism outweighs its effect on cholethiogenesis in sickle cell anemia patients.

Association between thyroid function and gallstone disease

AIM: To investigate those associations using data of the population-based Study of Health in Pomerania.

METHODS: A study population of 3 749 residents aged 20-79 years without previously diagnosed thyroid disease was available for analyses. Serum TSH was used to assess thyroid function. Cholelithiasis was defined by either a prior history of cholecystectomy or the presence of gallstones on ultrasound. Logistic regression was performed to analyze independent associations between thyroid function and cholelithiasis.

RESULTS: There were 385 persons (10.3%) with low (<0.3 mIU/L), 3 321 persons (88.6%) with normal and 43 persons (1.2%) with high serum TSH levels (>3 mIU/L). The proportion of cholelithiasis among males and females was 14.4% and 25.3%, respectively. Among males, there was an independent relation between high serum TSH and cholelithiasis (OR 3.77; 95%-CI 1.06-13.41; P<0.05). Also among males, there was a tendency towards an elevated risk of cholelithiasis in persons with low serum TSH (OR 1.40; 95%-CI 0.96-2.02; P = 0.07). In the female population, no such relation was identified.

CONCLUSION: There is an association between thyroid and gallstone disease with a gender-specific relation between hypothyroidism and cholelithiasis.

Hyperbilirubinemia and cholelithiasis in Chinese patients with hemoglobin H disease

Hemoglobin H disease (HbH) is a hemoglobinopathy peculiar to parts of the world with high incidence alpha-thalassemia mutations. Among 90 HbH cases, 50 cases suffered from clinically significant jaundice (bilirubin >30 mmol/l), including 14 with severe jaundice (bilirubin >60 mmol/l). Cholelithiasis was found in 38 cases. The incidence is roughly eight times higher than that in background control population but 50% lower than that in beta-thalassemia. The risk of gallstones was related to higher bilirubin levels but not alpha-globin genotype, sex, ferritin, and hemoglobin levels. Homozygotes or double heterozygotes for Gilbert alleles (17.2%), but not heterozgyotes (42.2%), were found to have a significantly increased risk of gallstones and jaundice. However, common Chinese Gilbert syndrome alleles do not completely explain the variable risks.

Clinicopathological study of cholelithiasis following gastric cancer surgery

The purpose of this study was to compare liver function tests preoperatively and postoperatively in 2 cohorts of patients, those that developed gallstones after gastrectomy for cancer and those that did not develop gallstones. The cohorts were taken from 698 consecutive patients who underwent curative gastrectomy for gastric cancer between April 1980 and March 1995. In comparison with 698 patients, the gallstone group was characterized by the findings that the incidence of cholelithiasis was significantly higher in totally-gastrectomized patients and patients with upper stomach cancer. Comparison of the perioperative status revealed a significantly higher rate of complications in the gallstone patients. Analysis of the changes in liver function showed significantly higher values of glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and alkaline phosphatase at time points of 1 and 3 months after surgery in the gallstone patients. The results suggest that the postoperative development of liver dysfunction and complications is associated with the formation of gallstones.

[Biochemical indexes of blood in the cholelithiasis on the background of fatty liver]

There was conducted the analysis of biochemical indexes in 45 patients suffering the cholelithiasis on the background of adipose hepatosis. In majority of them there were noted the lipids metabolism and hepatic function disorders, as well as activation of processes of peroxidal oxidation of lipids.

Serum leptin levels and their response during laparoscopic and open cholecystectomy

We compared serum leptin responses during and after laparoscopic and open cholecystectomy, and assessed their correlation with the responses of inflammatory cytokines. Serum levels of leptin, interleukin-1alpha (IL-1alpha), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were measured by an enzyme-linked immunoassay in 31 patients who underwent laparoscopic cholecystectomy and in 24 patients who underwent open cholecystectomy. Serum samples were obtained preoperatively, at 10 and 30 min after the commencement of surgery, and at 6 and 24 h after the operation. The cumulative responses of leptin, IL-1alpha, IL-6 and TNF-alpha to surgery were calculated and the associations between them were evaluated. Serum leptin levels were significantly increased at 24 h after both procedures. The serum leptin concentration at this time point and the cumulative leptin response were significantly lower after laparoscopic cholecystectomy than after open cholecystectomy. Changes in serum IL-1alpha, TNF-alpha and IL-6 concentrations showed similar kinetics in both groups, with postoperative IL-6 levels being consistently lower in the laparoscopic cholecystectomy group. Cumulative IL-6 and TNF-alpha responses were significantly lower after laparoscopic cholecystectomy than after open cholecystectomy. The cumulative responses of leptin, IL-1alpha and IL-6 correlated significantly with each other. Leptin may be involved in the systemic inflammatory response to surgical injury, and the postoperative leptin elevation and cumulative leptin response are significantly lower after laparoscopic cholecystectomy than after open cholecystectomy.

[Low density lipoproteins in patients with cholelithiasis and cholesterosis of the gallbladder]

AIM

To study heterogenic forms of LDLP and LP(a) in blood serum of patients with cholelithiasis (CL) and gallbladder cholesterosis (GBC).

MATERIAL AND METHODS

Native gradient (3-12%) electrophoresis in polyacrylamide gel, rocket immunoelectrophoresis with antibodies to apo(a) were made in 20 patients with CL and 20 with GBC, 13 controls without gastrointestinal disease. Correlation of retardation factor (Rf) of LDLP and LP(a) with blood lipids, cholesterol (C) and triglycerides (TG) levels, body mass index (BMI) and age was studied. CL and GBC risk factors were analysed basing on a retrospective assessment in random representative samples of patients (100 CL and 100 GBC patients).

RESULTS

There was a shift of the main peak in LDLP spectrum in the direction of smaller particles in GBC (Rf = 0.171 +/- 0.003) which was significant in comparison with CL group (Rf = 0.146 +/- 0.004, p < 0.001) and control (Rf = 0.114 +/- 0.013, p < 0.05). The analysis of LDLP Rf distribution in patients with different C levels has shown that LDLP small particles can occur in a normal C level: 75% in GBC and 50% in CL groups. Prevalence of small dense LDLP was recorded in both groups (87.5% cases) in hypercholesterolemia. Compared to control, LP(a) concentration was significantly elevated both in GBC (23.7 +/- 4.9 mg/dl) and CL (15.7 +/- 4.4 mg/dl) patients (control--7.5 +/- 1.4 mg/dl, p < 0.01), p > 0.5 in comparison between the groups. The correlation analysis found no correlations between LP9(a), other lipids, BMI and age in both study groups while Rf of LDLP correlated with C and TG levels (r = 0.596 and r = 0.226, respectively, p < 0.05), age and BMI (r = 0. 533 and r = 0.363, respectively, p < 0.05) in CL and did not correlate in GBC.

CONCLUSION

A C level in CL changes with age and BMI while in GBC high LDLP C level was caused by other factors. No correlation of LP(a), LDLP Rf with age, body mass and blood lipids indicates that the above factors are independent in development of GBC.

[Insulin resistance in patients with metabolic syndrome and cholelithiasis]

The aim of the study was to determine serum insulin level in patients with metabolic syndrome (MS), pronounced manifestation of cholelithiasis (CL), and abdominal obesity. The measurements were compared with hyperlipidemia and glycemia levels in these patients. The subjects were 55 women with MS, divided into two groups according to 1991 Kh. Kh. Mansurov's classification of CL stages. Insulin level was measured by immune-enzyme assay; carbohydrate and lipid metabolism (lipid levels, lipoprotein and fatty acid spectrums, malonic dialdehyde and catalase levels)--by conventional methods. The study revealed a correlation between high insulin level in patients with hyperglycemia, disorder of tolerance to glucose, and type II diabetes, on the one hand, and lipid peroxidation level and dislipidemia, on the other. The study also found high insulin level at various stages of CL, especially during the period of concrement formation. Insulin is a CL risk factor, i.e. it elevates the risk of nucleation.

[Lipid composition of blood serum and bile in biliary diseases in patients with diabetes mellitus]

AIM

To study content and correlation of lipids in the serum and bile from diabetic patients with biliary diseases (BD).

MATERIAL AND METHODS

Serum and bile lipids were studied biochemically in 125 patients with BD and diabetes mellitus and 87 healthy control subjects aged 20-59 years. Serum lipids were studied biochemically as well as content and correlation of duodenal bile lipids. Correlation was investigated between blood and bile lipids.

RESULTS

Compared to healthy controls, diabetic patients with chronic cholecystitis and cholelithiasis had higher serum total cholesterol, triglycerides (by 28-34% and 63%, respectively) and a 18-22% decrease in HDLP cholesterol. Bile of such patients is oversaturated with cholesterol. Patients with diabetes type 2 had a close direct correlation between levels of total cholesterol, LDLP in the serum and Thomas-Hofmann index.

CONCLUSION

BD patients with diabetes mellitus had high levels of serum lipids and high bile concentrations of cholesterol. Serum and bile lipids concentrations direcly correlate.

A comparison of serum interleukin-6 concentrations in patients treated by cholecystectomy via laparotomy or laparoscopy

BACKGROUND/AIMS

Interleukin-6 (IL-6), a multifunctional cytokine, is expressed by various cells after many stimuli. This cytokine release is related, among other things, to the extent of the surgically-induced trauma. Laparoscopic cholecystectomy (LC) is a so-called "mini-invasive" surgical procedure and, on the basis of this consideration, the aim of the present prospective non-randomized study, is to examine (a) whether the IL-6 is modified and how, in patients after LC compared to patients undergoing open cholecystectomy (OC), (b) whether these findings are indicative of an increased risk to develop infectious complications and whether they are therefore clinically significant.

METHODOLOGY

Circulating IL-6 level was measured using a random access chemiluminescense-immunoassay system in 71 patients before the operation (time 0) and 1, 2, 3, 6, 24 and 48 hours after the beginning of the operation. Thirty-five patients underwent OC and 36 LC.

RESULTS

The increase in the serum IL-6 during LC was found to be significantly smaller than that during OC and resulted in a smaller extent of postoperative elevations for C-reactive protein. We recorded three cases (8.5%) of postoperative infections in the "open" group and IL-6 concentration normalized only 6 days after surgery.

CONCLUSIONS

An increase in the serum IL-6 level during LC is lower in comparison to OC and results in lower postoperative elevation in C-reactive protein. Laparoscopic surgery, associated with a small skin incision and the avoidance of open laparotomy, can thus minimize surgical stress, and provide more favorable postoperative conditions for patients. Indeed excessive and prolonged post-injury elevations are associated with increased morbidity.

Cholelithiasis in Down syndrome

Cholelithiasis in infants, children and adolescents is rare, with a prevalence rate of less than 0.5%. The aim of this study was to determine the association between Down syndrome (DS) and cholelithiasis. We conducted a prospective, controlled study on 51 subjects (age range 11-20 years old) to assess the risk factors of cholelithiasis in children and adolescents with Down syndrome. The subjects recruited in the study consisted of 51 children with Down syndrome and 253 children in the control group. There was no statistical difference in gender and age between the DS and control groups. Gallstone disease was detected in 2 females, aged 17 and 19 years old, respectively. None had cholelithiasis in the control group. The result showed that children with DS had significantly higher prevalence of cholelithiasis (3.92%) compared with controls (0%) (p < 0.01). The overall prevalence of overweight and obesity in DS group was 83%, which was significantly higher than 20% in the control group (p < 0.01). Chromosome anomaly and overweight were two significant risk factors for cholelithiasis. Clinicians should be aware of increased risk of cholelithiasis in children with DS.

Increased prevalence of cholelithiasis in Gaucher disease: association with splenectomy but not with gilbert syndrome

GOALS

The purpose of this study is to ascertain the incidence of gallstones among adult patients with type 1 Gaucher disease and whether the presence of the UDPGT1 polymorphism (Gilbert syndrome), increases the incidence of gallstones.

BACKGROUND

Cholelithiasis was been observed among patients with type I Gaucher disease with variable frequency. Too, studies have addressed the possibility of an association between Gilbert syndrome and formation of bilirubinate gallstones in hereditary spherocytosis wherein, like Gaucher disease, there is hemolysis of blood cell membranes.

METHODS

Medical records of all adult patients with type 1 disease in a referral clinic were reviewed for evidence of gallstones or cholecystectomy. Blood samples were collected for molecular analysis for Gilbert syndrome.

RESULTS

Of 323 adult patients, 82 patients (25.4%), 54 women (65.9%) and 28 men (34.1%), had evidence of gallbladder disease (P < 0.001 relative to normal white controls). There was a statistically significant increase (P < 0.001) for all groups above the ages of 20 years other than for men aged 40 to 49 years. There was a statistically significant association between splenectomy and both cholelithiasis (P = 0.022) and Gilbert syndrome (P = 0.002).

CONCLUSIONS

This study highlights an increase incidence of cholelithiasis but not Gilbert syndrome among patients with Gaucher disease. Storage of glycolipid per se or an immune reaction to storage, may explain these findings.

Changes in the blood coagulation, fibrinolysis, and cytokine profile during laparoscopic and open cholecystectomy

BACKGROUND

It has long been known that a hypercoagulability state develops after surgery. A surge in circulating cytokine levels is also commonly found in the postoperative period. These cytokines have all been shown to be capable of inducing a hypercoagulability state. Recently laparoscopic cholecystectomy (LC) has been introduced, and its advantages over the open procedure seem related to the reduced surgical trauma. LC is associated with a diminished acute-phase response compared with the open procedure. Our present knowledge on the influence of laparoscopic upon coagulation and fibrinolysis is incomplete and based on a few studies.

METHODS

The aim of this prospective, nonrandomized study was to investigate hemostatic system alterations in patients who undergo open and laparoscopic cholecystectomy. In addition we also measured the plasma cytokine profile to explore any relationship between changes in plasma cytokine levels and postoperative coagulation profile. Between September 1999 and April 2002, 71 patients were nonrandomly assigned to open (group 1) or laparoscopic cholecystectomy (group 2). All patients from group 1 were operated by a surgical team different from ours, who prefers the OC procedure. The patients with acute cholecystitis were excluded. Prothrombin fragment 1.2 (F1.2), thrombin-antithrombin (TAT), fibrinogen, soluble fibrin, antithrombin III (AT), protein C, plasminogen, and D-dimer levels were measured at baseline and at 1, 24, 48, and 72 h postoperatively. Serial serum levels of IL-1beta and IL-6 were measured by colorimetric enzyme-linked immunosorbent assay (ELISA).

RESULTS

Plasma levels of F1.2, TAT, fibrinogen, soluble fibrin, and D-dimer increased significantly in group 1. Plasma levels of AT, protein C, and plasminogen decreased in both groups. In the OC group, the serum IL-3 and IL-6 levels began to significantly increased as early as 1 h from the beginning of the operation, revealing a peak at the sixth hour. When IL-6 and IL-1 levels were markedly elevated also, F1.2, fibrinogen, and soluble fibrin levels were increased.

CONCLUSIONS

Only mild hypercoagulability was observed in patients who had undergone laparoscopic cholecystectomy. The cytokine surge was correlated with hypercoagulability. There was in fact a positive correlation between IL-6 level and hypercoagulability. The correlation between cytokine levels and coagulation activation may be related to the type of surgery performed. Further studies are required to investigate these issues.

[Heterogeneity of low-density lipoproteins in cholesterolosis of the gallbladder and cholelithiasis]

The heterogeneity of serum low-density lipoproteins (LDL) was studied in patients with cholelithiasis (CL) and gallbladder cholesterolosis (GBC). Native gradient (3-12%) polyacrylamide gel electrophoresis was used, followed by densitometric scanning and analysis; a correlation analysis of the levels of cholesterol levels, the body-mass index (BMI), and age was made. Various heterogeneity of LDL was revealed in CL and GBC. In the group of patients with GBC, the subfraction spectrum of LDL was characterized by a predominance of minor dense particles of LDL (Rf = 0.171 +/- 0.003), which significantly differed from that in the patients with CL (Rf = 0.146 +/- 0.004) and the controls (Rf = 0.144 +/- 0.013, p < 0.05). The increased levels of total cholesterol were associated with the changes in the subfraction spectrum of LDL with a moderate correlation (r = 0.596 and r = 0.343, respectively). However, a correlation was found between the variability of LDL, BMI, and age (r = 0.533 and r = 0.363, respectively) whereas in GBC it was absent (r = 0.148 and r = 0.117). The findings suggest that the minor dense subfractions of LDL are a risk factor for GBC irrespective of age and body mass. The modified minor particles of LDL more rapidly penetrate than other LDL fractions into the gallbladder tissue, where the gallbladder wall is intensively captured by macrophages, and participate in the formation of foamy cells. In CL, the increase in total cholesterol levels is not followed by so marked changes in the structure of LDL. The much lower proportion of minor dense particles that are components of LDL is a cause of the low entry of apolipoproteins into the gallbladder wall in CL as compared with GBC.

Incidence of gallstones in chronic renal failure patients undergoing hemodialysis: experience of a center in Turkey

OBJECTIVE

In this case-control study, we sought to determine whether the incidence of gallbladder stones (GBS) was increased in chronic renal failure (CRF) patients on a hemodialysis (HD) program. We also evaluated factors, such as lipid profiles and gallbladder motility, that could affect the formation of GBS. In addition, we reviewed other available studies on this subject and compared the factors that might have some influence on the development of GBS.

METHODS

A total of 182 CRF patients (135 male, 47 female, mean age 32.1 yr) undergoing chronic HD and who were referred to our transplantation center in the last 10 yr and 194 healthy controls (137 male, 57 female, mean age 33.3 yr) were included in the study. Abdominal ultrasound was performed on all patients, and ALT, AST, and lipid profiles were determined. In addition, 19 patients with CRF (12 male, 7 female, mean age 33.5 yr) and 22 controls (14 male, 8 female, mean age 33.2 yr) who were age and sex matched were randomly chosen for gallbladder emptying, monitored by ultrasound at 30-min intervals for 2 h after a mixed meal. Fasting volume, minimal residual volume, and ejection fraction of the gallbladder were assessed. For statistical analysis, chi(2), t test, and logistic regression analysis were used.

RESULTS

GBS were detected in seven patients with CRF (3.85%, 5 male, 2 female) and three controls (1.55%, one male, two female) (p > 0.05). The mean follow-up time of CRF patients after diagnosis was 39.3 months (range: 2-168), the mean duration of HD was 21.8 months (range: 1-120). The analysis of seven stones in the CRF group revealed that five were cholesterol-rich stones, and two were mixed (cholesterol and bilirubin) stones. Cholesterol levels were higher in the control group, and triglycerides were higher in the CRF group, but these findings were nonsignificant (p > 0.05). Other biochemical values were not significantly different between the groups. CRF patients with and without GBS were similar in their duration of CRF and HD, age, and other biochemical parameters (p > 0.05). When gallbladder emptying was considered, there was no difference between the two groups in fasting volume, residual volume, and ejection fraction (CRF: 89.7%; controls: 92.3%) of the gallbladders (p > 0.05).

CONCLUSIONS

We detected similar incidences of GBS in CRF patients undergoing HD and healthy controls, and this was comparable to the results of most of the previous studies. Young male CRF patients had a nonsignificantly higher incidence of GBS than control males. Although cholesterol-rich GBS were predominant, we could not find any significant difference between the groups when factors that could affect GBS formation, such as lipid profiles and gallbladder motility, were taken into account.

Routine preoperative laboratory analyses are unnecessary before elective laparoscopic cholecystectomy

BACKGROUND

We formulated a clinical pathway (CP) for elective laparoscopic cholecystectomy (LC), which included the following preoperative evaluation: history and physical (H&P), right upper quadrant ultrasound (US), and liver function tests (LFTs). We hypothesized that routine LFTs did not alter management beyond that dictated by H&P and US, and could be excluded from the CP.

METHODS

The study involved 387 consecutive patients undergoing elective LC. Abnormalities in the preoperative evaluation were compared with the finding of choledocholithiasis or other unexpected outcomes.

RESULTS

In 187 (48%) patients, abnormalities were found by H&P (n = 7), US (n = 13), and LFTs (n = 177). Seven patients (2%) had documented choledocholithiasis; two had abnormal H & P; three had abnormal US; and four had abnormal LFTs. No patient with choledocholithiasis had abnormal LFTs but normal H&P and US.

CONCLUSIONS

Routine LFTs before elective LC are not cost effective. Before LC H&P and US are warranted, but LFTs do not add any useful information and should not be routinely measured.

The biochemical detection of biliary etiology of acute pancreatitis on admission: a revisit in the modern era of biliary imaging

INTRODUCTION

Compared with traditional radiologic methods for the detection of cholelithiasis, early transient hypertransaminasemia had provided a useful prediction of biliary etiology in patients with acute pancreatitis.

AIM

To investigate whether this application remains valid in the modern era of imaging for microlithiasis.

METHODOLOGY

The biochemical detection (LFT) of cholelithiasis was based on an increase in serum alanine transaminase of >or=80 IU/L (normal range, 0-45 IU/L) within 24 hours of admission. We have taken the collective findings of abdominal ultrasound (USS), endoscopic ultrasound (EUS), and postmortem examination to represent the denominator for the diagnosis of cholelithiasis against which comparison with LFT was made.

RESULTS

Of 68 patients with acute pancreatitis who were treated between October 2000 and December 2001, cholelithiasis was the etiological factor in 44 patients (65%). EUS detected microlithiasis in 5 of 10 patients examined. The etiology remained idiopathic in 3 patients (4.4%). The sensitivity, specificity, and positive and negative predictive values for USS were 86%, 100%, 100%, and 80% respectively; for LFT, they were 91%, 100%, 100%, and 86%; and for USS and LFT combined, they were 98%, 100%, 100%, and 96%, respectively.

CONCLUSIONS

In patients with acute pancreatitis, the biochemical analysis within 24 hours of admission provided a simple, rapid, and more accurate prediction of cholelithiasis than USS. The combination of LFT and USS detected or excluded a biliary etiology in almost all patients.

Factors predicting concurrent cholangiocarcinomas associated with hepatolithiasis

BACKGROUND/AIMS

Hepatolithiasis is a risk factor for cholangiocarcinoma. However, it is difficult to detect early cholangiocarcinoma that occurs as a complication of hepatolithiasis. To identify the factors, which can be used for predicting cholangiocarcinomas in patients with hepatolithiasis, we compared the clinical characteristics of patients who had cholangiocarcinoma associated with hepatolithiasis with those of patients with hepatolithiasis only.

METHODOLOGY

Forty patients with cholangiocarcinoma associated with hepatolithiasis (group HC) and 73 patients with hepatolithiasis only (group H) were randomly selected for this study. Mean tumor size was 6.1 +/- 2.4 cm in diameter.

RESULTS

Patients of group HC were older (56.7 +/- 8.9 yr) than those of group H (49.2 +/- 12.9 yr) (p < 0.001). Weight loss was more frequent in group HC (51.5%) than in group H (5.5%) (p < 0.001) and serum alkaline phosphatase levels were higher in group HC (181 +/- 184 IU/L) than in group H (426 +/- 385 IU/L) (p < 0.001). The proportion of the patients who had hepatolithiasis in the right or both lobes of the liver was higher in group HC (72.5%) than in group H (50.6%) (p = 0.024). The optimal cutoff value of serum CEA level for cholangiocarcinoma detection was set at 4.2 ng/mL using ROC cure to give a sensitivity of 67.6% and a specificity of 90.5%. Group HC differed from group H because of its lower rates of both abdominal pain and cholangitis, longer duration of stone history, and lower serum albumin level. Factors that did not predict cholangiocarcinoma included sex ratio, white blood cell count, serum bilirubin level, and hepatic atrophy.

CONCLUSIONS

Cholangiocarcinoma should be suspected in patients with hepatolithiasis, especially when, the patient is over 40 years old, has a long history of hepatolithiasis with weight loss, a higher level of serum alkaline phosphatase, a lower level of serum albumin, a serum carcinoembryonic antigen level exceeding 4.2 ng/mL, and hepatolithiasis that is located either in the right or both lobes of the liver.