Endoscopic papillotomy (sphincterotomy) in the 1990-s]

This review summarizes the past history and presence of endoscopic papillotomy (EPT, sphincterotomy) in the treatment of biliary and pancreatic tract diseases. The indications of the different techniques used, and the comparison of the effectiveness of EPT with that of the traditional surgical treatment is also discussed. Based on the results, EPT is an up-to-date technique with good effectiveness, low risk for patients and widening indication range. EPT in the future, will play a determining role in the effective treatment of biliary and pancreatic tract diseases.     

Erythrocyte fatty acid composition and gallstone disease: results of an epidemiological survey

Within a cross-sectional study on the epidemiology of gallstone disease (GD) and its related factors, relation of GD to habitual dietary fat types has been investigated. Gallbladder status was assessed by ultrasound; fatty acid composition of the habitual diet was estimated by GLC of erythrocyte fatty acids. No differences in erythrocyte fatty acid composition were observed between women without gallstones, women with gallstones (aware and unaware of their condition), and women who had cholecystectomies. Multivariate analysis, including other diet-dependent and gallstone-related variables, showed no significant association between erythrocyte fatty acids and risk for gallstones. However, raised erythrocyte linoleic:saturated ratio was associated with increased risk for gallstones only in women with very low serum triglycerides. This latter finding needs further confirmation and is presently unexplainable. Our results suggest that dietary fatty acids do not play a major role in GD.     

血清视黄醇结合蛋白4在胆固醇结石病中的表达

目的 探讨血清视黄醇结合蛋白4(RBP4)在胆固醇结石病中是否发生异常表达.方法 采用酶联免疫吸附法分别对100例胆固醇结石病患者(胆固醇结石病组)和147例健康人(健康对照组)的血清RBP4水平以及与之相关的临床生化指标进行检测,包括胰岛素水平和肾功能.胆石的化学构成分析由术后病理检查确定.结果 胆固醇结石病组血清RBP4水平显著低于健康对照组[(30.57±13.64) mg/L比(41.52±20.25) mg/L](P＜ 0.01).胆固醇结石病发生与血清RBP4水平有关(优势比为0.93,95％可信区间0.88 ～ 0.96,P=0.004).相关性分析显示血清RBP4水平与总胆固醇(TC)、三酰甘油(TG)、肌酐(Cr)、胰岛素抵抗指数及白蛋白(ALB)水平呈正相关(P＜0.05或＜0.01),而与天冬氨酸氨基转移酶(AST)水平呈负相关(P＜0.01).多变量分析发现低RBP4水平与胆固醇结石病显著相关(优势比为2.97;95％可信区间1.15～ 7.68,P=0.025).将胆固醇结石病组和健康对照组按照血清Cr水平分为≥88.40μmol/L组和＜88.40μmol/L组,两组中胆固醇结石病组血清RBP4水平均显著低于健康对照组(P值分别为0.012和0.045).再将胆固醇结石病组和健康对照组按照肾小球滤过率(GFR)的测定值分为≥90 ml/(min· 1.73 m2)组、60～ 89ml/(min·1.73m2)组和＜60 ml/(min· 1.73 m2)组,发现在健康对照组中,低GFR与血清高RBP4水平有关,而在胆固醇结石病组则未能观察到这种趋势.结论 胆固醇结石病患者血清RBP4水平下降且不依赖肾功能.患者的肝功能和血清RBP4水平之间的关系值得进一步研究.     

重庆地区胆囊结石危险因素的病例对照研究

目的了解重庆地区胆囊结石的危险因素,为防制提供依据.方法住院人群的成组匹配病例对照研究.病例(107例)与对照组在性别、年龄、职业、婚姻及文化程度方面具有可比性.对各因素进行多因素分析.结果患病的危险因素有家族史、性别、口服避孕药、饮食喜油腻、饮酒、腹围;饮用地下水、咖啡、素食习惯、锻炼为胆囊结石的保护因素.结论胆囊结石与遗传、性别、内分泌、饮食、生活习惯及体型有关,环境因素对发病的影响值得深入研究.     

A survey of current surgical treatment of acute gallstone disease in the west of Scotland

BACKGROUND: National guidelines exist for the treatment of acute gallstone pancreatitis, but not for the management of acute cholecystitis (AC). AIMS: To establish the preferred management of uncomplicated AC and adherence to guidelines for the management of mild gallstone pancreatitis in the west of Scotland. METHODS: A postal survey of all 100 consultant general surgeons in the west of Scotland. RESULTS: 67 of 71 responses received were suitable for analysis. For uncomplicated AC, 24 (36%) perform urgent laparoscopic cholecystectomy (LC), 16 (24%) perform same admission LC after clinical improvement. 23 (34%) perform interval LC after discharge. Within this group, 9 surgeons (13%) manage AC conservatively due to insufficient operating time or equipment when on call. In mild gallstone pancreatitis, 33 (49%) perform same admission LC, 13 (19%) perform sphincterotomy, 3 (4.5%) perform one of these depending on the patient and 6 (9.5%) refer to a colleague with an interest in upper gastrointestinal surgery. CONCLUSIONS: The majority of surgeons (over 60%) manage AC with same admission LC. Of those who do not, more than a third report lack of resources as being the reason. The majority of surgeons in the West of Scotland manage mild gallstone pancreatitis in accordance with current guidelines.     

Quality-of-life measures in Taiwanese adults with symptomatic gallstone disease

Purpose  

The objective of this study was to investigate the association of quality-of-life status with baseline laboratory findings among Taiwanese adults having symptomatic gallstone disease.     

Health-related quality of life among patients with gallstone disease: a systematic review and meta-analysis of EQ-5D utility scores

Quality of Life Research - Gallstone disease or cholelithiasis is a chronic illness that usually presents with pain in the abdomen, vomiting and indigestion leading to impaired quality of...     

Symptomatic gallstone disease: an indication for surgery

Three patients, men in the ages of 58, 66 and 56 years, respectively, had experienced 'warning colics' a considerable time before gallstone complications or severe recurrent colic. Ultrasonographically proven gallstones had not led to cholecystectomy. The 58-year-old man died of sepsis due to infected pancreatic necrosis; the other men underwent laparoscopic cholecystectomy, after which they recovered fully. Approximately 10-5% of the adult Dutch population have gallstones, but only 10% will develop symptoms. The annual risk for developing complicated gallstone disease is 1-2% in asymptomatic gallstone carriers. Of patients admitted with complicated gallstone disease, 58% have had prior 'warning colics'. Complicated gallstone disease can be prevented by timely treatment after recognition of warning colics. Cholecystectomy is indicated in patients with intermittent upper-abdominal pain and proven gallstones or sludge.     

Diet as a risk factor for cholesterol gallstone disease

Cholesterol gallstone disease is a common condition in western populations. The etiology is multifactorial with interaction of genetic and environmental factors. Obesity, aging, estrogen treatment, pregnancy and diabetes are consistently associated to a higher risk. A number of dietary factors have been involved in the pathogenesis of cholelithiasis. In this article we summarize several studies that have evaluated the role of diet as a potential risk factor for gallstone formation, including energy intake, cholesterol, fatty acids, fiber, carbohydrates, vitamins and minerals, and alcohol intake. Consumption of simple sugars and saturated fat has been mostly associated to a higher risk, while fiber intake and moderate consumption of alcohol, consistently reduce the risk. The association between cholesterol intake and gallstone disease has been variable in different studies. The effects of other dietary factors are less conclusive; additional studies are therefore necessary to clarify their relevance in the pathogenesis of gallstone disease. Recent discoveries of the role of orphan nuclear receptors in the regulation of fatty acid and hepatic cholesterol metabolism and excretion open new perspectives for a better understanding of the role of dietary constituents on cholesterol gallstone formation. KEY TEACHING POINTS: The etiology of cholesterol gallstone disease is multifactorial with interaction between genome and environment. It has been postulated that dietary constituents are important determinants for the formation of lithogenic bile. Intake of high energy, simple sugar and saturated fat favors gallstone formation. Fiber and moderate consumption of alcohol reduce the risk. The role of orphan nuclear receptors in the regulation of hepatic cholesterol metabolism and excretion open new leads for understanding the role of dietary constituents on cholesterol gallstone formation.     

Healthcare access and burden of care for patients with Lyme disease: a large United States survey

Objective

To evaluate the challenges faced by Lyme disease patients in obtaining adequate healthcare.

Methods

A web-based survey conducted over nine months was analyzed for the study. The survey focused on medical status, access to healthcare, and burden of illness. For inclusion in the study, survey respondents had to reside in the United States, be more than 10 years old, and have clinically diagnosed Lyme disease with chronic symptoms and positive laboratory testing.

Results

Responses from 2424 patients were included in the study. Half of the respondents reported seeing at least seven physicians before the diagnosis of Lyme disease was made. Nearly half had Lyme disease for more than 10 years and traveled over 50 miles to obtain treatment. Most respondents experienced symptoms lasting six months or more despite receiving at least 21 days of antibiotic treatment. A quarter of respondents had been on public support or received disability benefits due to Lyme disease symptoms, and over half had visited an emergency room at least once as a result of these symptoms.

Conclusions

Lyme disease patients frequently endure extensive delays in obtaining an initial diagnosis, have poor access to healthcare and suffer a severe burden of illness.     

Prevalence rates of gallstone disease in Italy

The prevalence of gallstone disease and associated factors in the entire population of subjects aged 15–65 years born and resident in Chianciano Terme (Siena — Tuscany) was examined in the years 1985 and 1986. The investigation included gallbladder ultrasonography, administration of a questionnaire on personal and family history, physical examination and blood chemistry. A total of 1809 subjects (attendance rate 87.7%) participated in the study. Personal history and physical examination showed that Chianciano inhabitants have a low prevalence of obesity (4.3%) and only 4.4% of the female population had more than two pregnancies. Overall prevalence of gallstone disease (cholecystectomy + cholelithiasis) was 5.9% (3.7% for males and 8.4% for females). Age standardized relative risk of gallstone disease for females was 2.25 (95% confidence limits=1.68–2.68). Prevalence of cholelithiasis was 3.5% (2.7% for males and 4.2% for females). Prevalence of gallstone disease increased with increasing age in both sexes, being extremely low in the age interval of 15–29 years (0.25%). The overall gallstones/cholecystectomy ratio was found to be lower (1:1) in females than in males (2.7:1). Although subjects with gallstones reported more frequently biliary colics and nonspecific dyspeptic symptoms, the diagnostic power of all symptoms in identifying cholelithiasis was very poor due to low sensitivity. Only one third of subjects with gallstones was aware of having the disease. Age, obesity and number of pregnancies were positively associated with gallstone disease in univariate analyses. The association with obesity and parity disappeared in multivariate analysis. Blood lipids and glucose were not associated with the disease both in univariate and multivariate analyses. Our data show that the prevalence of gallbladder disease in Chianciano is lower than that previously reported in Italy. This difference could be related to a lower prevalence of obesity and to a smaller number of pregnancies or to the effect of environmental and genetic factors.     

Serum organochlorine pesticide residues and risk of gallstone disease: a case-control study in Xiamen

PurposeTo investigate the association between serum organochlorine pesticide residues and risk of gallstone disease.MethodsA 1:1, pair-matched, case-control study was designed. Data from 150 patients with gallstones diagnosed by abdominal ultrasonography at a single hospital from June 2009 to June 2010 were collected. A total of 150 patients without gallstones during the same period at the same hospital were recruited as the control group. Capillary gas chromatography was employed to measure the serum concentrations of dichlorodiphenyltrichloroethane (DDT) and hexachlorocyclohexane (HCH) residues. Multiple-factor conditional logistic regression analysis was conducted to estimate the relative risk of gallstones in relation to organochlorine pesticide residues in serum.ResultsThe percentages of p,p′-DDD and o,p′-DDT in serum of patients were significantly higher than those in serum of controls. The p,p′-DDE, α-HCH, and δ-HCH residues in serum of patients were also significantly increased compared with those in serum of controls. Multiple-factor conditional logistic regression analysis showed that high levels of p,p′-DDE and p,p′-DDT residues were risk factors for gallstone disease.ConclusionsA high level of organochlorine pesticide residues in serum is a potential risk factor for gallstone disease, which suggests that environmental exposure to organochlorine pesticides should be evaluated with respect to gallstone formation.     

Prevalence of gallstone disease in a general population of Okinawa, Japan

A total of 2,584 healthy residents in the Yaeyama District of Okinawa, Japan, were investigated in 1984 to determine the prevalence of gallstone disease and its associated factors. Diagnosis of gallstone disease was assessed by real-time ultrasonography. For participants over 20 years of age, obesity index and serum levels of total cholesterol and triglycerides were measured. Overall prevalence of gallstone disease was 3.2%. Prevalence increased with age from 0% under 19 years of age to 11.4% over 70 years of age and was higher in females (4.0%) than in males (2.5%). The results of the logistic regression analysis indicated that age and fatty liver were significant predictors of gallstone disease. The results of the automatic interaction detector analysis indicated that age and fatty liver were strong factors associated with gallstone disease and that prevalence was highest in females over age 50 with fatty liver.     

The treatment of gallstone disease in the elderly

Gallstone diseases (asymptomatic, symptomatic and complicated) are frequently seen in the elderly; the prevalence increases proportionally with age. At higher ages (> 60 years) the presentation of symptomatic or complicated gallstone disease is frequently atypical. Complicated gallstone disease (especially cholecystitis and cholangitis) in the elderly is associated with high morbidity and mortality rates. The introduction of laparoscopic cholecystectomy has decreased the morbidity and mortality rates of symptomatic and complicated gallstone disease in the elderly; for elective procedures in particular, the risks hardly differ from those for younger patients. Percutaneous cholecystostomy is an effective and safe alternative for (laparoscopic) cholecystectomy in high-risk patients with an acute cholecystitis. Endoscopic retrograde cholangiopancreaticography (ERCP) with sphincterotomy is also the treatment of choice for common bile duct stones in the elderly. After removal of common bile duct stones (whether or not accompanied by cholangitis or pancreatitis) a laparoscopic cholecystectomy should be performed, unless contraindications are present.     

Pseudomonas spp. complications in patients with HIV disease: An eight-year clinical and microbiological survey

Two hundred and twenty-four episodes of Pseudomonas spp. complications that occurred in 179 consecutive patients with HIV infection were retrospectively reviewed. Pseudomonas spp. organisms were responsible for 11.6% of 1933 episodes of non-mycobacterial bacterial diseases (5.4% of 1072 episodes of sepsis), observed over an 8-year period; 20.7% of patients experienced disease relapses (45 episodes). These complications mostly involved lower airways (66 cases), urinary tract (53 episodes), and blood (34 cases), with Pseudomonas aeruginosa isolated in 161 episodes, and other Pseudomonas spp. in the remaining 63 cases. An advanced HIV disease was frequently present (as expressed by a prior diagnosis of AIDS, a low CD4+ lymphocyte count, and leukopenia–neutropenia). Indwelling intravascular and urinary catheters were often associated with bacteremia and urinary tract involvement, respectively. More than 60% of patients were given antibiotics and/or cotrimoxazole in the month preceding the onset of Pseudomonas spp. disease. Bacterial strains isolated from our HIV-infected patients showed a favorable sensitivity to piperacillin, ceftazidime, imipenem, amikacin, tobramycin, and ciprofloxacin. An adequate antimicrobial treatment led to clinical and microbiological cure in 73.2% of patients at the first episode, and in 22.3% more subjects after one or more relapses. A lethal outcome occurred in only eight patients of 179 (4.5%), suffering from a far advanced HIV disease; P. aeruginosa infection directly contributed to death in four cases (sepsis, and/or pneumonia). Nosocomial disease occurred in 46.4% of the 224 episodes, and was significantly related to a previous diagnosis of AIDS, concurrent neutropenia, the occurrence of sepsis or urinary tract infection, disease relapses, the involvement of non-aeruginosa Pseudomonas spp., and a lethal outcome, compared with community-acquired infection. Our experience (the largest reported to date) confirms that Pseudomonas spp. (including non-aeruginosa Pseudomonas spp. organisms) is responsible for remarkable morbidity and mortality among patients with HIV infection, and may pose relevant problems to clinicians and microbiologists involved in the care of HIV-infected patients.