THE CHOLESTEROL FUNCTION OF THE GALL BLADDER

Cholesterol determinations of gall bladder and hepatic bile obtained from the same source reveal a greater concentration in the former even after the inspissating effect of the gall bladder is allowed for. This evidence together with that from other experiments indicates that the gall bladder has the power to excrete cholesterol into its lumen. There is evidence also that infection may accelerate this excretion. An hypothesis is presented to explain the precipitation of cholesterol in the bile, and the bearing of these findings on the pathogenesis of cholesterol stones is briefly discussed.     

THE CONCENTRATING ACTIVITY OF THE GALL BLADDER

The bile coming at one time from different portions of the liver of the dog has nearly the same amount of pigment per cubic centimeter. With this determined we have studied the power of the gall bladder to concentrate bile directed to it, using as criterion the pigment strength of a sample collected throughout the period of experiment from a duct branch. The extent and rapidity of the concentration are alike remarkable. A gall bladder emptied at the beginning of one experiment and left to fill from the liver, concentrated the 49.8 cc. of bile reaching it in 22½ hours to 4.6 cc., that is to say reduced its bulk 10.8 times; while another bladder left distended with a bile of known constitution and receiving in addition fresh increments from the liver concentrated the secretion 8.9 times in 22 hours. A series of five emptied bladders concentrated the bile coming to them in about 24 hours on the average 7.1 times, or a little more than the 6.4 times of seven organs left full. The conditions in both cases were relatively unfavorable to the withdrawal of fluid from the bile because this takes place by osmosis and diffusion, with the ultimate Δ always that of the blood, and the secretion in our animals was notably rich in solids as an indirect result of the operation. The rapidity with which fluid is withdrawn through the wall of the bladder may be judged from some experiments in which a bag was connected with the tip of the organ by a large cannula. Merely in its passage through the bladder the bile was concentrated 2.3 to 4.8 times. The finding indicates a potential source of error in observations upon samples of bile obtained from fistulous channels of which the bladder forms a part. The bile ducts do not withdraw fluid from the secretion they convey but tend to dilute it, as we shall show in a companion paper. The restriction of the concentrating activity to the receptaculum chyli is good evidence that the latter has special significance for the organism. The nature of this significance is briefly discussed.     

STUDIES ON GALL BLADDER FUNCTION : VIII. THE FATE OF BILE PIGMENT AND CHOLESTEROL IN HEPATIC BILE SUBJECTED TO GALL BLADDER ACTIVITY

1. When the soluble specific substance of Type II pneumococcus was fed to rats, little or no increased resistance to the organism was obtained. 2. When the specific substance of Type III pneumococcus was fed, an increased resistance to the virulent organism resulted. The percentage of animals protected is smaller than when the whole or the dissolved cell is fed. 3. When the specific polysaccharide of Type I was fed, no immunity against Type II or III was obtained, and the ingestion of the specific substances of Types II and III did not protect rats against the Type I organism.     

FUNCTION OF THE GALL BLADDER EPITHELIUM AS AN OSTEOGENIC STIMULUS AND THE PHYSIOLOGICAL DIFFERENTIATION OF CONNECTIVE TISSUE

Evidence is presented that the proliferating gall bladder epithelium in the dog and guinea pig is capable of stimulating bone formation in certain connective tissues such as the abdominal wall. Other connective tissue areas such as the subepithelial connective tissue of the gall bladder and urinary bladder do not share in this tissue reaction and resist the bone stimulus of the epithelium. The formation of bone in these circumstances is thus biphasic. A difference between connective tissues morphologically identical can be proven physiologically, by their response to the osteogenic stimulus of appropriate epithelia. Calcium carbonate microliths occurred in the mucus of the occluded gall bladder in which there was transplanted connective tissue forming part of the wall.     

OBSERVATIONS ON EXPERIMENTAL TYPHOID INFECTION OF THE GALL BLADDER IN THE RABBIT

1. Besredka''s living sensitized vaccine, given intravenously, does not produce a typhoid lesion of the gall bladder in the rabbit. 2. The first transplant of this vaccine is capable of producing this lesion. Hence this vaccine is not entirely safe to handle. 3. Regular infections of the gall bladder have not been produced by carrying a known pathogenic strain on rabbit blood agar, by successive passage through animals, or by the use of freshly isolated strains. 4. No evidence could be demonstrated in the rabbit of the immunity produced in man by vaccination with a whole killed vaccine. 5. Vaccine treatment did not cure the gall bladder lesion. 6. With the present methods of producing infections in the chimpanzee and the rabbit, neither of these animals is suitable for deciding the problems of the immunization of man by vaccines. These problems must be settled, as some of them already have been settled, by actual experience with large numbers of men kept under close observation.     

ON THE EXPULSION OF BILE BY THE GALL BLADDER; AND A RECIPROCAL RELATIONSHIP WITH THE SPHINCTER ACTIVITY

Four unrelated strains of mice were tested over a period of 1 year for their seasonal variation in susceptibility to per os feeding with a culture of Bacillus pestis caviæ of known virulence. Certain consistent fluctuations, determined to be in general agreement with those already recorded in a previous paper, were found and described.     

OBSERVATIONS ON SOME CAUSES OF GALL STONE FORMATION : I. EXPERIMENTAL CHOLELITHIASIS IN THE ABSENCE OF STASIS,INFECTION, AND GALL BLADDER INFLUENCES.

Gall stones frequently form in dogs intubated for the collection of bile under sterile conditions, in the absence of stasis and of gall bladder influence. The stones consist almost entirely of two substances—calcium carbonate and calcium bilirubinate—and they are remarkably uniform in character, as would follow from the limiting conditions of their development. They are not the result of bile loss, for similar ones may be recovered from the wall of glass tubes interpolated in ducts with intestinal connection undisturbed. The study of them has brought out evidence on the general problem of cholelithiasis. Some factors in their causation and that of gall stones as a class will be considered in succeeding papers.     

EFFECT OF STRESS ON THE GASTRIC EMPTYING OF CAPSULES

During a series of experiments on the gastric emptying of capsules, certain subjects were exposed to stress in the form of high noise levels. In the non-fasting condition, these subjects showed a significantly faster gastric emptying than those who were not exposed to the stress.     

THE REACTION OF HUMAN BILE AND ITS RELATION TO GALL STONE FORMATION

1. The human gall bladder acidifies the bile. In this respect its action is similar to that of the gall bladders of lower animals, previously described by other workers. 2. The hydrogen ion concentration of gall bladder bile is increased considerably in cases of obstruction of the common or cystic ducts. The highest values were found following complete obstruction. 3. The occurrence of gall stones was not associated with a consistent change in the hydrogen ion concentration of the gall bladder bile.     

经尿道膀胱颈电切术治疗女性膀胱颈梗阻

目的：提高女性膀胱颈梗阻的诊断和治疗水平。方法：对21例女性膀胱颈梗阻患者进行尿流动力学和膀胱镜检查，全部患者均行经尿道膀胱颈电切术。结果：所有患者术后随访1～24个月，疗效满意，其最大尿流率（Qmax），残余尿量均有显著改善（P〈0．01），无尿失禁及尿瘘发生。结论：尿流动力学和膀胱镜检查是诊断该病的可靠方法，经尿道膀胱颈电切术是治疗女性膀胱颈梗阻的最佳治疗方法。     

膀胱移行细胞癌组织APE1与VEGF表达及意义

目的探讨膀胱移行细胞癌组织中脱嘌呤脱嘧啶核酸内切酶-1（APE1）与血管内皮生长因子（VEGF）的表达及其临床意义。方法应用免疫组织化学方法检测55例膀胱移行细胞癌和15例正常膀胱黏膜中APE1及VEGF的表达。结果55例膀胱移行细胞癌组织中均有APE1蛋白表达,正常膀胱黏膜有8例表达（53.3%）,二者比较差异有显著性（χ^2=28.52,P〈0.01）。膀胱移行细胞癌APE1蛋白细胞浆与细胞核共表达27例（49.1%）,正常膀胱黏膜0例,二者比较差异有显著性（χ^2=11.99,P〈0.01）。VEGF在正常膀胱黏膜和膀胱移行细胞癌表达的阳性率分别为0和67.3%,差异有显著性（χ^2=21.41,P〈0.01）。随病理分级及临床分期的增加,膀胱移行细胞癌中APE1蛋白细胞浆和细胞核共表达的比例有增加趋势,差异有显著性（χ^2=7.73～11.25,P〈0.01）;APE1在细胞浆中的表达与VEGF表达呈显著正相关（r=0.458,P〈0.01）。结论APE1和VEGF可能在膀胱移行细胞癌发生发展中发挥重要的作用。     

腹腔镜在闭合性腹膜内膀胱破裂中的应用

目的探讨腹腔镜诊断与治疗腹膜内膀胱破裂的临床价值。方法回顾分析我院2005年3月-2007年4月收治的10例腹腔镜诊治腹膜内膀胱破裂病人的临床资料。结果10例均在腹腔镜下明确诊断,并行镜下治疗,无1例发生并发症,均治愈出院。结论腹腔镜治疗腹膜内膀胱破裂具有创伤小、安全可靠、诊断率高等优点。     

硅凝胶辐照灭菌后遗传毒性及适应性试验

目的研究硅凝胶充填乳房植入物辐照灭菌后遗传毒性和适应性,探索辐照灭菌在高分子生物材料灭菌中的应用。方法按照ISO11737和ISO10993标准规定,采用活菌计数方法和遗传毒性试验,对硅凝胶充填乳房植入物初始污染菌量、辐照后产品遗传毒性等进行测定。结果不同批次细菌数平均范围为165~215 cfu/件,真菌数平均范围为24~41 cfu/件;3个批次不同次检出初始染菌数,细菌数平均范围13~512 cfu/件,真菌数平均范围为3~76 cfu/件。硅凝胶产品经辐照灭菌处理,不引起细胞及其内部结构改变,无致突变和致畸变作用,无遗传毒性。经辐照灭菌处理后的硅凝胶包装不能穿透细菌和真菌,亦不能穿透人工污染的粘质沙雷菌,辐照灭菌包装材料可以阻菌。经验证剂量辐照后,抽检100件产品均达到无菌,经过计算查表得出硅凝胶产品灭菌剂量为23.1 kGy。结论硅凝胶充填乳房植入物经辐照灭菌处理不会产生遗传毒性,对其包装材料性质无影响,通过灭菌剂量验证。