Gallbladder Fasting Volume Is Reduced and Gallbladder Postprandial Emptying Is Enhanced by Intravenous Erythromycin

It has been recently shown that erythromycin, amacrolide antibiotic, exhibits prokinetic properties, byenhancing gastric emptying in health and disease and byinducing gallbladder contraction. The aim of the study was to further investigate theeffect of intravenous erythromycin on gallbladdermotility during fasting and postprandial states. In 10healthy male subjects gallbladder emptying was assessed by ultrasonography on three differentoccasions, each in a random sequence, as follows: (1)after giving 300 ml of fresh milk and infusing normalsaline as placebo (postprandial emptying), (2) afterinfusing 200 mg of erythromycin during the fastingstate, and (3) after infusing 200 mg of erythromycinalong with ingestion of 300 ml of fresh milk. Infusionof erythromycin and placebo lasted 10 min. From the emptying curves, the duration of the lag phaseof emptying, the ejection fraction of emptying, and thetime by which maximal emptying was achieved werecalculated. Infusion of erythromycin induced animmediate contraction [lag phase (±SD): 1.3± 2.6 SD min] of the gallbladder by 42.1 ±22% of its initial volume. Infusion of erythromycinduring the postprandial state significantly decreasedthe duration of the lag phase (1.3 ± 3.5 min after erythromycinplus test meal versus 3.6 ± 4.2 min after testmeal only, P < 0.04) and significantly increased theejection fraction (78 ± 8.5% after erythromycinplus test meal versus 60.6 ± 8.5% after test meal only, P <0.0008). It is concluded that intravenously givenerythromycin induces contraction of the gallbladderduring the fasting state and enhances postprandialgallbladder emptying by accelerating the initiation and increasingthe extent of emptying.     

Gallbladder complications after bariatric surgery

With the increased incidence of obesity in the developed countries, and the failure of medical treatments, bariatric surgery has increased rapidly. Although laparoscopic gastroplasty is the most popular bariatric intervention in France, the gold standard tends to be the laparoscopic gastric bypass. The severe weight loss caused by this type of procedure induces specific middle or long term complications such as biliary lithiasis. In this literature we describe different physiopathological mechanisms of lithiasis after gastric bypass by coeliosurgery or gastroplasty, their diagnosis, and preventive treatment to avoid these complications.     

Gallbladder Volume Variations after Meal Ingestion

Objective: To assess gallbladder (GB) volume variations in response to a standard meal. Methods : We assessed these variations with ultrasonography at brief intervals over the postprandial period, which included the emptying and refilling phases of the GB. Results: During both emptying and refilling of the GB, the volume fluctuated continuously, with brief alternating volume decrements and increments. The phases of emptying and refilling appear to be the net result of the algebraic sum of these volume fluctuations. In the emptying phase, the volume decrements showed a greater volume (35.7 ± 10.7 ml vs. 14.8 ± 8.4 ml) and lasted longer (158 ± 37 min vs. 85 ± 44 min) than the volume increments, whereas the opposite took place in the refilling phase (4.3 ± 3.4 ml vs. 16.4 ± 12.2 ml; 39 ± 20 min vs. 84 ± 37 min). Conclusion: It is probable that the continuous GB volume fluctuations are the expression of hepatic bile recycling in the GB during the entire postprandial period, and the amount of bile recycled by the GB is greater during the emptying than the refilling phase.     

Gallbladder motility before and after extracorporeal shock-wave lithotripsy

To determine whether extracorporeal shock-wave lithotripsy of gallbladder stones alters gallbladder motility, gallbladder contraction in response to intravenous cholecystokinin was investigated by ultrasound. Twenty-one patients with symptomatic gallstones were studied before and after shock-wave lithotripsy, 12 with and 9 without concomitant litholytic therapy (combination of ursodeoxycholic acid and chenodeoxycholic acid). Gallbladder emptying was significantly delayed and less complete in both groups of patients before shock-wave treatment (with bile salts: residual volume, 51% +/- 10% and half-ejection time, 40 +/- 5 min; without bile salts: residual volume, 46% +/- 7%; half-ejection time, 30 +/- 4 min) compared with healthy controls (residual volume, 15% +/- 4%; half-ejection time, 18 +/- 2 min). Gallbladder motility was not altered in either group 1 day and 1 yr after lithotripsy. The findings indicate (a) that extracorporeal shock-wave lithotripsy has no immediate or long-term adverse effects on gallbladder motility and (b) that the defect of gallbladder motility associated with gallstone disease is not abolished by removal of the stone.     

Exaggerated Acetaldehyde Response after Ethanol Administration during Pregnancy and Lactation in Rats

The exaggerated blood acetaldehyde response that has been reported after ethanol administration to pregnant rats was found to be the beginning of a much larger alteration occurring during lactation. Indeed, at the end of pregnancy, we confirmed a 4-fold increase in the acetaldehyde values above nonpregnant values after an intragastric dose of 3 g/kg ethanol. During gestational days 1 to 17, the levels did not differ. After delivery, the exaggerated acetaldehyde response to ethanol was increased, producing acetaldehyde concentrations 15-fold greater than in nonlactating controls. This response returned to nonpregnant levels with weaning and could be abolished by removing the pups at birth. The intensified response was associated with both an enhanced rate of ethanol oxidation and a decreased low Km aldehyde dehydrogenase activity in liver mitochondria. At the end of pregnancy, measurable concentrations of acetaldehyde were found in umbilical venous blood and fetal blood. However, they amounted to only one-quarter of maternal values whereas ethanol levels were similar. Thus, during late pregnancy and lactation, there is a marked increase in maternal blood acetaldehyde after ethanol intake. In the presence of a normal placenta, however, an acetaldehyde concentration gradient exists between the mother and the fetus.     

Cardioversion during Pregnancy

ABSTRACT. A case of atrial fibrillation during pregnancy in a 20-year-old patient with valvular heart disease is presented. Synchronized direct-current Cardioversion was carried out successfully during monitoring of maternal and fetal ECG. Previously published cases are reviewed.     

Thiocyanate and Drinking during Pregnancy

Alcohol appears to have a relatively direct effect in decreasing fetal growth; however, it also appears that other factors associated with alcohol consumption may also contribute to lowered birthweight. Three studies have suggested that beverage source of alcohol may be a determinant of decreased intrauterine growth and that beer may have a comparatively greater effect than wine and liquor. Since beer is reported to contain thiocyanate (SCN), a substance which has been implicated as a determinant of fetal growth retardation in relation to cigarette smoking, we studied maternal and fetal serum SCN levels in 82 pregnancies. After controlling for maternal characteristics, gestational age, and tobacco and marijuana use, the quantity of beer consumed was found to have a significant positive correlation with fetal serum SCN (p < 0.005). Consumption of other types of alcoholic beverages was not significantly associated with elevated fetal serum SCN, although the numbers of wine and liquor drinkers in this study were limited. Further research is warranted to explore the possibility that the correlation of beer consumption with increased SCN might provide at least one explanation for the reported linkage of diminished fetal growth and beer drinking .     

Gallbladder and Duodenal Bacterial Flora after Papillotomy in Rabbits

Gallbladder and duodenal bacteria were studied in New Zealand white rabbits 1 and 4 weeks after papillotomy. The gallbladder bile was sterile in all animals before papillotomy. One and 4 weeks after papillotomy growth of both aerobic and anaerobic bacteria was found in the gallbladder bile in five of eight test animals and in none of the control rabbits. The number of bacteria in the duodenum increased in rabbits that developed growth of bacteria in the gallbladder bile after papillotomy. In the test rabbits that did not develop bacteria in the gallbladder bile and in the control group no changes in duodenal bacteria were observed.     

Gallbladder Motility and Cholecystokinin Secretion during Continuous Enteral Nutrition

Objectives: During total parenteral nutrition, gallbladder motility is impaired, resulting in sludge and stone formation. Little is known about gallbladder motility during prolonged enteral nutrition. Methods : We studied gallbladder motility during continuous enteral nutrition (CEN) in nine hospitalized patients with active inflammatory bowel disease. The patients received a polymeric diet (2000 kcal/24 h) by CEN through a nasogastric tube for a prolonged period. Gallbladder volumes were obtained daily by ultrasonography, starting from day 0 (before CEN) and on 7 consecutive days during CEN. At days 0, 1, 4, and 7, the gallbladder response to i.v. cholecystokinin (CCK-33; 0.5 Ivy Dog unit/kg/h) was studied. Plasma CCK levels were determined at regular intervals by radioimmunoassay. Results : No significant differences were observed on day 0 between patients and a group of nine healthy control subjects in fasting gallbladder volumes (19.4 ± 2.3 and 19.6 ± 2.4 cm³ respectively) and gallbladder contraction during CCK infusion (56 ± 14% and 69 ± 7%, respectively). During CEN, from day 1 to day 7, mean gallbladder volume remained significantly ( p < 0.05) reduced compared with fasting gallbladder volume, and mean plasma CCK levels remained significantly ( p < 0.05) increased compared with fasting levels. Although gallbladder volume was significantly reduced during CEN, the gallbladder contractile response to CCK was not affected; at days 1, 4, and 7, gallbladder contraction was 36–57%. Conclusions : During CEN, 1) gallbladder volume is significantly reduced and plasma CCK levels are significantly increased, 2) these effects are sustained over time (7 days), and 3) the gallbladder remains responsive to exogenous CCK. These results indicate that gallbladder contractility and gallbladder responsiveness to CCK are preserved during prolonged CEN in patients with inflammatory bowel disease.     

Pregnancy after liver transplantation

Although the transplant community has begun to gather experience in pregnancy after liver transplant, much remains to be learned about the effects of pregnancy on mother and child. Most women with end stage liver disease have amenorrhea or are unable to conceive due to medical complications. Liver transplantation offers such patients the opportunity to have children. Since libido and fertility can return fairly rapidly, it is important to discuss birth control in the early post transplant period. It is recommended that pregnancy be delayed for 1 and preferably 2 years post-transplant as pregnancies within the first year are associated with higher rates of premature birth and cellular rejection. The current evidence suggests that pregnancy is safe after transplant, however it requires close follow-up by a team of experienced physicians.     

Pregnancy after Heart Transplantation

As post-transplant survival improves, many heart transplant (HT) recipients are of, or are surviving to, childbearing age. Solid-organ transplant recipients who become pregnant should be managed by a multidisciplinary cardio-obstetrics team, including specialists in maternal and fetal medicine, cardiology and transplant medicine, as well as anesthesia, neonatology, psychology, genetics, and social services. With careful patient selection, pregnancy after HT can been managed safely. The purpose of this comprehensive review was to summarize the current evidence and recommendations surrounding preconception counseling, medical management and surveillance, maternal outcomes, breastfeeding, and remaining gaps in knowledge.     

Impaired Contractile Motility of the Gallbladder after Gastrectomy

Contractile motility of the gallbladder was compared using a real-time ultrasonography in 13 patients with gastric ulcer and 31 patients with gastric cancer who had undergone either subtotal or total gastrectomy within 1 month previously. Contractile motility of the gallbladder after oral administration of dried egg yolk (Daiyan, Maruishi, Osaka), which was slightly but not significantly reduced in patients with gastric ulcer, was remarkedly impaired in patients with gastric cancer who had either subtotal or total gastrectomy including radical lymph node dissection. Especially, maximum contractile rate after Daiyan in Billroth II patients was significantly reduced than that of Billroth I patients. Intramuscular injection of naloxone (0.4 mg), which had no effects on contractions after Daiyan in healthy subjects, significantly improved the hypomotility in response to Daiyan in these gastric cancer patients. It was suggested, therefore, that the possible roles of various anatomical and mechanical changes resulting from gastrectomy including vagotomy and sympathectomy, and in particular exclusion of duodenum from digestive circuits and relative or absolute excess of endogenous opioids, were involved in the control of the gallbladder motility within 1 month after gastrectomy including lymphadenectomy.     

Diagnosing Rhinitis during Pregnancy

Chronic rhinitis is a common medical condition to affect pregnant women. Uncontrolled rhinitis during pregnancy may have a significant adverse effect on quality of life and may have an effect on coexisting asthma. This article reviews the most common causes of rhinitis to occur during pregnancy as well as treatment options for pregnant women.     

Pregnancy after lupus nephritis

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects primarily women, commonly in their reproductive years but does not influence fertility. For these reasons, the clinician has often to face the many problems of pregnancy in patients with SLE including the influence of SLE on fetal outcome and that of pregnancy on SLE. As there is increasing evidence of an important role of sex hormones in immunity, the influence of pregnancy on SLE is probably due to the changes in sex hormone levels during pregnancy that are more important than in any other period of life. Early reports emphasized a high fetal and maternal risk in particular in patients with lupus nephritis. However in the same period the prognosis of lupus nephritis was poor, so it was difficult to know whether pregnancy actually influenced the prognosis of the disease. More recent prospective studies indicate that pregnancy is safe for the majority of mothers if it is planned when SLE is quiescent. Instead, although fetal risk has been progressively reduced in the last 40 years, it continues to be higher than that occurring in pregnancies of healthy women. In particular the presence of antiphospholipid antibodies considerably worsen the fetal outcome.     

Pregnancy after kidney transplantation

In the period 1966-1997 renal allografting was performed in 1746 recipients, 244 of whom were women in fertile age. In 32 of them 45 pregnancies were registered. 29 of them (64%) resulted in abortion, which was spontaneous in 4 and medically advised in 25. There were 16 labours, 4 of them free of any complications; of the latter, hypertension was the most frequent one (8). Of the former, 13 were solved by caesarean section and 3 were vaginal deliveries. Of 15 live babies 7 were immature (one died 1.5 year later of renal failure due to microcystic kidneys). No unfavourable effect of pregnancy on prognosis and on long-term graft function was found.     

Pregnancy after jejuno-ileal bypass

The clinical details of two patients who have conceived after jejuno-ileal bypass for gross refractory obesity are presented. One was a twin pregnancy which yielded a stillborn and a normal baby. The other yielded a normal baby. The management of pregnancy in patients with small bowel bypass is discussed.