Current management of concomitant cholelithiasis and common bile duct stones

The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one-or two-stage procedure.It basically includes either laparoscopic cholecystectomy(LC)with laparoscopic common bile duct(CBD)exploration(LCBDE)in the same operation or LC with preoperative,postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy(ERCP-ES)for stone clearance.The most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC,preferably on the next day.In cases where preoperative ERCP-ES is not feasible,the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been advocated.The intraoperative extraction of CBD stones is superior to postoperative rendezvous ERCP-ES.However,there is no consensus on the superiority of laparoendoscopic rendezvous.This is equivalent to a traditional two-stage procedure.Endoscopic papillary large balloon dilation reduces recurrence.LCBDE and intraoperative ERCP have similar good outcomes.The risk of recurrence after ERCP-ES is greater than that after LCBDE.Laparoscopic ultrasonography may delineate the anatomy and detect CBD stones.The majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage,but the transcystic approach must be used where possible.LCBDE is a safe and effective choice when performed by an experienced surgeon.However,the requirement of specific equipment and advanced training are drawbacks.The percutaneous approach is an alternative when ERCP fails.Surgical or endoscopic reintervention for retained stones may be needed.For asymptomatic CBD stones,ERCP clearance is the firstchoice method.Both one-stage and two-stage management are acceptable and can ensure improved quality of life.

Improvement of inflammatory response and gastrointestinal function in perioperative of cholelithiasis by Modified Xiao-Cheng-Qi decoction

BACKGROUND In the perioperative period of biliary surgery,various factors can induce the release of a large number of inflammatory factors,leading to an imbalance in proinflammatory and anti-inflammatory responses and resulting in gastrointestinal(GI)dysfunction.Enhanced Recovery After Surgery protocols in biliary surgery have been shown to reduce the stress response and accelerate postoperative recovery.It is crucial to reduce the inflammatory response and promote the recovery of GI function after biliary surgery,both of which are the basis and key for perioperative care and postoperative recovery.AIM To better understand the effects of Modified Xiao-Cheng-Qi decoction(MXD)on inflammatory response and GI function in the perioperative management of cholelithiasis and their correlation.METHODS This was a prospective randomized placebo-controlled trial,in which 162 patients who received biliary tract surgery were randomly assigned to three groups:MXD group,XD group,and placebo-control group.The observed parameters included frequency of bowel sounds,time of first flatus and defecation,time of diet,and amount of activity after surgery.The serum levels of C-reactive protein(CRP),interleukin(IL)-6,IL-10,serum amyloid A protein(SAA),and substance P were measured by the enzyme-linked immunosorbent assay.Then,the spearman correlation coefficient was used to analyze the relationship between the indicators of GI function and inflammation.RESULTS Compared to the placebo-control,improvements in GI function were observed in the MXD groups including reduced incidence of nausea,vomiting,and bloating;and earlier first exhaust time,first defecation time,and feeding time after surgery(P<0.05).On the 1st and 2nd d after surgery,IL-6,CRP and SAA levels in MXD group were lower than that in placebo control,but substance P level was higher,compared to the control(P<0.05).Functional diarrhea occurred in both MXD and XD groups without any other adverse effects,toxic reactions,and allergic reactions.Diarrhea was relieved after the discontinuation of the investigational remedies.Bowel sounds at 12 h after surgery,the occurring time of the first flatus,first defecation,postoperative liquid diet and semiliquid diet were significantly correlated with levels of IL-6,CRP,SAA and substance P on second day after surgery(P<0.05).CONCLUSION Treatment with MXD can relieve inflammatory response and improve GI function after surgery.Moreover,there are significant correlations between them.Furthermore,it does not cause serious adverse reactions.

Research Progress of Ethnic Medicine in the Treatment of Cholelithiasis

In a broad sense, ethnic medicine includes Han traditional Chinese medicine, folk medicine and ethnic minority medicine;ethnic medicine in a narrow sense refers to ethnic minority medicine. It is a medicine developed by ethnic minorities in order to survive and reproduce and in the process of fighting diseases. Culture, based on its own language, life experience and cultural traditions, has its own understanding and theoretical system of disease naming, etiology and pathogenesis, treatment principles and treatment methods, which is a major feature of my country’s medical care. Among them, ethnic medicine has unique advantages and good clinical efficacy in the prevention and treatment of cholelithiasis. Therefore, this paper focuses on summarizing the characteristic theories and diagnosis and treatment experience of Tibetan medicine, Mongolian medicine, Miao medicine, Yao medicine, and Beijing medicine in ethnic medicine by sorting out and summarizing the relevant materials in this regard, so as to provide new ideas for improving the treatment of cholelithiasis and enriching clinical drug selection.

Laparoscopic Surgery and Modified Xiaoyan Lidan Decoction:An Effective Combination for Treating Cholecystitis with Cholelithiasis

Objective:To assess the clinical effects of combining laparoscopic surgery with Modified Xiaoyan Lidan Decoction in patients diagnosed with cholecystitis and cholelithiasis.Methods:Following the guidelines of the double-blind method,86 cases of cholecystitis with cholelithiasis were randomly divided into two groups,each comprising 43 cases.Both groups underwent laparoscopic surgery,with the observation group additionally receiving Modified Xiaoyan Lidan Decoction.A comparative analysis was conducted on clinical treatment effectiveness,general observation indicators,Traditional Chinese Medicine(TCM)syndrome scores,and the occurrence of adverse reactions between the two groups.Results:The observation group demonstrated a significantly higher overall clinical treatment effectiveness compared to the control group(P<0.05).The clinical symptom improvement time and hospitalization time were shorter in the observation group,and the pain score and TCM syndrome score after treatment were lower than those in the control group(P<0.05).No statistically significant difference was observed in the total reaction values(P>0.05).Conclusion:The combined application of laparoscopic surgery and Modified Xiaoyan Lidan Decoction can enhance clinical treatment efficiency for patients with cholecystitis and cholelithiasis.It facilitates a quicker improvement in clinical symptoms without causing serious adverse reactions,suggesting its potential for widespread adoption.

Low phospholipid-associated cholelithiasis syndrome:A rare cause of acute pancreatitis that should not be neglected

BACKGROUND Low phospholipid-associated cholelithiasis(LPAC)syndrome is a very particular form of biliary lithiasis with no excess of cholesterol secretion into bile,but a decrease in phosphatidylcholine secretion,which is responsible for stones forming not only in the gallbladder,but also in the liver.LPAC syndrome may be underreported due to a lack of testing resulting from insufficient awareness among clinicians.AIM To describe the clinical and radiological characteristics of patients with LPAC syndrome to better identify and diagnose the disease.METHODS We prospectively evaluated all patients aged over 18 years old who were consulted or hospitalized in two hospitals in Paris,France(Bichat University Hospital and Croix-Saint-Simon Hospital)between January 1,2017 and August 31,2018.All patients whose profiles led to a clinical suspicion of LPAC syndrome underwent a liver ultrasound examination performed by an experienced radiologist to confirm the diagnosis of LPAC syndrome.Twenty-four patients were selected.Data about the patients’general characteristics,their medical history,their symptoms,and their blood tests results were collected during both their initial hospitalization and follow-up.Cytolysis and cholestasis were expressed compared to the normal values(N)of serum aspartate and alanine transaminase activities,and to the normal value of alkaline phosphatase level,respectively.The subjects were systematically reevaluated and asked about their symptoms 6 mo after inclusion in the study through an in-person medical appointment or phone call.Genetic testing was not performed systematically,but according to the decision of each physician.RESULTS Most patients were young(median age of 37 years),male(58%),and not overweight(median body mass index was 24).Many had a personal history of acute pancreatitis(54%)or cholecystectomy(42%),and a family history of gallstones in first-degree relatives(30%).LPAC syndrome was identified primarily in patients with recurring biliary pain(88%)or after a new episode of acute pancreatitis(38%).When present,cytolysis and cholestasis were not severe(2.8N and 1.7N,respectively)and disappeared quickly.Interestingly,four patients from the same family were diagnosed with LPAC syndrome.At ultrasound examination,the most frequent findings in intrahepatic bile ducts were comet-tail artifacts(96%),microlithiasis(83%),and acoustic shadows(71%).Computed tomography scans and magnetic resonance imaging were performed on 15 and three patients,respectively,but microlithiasis was not detected.Complications of LPAC syndrome required hospitalizing 18 patients(75%)in a conventional care unit for a mean duration of 6.8 d.None of them died.Treatment with ursodeoxycholic acid(UDCA)was effective and well-tolerated in almost all patients(94%)with a rapid onset of action(3.4 wk).Twelve patients’(67%)adherence to UDCA treatment was considered“good.”Five patients(36%)underwent cholecystectomy(three of them were treated both by UDCA and cholecystectomy).Despite UDCA efficacy,biliary pain recurred in five patients(28%),three of whom adhered well to treatment guidelines.CONCLUSION LPAC syndrome is easy to diagnose and treat;therefore,it should no longer be overlooked.To increase its detection rate,all patients who experience recurrent biliary symptoms following an episode of acute pancreatitis should undergo an ultrasound examination performed by a radiologist with knowledge of the disease.

Operative treatment for patients with cholelithiasis and liver cirrhosis

BACKGROUND: Liver cirrhosis and cholelithiasis are both familiar diseases in China. However, the rates of operative complications and death are still high in patients with these diseases. This study was designed to determine the operative indications as well as suitable procedures in the treatment of patients with cholelithiasis and liver cirrhosis. METHODS: We studied retrospectively 60 patients with cholelithiasis and liver cirrhosis who had undergone operation from January 2000 to July 2006. We analyzed the loss of blood during operation, postoperative complications and death rate to determine the proper treatment. RESULTS: Fifty patients were cured and 10 (16.7%) died postoperatively, i.e., six patients died from hepatic-renal failure and multisystem organ dysfunction and 4 from massive bleeding in the gallbladder bed. The 10 patients were clearly correlated with the Child-Pugh classification: Child A (8%), Child B (20%) and Child C (30%). Postoperative bleeding occurred in 10 patients (16.7%), intraabdominal in 6 and gastrointestinal in 4. Seven of the 10 patients with bleeding died postoperatively. CONCLUSIONS: The proper perioperative management of patients with cholelithiasis and liver cirrhosis can decrease the mortality. Cholelithiasis should be managed first by emergency operation. It is safe for the patients of Child A to undergo laparoscopy. It is very safe for patients with cirrhosis and cholelithiasis to undergo devascularization and shunt operation followed by biliary tract surgery.

Pregnane receptor gene polymorphisms,pathogenic bacteria distribution and drug sensitivity,and TCM dyndrome differentiation in patients with cholelithiasis

Objective:To investigate the distribution of pathogens and drug resistance in bile and the association between the pregane X receptor(PXR) gene polymorphisms,traditional Chinese medicine(TCM) syndromes and the risk of cholesterol gallstone disease(CGD).Methods:A total of 392 samples were enrolled in this study from January 2014 to February 2015.among which 192 patients were with CGD.and 200 samples were healthy.Strains were isolated and susceptibility testing was the disk diffusion method susceptibility testing.The patients were divided into hepatochlic hygropyrexia.stagnation of liver-qi.and the accumulation of damp.The PXR gene polymorphisms were analyzed by polymerase chain reaction-restriction fragment length polymorphism.The association between the PXR gene polymorphisms and the risk of CGD was examined by logistic regression analysis.Results:A total of 192 cases were detected in 230 of bile culture pathogens,including Grain-negative bacteria 133(57.83%),Gram-positive bacteria76(33.04%),and fungi 21(9.13%).The top five pathogens were Escherichia coli,Klebsiella pneumoniae.Enterococcus faecalis,Candida albicans,and Enterococcus feces,ot which 110 cases was of single infection.48 cases of mixed infection of two strains,eight cases of mixed infection of three bacteria.Among 59 Escherichia coli,the yield extended-spectrum beta-laetamases had 40(67.80%).The hepatochlic hygropyrexia was the most TCM syndrome,followed by stagnation of liver-qi.and the accumulation of damp was least.Different pathogens and the rs6785049 genotypes distributed differently in cholelithiasis patients with different TCM syndromes(P<0.05).In hepatochlic hygropyrexia patients the Gram-negative bacteria was most.There was significant differences between CGD group and control group in rs6785049(P<0.001).Comparison with wild-type portable GG.GA genotype increased the risk of the occurrence of gallstones(OR=0.40.95%CI:0.16-0.79);likewise,carrying the GA + AA genotype also increased the risk(OR=0.38,95%CI:0.19-0.81).There was no significant differences in rs2276707,rs3814055 site polymorphic loci alleles in CGD group and control group.Conclusions:In the treatment of cholelithiasis,bile samples should be collected for bacterial culture and sensitivity test,and drugs should be strictly chosen based on the results.The rs6785049 polymorphisms in PXR gene may increase the risk of gallstones ontogeny,and gallstones can he early detected and prevented by detecting genotypes.rs6785049 polymorphisms in PXR gene may has relationship with TCM syndromes.

Is intraoperative cholangiography necessary during laparoscopic cholecystectomy for cholelithiasis?

AIM:To determine the efficacy and safety benefits of performing intraoperative cholangiography(IOC)during laparoscopic cholecystectomy(LC)to treat symptomatic cholelithiasis.METHODS:Patients admitted to the Minimally Invasive Surgery Center of Tianjin Nankai Hospital between January2012 and January 2014 for management of symptomaticcholelithiasis were recruited for this prospective randomized trial.Study enrollment was offered to patients with clinical presentation of biliary colic symptoms,radiological findings suggestive of gallstones,and normal serum biochemistry results.Study participants were randomized to receive either routine LC treatment or LC+IOC treatment.The routine LC procedure was carried out using the standard four-port technique;the LC+IOC procedure was carried out with the addition of meglumine diatrizoate(1:1 dilution with normal saline)injection via a catheter introduced through a small incision in the cystic duct made by laparoscopic scissors.Operative data and postoperative outcomes,including operative time,retained common bile duct(CBD)stones,CBD injury,other complications and length of hospital stay,were recorded for comparative analysis.Inter-group differences were statistically assessed by theχ2 test(categorical variables)and Fisher’s exact test(binary variables),with the threshold for statistical significance set at P<0.05.RESULTS:A total of 371 patients were enrolled in the trial(late-adolescent to adult,age range:16-70 years),with 185 assigned to the routine LC group and 186 to the LC+IOC group.The two treatment groups were similar in age,sex,body mass index,duration of symptomology,number and size of gallstones,and clinical symptoms.The two treatment groups also showed no significant differences in the rates of successful LC(98.38%vs97.85%),CBD stone retainment(0.54%vs 0.00%),CBD injury(0.54%vs 0.53%)and other complications(2.16%vs 2.15%),as well as in duration of hospital stay(5.10±1.41 d vs 4.99±1.53 d).However,the LC+IOC treatment group showed significantly longer mean operative time(routine LC group:43.00±4.15 min vs 52.86±4.47 min,P<0.01).There were no cases of fatal complications in either group.At the one-year follow-up assessment,one patient in the routine LC group reported experiencing diarrhea for three months after the LC and one patient in the LC+IOC group reported ongoing intermittent epigastric discomfort,but radiologicalexamination provided no abnormal findings.CONCLUSION:IOC addition to the routine LC treatment of symptomatic cholelithiasis does not improve rates of CBD stone retainment or bile duct injury but lengthens operative time.

Rat model of cholelithiasis with human gallstones implanted in cholestasis-induced virtual gallbladder

AIM:To facilitate translational research on cholelithiasis,we have developed a rat model of human gallstones by exploiting the unique biliopancreatic features of this species.METHODS:Under anesthesia,16 adult rats of equal genders underwent two times of abdominal surgery.First,their common bile duct(CBD)was ligated to cause cholestasis by total biliary obstruction(TBO).On day 0,1,3,7,14,21 and 28 after TBO,magnetic resonance imaging(MRI)was conducted to monitor the dilatation of the CBD,and blood was sampled to analyze total serum bilirubin(TSB).Secondly,on day 30,the abdomen was re-opened and gallstone(s)collected from human patients were implanted in the dilated CBD asa virtual gallbladder(VGB),which was closed by suture ligation.This rat cholelithiasis model was examined by MRI,clinical observation,microcholangiography and histology.RESULTS:All rats survived two laparotomies.After ligation,the CBD was dilated to a stable size of 4 to30 mm in diameter on day 21-28,which became a VGB.The rats initially showed signs of jaundice that diminished over time,which paralleled with the evolving TSB levels from 0.6±0.3 mg/d L before ligation,through a peak of 10.9±1.9 mg/dL on day 14,until a nearly normalized value after day 28.The dilated CBD with thickened wall allowed an incision for implantation of human gallstones of 1-10 mm in diameter.The rat cholelithiasis was proven by in vivo MRI and postmortem microcholangiography and histomorphology.CONCLUSION:A rat model cholelithiasis with human gallstones has been established,which proves feasible,safe,reliable,nontoxic and cost-effective.Given the gallstones of human origin,applications of this model may be of help in translational research such as optical detection and lysis of gallstones by systemic drug administration.

Acute pain management in symptomatic cholelithiasis

AIM To review the evidence for the use of different nonsteroidal anti-inflammatory drugs(NSAIDs) in the treatment of biliary colic.METHODS The strategies employed included an extensive literature review for articles and studies related to biliary colic from electronic databases including Pub Med,Science Direct,Wiley Inter Science,Medline and Cochrane from last 15 years.Keywords: "Biliary colic","management of biliary colic","non-steroidal anti-inflammatory drugs","cholelithiasis" and "biliary colic management".Six randomized control trials,1 non-randomized trial and 1 meta-analysis were included in this review.The outcomes of these studies and their significance have been reviewed in this paper.RESULTS Current evidence suggests there are no set protocols for biliary colic pain management.NSAIDs are potent in the management of biliary colic,not only in terms of symptom control but in disease progression as well.Apart from the studies on diclofenac and ketorolac,there are studies which have shown that intravenous tenoxicam and injectable flurbiprofen are equally effective in managing biliary colic.The efficacy of NSAIDs is superior in terms of lower number of doses and longer duration of action in comparison to other analgesic agents.CONCLUSION This literature review has found that NSAIDs are safe and effective for pain control in biliary colic,and reduce the likelihood of further complications.

Incidence of congenital hemolytic anemias in young cholelithiasis patients

AIM: To clarify the incidence of congenital hemolytic anemias (CHA) in young cholelithiasis patients and to determine a possible screening test based on the results. METHODS: Young cholelithiasis patients (< 35 years) were invited to our outpatient clinic. Participants were asked for comorbidities and family history. The number of gallstones were recorded. Blood samples were obtained to perform a complete blood count, standard Wright-Giemsa staining, reticulocyte count, hemoglobin (Hb) electrophoresis, serum lactate dehydrogenase and bilirubin levels, and lipid profile. RESULTS: Of 3226 cholecystectomy patients, 199 were under 35 years, and 190 with no diagnosis of CHA were invited to take part in the study. Fifty three patients consented to the study. The median age was 29 years (range, 17-35 years), 5 were male and 48 were female. Twelve patients (22.6%) were diagnosed as thalassemia trait and/or ?ron-deficiency anemia. Hblevels were significantly lower (P = 0.046), and mean corpuscular volume (MCV) and hematocrit levels were slightly lower (P = 0.072 and 0.082, respectively) than normal. There was also a significantly lower number of gallstones with the diagnosis (P = 0.007). CONCLUSION: In endemic regions, for young cholelithiasis patients (age under 35) with 2-5 gallstones, the clinician/surgeon should pay attention to MCV and Hb levels as indicative of CHA.

Clinical epidemiological study on intrahepatic cholelithiasis: analysis of 8585 cases

OBJECTIVE: To investigate the clinical epidemiology of intrahepatic cholelithiasis in Guangxi area, China. METHODS: 8585 cases of cholelithiasis proved by surgery in a period of 19 years were analyzed retrospectively. Data were collected and analyzed by computer software package PEMS. RESULTS: Cases of intrahepatic cholelithiasis accounted for more than one third of cases of cholelithiasis treated in the same period. The prevalence of intrahepatic cholelithiasis in farmers increased from 23.4% out of all cases with gallstone in 1981-1985 to 55.8% in 1991-1999. The constituent ratio of intrahepatic cholelithiasis in males was nearly the same in females. The peak prevalence age of patients with intrahepatic cholelithiasis ranged from 31 to 40 years, and the mortality was the highest among all bile stone cases. CONCLUSION: Intrahepatic cholelithiasis is by no means a vanishing disease, especially in rural area.

Cholelithiasis in Children with Sickle Cell Disease in Ouagadougou Pediatric Hospital

Introduction: Sickle cell disease (SCD) causes chronic hemolysis which is a risk factor for cholelithiasis. Its development may lead to severe and life-threatening complications. Objective: Determine the prevalence of cholelithiasis, the conditions of diagnosis and related factors. Materials and Method: We retrospectively reviewed records of 110 patients with sickle cell disease followed up in Charles de Gaulle University Pediatric Hospital from January 2003 to December 2013, including 103 patients who had abdominal ultrasonography. Results: Cholelithiasis prevalence was 24.3%. The mean age of patients was 10.8 years, (range 3 to 15 years). Sex ratio was 2.1. In 88% cases, cholelithiasis was diagnosed based on the characteristic symptoms of right hypocondrial pain, fever and icterus. Most factors associated with cholelithiasis were as follows: age above 10 years (OR = 4), occurrence of at least three (03) vaso-occlusive crises per year (OR = 7.6), history of blood transfusion (OR = 8), right hypochondrial pain (OR = 4.5) and icterus (OR = 15). Only 20% of patients suffering from a symptomatic cholelithiasis underwent laparoscopic cholecystectomy and results were conclusive. Conclusion: Patients with sickle cell disease, especially those aged above 10, should be routinely tested for cholelithiasis using abdominal ultrasonography at least once a year. Because of the difficulties in managing evolutive complications in case of an emergency in our context, we advocate laparoscopic cholecystectomy of any cholelithiasisas soon as it is diagnosed in children with sickle cell disease.

Liver fat accumulation measured by high-speed T2-corrected multiecho magnetic resonance spectroscopy can predict risk of cholelithiasis

BACKGROUND Liver fat accumulation is associated with increased cholesterol synthesis and hypersecretion of biliary cholesterol,which may be related to the development of cholelithiasis.AIM To investigate whether liver fat accumulation measured by high-speed T2-corrected multi-echo magnetic resonance spectroscopy(MRS)is a risk factor for cholelithiasis.METHODS Forty patients with cholelithiasis and thirty-one healthy controls were retrospectively enrolled.The participants underwent high-speed T2-corrected multi-echo single-voxel MRS of the liver at a 3T MR scanner.The proton density fat fraction(PDFF)and R2 value were calculated.Serum parameters and waist circumference(WC)were recorded.Spearman’s correlation analysis was used to analyze the relationship between PDFF,R2,and WC values.Multivariate logistic regression analysis was carried out to determine the significant predictors of the risk of cholelithiasis.Receiver operating characteristic curve(ROC)analysis was used to evaluate the discriminative performance of significant predictors.RESULTS Patients with cholelithiasis had higher PDFF,R2,and WC values compared with healthy controls(5.8%±4.2%vs 3.3%±2.4%,P=0.001;50.4±24.8/s vs 38.3±8.8/s,P=0.034;85.3±9.0 cm vs 81.0±6.9 cm,P=0.030;respectively).Liver iron concentration extrapolated from R2 values was significantly higher in the cholelithiasis group(2.21±2.17 mg/g dry tissue vs 1.22±0.49 mg/g dry tissue,P=0.034)than in the healthy group.PDFF was positively correlated with WC(r=0.502,P<0.001)and R2(r=0.425,P<0.001).Multivariate logistic regression analysis showed that only PDFF was an independent risk factor for cholelithiasis(odds ratio=1.79,95%CI:1.22-2.62,P=0.003).ROC analysis showed that the area under the curve of PDFF was 0.723 for discriminating cholelithiasis from healthy controls,with a sensitivity of 55.0%and specificity of 83.9%when the cut-off value of PDFF was 4.4%.CONCLUSION PDFF derived from high speed T2-corrected multi-echo MRS can predict the risk of cholelithiasis.

Spinal cord injury and cholelithiasis

BACKGROUND: Spinal cord injury (SCI) is found to be related to increased prevalence of gallstones and acute acal- culous cholecystitis. In this study we assessed the prevalence of cholelithiasis in male patients with SCI and the correla- tion of cholelithiasis with age and weight of patients, level of injury, as well as severity and duration of SCI. METHODS: One hundred male SCI patients (58 patients rated ASIA A or B and 42 rated ASIA C or D) aged more than 20 years (average 46.5 years) suffered from a spinal cord injury for more than one year. One hundred male vo- lunteers served as controls without SCI and biliary diseases (age range 20-68 years; average 42.6 years). The two groups were subjected to ultrasonography of the gallbladder and biliary tract. RESULTS: The prevalence of cholelithiasis in the group of SCI patients and the control group was 26% and 10% re- spectively. Significant differences in the prevalence of cho- lelithiasis were found between the normal controls and SCI patients and between high- and low-level injury (P <0.01). But the differences were not statistically significant when correlating the presence of cholelithiasis with the age and weight of the patients, the duration of SCI, and the severity of spinal lesion(P >0.05). CONCLUSIONS: SCI represents a major risk factor for the development of cholelithiasis, especially in patients with high-level injury. Cholelithiasis in SCI patients is not relat- ed to their age and weight, the severity of spinal lesion, and the duration of spinal cord injury.

Microbial spectrum and drug resistance of pathogens cultured from gallbladder bile specimens of patients with cholelithiasis:A singlecenter retrospective study

BACKGROUND Bacterial infection is an important cause of cholelithiasis or gallstones and interferes with its treatment.There is no consensus on bile microbial culture profiles in previous studies,and identified microbial spectrum and drug resistance is helpful for targeted preventive and therapeutic drugs in the perioperative period.AIM To analyze the bile microbial spectrum of patients with cholelithiasis and the drug susceptibility patterns in order to establish an empirical antibiotic treatment for cholelithiasis-associated infection.METHODS A retrospective single-center study was conducted on patients diagnosed with cholelithiasis between May 2013 and December 2018.RESULTS This study included 185 patients,of whom 163(88.1%)were diagnosed with gallstones and 22(11.9%)were diagnosed with gallstones and common bile duct stones(CBDSs).Bile culture in 38 cases(20.5%)was positive.The presence of CBDSs(OR=5.4,95%CI:1.3-21.9,P=0.03)and longer operation time(>80 min)(OR=4.3,95%CI:1.4-13.1,P=0.01)were identified as independent risk factors for positive bile culture.Gram-negative bacteria were detected in 28 positive bile specimens,and Escherichia coli(E.coli)(19/28)and Klebsiella pneumoniae(5/28)were the most frequently identified species.Gram-positive bacteria were present in 10 specimens.The resistance rate to cephalosporin in E.coli was above 42%and varied across generations.All the isolated E.coli strains were sensitive to carbapenems,with the exception of one imipenem-resistant strain.K.pneumoniae showed a similar resistance spectrum to E.coli.Enterococcus spp.was largely sensitive to glycopeptides and penicillin,except for a few strains of E.faecium.CONCLUSION The presence of common bile duct stones and longer operation time were identified as independent risk factors for positive bile culture in patients with cholelithiasis.The most commonly detected bacterium was E.coli.The combination ofβ-lactam antibiotics andβ-lactamase inhibitors prescribed perioperatively appears to be effective against bile pathogens and is recommended.Additionally,regular monitoring of emerging resistance patterns is required in the future.

Risk factors,manifestations,diagnosis and treatment of cholelithiasis in children

Cholelithiasis in children refers to cholelithiasis or choledocholithiasis in newborns,infants and adolescents,including a series of symptoms and complications related to stones.The incidence rate of cholelithiasis in children is far lower than that in adults.However,the detection rate of cholelithiasis in children has risen in recent years.The aetiology of cholelithiasis in children is complex,and the pathogenesis is still unclear.According to existing studies,cholelithiasis in children may be related to sex and hormones,obesity,drugs,haemolytic diseases,genetic factors,chemokines,abnormal biliary tract formation,ileal surgery,total parenteral nutrition and other factors.In addition,there is a large occurrence of idiopathic cholelithiasis in children with unknown aetiology.The clinical manifestations of cholelithiasis in children are not completely the same as those in adults,mainly due to the different ages and causes.At present,there is no consensus on the clinical treatment of cholelithiasis in children.Followup and observation,drug dissolution and surgical treatment are all treatment methods for children with cholelithiasis.This study reviewed the related literature reports of cholelithiasis in children and summarized the risk factors,clinical manifestations,diagnosis and treatment of cholelithiasis in children to improve the understanding,diagnosis,and treatment of cholelithiasis in children.

Cholelithiasis in Children with Sickle Cell Anaemia: A Cross-Sectional Analysis from Northeast Nigeria

Background: Nigeria contributes 30% to the global sickle cell anaemia burden. Cholelithiasis occurs commonly in children with sickle cell anaemia and may remain undiagnosed, mimic abdominal vaso-occlusive crises or become complicated by calculus cholecystitis. Early identification of children with sickle cell anaemia who have Cholelithiasis reduces the chances of misdiagnosis, mistreatment and improves outcomes. There is limited knowledge about the prevalence of Cholelithiasis among Nigerian children with sickle cell anaemia. The present study aimed to determine the prevalence of Cholelithiasis in children with sickle cell anaemia in Gombe, northeast Nigeria. Methodology: This was a cross-sectional analysis of children with sickle cell anaemia being followed-up at the sickle cell centre of the Federal Teaching Hospital, Gombe, northeast Nigeria. We consecutively recruited 294 children aged 2 - 17 years while in steady state from June to November 2017. Quantitative data were collected from parents/caregivers via a researcher administered questionnaire and cholecystosonography performed after a minimum of 8-hour fast. Predictors of Cholelithiasis were examined using binary logistic regression. Results: The mean age of children with sickle cell anaemia was 9.0 ± 4.5 years. The prevalence of Cholelithiasis in children with sickle cell anaemia in steady state was 4.8%. Children aged 15 - 17 years had 12 times higher odds of having Cholelithiasis [AOR = 12.268 (95% CI = 1.3 - 112.8)]. Conclusion: The prevalence of Cholelithiasis in children with sickle cell anaemia though generally low, increases progressively with age to peak during middle to late adolescence.

Risk Factors Associated with Cholelithiasis during Pregnancy and Postpartum

Gallbladder disease is the most common non-obstetrical cause of maternal hospitalization in the first year postpartum. Many risk factors have been associated with gallbladder disease in pregnancy including body mass index, prenatal weight gain, prenatal physical activity, dietary fat, age, parity, a history of gallbladder disease and the number of previous pregnancies were significant factors related to new gallstones and biliary sludge formation in the pregnant group. The aim of this study is to evaluate the risk factors for gallstones formation in pregnancy and one year after labour. The study included 328 female patients (pregnant or postpartum) divided into two groups;patient group (164 patient) that are pregnant or postpartum patient have gallstones and control group (164 patient) that are pregnant or postpartum patient does not have gallstones. All patients were subjected to full history taking;especially about risk factors predisposing for gallstones, physical examination and pre-operative routine laboratory investigations and imaging as abdominal ultrasound study (U/S). Obesity, young age, history of gallbladder disease and use of estrogen and progesterone are the main risk factors that increase incidence of gallstones during pregnancy or one year postpartum. Use of vit C, iron, drinking coffee and practicing regular physical activity are considered protective factors.

Effects of laparoscopic normal hepatectomy and partial hepatectomy on inflammatory factors, stress hormones and immune function in patients with intrahepatic cholelithiasis

Objective:To investigate the effects of laparoscopic normal hepatectomy and partial open hepatectomy on inflammatory factors, stress hormones and immune function in patients with intrahepatic cholelithiasis.Methods: A total of 90 patients with intrahepatic cholelithiasis were randomly divided into control group and the observation group. The patients in the control group were treated with partial hepatectomy. Patients in observation group were treated with laparoscopic normal hepatectomy. The levels of inflammatory factors, stress hormones and immune function were compared in two groups before and after treatment.Results: Before treatment, there was no significant difference in the levels of neutrophile granulocyte, CRP, WBC, COR, E, CD3+, CD4+, CD8+ and NK cells between the two groups. After treatment, the levels of CD3+, CD4+ and NK cells in the observation group were significantly higher than those in the control group, moreover, these levels after treatment were obviously lower than before treatment;The levels of neutrophile granulocyte, CRP, WBC, COR, E and CD8+ in the observation group were significantly lower than those in the control group, and these levels were significantly higher than before treatment.Conclusion: Compared with partial open hepatectomy, laparoscopic normal hepatectomy can effectively reduce the inflammatory factors and stress hormone levels, improve the immune function of the body, and have a certain clinical value.