Ultrasound Prevalence of Gallstone Disease in Diabetic Patients at Ibadan; Nigeria

Background: Gallstones (GS) in the gallbladder (GB) can be responsible for a whole spectrum of disease entities which may lead to a surgical emergency with high mortality. Diabetes mellitus (DM) is a debilitating disease that affects all systems in the body; and literature documents a higher incidence of gallstone disease (GSD) and its complications in diabetics than in the non-diabetic population. Most local studies on the association between GS formation and DM have focused on type 2 diabetics. This study was therefore designed to determine the prevalence of GS in both type 1 and type 2 DM and elucidate the demographic and social factors associated with formation of GS in diabetic patients. Materials and Methods: Four hundred diabetic patients aged between 15 and 82 years had abdominal ultrasound to diagnose or exclude the presence of GS. Results: GS was found in 70 (17.5) of the 400 patients. Positive cases had a male to female ratio of 3:4 and 59 (51.92) were above the age of 40 years with type 2 DM. Body mass index (BMI) greater than 25 kg/m 2 was seen in 56 (48.3) patients; smoking and alcohol intake were insignificantly implicated. Jaundice was recorded in 8 (11.4) while abdominal pain was in 24 (34.3) patients; and 52 (74.3) patients of those with GSD had had diabetes for more than 4 years. Conclusion: GSD in DM is influenced significantly by age; BMI; and duration of the disease; while gender; social factors; and parity do not influence as strong associated factors

Laparoscopic Cholecystectomy at the Korle Bu Teaching Hospital; Accra; Ghana: an Initial Report

BACKGROUND: Laparoscopic cholecystectomy (LC) the preferred treatment for gallstones was not available in Ghana until 2005. OBJECTIVE: To report experience from Ghana of laparoscopic cholecystectomy in the treatment of galestones. METHODS: In a prospective study of patients with gallstones; information was obtained on demography; duration of various stages of the operation; analgesia and complication of patients with gallstones. All patients had general anaesthesia using endotracheal intubation; muscle relaxant and intermittent positive pressure ventilation. A standard four-trocar technique and maximum pneumoperitoneum pressure of 14mmHg were maintained during surgery. RESULTS: There were 50 women and two men aged 17-72 years (mean 44.2 years). All had symptomatic gallstones treated by interval LC. The main indications were biliary colic 23(44) and previous cholecystitis 15(29). There were scars from previous abdominal surgery in 22 (42); mainly pfannenstiel. The Verres needle was used to obtain pneumoperitoneum in 40 (77). Only one patient (1.9) had the operation converted to open cholecystectomy. Most patients; 47/51 (92); were discharged in 24 hours. The mean durations of various stages were: anaesthesia (110 minutes); pneumo-peritoneum (67.5 minutes) and reverse trendelenburg (47.8 minutes). The mean operating time reduced from 81 to 68 minutes in the last 20 patients. Complications were sore throat 11(21.6); infection of the umbilical wound 3(5.9); right shoulder tip pain (3; 5.9) and bile leak 1(2). There was no peri-operative mortality. CONCLUSION: Elective laparoscopic cholecystectomy can be performed with good results in patients with symptomatic gallstones in Accra

Prevalence of Gallstone Disease in South-Eastern Nigeria

"Classically; gallstones are said to occur in a fat; fertile; flatulent female of fifty!1. in this prospective study; we found a prevalence rate of 3.3. the results did not correlate with the body mass index (BMI); weight (Wt) or complexion (Cpx). The mean BMI for those with stones was 24.43 with standard deviation (SD) of 1.97 as against mean BMI of 26.35 and SD of 4.98 for those without. The mean Wt. of those with gallstones was 65.43kg with SD of 9.55 while the mean Wt of those without was 68.01kg with SD of 15.43. regarding ""colour"". The Dark complexioned (Dc) were more common constituting 71.4of affected persons. The fair complexioned (Fc) constituted 28.6. Patients with tertiary education were the most frequently affected constituting 71.4and the same group constituted 51of those randomized. Patients with secondary school level of education constituted 33.14of those randomized and 28.43found with gallstones. In the studied sample; t6he female to male ratio in those affected was 6.1. the females also dominated the sample population to the tune of 84. In relation to occupation; the highest incidence was amongst civil servants who made up 43of those affected. Surprisingly; the unemployed came second making up 28.5and the professionals were 14.28of those affected. These results confirm a rising incidence of cholelithiasis in our population when compared with previous studies (0.007the sixties and 1.79in 2002. it also clearly demonstrates a different epidemiological profile from that classically described amongst the Caucasians."

Quantitative Analysis of Gallstones in Libyan Patients

Gallstone disease is one of the major surgical problems in the Libyan population; it is probably related to diet; especially excessive consumption of meat. The study was conducted to determine the composition of gallstones and their possible etiology in a Libyan population. The chemical composition of gallstones from 41 patients (six males and 35 females) was analyzed. The stones were classified into cholesterol; pigment; and mixed stones (MS). Cholesterol stones (CS) showed a significantly higher cholesterol content than pigment stones (PS) (p=0.0085) though not significantly higher than MS. Their phospholipid content and inorganic phosphates were higher than in the other types of stones and oxalate content was significantly elevated in comparison with MS (p=0.0471). In MS; the cholesterol; bile acids; and bilirubin were intermediate between cholesterol and PS; whereas triglycerides were significantly more than PS (p=0.0004). Bilirubin (0.0001) and bile acids (p=0.0009) were significantly higher than CS (p=0.0001). However; they contained the lowest amounts of sodium; potassium; magnesium; and oxalate. In PS; bilirubin (p=0.0001) was significantly higher than both groups. Bile acid content was significantly higher than CS (p=0.0001) but not significantly more than MS. They showed the highest values of calcium; sodium; potassium; magnesium; and chlorides compared to the other types of stones. High levels of cholesterol in stones and dyslipidemia associated with mixed as well as cholesterol gallstones suggest an etiological association and efforts to reduce dietary fat among the Libyan population may lead to decreased cholesterol and mixed gallstones

Cholecystectomy: Indications at University of Calabar Teaching Hospital; Calabar; Nigeria

Background/objective: The relative rarity of gallbladder disease has been documented in various parts of Africa. Recently the incidence has been reported as rising in some African countries. We undertook this study to evaluate the indications for cholecystectomy in our center and compare with others. Methods: This is a retrospective study of 18 open cholecystectomies in 10years. Results: The ages ranged from 13 and 65 years (mean 39.2years). There were 15 females and 3 males (F: M=ratio 5:1). Calculous cholecystitis 9(50) in patients; acalculous cholecystitis 8(44.4) and a patient with carcinoma of the gallbladder were offered cholecystectomy. The commonest stone was mixed multiple stones. -Conclusion: The numbers of cholecystectomies attest to the rarity of gallbladder disease in this environment. This may be due to the high fiber and low cholesterol diet predominant in this costal population in southern Nigeria

Epidemiology of Gallstone Disease in Gondar University Hospital; as seen in the Department of Radiology

Background: Gallstone disease is a world wide problem and remains to be one of the most common health problems leading to surgical intervention. The magnitude of Gallstone disease in Ethiopia is not well known. Objective: To assess the magnitude of gallbladder stones in Gondar university hospital among patients visiting at the department of radiology for ultrasound examination. Methods: A retrospective observational study design was used over the period of September 2004 to January 2006 at the department of radiology; Gondar university hospital. Patients above the age of 14 years and whose Gallbladder was examined by ultrasound were considered as the study subjects. Results: Among a total of 1603 study subjects; the proportion of patients with cholelithiasis was 5.2. Of the patients with gallstone disease 55 were females and 28 were males with a ratio of 2:1. The prevalence of cholelithiasis in the age group 35-64 was 7.3; 10.1for females and 4.8for males. The ratio of symptomatic to asymptomatic cholelithiasis was 1:1 (34/34). The prevalence of cholelithiasis among patients clinically suspected to have cholelithiasis was 27.2. Of the 68 patients with cholelithiasis; 22.1had evidences of complication; 5 (7.4) choledocholithiasis; 3 (4.4) acute cholecystitis; 4 (5.9) chronic cholecystitis; 2 with gallbladder (GB) hydrops and one patient with porcelain GB. Conclusion: The prevalence of cholelithiasis (5.2) in Gondar university hospital suggesting that cholelithiasis is not an uncommon disease in the area. A further community based and multi centered study is recommended to determine the prevalence of gallstone disease in Ethiopia

The Effect of Moderate Alcohol Intake on Gallblader Motility: a Milk Ultrasonographic Study

Objectives: To assess the effect of periodic and moderate alcohol intake on gallbladder motility. Methods: The ultrasonographic ellipsoid method was used in 21 healthy male subjects: 12 non-alcohol and 9 alcohol drinkers. The stimulus for gallbladder contraction was 165 ml of half cream milk. Gallbladder dynamics were studied for 20 minutes following the ingestion of the milk. The mean percentage change in gallbladder volume after 10 and 20 minutes gave indications of gallbladder motility. Results: Moderate and periodic alcohol intake did not stimulate rapid postprandial gallbladder emptying. Conclusion: The protective effect of alcohol against biliary cholesterol cholelithiasis could not be due to stimulation of gallbladder emptying