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

Relation of gall stone type with bile composition

The present study was planned to investigate the relation of gall stone type with bile composition. This study was carried out on 41 patients who underwent elective cholecystectomy for calcular cholecystitis. These patients were classified into three groups according to the chemical constituents of stones: group [1] comprised 25 patients with cholesterol gall stones, group [2] comprised 8 patients with mixed stones, and group [3] comprised 8 patients with pigment stones. In addition 8 subjects were included as a control group. Blood sample, gall bladder bile and stones were collected from every patient. Fasting blood glucose, bilirubin, albumin, AST, ALT and lipid profile were measured by the traditional colorimetric methods. At the same time plasma ascorbic acid was determined by dinitrophenyihydrazine thiourea copper sulphate [DTC] reagent. In addition serum insulin was measured by chemiluminescent method and leptin by enzyme immunoassay. Biliary bile acids were measured by HPLC while biliary cholesterol, phospholipids, calcium, bilirubin and total protein were determined by colorimetric methods The present study revealed that ages of patients with pigment stones were significantly higher while BMI was elevated in patients with cholesterol gall stones. Serum cholesterol, TG, LDL, insulin and leptin were significantly increased while HDL and serum ascorbic acid were significantly decreased in patients with cholesterol gall stones when compared to control group. In addition, there was significant positive correlation between leptin and BMI, insulin and biliary cholesterol. In patients with cholesterol gall stones there were significant increase of biliary protein, biliary cholesterol and decrease of biliary phospholipids, total and direct bilirubin when compared to control group. In patients with mixed and pigment gall stones, there were significant decrease of serum HDL, biliary phospholipid, total and direct biliary bilirubin beside significant increase of indirect bilirubin when compared to control group. Concerning biliamy bile acids there were significant decrease of primary bile acids conjugates [GCA, TCA, GCDCA, and TCDCA] and significant increase of secondary bile acids conjugates [GDCA, TDCA, GLCA, and TLCA] in all patient groups when compared to control group. Leptin was associated with increased risk of cholesterol gall stone formation while advance of age was associated with pigment gall stone. Hypovitaminosjs C may have a pivotal role in gall stone formation specially cholesterol type. Expand of secondary bile acid pool and contracted primary bile acid pool play an important role in various types of gall stones

Regional differences in constituents of gall stones.

The pathogenesis of pigment and mixed gall stone formation remains elusive. The elemental constituents of gall stones from southern states of Tamil Nadu, Kerala and Karnataka have been characterized. Our aim was to determine the elemental concentration of representative samples of pigment, mixed and cholesterol gall stones from Andhra Pradesh using proton-induced X-ray emission (PIXE) using a 3 MV horizontal pelletron accelerator. Pigment gall stones had significantly high concentrations of copper, iron and lead; chromium was absent. Except for iron all these elements were significantly low in cholesterol gall stones and intermediate levels were seen in mixed gall stones. Highest concentrations of chromium was seen in cholesterol and titanium in mixed gall stones respectively; latter similar to other southern states. Arsenic was distinctly absent in cholesterol and mixed gall stones. The study has identified differences in elemental components of the gall stones from Andhra Pradesh.

Association of gallstone disease risk with serum level of alkaline phosphatase

To see the relationship between personal history and blood chemistry of preoperative gallstone patients with gallstone disease. A Cross sectional study. Liaquat University Hospital Jamshoro for a period of three years. Gallstone patients admitted for the treatment during January 1999 to December 2001 were studied with the help of a predesigned proforma for recording the personal history and blood chemistry results of the individual patients. A total of 172 patients was studied. Majority [85.33%] of the gallstone patients was females. Females under 45 years age [65.38%] and females having more than three children [70.55%] were more prone to develop gallstones than the respective female group of over 45 years age [34.62%] and having upto three children [29.45%]. Past history of the gallstone patients revealed that 53.5%, 23.2%, and 9.3% of the cases had jaundice, diabetes mellitus and renal stones respectively. Blood chemistry of the patients showed that 18.2%, 2.8%, 3.44% and 4.1% had respectively hyperbilirubinemia, hyperuremia, hyperglycemia and hypoglycemia. Alkaline phosphatase and alanine aminotransferase levels in plasma and total leuckocyte count in blood were raised in 17%, 39.7% and 9% cases respectively. However, low plasma alkaline phosphatase levels were also found in 31.1% gallstone patients. The levels of plasma alkaline phosphatase were significantly high [p<0.01] in females than in males, and in females over 45 years age than under 45. Risk of gallstone disease in females is associated with serum alkaline phosphatase level

Gall-stone composition and biochemical alterations in the serum of patients with cholelithiasis

The levels of cholesterol, calcium and bilirubin were determined in the seruih and gall stones in 47 cases with cholelithiasis. The mixed stones were observed in 87.5 percent, high cholesterol stone in 8.5 percent and high bilirubin stones in 4.2 percent. Serum and stone cholesterol levels were inversely proportional and the bilirubin levels were directly proportional to each other

Survey of the frequency of the types of gall stones and it's related risk factors in cholecystectomized patients in Semnan [2002-2003]

Cholecystolithiasis is one of the most common diseases. Prevalence of the biliary stones has a close relation with the one's life condition. Howeve its frequency can be reduced by controlling the known risk factors in each area. The aim of this study was to determine the types of gall stones and the related risk factors in Semnan during 2002-2003. All patients who underwent cholecystectomy during 2002-2003 included in this study. Their F.B.S, triglyceride, cholesterol and HDL were measured by standard laboratory methods. BMI and type of stones analyzed by macro-microscopic methods and biopsy of gall bladder was performed. Finally, the relation of the risk factors with the type of stone, histologic findings, age and gender distribution were assessed. All data were recorded in a specified questionaire. Chi-Square test at the significant level of 0.05 was used to analyze the data. The most frequent risk factor for biliary stone was drug consumption. The most usual type of stone was mixed and the most ordinary pathology finding was chronic non-specific cholecystitis. Meanwhile the finding suggest significant relation between cholecystolithiasis and the quantity of drug used, diabetes, multiparity, hyperlipidemia and obesity. We suggest that by controlling these known risk factors such as drug consumption especially OCP by obese and multigravida women, reducing weight, and hyperlipidemia especially in aged groups, the frequency of the gall stones can be reduced

Clinical and biochemical comparative study of different types of common bile duct stones.

BACKGROUND: The chemical composition of common bile duct (CBD) stones may have significance with regard to the origin, clinical presentation and treatment. OBJECTIVE: To study the chemical composition of CBD stones and compare different types of CBD stones. METHODS: Consecutive patients with CBD stones seen over a 1-year period were studied prospectively. Their stones were analyzed for cholesterol, bilirubin and calcium contents. RESULTS: Of 74 patients with CBD stones, 42 had associated gall bladder (GB) stones (Group 1), 14 had post-cholecystectomy CBD stones (Group 2) and 18 had CBD stones with a stoneless GB in situ (Group 3). Of the 40 patients whose CBD stones were analyzed, 34 (85%; 18/19 in Group 1, 5/6 in Group 2 and 11/15 in Group 3) had cholesterol stones; the remaining 6 patients had pigment stones. CONCLUSION: Most CBD stones in northern Indian patients are cholesterol stones. Even in patients with isolated CBD stones (with stoneless GB in situ), three-quarters are cholesterol stones.