Efecto de una dieta alta en grasas en el proceso de formación de cálculos biliares de colesterol / Effect of a high-fat diet on cholesterol gallstone formation

Background: It is known that some nutrients play an important role in the development of cholelithiasis. Cholesterol is carried by micelles and vesicles in the bile. During the first stage of gallstone formation, cholesterol crystals derive from thermodynamically unstable vesicles. Aim: To determine the effect of a high fat diet on blood lipids and bile composition, and its implication in the formation of gallstones. Material and Methods: Two groups of 15 BALB/c mice each, coming from the same litter, were treated with a control or with a high-fat diet (64% fat and 0.14% cholesterol). After two months, the animals were sacrificed, blood and bile samples were obtained. Serum glucose and the corresponding lipid profiles were measured. In bile samples, cholesterol and phospholipid levels were analyzed, and cholesterol transporters (vesicles and micelles) were separated by gel filtration chromatography. Results: Treated animals showed an 87% increase in serum total cholesterol (p < 0.01), a 97% increase in HDL-cholesterol (p < 0.05) and a 140% increase in LDL-cholesterol (p < 0.05). No changes in serum triglycerides or glucose were observed. In bile, a 13% increase in biliary cholesterol (p < 0.05) was observed but no change in biliary phospholipids. Also, an increase in biliary vesicular transporters and an increase of cholesterol/phospholipid ratio in vesicular transporters were observed. Conclusions: A high fat diet may contribute to the formation of gallstones in our experimental model.

Tolerance Tests of Alcaligenes faecalis BW1 Extract.

Aims: To highlight whether metabolites of Alcaligenes faecalis BW1 extract can be administered orally for their possible antimycobacterial effects. Study Design: Study of the influence of certain parameters on the extract of Alcaligenes faecalis by using either discs or well diffusion methods against M. smegmatis. Place and duration of study: Laboratory of Microbial Biotechnology, Department of Biology, Faculty of Sciences and Technical, University Sidi Mohamed Ben Abdellah, BP 2202, Road of Immouzer, Fez, Morocco. From April to August, 2012. Methodology: The impact of acidic pH of gastric juice, bile, hydrogen peroxide, pancreatic enzymes and lysozyme on the antimycobacterial activity of Alcaligenes faecalis BW1 extract was evaluated by agar diffusion method. Detection whether or not antibacterial metabolites having a synergistic effect with rifampicin against M. smegmatis was also explored. Results: Antibacterial metabolites of Alcaligenes faecalis BW1 extract resist to the action of gastric pH, gallbladder bile and hydrogen peroxide. In addition, they are not affected by pancreatic enzymes and lysozyme. Moreover, they have a synergistic effect with rifampicin against M. smegmatis. Conclusion: Anti-mycobacterial metabolites of Alcaligenes faecalis BW1 extract are compatible with rifampicin and could be administered orally as antitubercular agents after their purification, identification in further work.

Reflujo pancreáticobiliar en pacientes con colelitiasis y sin colelitiasis: estudio comparativo / Pancreaticobiliary reflux in patients with cholelithiasis and without cholelithiasis: a comparative study

Background. Pancreaticobiliary reflux is a pathologic phenomenon occurring in patients with gallstones. However, the occurrence of pancreaticobiliary reflux has not been studied in patients without gallstones. The objective of this study was to measure the bile levels of amylase and lipase in patients without gallstones submitted to cholecystectomy as part of another surgical procedure, and to compare these values with patients submitted to cholecystectomy for gallstone disease. Patients and Methods. A prospective observational comparative study was designed. A sample of 136 consecutive patients was included. Amylase and lipase levels were measured in bile. Normal serum amylase levels at our institution are 28-100 U/L and for lipase are 13-60 U/L. There are no established normal levels for pancreatic enzymes in bile. However, we considered elevated the bile amylase and lipase levels whenever they were higher than normal plasma levels. Results. One-hundred three patients (76 percent) had gallstones and 33 (24 percent) liad healthy gallbladders without gallstones. According to normal plasma levels for amylase and lipase, these enzymes in bile were elevated in 83.5 percent patients with gallstones, compared to elevated levels of amylase in 6 percent patients and lipase in 3 percent patients without gallstones. Conclusions. Pancreaticobiliary reflux is a common phenomenon in patients with gallstones and occurs sporadically in patients without gallstones.

Introducción. El reflujo pancreáticobiliar es un fenómeno patológico que ocurre en pacientes con colelitiasis. La ocurrencia de este fenómeno no ha sido estudiada en pacientes sin colelitiasis. El presente estudio tiene por objetivo medir los niveles de amilasa y lipasa en la bilis de pacientes sin colelitiasis, colecistectomizados como parte de otro procedimiento quirúrgico y comparar estos valores con pacientes colecistectomizados por colelitiasis. Pacientes y Métodos. Se diseñó un estudio observacional y comparativo. Una muestra de 136 pacientes consecutivos fue incluida. Se midieron los niveles de amilasa y lipasa en la bilis. En nuestra institución los valores normales para amilasa son 28-100 U/L y para lipasa 13-60 U/L. No se han establecido valores normales de enzimas pancreáticas en la bilis. Para efectos del presente estudio, se consideró como elevados los niveles biliares de amilasa y lipasa cuando fueron mayores a los valores plasmáticos normales. Resultados. 103 pacientes (76 por ciento) tenían colelitiasis y 33 (24 por ciento) tenían vesículas normales sin cálculos. De acuerdo a los valores plasmáticos normales de amilasa y lipasa, estas enzimas se encontraron elevadas en 83,5 por ciento de los pacientes con colelitiasis comparados con valores elevados de amilasa en 6 por ciento en pacientes sin colelitiasis y de lipasa en 3 por ciento de estos pacientes. Conclusiones. El reflujo pancreaticobiliar es un fenómeno común en pacientes con colelitiasis y ocurre esporádicamente en pacientes sin colelitiasis.

Distribution of aconitum alkaloids in the corpse died of acute aconite intoxication / 法医学杂志

OBJECTIVE@#To investigate the distribution of aconite alkaloids in biological fluids and tissues in the corpse died of acute aconite intoxication and to provide information for sample selection and result evaluation in forensic identification.@*METHODS@#The content of aconite alkaloids in biological fluids and tissues were determined by liquid chromatography-tandem mass spectrometry.@*RESULTS@#The content of aconite displayed in decending order of urine, bile, gastric content, heart blood, pancreas, heart, intestine, liver, kidney, stomach, lung, gallbladder and spleen, with no aconite detected in the brain.@*CONCLUSION@#It was indicated that urine, bile and blood are the best specimens for the determination of aconite in body of the acute aconite intoxication.

Clinical Significance of White Bile (Bilirubin-Free Bile) in Malignant Bile Duct Obstruction / 대한소화기학회지

BACKGROUND/AIMS: White bile is colorless, translucent fluid found occasionally in malignant bile duct obstruction (MBO). Little information is available on the cause and effect of white bile. The aim of this study was to determine the frequency and clinical significance of white bile in MBO. METHODS: Bile was aspirated during endoscopic retrograde cholangiopancreatography in consecutive patients with MBO. White bile was defined as bile bilirubin or=1.5 mg/dL in the bile. Two groups were compared prospectively for the duration of jaundice, itching, cholangitis, level of obstruction, and decremental rate of bilirubin after the insertion of 7 Fr endoscopic nasobiliary drainage until the insertion of metal stent or 10 Fr plastic stent. RESULTS: Among 60 patients with MBO, 16 (26.7%) had white bile. WBC count in blood was higher (9,456/mm3 vs. 7,400/mm3, p=0.029) and cholangitis was more common (11/16 vs. 7/44, p=0.000) in white than yellow bile group. Proximal portion of MBO had no communication with GB in 9/16 patients with white bile group and 17/44 patients with yellow bile group (p>0.05). Mean survival of the inoperable 35 patients was 242 days in yellow bile and 227 days in white bile group (p>0.05). CONCLUSIONS: White bile in MBO was not rare and was associated with cholangitis. Gallbladder did not seem to play a role in the formation of white bile. Further study for the pathogenesis and prognosis of white bile in MBO will be necessary.

Cytochrome P450 1A activity in liver and fixed wavelength fluorescence detection of polycyclic aromatic hydrocarbons in the bile of tongue-fish (Cynoglossus acrolepidotus, Bleeker) in relation to petroleum hydrocarbons in the eastern Gulf of Thailand.

This investigation was conducted in an area of oil spill along the east coast of Thailand to examine the relations among cytochrome P450 1A activity in liver and PAHs in the bile of the tonguefish and petroleum hydrocarbons in the sediments. PAH sediment concentrations in the reference and oil spill areas were 5.03 +/- 0.42 and 0.21 +/- 0.043 microg(-1) dry weight respectively Cytochrome activity in fish liver from oil spill area was 45.40 +/- 3.50 pmoles/ min/mg protein, almost threefold higher than that from the reference sites. Flourescense detection in bile metabolites at the oil spill area, 69.8 +/- 9.9 flourescense unit was significantly higher than that at the reference sites, 22.9 +/- 5.5 and 22.2 +/- 3.5 fluorescence unit. A strong correlation was found among cytochrome P450 1A activity in liver, PAH of bile metabolites and petroleum hydrocarbons. Both cytochrome and bile metabolites activity decreased seaward varying to the distance from the oil polluted area. We concluded that both detections in tonguefish can be regarded as a complementary biomarkers for the exposure of PAHs in tropical marine environments.

Efecto de la administración de triiodotironina y glucagón sobre la expresión hepática del receptor de lipoproteínas de alta densidad y el metabolismo del colesterol en el ratón / Effect of triiodothyronine (T3) and glucagon on hepatic expression of SR-BI and lipoprotein cholesterol metabolism in mice

Introducción: El receptor scavenger clase B tipo I (SR-BI) es un elemento clave en el metabolismo de las HDL, donde su expresión ejerce un importante efecto anti-aterogénico controlando la fase hepática del transporte reverso de colesterol. Así, el estudio de la modulación de la expresión de SR-BI permitiría el desarrollo de nuevas alternativas farmacológicas para el tratamiento de la ateroesclerosis. Objetivo: La meta de nuestro estudio fue determinar el efecto de la triiodotironina (T3) y el glucagón sobre el metabolismo del colesterol HDL y la expresión hepática de SR-BI en el ratón, evaluando simultáneamente su impacto sobre el colesterol total y lipoproteico plasmático y la secreción biliar de colesterol. Métodos: Se utilizaron ratones C57BL/6 tratados con T3 (30 nmol/kg/día) o glucagón (80 µg/día) más los respectivos grupos controles. Después del tratamiento, los animales se anestesiaron para recolección de bilis, plasma y tejido hepático. Los niveles totales de colesterol plasmático y biliar fueron medidos por métodos enzimáticos. El colesterol lipoproteico plasmático se evaluó por fraccionamiento cromatográfico del plasma y medición enzimática del colesterol en cada fracción. La expresión hepática de SR-BI se cuantificó mediante western blot. Resultados: El uso de T3 o glucagón disminuyeron significativamente el colesterol plasmático total y aumentaron el colesterol biliar con respecto al grupo control correspondiente. Las fracciones de colesterol VLDL, LDL y HDL disminuyeron en ambos grupos tratados, con un mayor efecto observado en la fracción HDL. La administración de ambas hormonas aumentaron significativamente los niveles hepáticos de SR-BI. Conclusión: Los resultados establecen que T3 y glucagón disminuyen el colesterol plasmático, predominantemente de tipo HDL, y aumentan la secreción de colesterol biliar en el ratón, probablemente como consecuencia del incremento en la expresión hepática...

Introduction: The scavenger receptor class B type I (SR-BI) plays a key role in the metabolism of high-density lipoprotein (HDL) cholesterol. Its expression has an important anti-atherogenic effect by controlling the hepatic phase of the reverse cholesterol transport pathway in vivo. Thus, the study of the modulation of SR-BI expression may allow the development of new pharmacologic approaches for treatment of atherosclerotic cardiovascular disease. Objective: The goal of this study was to determine the effect of triiodothyronine (T3) and glucagon on HDL metabolism and hepatic expression of SR-BI in mice, evaluating also the impact in total and lipoprotein cholesterol as well as biliary cholesterol secretion. Methods: C57BL/6 mice were treated with T3 (30 nmol/kg/día) or glucagon (80 µg/día) in comparison to appropriate control groups. After treatment, bile, plasma and hepatic tissue were collected for analysis. Total plasma and biliary cholesterol levels were measured by enzymatic methods. Lipoprotein cholesterol was also measured enzymatically after chromatographic separation of plasma samples. The hepatic expression of SR-BI protein was quantified by western blotting. Results: The use of T3 or glucagon significantly decreased total plasma cholesterol levels and increased of biliary cholesterol concentrations compared to control groups. Levels of VLDL, LDL and HDL cholesterol were reduced in both treatment groups, with a more important effect observed in the HDL fraction. Both treatments increased hepatic SR-BI protein levels. Conclusions: These results show that T3 and glucagon decrease plasma cholesterol levels, particularly in HDL, and increase biliary cholesterol secretion in mice, probably as a consecuence of higher hepatic expression of SR-BI, which may have led to facilitated HDL cholesterol transport from plasma into bile.

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

C-reactive protein in patients with gallbladder and biliary tract diseases.

C-reactive protein (CRP) assay is widely used as a clinical tool for the evaluation of bacterial infections. No study has been undertaken to evaluate the presence of CRP and/or the estimation of this protein in the bile of patients with diseases of the gallbladder (GB). In the present study, we estimated the quantity of CRP in bile (n=358) as well as serum samples (n=186) obtained from patients with GB and biliary tract diseases, using the semiquantitative Avitex CRP kit. Bacteriological study was also done on the bile samples. CRP was positive in the bile of 56 patients, (15.6%) many of who had bacteriobilia. CRP was also present in 49 of the serum samples studied (26.3%). Control serum samples did not show any CRP within detectable limits. Hitherto, this is the first report that investigated the level of CRP in the bile of patients with GB and biliary tract diseases, along with biliary bacterial profile.

Oxysterol (3,5-cholestadien-7-one, 5beta-cholestan-3-one, 5,24-cholestadien-3beta-OL) Induced Cytotoxicity and Apoptosis in Gallbladder Epithelial Cells / 대한소화기학회지

BACKGROUND/AIMS: Biliary epithelial cells are exposed to highly concentrated oxysterols. Therefore, oxysterols may play a role in pathogenesis of biliary tract diseases. We investigated the cytotoxic effect and apoptosis inducing effect of oxysterol on gallbladder epithelial cells. METHODS: We studied the cytotoxic effect of 3,5- cholestadien-7-one, 5beta-cholestan-3-one and 5,24-cholestadien-3beta-OL which are identified in human bile and pigment gallstones on dog gallbladder epithelial cells (DGBE) and mouse gallbladder epithelial cells (MGBE). We used model bile to dissolve oxysterols as in vitro experiment and also used MTT, cell count, Diff-Quick stain, and flow cytometry to investigate cytotoxicity and apoptosis. RESULTS: Oxysterols dissolved in model bile have cytotoxic effects in a dose dependent fashion. In oxysterol containing model bile, viable cells are 51% in 500 microM 5beta-cholestan-3-one (cholesterol : oxysterol 50:50) and 47% in 5 mM 3,5-cholestadien-7-one (90:10) on MGBE, and are 129% and 38% in 500 microM (50:50) 3,5-cholestadien-7-one and 5beta-cholestan-3-one on DGBE, and are 74% and 71.5% in 5 mM (90:10) 3,5-cholestadien-7-one and 5beta-cholestan-3-one on DGBE, respectively. 500 microM (50:50) 3,5- cholestadien-7-one, 5beta-cholestan-3-one, and 5,24-cholestadien-3beta-OL treated on DGBE increase the apoptotic cell number as 22.0+/-8.8, 30.2+/-12.6, and 45.5+/-13.2%, respectively, compared with control (14.6+/-10.0%). 500 microM (50:50) 3,5-cholestadien-7-one, 5beta-cholestan-3-one, and 5,24-cholestadien-3beta-OL also affect the changes in cell cycles compared with the control. CONCLUSIONS: We concluded that oxysterol containing model bile is useful as an in vitro experiment as model to analyze the effects of oxysterols on biliary epithelial cells and that adequate concentration of oxysterols can induce the cytotoxic effect and the apoptosis on gallbladder epithelial cells.

The Role of Bile Carcinoembryonic Antigen in Diagnosing Bile Duct Cancer

It is known that the fluids bathing tumors might contain a higher level of the carcinoembryonic antigen (CEA) than those found in the blood. Therefore, we evaluated the role of bile CEA in diagnosing bile duct cancer. One hundred and thirty two patients were prospectively studied. The patients were divided into 3 groups: the bile duct cancer (n=32), pancreatic cancer (n=16), and benign biliary diseases (n=84) groups. Bile samples were obtained on the next day of the biliary drainage procedures. The mean bile CEA level in those with bile duct cancer (120.6+/-156.9 ng/mL) was significantly higher than those with pancreatic cancer and benign biliary diseases (32.0+/-28.5 ng/mL, 29.3+/-56.3 ng/mL). Using the level of 20 ng/mL, the sensitivity and specificity of bile CEA in the diagnosis of bile duct cancer from benign biliary diseases were 65.6% and 66.7%, respectively. Both the bile CEA and total bilirubin level were found to be an independent factor linked to bile duct cancer. This study result suggests that bile CEA level is a useful supplementary test for diagnosing bile duct cancer.

Epidemiological correlation between chromium content in gallstones and cholesterol in blood.

The authors measured the chromium in gallstones and bile from patients in three areas (Kawasaki (a city adjacent to Tokyo) in Japan, Chiang Mai and Bangkok in Thailand) by means of neutron activation analysis. The chromium in three types of gallstones (cholesterol, pigment, and rare stones) and bile from patients living in Bangkok were evidently larger than those from patients living in Kawasaki and Chiang Mai. The high chromium intake by Bangkok patients continued from the start of gallstone formation until the time the stones were removed. The total-cholesterol, triglyceride, and hemoglobin A(1C) levels in the blood from Bangkok residents with high chromium intake over a long period were clearly lower than those of Japanese and Chiang Mai residents. The authors showed that the high dietary intake of chromium over a long period may play a role in the lowering of total-cholesterol, triglyceride, and hemoglobin A(1C) in blood.

Comparison of effects of cholecystokinin and erythromycin on bile chemistry and gallstone formation in aged guinea pigs.

BACKGROUND: There has been considerable interest in gall bladder motility in recent years. We compared the effects of cholecystokinin (CCK) and erythromycin on bile chemistry and gallstone formation in aged guinea pigs. METHODS: Two groups of guinea pigs (1-mo and 3-y old; n=40 each) were studied. Each group was divided into four subgroups of 10 animals each; one subgroup received lithogenic diet, one each received CCK or erythromycin daily in addition to lithogenic diet for 4 weeks, and one received normal diet. After 4 weeks, the presence of gallstones or sludge was recorded and bile composition including concentrations of bile acid, cholesterol, lecithin and protein concentrations was studied. RESULTS: No gallstones were observed in the 1-mo-old animals. In the 3-year-old animals, 9 of 10 guinea pigs on lithogenic diet and 4 of 10 in each treatment subgroup and the normal diet subgroup developed gallstones. CCK and erythromycin had similar effects on bile chemistry and stone formation. CONCLUSIONS: Aging increases the formation of gallstones in guinea pigs. Erythromycin is as effective as CCK in reducing gallstone formation by improving gall bladder motility.

Role of duodenal bile crystal analysis in idiopathic pancreatitis.

BACKGROUND/AIM: The aim of this study was to find out the incidence and clinical use of duodenal bile crystal analysis in patients presenting with idiopathic pancreatitis. MATERIALS AND METHODS: Sixty consecutive patients with acute pancreatitis were studied. They were divided into two subgroups (known and unknown causes). Sixty patients were used as controls and divided into 3 subgroups (n = 20 each). The patients of acute pancreatitis with severe or life threatening complications or those requiring surgical interventions were excluded. Bile samples from both groups were analyzed for presence or absence of crystals. RESULTS: The maximum age incidence of acute pancreatitis was in the fifth decade (41-50 years). The M/F ratio was 3.6:1. Recurrent acute pancreatitis was observed in 26.6% cases (20% idiopathic vs. 6.6% known aetiology). Twenty-five percent of the control sub group (n = 20) cases of cholelithiasis without history of pancreatitis had positive microcrystals in their bile sample. In patients with idiopathic pancreatitis (n = 18), 7 cases (11.6%) had crystals in the bile. In those with known causes of pancreatitis (n = 42), 33 cases (55%) had positive crystals in the bile. CONCLUSION: Thirty percent of our patients had idiopathic acute pancreatitis with a high rate of clinical recurrence (20%). Duodenal bile crystal analysis detected 7 cases of microlithiasis out of 18 cases in this group and suggested an aetiology. This procedure should be used more often.

Microcristais biliares na pancreatite aguda idiopática: indicío para etiologia biliar oculta subjacente / Biliary microcrystals in idiopathic acute pancreatitis: cleu for occult underlying biliary etiology

The main causes of pancreatic inflammation worldwide are biliary lithiasis and alcoholism. However, 10 to 30 per cent of patients have been considered to have "idiopathic" acute pancreatitis. Recently, some studies showed that a significant rate of the so called idiopathic pancreatitis are caused by microlithiasis and/or biliary sludge, identified by the presence of cholesterol monohidrate and/or calcium bilirubinate microcrystals in the biliary sediment. In the present study, the analysis of microcrystals from bile obtained during endoscopic retrograde cholangiopancreatography was done in patients with pancreatitis (idiopathic, biliary or alcoholic-20 in each group). Patients with idiopathic pancreatitis and microcrystals in the bile underwent cholecystectomy whenever possible. Those who refused or were inapt to surgery underwent endoscopic sphincterotomy or received continuous therapy with ursodeoxycholic acid. Patients with idiopathic pancreatitis without biliary crystals did not receive any specific treatment. The prevalence of biliary microcrystals in patients with idiopathic pancreatitis (75 per cent) and biliary pancreatitis (90 per cent) was significantly higher than in those with alcoholic pancreatitis (15 per cent). In the identification of the etiology of biliary pancreatitis, the presence of microcrystals had a sensitivity of 90 per cent, specificity of 85 per cent, positive predictive value of 85.7 per cent, negative predictive value of 89.4 per cent and accuracy of 87.5 per cent...

Tissue plasminogen activator and plasminogen activator inhibitor-1 in human choledochal bile

Fibrinolytic properties have been detected in animal and human gallbladder (GB) bile. Plasminogen activator inhibitor-1 (PAI-1) has been reported in greater concentration in GB stone bile and may be a nucleating factor in the pathogenesis of GB stone formation. It is unknown whether or not human choledochal bile has similar properties, which could have a role in choledocholithiasis. The aims of this study were to determine the presence of fibrinolytic properties of human choledochal bile and to compare those properties among normal, acalculous, and calculous-infected choledochal bile. Tissue plasminogen activator (t-PA) and PAI-1 of choledochal bile were measured by enzyme linked immunosorbent assay in patients with cholangitis due to acalculous bile duct obstructions (n = 9), choledocholithiasis with cholangitis (n = 20), and normal bile (n = 7). The t-PA concentration of choledochal bile was no different among the three groups (acalculous-infected bile, median 4.61 ng/ml, and calculous-infected bile, 4.61 ng/ml, versus normal bile, 7.33 ng/ml). PAI-1 was detected in choledochal bile in significantly greater concentrations in patients with acalculous cholangitis due to bile duct obstructions and choledocholithiasis with cholangitis (acalculous-infected bile, median 0.36 ng/ml, and calculous-infected bile, 0.1 ng/ml, versus normal bile, 0.02 ng/ml, p < 0.05), but the bile concentration of PAI-1 was no different between the acalculous and calculous-infected choledochal bile. Human choledochal bile possesses t-PA and PAI-1. PAI-1 was present in greater concentrations in both acalculous and calculous-infected choledochal bile. Increased levels of PAI-1 may be an epiphenomenon of cholangitis rather than a factor in the pathogenesis of choledocholithiasis.

Comparative studies on iodine levels in gallstones and bile of Japanese and Thais (Chiang Mai and Bangkok).

We measured the iodine content of gallstones and bile from patients in three areas (Kawasaki in Japan, and Chiang Mai and Bangkok in Thailand) by means of neutron activation analysis. The mean values for iodine content in three types of gallstones (cholesterol, pigment and rare stones) and bile from patients living in Chiang Mai were clearly smaller than those from patients living in Kawasaki and Bangkok. The low iodine intake by Chiang Mai patients continued from the start of gallstone formation until the time when the stones were excised, and the iodine intake was low when bile was collected. The PBI levels in the sera of Chiang Mai residents with low iodine intake over a long period were clearly lower than those of Bangkok patients with normal intake, and the levels in goiter patients were similar to those in healthy people and patients with gallstones among Chiang Mai residents.

Lipids in biliary lithogenesis

Serum and biliary lipoproteins, total cholesterol [Tc] and triglycerides [TG] were measured in patients with gallstones and in those without gallstones. Serum and biliary LDLc, TG and Tc were significantly higher [P < 0.001] in cases having gall stones than those without stones while HDLc were low [P < 0.001] in those with stones. No difference was found in very low density lipoproteins [VLDLc] in the two groups. Present data showed that there is a statistically significant correlation of serum and biliary lipoproteins specifically LDLc and HDLc [r = +.67 and r = +.56]. This report shows that serum HDLc [67.42%] and LDLc [70.28%] play a more critical role in comparison to total cholesterol [59.43%] and triglyceride [57.15%] levels in the formation of gallstone

Microcristais e "barro biliar": patogênese e significado clínico / Microcrystals and biliary sludge: pathogenesis and clinical significance

RevisÒo da literatura referente Ó patogÛnese e o significado clÝnico dos microcristais e "barro biliar". SÒo descritas, tambÚm, as vantagens e limitações dos mÚtodos de investigaçÒo disponÝveis para detecçÒo destes precipitados microscópicos, assim como as situações clÝnicas nas quais sÒo indicados o estudo da bile para pesquisa de microcristais de colesterol e bilirrubinato de cßlcio. Finalmente, sÒo propostos algoritmos para tratamento das patologias biliopancreßticas causadas por microcristais e/ou "barro biliar".