Estado nutricional, actividad física y consumo de comida chatarra asociados a colelitiasis en huánuco: estudio de casos y controles / Nutritional status, physical activity and consumption of junk food were associating to colelitiasis in huánuco: a case-control study

Resumen Objetivos: Determinar la asociación entre el consumo de comida chatarra, actividad física y estado nutricional en pacientes con colelitiasis a la ecografía (casos), comparados con controles aparentemente sanos sin colelitiasis a la ecografía, en consulta externa del Hospital EsSalud II Huánuco. Materiales y Método: Estudio de casos y controles. Se incluyeron 107 casos y 107 controles. El consumo de comida "chatarra" se valoró con la encuesta validada por RSEQ (Red deportiva estudiantil de Québec), la frecuencia del consumo (días por semana); la actividad física por el cuestionario IPAQ (Cuestionario Internacional de Actividad Física) y el estado nutricional mediante el índice de masa corporal. En el análisis estadístico se empleó el χ2, U de Mann Whitney y Odds Ratio (p < 0,05). Resultados: La edad y la procedencia no fueron significativos. El consumo de comida "chatarra" estuvo asociado a la colecistitis (OR 10,30; IC 95% 5,48-19,37). La actividad física moderada-vigorosa (≥ 600 MET) promovió el diagnóstico de colecistitis (OR 8,38; IC 95% 4,54-15,48) y el estado nutricional (sobrepeso o mayor), en forma significativa, promovía la colecistitis (OR 11,38; IC 95% 6,01-21,55). Ser femenino estuvo asociado al desarrollo de colecistitis (OR 2,06; IC 95% 1,19-3,55). Conclusión: El consumo de comida "chatarra", la actividad física moderada-vigorosa (≥ 600 MET), el estado nutricional (sobrepeso o mayor) y el género (femenino) fueron asociados al desarrollo de colelitiasis diagnosticados mediante ecografía.

Aim: To determine the association between junk food consumption, physical activity and nutritional status in patients with cholelithiasis on ultrasound (cases), compared with apparently healthy controls without cholelithiasis on ultrasound, in an outpatient EsSalud II Hospital, Huánuco Hospital, 2017. Materials and Method: Case-control study. 107 cases and 107 controls were included. The consumption of junk food was assessed with the survey validated by RSEQ (Québec Student Sports Network), the frequency of consumption (days per week); Physical activity through the IPAQ questionnaire (International Physical Activity Questionnaire) and nutritional status through the Body Mass Index. The chi-square, Mann Whitney U and Odds Ratio (p < 0.05) were used in the statistical analysis. Results: Gender, age and origin were not significant. None or low consumption of "junk" food were associated with cholecystitis (OR 0.097; 95% CI 0.052-0.182). Low physical activity (< 600 MET) did not promote the diagnosis of cholecystitis (OR 0.119; 95% CI 0.064-0.22) and the nutritional status (normal weight), significantly, did not promote cholecystitis (OR 0.09; 95% CI 0.05-0.167). Being male was associated with the non-development of cholecystitis (OR 0.48; 95% CI 0.281-0.838). Conclusión: Low or no consumption of "junk" food, low physical activity (< 600 MET), nutritional status (normal) and gender (male) were associated for the non-development of cholelithiasis diagnosed by ultrasound.

Alterações histológicas da vesícula biliar de doentes submetidos à colecistectomia por colelitíase / Gallbladder histological alterations in patients undergoing cholecystectomy for cholelithiasis

RESUMO Objetivo: descrever os achados histológicos das vesículas biliares de pacientes submetidos à colecistectomia e avaliar a presença de fatores associados ao câncer incidental da vesícula. Métodos: estudo descritivo, transversal e observacional de 1.278 exames anatomopatológicos de vesículas biliares oriundas de colecistectomias por colelitíase e de seus respectivos laudos, realizadas no período de janeiro de 2008 a dezembro de 2017. Resultados: o achado anatomopatológico mais frequente foi a colecistite crônica, presente em 1.251 pacientes (97,8%), seguido pela colesterolose em 131 (10,2%). O câncer de vesícula foi identificado em seis pacientes, com prevalência de 0,5% nesta amostra. Houve associação significativa entre a presença de câncer e idade ≥60 anos e com a espessura da parede ≥0,3cm. Conclusão: houve baixa prevalência de câncer de vesícula na população avaliada, maior ocorrência na população idosa e associação de tumor com espessamento da parede vesicular.

ABSTRACT Objective: to describe the histological findings of the gallbladders of patients undergoing cholecystectomy and to evaluate the presence of factors associated with gallbladder incidental cancer. Methods: we conducted a descriptive, cross-sectional, observational study with 1,278 histopathological exams of gallbladders coming from cholecystectomy for cholelithiasis and of their reports, held from January 2008 to December 2017. Results: the most common pathological finding was chronic cholecystitis, present in 1,251 patients (97.8%), followed by gallbladder cholesterolosis, in 131 (10.2%). Gallbladder cancer was identified in six patients, with a prevalence of 0.5% in this sample. There was a significant association between the presence of cancer and age ≥60 years and wall thickness ≥0.3cm. Conclusion: there was low prevalence of gallbladder cancer in this population, higher occurrence in the elderly and association of the tumor with gallbladder wall thickness.

Colelitiasis fetal congénita / Congenital fetal cholelithiasis

La colelitiasis fetal es una patología poco frecuente, diagnosticada incidentalmente en el tercer trimestre del embarazo por medio de ecografía. Se ha reportado una incidencia entre 0,3 a 2,3% y una prevalencia de 1:200 a 1:1500. Potter fue el primero en reportar en 1928 un caso de colelitiasis congénita y neonatal, por medio de hallazgos anatomopatológicos que encontró en el período neonatal. En 1983 fue la colelitiasis fetal fue diagnosticada por primera vez por Beretsky y Lankin y desde entonces pocos autores han reportado sobre esta patología...

Experiencia con el método laparoendoscópico rendez-vous para manejo en un solo tiempo delitiasis vesicular y coledocolitiasis / Experience with laparoendoscopic rendez-vous approach in a single time management of vesicular lithiasis and choledocholithiasis

Se describe la primera experiencia con la utilización del método laparoendoscópico rendez-vous en el manejo de pacientes con litiasis vesicular y alta sospecha de coledocolitiasis en el servicio de Cirugía I del Hospital Universitario de Caracas. Método: Se aplicó el método rendez-vous a 8 pacientes que ingresaron con los diagnósticos de litiasis vesicular y alta sospecha de coledocolitiasis de forma electiva. Resultados: Se realizó la colangiografía intraoperatoria en 7 de 8 pacientes, se confirmó la presencia de coledocolitiasis en cuatro pacientes (57%) y se logró la extracción exitosa de cálculos de la vía biliar en 3 (75%) a través de colangiografía retrógrada endoscópica selectiva sobre guía biliar previa-mente colocada por el cirujano vía transcística. No se reportaron casos de pancreatitis post procedimiento ni casos de litiasis residual en 3 meses de seguimiento. La media de estadía hospitalaria fue de 9,75 días (2 ­ 25 días) y de estadía postoperatoria 2,87 días (1 ­ 7 días). Conclusión: El método rendez-vous se presenta como alternativa terapéutica mínimamente invasiva segura y exitosa para el manejo de pacientes con alta sospecha de coledocolitiasis y litiasis vesicular, trayendo como beneficios la resolución en un tiempo anestésico de ambas patologías, la disminución de las complicaciones de la CPRE y una estancia hospitalaria corta(AU)

We describe the first experience using laparoendoscopic "ren-dez-vous" approach in the management of patients diagnosed with simultaneous cholecystolithiasis and choledocholithiasis at General Surgery Department of "Hospital Universitario de Caracas". Method: Eight patients diagnosed with simultaneous cholecystolithiasis and choledocholithiasis underwent elective laparoendoscopic "rendez-vous" approach. Results: Intraoperative cholangiography confirmed choledocholithiasis in four patients (57%), lithiasis were successfully extracted on three of them (75%) using intraoperative endoscopic retrograde cholangiography after transcystic insertion of a guide wire to reach Vater's papilla. No post endoscopic retrograde cholangiography pacreatitis or residual common ductal stones were reported after a 3 months follow. Mean hospital stay was 9.75 days (2-25 days), and mean post operatory stay was 2.87 days (1-7 days). Conclusion: Rendez-vous approach isa minimal invasive, safe and effective choice available to the management of patients diagnosed with simultaneous cholecystolithiasis and choledocholithiasis, which is performed in a single anesthesia, needs a short hospital stay and lowers ERC complications(AU)

Colesterolosis y cáncer de la vesícula biliar / Association between cholesterolosis and gallbladder cancer

Background: Cholesterolosis is frequently observed in cholecystectomies performed for lithiasis or chronic cholecystitis. Aim: To determine the degree of association between cholesterolosis and gallbladder cancer. Material and Methods: In a prospective study of gallbladder cancer, all gallbladders obtained during cholecystectomies were processed for pathological study, following a special protocol. As part of this study, 23304 surgical samples obtained between 1993 and 2002 were studied, looking for a relationship between cholesterolosis and chronic cholecystitis, adenomas, dysplasia and gallbladder cancer. Results: Seventy nine percent of patients were women. Cholesterolosis was observed in 3,123 cases (13.4 percent). Cholesterolosis was more common in women (14.2 percent) than in men (10.2 percent) (p < 0.001). In the same period, 29 patients were diagnosed with adenomas (0.12 percent), 179 cases with dysplasia not associated with gallbladder cancer (0.8 percent) and 739 gallbladder cancer (3.2 percent). The frequency of cholesterolosis was 13.8 percent in chronic cholecystitis, 13.7 percent in adenomas, 12.1 percent in dysplasias and 1.35 percent in patients with gallbladder cancer (p < 0.01). Of the thirteen cases with gallbladder cancer and cholesterolosis, 10 were early gallbladder carcinomas. Patients with cholesterolosis were 9.2 times less likely to have cancer than those who did not have cholesterolosis. Conclusions: Cholesterolosis has a strong negative association with gallbladder cancer.

study of the histochemical alterations of mucin in cases of cholelithiasis and gall bladder tumors

To investigate the alterations in these oligosaccharide side chains in gall bladder epithelial cells by histochemical techniques to shed further light in elucidating the development of gall stones and gall bladder neoplasia. The study was conducted on 35 cholecystectomies performed over a period of 3 months started from September[1st] 2008 to December[1st] 2008 in the laparoscopic unit in Al-Jomhori Teaching hospital in western side of Mosul city in northern Iraq. Clinical details and pathological data were retrieved from the records. The cholecystectomy specimens that were received were fixed in 10% formalin. The gall bladders were classified into two groups [calculus and acalculus]. Multiple sections were taken from each gall bladder [body, neck, and fundus] for paraffin blocks and were examined after staining with hematoxylin and eosin [H and E] in the Laboratory of Postgraduate Studies at the Department of Anatomy, Histology and Embryology in Mosul College of Medicine. Microscopic examination was done to assess the type of different lesions including inflammatory infiltrate, presence of fibrosis, cholesterolosis, metaplasia, dysplasia, tumor or tumor-like lesion. To evaluate the intra-epithelial mucin content multiple sections were processed and stained with Alcian blue [AB] /Periodic acid Schiff's stain [PAS]. The histochemical analysis of mucin of the sections which showed normal gallbladder mucosa revealed that most of the cells of normal gallbladder epithelium exhibiting positive PAS reaction indicating the presence of neutral mucins, while the acidic mucins showed weak reaction by alcian blue but brown color staining were not observed indicating the absence of sulfomucins. Histochemical analysis of mucin of the stone-containing gallbladder epithelium which showed different histological findings including inflammatory infiltrate, presence of fibrosis, cholesterolosis, and Rokitansky-Aschoff sinuses, revealed that the intense blue staining of sialomucins along with the very weak staining intensity of neutral mucins in goblet cells was observed by PAS-AB at pH 2.5 with strong intensity of Sulfomucins with as shown by the brown staining of alcian blue at pH 1.0. Histochemical alteration of mucin in the cases of adenoma of the gall bladder revealed that the intense blue staining of sialomucins with the weak staining intensity of neutral mucins in goblet cells was observed by PAS-AB at pH 2.5 with strong reaction of sulfomucins. On the other hand, intense blue staining of sialomucins along with the moderate staining intensity of neutral mucins was observed in section which showed dysplastic changes and in those which was diagnosed as carcinoma of the gall bladder. This study concluded that the sulfomucins and then the sialomucins may have a greater role in gall stone formation than the neutral mucins

Colelitíase associada à anemia falciforme na infância / Cholelithiasis related to sickle cell disease in childhood

A colelitíase na infância é considerada uma situação rara. É mais comun em crianças do sexo feminino, entre 8 e 12 anos de idade. As causas mais comuns de coleitíase na crinça são as anemias hemolíticas, por causa das altas taxas de excreção da bilirrubina, devido à hemólise. No mundo, 40 por cento das crianças com anemia falciforme tem colelitíase. Os autores apresentam um caso de colelitíase associado à anemia faciforme em uma criança do sexo masculino, com 7 anos de idade, atendida no serviço de Cirurgia Pediátrica do HULW-UFPB. Após exame clínico, laboratorial e ultrassonografia, foi confirmado a colelitíase. Foi submetida à colecistectomia convencional, recebendo alta no quinto dia pós-operatório, evoluindo sem intercorrências

Double gall bladder with two disease processes.

A double gall bladder is a rare congenital anomaly which is usually diagnosed by preoperative ultrasonography. Either one, or both lobes, of the double gall bladder, may be diseased. We report a patient in whom the two lobes were affected by different disease processes, namely, cholesterosis, and cholelithiasis with mucocele.

Gallstone formation and gallbladder mucosal changes in mice fed a lithogenic diet

To investigate the pathologic change of gallbladder mucosa related to gallstone formation, 52 mice were fed a lithogenic diet containing 1% cholesterol and 0.5% cholic acid and we evaluated the sequential morphologic changes in the gallbladder from two days to 40 weeks. Cholesterol gallstones began to appear after two weeks and all the mice had gallstones after eight weeks. At two days, the mitotic index was at its highest. The gallbladder mucosa showed progressive hyperplastic change with earlier papillary projection of the folds and later inward proliferation. At the same time of stone formation, mucous cells forming glands appeared. Their histochemical profile of mucin was different from that of normal epithelium. Numbers of mucous cells increased gradually until 24 weeks but slightly decreased afterward. These results suggest hyperplasia and metaplasia are closely related to the gallstone formation. Hyperplasia is probably reactive to irritating effect of lithogenic bile or stone. Metaplasia and cholesterol gallstone may develop simultaneously, and act synergistically.

Neoplasias y displasias de vesícula biliar y su relación con litiasis. Estudio clinicopatológico de casos y controles / Neoplasm and dysplasia of the gallbladder and their relation with lithiasis. A case-control clinical-pathological study

Antecedentes. la litiasis es uno de los mayores factores de riesgo para cambios inflamatorios, metaplásicos, displásicos y neoplásicos de vesícula biliar, con frecuencia variable en diferenes poblaciones. Objetivo. determinar la frecuencia de asociación de los principales procesos patológicos y datos clínicos con litiasis vesicular. Material y métodos. estudio transveral, descriptivo de 1,367 piezas de colecistectomía, con (1,096) y sin (271) litiasis fue la siguiente: metaplasia psudopilórica 50 por ciento y 25 por ciento; metaplasia intestinal 16 por ciento y 2 por ciento; displasia de bajo grado 40 por ciento y 17 por ciento; displasia de alto grado 16 por ciento y 2 por ciento; carcinoma in situ 1.5 por ciento y 0 por ciento y carcinoma invasor 2.6 por ciento y 0 por ciento. El 80 por ciento de los casos con litiasis, el 65 por ciento de los casos de carcinoma in situ y el 90 por ciento de los casos de carcinoma invasor correspondieron a mujeres. La edad media de los pacientes con displasia de bajo y alto grado, carcinoma in situ y carcinoma invasor fue de 42, 48, 53 y 61 años, en ese orden. Conclusiones. la frecuencia de procesos inflamatorios agudos, colecititis crónica xantogranulomatosa, adenomiomatosis, metaplasia pseudopilórica e intestinal, pólipos hiperplásicos, displasia de bajo y alto grado, adenomas tubulares, carcinoma in situ y carcinoma invasor fue mayor en vesículas con litiasis que en vesículas sin litiasis (p<.05)

Litíase biliar em pacientes jovens: análise de 100 casos / Biliary lithiasis on young patients: analysis of 100 cases

Os autores apresentam um estudo retrospectivo de 100 pacientes submetidos à colecistectomia por litíase biliar com idade entre 12 e 30 anos no Hospital das Forças Armadas-DF no períodp de 1990 a 1995. Desses 100 pacientes, 47 (47,0 por cento) pacientes foram tratados por colecistectomia videolaparoscópica e 53 (53,0 por cento) por colecistectomia convencional. A prevalência da litíase biliar nesta faixa etária foi de 15,6 por cento (100/641) com predomínio do sexo feminino-88 (88 por cento). As manifestaçöes clínicas mais freqüentes foram a cólica biliar, as náuseas e vômitos. Um total de 89 (89,0 por cento) pacientes apresentavam colecistite crônica e 11 (11,0 por cento) colecistite aguda. A prevalência de coledocolitíase foi de 4,0 por cento. As complicaçöes pós-operatórias ocorreram em dois (2,0 por cento) casos e a mortalidade foi nula. O tempo de permanência hospitalar e as queixas pós-operatórias foram menores nos pacientes submetidos à colecistectomia videolaparoscópica, fazendo com que essa técnica seja uma boa opçäo no tratamento da colelitíase em jovens.

Quimiorradiación previo a cirugía en cáncer de la vesícula biliar / Chemoradiation before gallbladder cancer surgery

El cáncer de la vesícula biliar presenta diseminación prerentemente de tipo local, por lo cual su tratamiento debe ser de preferencia locorregional. Con el objetivo de conocer la factibilidad de emplear quimiorradiación previo a cirugía de tipo radical, desarrollamos un protocolo prospectivo. Desde abril de 1993 hasta octubre de 1995, incluímos a 13 pacientes portadores de un cáncer de la vesícula biliar diagnosticado luego del estudio anatomopatológico de la pieza de colecistectomía. Del total de pacientes, 12 completaron el esquema de qQuimiorradiación y fueron reintervenidos. De éstos, 11 fueron resecados con expectativas de cirugía curativa. El tiempo transcurrido entre el diagnóstico y el inicio del protocolo nunca fue superior a 2 meses. El efecto secundario más común relacionado a la quimiorradiación fue la presencia de plaquetopenia, observada en 6 pacientes. Del total de pacientes, 7 permanecen vivos con un seguimiento máximo de 32 meses. Como conclusión, podemos decir que el empleo de quimiorradiación previo a cirugía representaría una forma útil de terapia sin afectar mayormente la realización de cirugía radical. En la actualidad, está en desarrollo otro protocolo prospectivo randomizado tendiente a comparar el efecto de la quimiorradiación en relación al momento de la cirugía

Effect of cholestyramine on the formation of pigment gallstone in high carbohydrate diet-fed hamsters

This study was designed to investigate the effect of cholestyramine on the formation of pigment gallstones in high carbohydrate diet-fed hamsters and whether that effect occurred because of cholecystokinin action. Forty seven hamsters were divided into three groups: group I(n = 16) was fed on normal rodent chow(43% carbohydrate), group II(n = 14) was fed on a high CHO diet(65% carbohydrate), group III(n = 17) was fed on a high CHO diet containing 4% cholestyramine. Gallstones developed in 0% of group I, 42.9% of group II and 5.9% of group III(P 0.05). In gallbladder bile analysis, there was also no significant difference between group II and group III in cholesterol, phospholipid, total calcium, total bilirubin and bile acid levels. In conclusion, cholestyramine decreases the frequency of pigment gallstone formation in high CHO diet-fed hamsters, but it is not clear whether the mechanism of cholestyramine decreasing the gallstone formation is due to the action of cholecystokinin.

Bilicultivo de germenes aeróbios y sensibilidad antimicrobiana por función intraoperatoria en colecistitis aguda y colelitiasis en el H.R.H.D., mayo a julio 1995

Se realizó un estudio retrospectivo en 50 pacientes, 36 del sexo femenino y 14 masculino, que ingresaron al servicio de cirugía del HRHD, presentando cuadros de colecistitis aguda (52 por ciento) y de colelitiasis (48 por ciento), a quienes se les realizó biblicultivo por punción intraoperatoria. Encontrándose mayor incidencia en ambas patologías entre la 3 a 4 década de la vida. Se obtuvo un 52 por ciento de cultivos positivos y un 48 por ciento de cultivos negativos. Hubo mayor frecuencia de positividad entre los pacientes con colecistitis aguda (57.69 por ciento) y de colelitiasis (45.83 por ciento). Los gérmenes más frecuentes fueron E. coli (24 por ciento) y salmonella (16 por ciento), siendo más frecuente E. coli en colecistitis aguda (30.76 por ciento) y en colelitiasis con (20.83 por ciento) salmonella. Entre los fármacos con mayor sensibilidad destaca Lomefloxacina con 96.15 por ciento y cloramfenicol 88.46 por ciento, siendo E. coli y salmonella sensibles en un 100 por ciento a estos dos fármacos

Frequency of carcinoma in gall bladder specimens

A retrospective study on 485 surgically removed gall bladders was conducted in the Department of Pathology, Dow Medical College, Karachi, between 1st January 1991 to 31st December, 1994. Four hundred and twenty [86.60%] specimens of the gall bladder showed chronic cholecystitis and of these 239 were associated with cholelithiasis. Adenocarcinoma of the gall bladder was seen in 31 [6.39%] specimens and of these 20 were associated with cholelithiasis

Enfrentamiento quirúrgico de la litiasis biliar / Surgical confront of the biliary litiasis

Se presenta un casuística personal de 222 pacientes biliares sintomáticos. Se comunica su estudio preoperatorio, los procedimientos quirúrgicos y sus resultados. Se concluye que la patología biliar es un problema real, que hay un importante grupo de pacientes en los que debe resolverse complicaciones serias. Un buen método de estudio preoperatorio es el criterio clínico radiológico. La colangiografía intraoperatoria de rutina no influye en la prevención de daño de la vía biliar, siempre que se mantengan los principios básicos de la cirugía y, se reconfirman los buenos resultados de la colecistectomía laparoscópica

Asociación de colesterolosis y litiasis de la vesícula biliar: implicancia patogénica y efecto sobre la historia natural de la colelitiasis / Association between cholesterolosis and lithiasis of gallbladder: pathogenic implication and effect over natural history of cholelithiasis

We studied 793 patients subjected to cholecystectomy to determine a) the relative frequency of cholesterolosis and cholelithiasis b) the effect of their association on the natural history of biliary disease, c) the characteristics of gallstones associated to cholesterolosis and d) factors potentially associated to their pathogenesis. The gallbladders of all patients were examined and in 289 subjects a preoperative clinical history was taken. We observed that cholesterolosis is associated to earlier clinical manifestations of biliary disease and cholecystectomy, to a greater frequency of single calculus and to a higher weight/height index. It is concluded that there are relationships between the pathogenesis of cholesterolosis and cholelithiasis and that their association favors the development of clinical manifestations

Prevalência de litíase biliar em cirróticos: avaliaçäo necroscópica / Prevalence of biliary lithiasis in cirrhotics: necroscopic evaluation

Foram analisados os diagnósticos de 3.332 laudos de necropsias visando estabelecer uma possível associaçäo entre a cirrose hepática e a litíase biliar. Cálculos biliares ocorreram em 19,5 por cento dos 123 cirróticos e em 4,9 por cento dos 3.209 näo cirróticos da casuística analisada; conclui-se que a litíase foi significativamente mais freqüente nos cirróticos. Na tentativa de explicar tal associaçäo, säo implicados vários fatores, dentre os quais a hemólise crônica, o esvaziamento vesicular lento e a acidificaçäo defeituosa da bile pela vesícula. A proporçäo de casos de litíase no sexo feminino em relaçäo ao masculino foi de 2,08:1 entre os cirróticos e 2,4:1 entre os näo-cirróticos; tal diferença näo se mostrou significativa. Os cálculos pigmentares foram os mais comuns entre os cirróticos, sendo sua prevalência significativamente alta em relaçäo aos näo cirróticos, o que pode ser explicado pela hemólise crônica e por defeitos na conjugaçäo da bilirrubina. A litíase foi mais freqüente na cirrose biliar secundária, seguida de pós-necrótica de etiologia viral