ABSTRACT
delta 6-Lithocholenic acid was identified in small amounts in fecal samples in vitro after incubation with ursodeoxycholic acid and in vivo in controls and after chenodeoxycholic and ursodeoxycholic acid ingestion. Fourteen to 45.0% of delta 6-[24-14C]lithocholenic acid was biotransformed in vitro in feces within 30 s. After colonic instillation of delta 6-[24-14C]lithocholenic acid, 50% of the radioactivity appeared in bile acids, most of it in lithocholic acid, within 3 h. Jejunal perfusions with delta 6-[24-14C]lithocholenic acid showed 33-92% absorption. One hour after jejunal instillation of 1 mmol, 4.4-27.5% of the biliary radioactivity was found in ursodeoxycholic, chenodeoxycholic, lithocholic, and 7-ketolithocholic acids. A sulfated glycine conjugate of delta 6-lithocholenic acid was identified in bile. One hour after intravenous injection of delta 6-[24-14C]lithocholenic acid, 40.1-42.6% of biliary radioactivity appeared in 7-ketolithocholic, chenodeoxycholic, lithocholic/isolithocholic, and ursodeoxycholic acids. The studies show that delta 6-lithocholenic acid is 1) formed in colonic lumen from chenodeoxycholic and ursodeoxycholic acids, 2) well absorbed in small intestine, and 3) biotransformed in both the colonic lumen and liver. The studies also identified delta 6-lithocholenic acid as a new intermediate in formation of lithocholic acid. Finally, the studies showed that a small portion of delta 6-lithocholenic acid is excreted as a sulfated glycine conjugate in bile.
Subject(s)
Intestinal Absorption , Lithocholic Acid/analogs & derivatives , Bile/metabolism , Biotransformation , Chenodeoxycholic Acid/pharmacology , Feces/chemistry , Humans , Lithocholic Acid/biosynthesis , Lithocholic Acid/chemistry , Lithocholic Acid/pharmacokinetics , Liver/metabolism , Reference Values , Ursodeoxycholic Acid/pharmacologyABSTRACT
A patient with biliary pain and a densely calcified gallbladder stone was treated successfully with piezoelectric extracorporeal shock-wave lithotripsy. The gallstone was fragmented to particles of less than 1-2 mm in diameter in a single 1-h session. The procedure was performed in the outpatient setting and required no anesthesia or analgesia. Follow-up sonograms showed that clearance of residual fragments from the gallbladder had occurred within 1 wk. Our encouraging treatment result suggests the need for future research to be directed towards broadening the currently recommended criteria for biliary lithotripsy, which currently exclude treatment of densely calcified gallstones.
Subject(s)
Calcinosis/therapy , Cholelithiasis/therapy , Lithotripsy/methods , Biliary Tract Diseases/therapy , Calcinosis/diagnosis , Cholecystography , Cholelithiasis/diagnosis , Colic/therapy , Gallbladder/pathology , Humans , Male , Middle Aged , Recurrence , UltrasonographyABSTRACT
There are no absolutely reliable methods of detecting precancerous change in the colons of patients with ulcerative colitis. Periodic surveillance colonoscopy and biopsy are the mainstay of follow-up of patients with extensive, longstanding disease.
Subject(s)
Colitis, Ulcerative/complications , Colonic Neoplasms/prevention & control , Colon/pathology , Humans , Mass Screening , Risk FactorsABSTRACT
The purpose of the present study was to examine the relationship between the "tumor marker," CA19-9, and benign biliary tract disease. We measured serum and bile CA19-9 in 40 patients with (1) symptomatic cholelithiasis (N = 14), (2) common bile duct obstruction without cholangitis (N = 8), (3) acute cholangitis secondary to gallstone disease (N = 7), and (4) acute cholecystitis (N = 11). All seven patients with acute cholangitis had marked elevations of serum CA19-9 (range 190-32,000 units/ml; 75 units/ml cutoff), whereas none of the patients in the other groups had elevated levels despite similar degrees of cholestasis and similarly high levels of CA19-9 in gallbladder and common duct bile (range 7.3 X 10(4)-2.3 X 10(9) units/ml). Of the three patients with cholangitis in whom CA19-9 levels were followed serially, all had rapid return of levels to normal after successful treatment. We conclude that the "tumor marker" CA19-9 is markedly elevated in the serum of patients with acute cholangitis but not in patients with other forms of benign biliary tract disease.
Subject(s)
Antigens, Tumor-Associated, Carbohydrate/analysis , Biomarkers, Tumor/analysis , Cholangitis/immunology , Bile/immunology , Cholangitis/surgery , Cholestasis/immunology , Female , Humans , Male , Middle Aged , Prospective Studies , Statistics as TopicABSTRACT
A 37-year-old homosexual man was evaluated for a one-week history of hematochezia. Results of a physical examination were remarkable only for grossly bloody stool. Sigmoidoscopy to 30 cm showed a friable mucosa compatible with an acute colitis, and a rectal biopsy specimen demonstrated an increased plasma cell infiltrate. Stool cultures subsequently yielded Aeromonas hydrophila; serum human T-cell lymphotropic virus type III antibody titer was positive. The patient responded to a course of treatment with sulfamethoxazole and trimethoprim with resolution of his symptoms and restoration of the bowel to a normal sigmoidoscopic appearance. Aeromonas hydrophila infection should be considered in the differential diagnosis of acute proctocolitis, particularly in patients with underlying immunodeficiency states.
