Chenodeoxycholic acid administration monitored by serum bile acid profiles: a dose-response study.

Serum bile acid analysis was used to monitor the bile acid composition of bile in 16 healthy male volunteers before and during the oral administration of different doses of the gallstone-dissolving bile acid, chenodeoxycholic acid. Daily chenodeoxycholic acid ingestion increased the percentage of this bile acid in bile to a new steady-state level after two to three weeks. Doses of 125, 250, 500, and 750 mg/day significantly increased the proportion of chenodeoxycholic acid in bile from 41% to 55, 61, 78, and 79%, respectively, during the fourth week of ingestion. The results indicate that useful information concerning chenodeoxycholic acid-induced changes in the bile acid composition of bile can be obtained solely by serum bile acid analysis, and bile collection by duodenal intubation can be avoided.

Effect of synthetic oestrogens and progestagens in oral contraceptives on bile lipid composition.

The prevalence of cholesterol gall stones in young women has increased since the introduction of oral contraceptives. The synthetic female sex hormones used in these preparations, increase the degree of cholesterol saturation in bile. To determine whether oestrogens, progestagens, or both, are responsible for the change in biliary cholesterol saturation index, a prospective randomised, controlled study was performed. A significant increase in the cholesterol saturation index of bile was observed when either 30 micrograms ethinyloestradiol plus 150 micrograms norgestrel (p = 0.01) or 50 micrograms ethinyloestradiol plus 250 micrograms norgestrel (p less than 0.01) were ingested daily for two months. No change in the cholesterol saturation index was observed when 30 micrograms ethinyloestradiol alone, or 30 micrograms ethinyloestradiol plus 2.5 mg norethisterone were used. The mechanism for the increase in cholesterol saturation index did not appear to involve bile acid metabolism. These results indicate that the progestagen, norgestrel, and not as previously thought the oestrogen, ethinyloestradiol, is responsible for the increase in cholesterol saturation of bile which accompanies the use of oral contraceptives.

PIP: The prevalence of cholesterol gall stones in young women has increased since the introduction of oral contraceptives. The synthetic female sex hormones used in these preparations increase the degree of cholesterol saturation in bile. To determine whether estrogens, progestagens, or both, are responsible for the change in biliary cholesterol saturation index, a prospective randomized, controlled study was performed. A significant increase in the cholesterol saturation index of bile was observed when either 30 mcg ethnylestradiol plus 150 mcg norgestrel (p=0.01) or 50 mcg ethinylestradiol plus 250 mcg norgestrel (p0.01) were ingested daily for 2 months. No change in the cholesterol saturation index was observed when 30 mcg ethinylestradiol alone, or 30 mcg ethinylestradiol plus 2.5 mg norethisterone were used. The mechanism for the increase in cholesterol saturation index did not appear to involve bile acid metabolism. These results indicate that the progestagen, norgestrel, and not as previously thought the estrogen, ethinylestradiol, is responsible for the increase in cholesterol saturation of bile which accompaines the use of oral contraceptives.

Precision and accuracy in the measurement of the cholesterol saturation index of duodenal bile. Lack of variation due to the menstrual cycle.

The reproducibility of measurement of the cholesterol saturation index of duodenal bile has been investigated in 5 healthy male and 10 healthy female volunteers. Two possible causes for variation in the saturation index were examined. First, the precision of the assays for cholesterol, bile acids, and phospholipids was such that after replicate analysis of eight individual bile samples, analytic variation produced cholesterol saturation index values which covered a mean range of 0.09 +/- 0.01 (SEM). Secondly, biologic variation was observed in all volunteers when eight duodenal bile samples were collected on different days over a 1-month period. Biologic plus analytic variation accounted for large fluctuations in the biliary cholesterol saturation index, covering a mean range of 0.32 +/- 0.05 (SEM). The magnitude of both types of variation was the same for men and women and was not related to physiologic changes in sex hormone levels during the menstrual cycle. After allowing for analytic variation, the cholesterol saturation index of duodenal bile accurately reflected that of gallbladder bile when collected at the same time from gallstone patients at operation.

Why do surgical packs cause peritoneal adhesions?

Our experiments in the Porton rat have shown that the foreign debris from surgical sponges left in the peritoneal cavity after use is not the cause of peritoneal adhesions. Instead, the abrasive effect of introducing the sponge produces mesothelial trauma. This is the stimulus for an inflammatory response, followed by adherence of adjacent involved peritoneal surfaces. Adhesions formation did not occur between the abraded peritoneal surfaces of mobile intraabdominal viscera, which suggests that intestinal motility in the early postoperative period is important in the prevention of adhesions.

Comparison of accuracy of 99mTc-pyridoxylidene glutamate scanning with oral cholecystography and ultrasonography in diagnosis of acute cholecystitis.

A prospective study of 116 patients admitted as emergencies with a clinical diagnosis of acute cholecystitis or biliary colic has shown that the best investigation for confirming a diagnosis of acute cholecystitis is 99mTc-pyridoxylidene glutamate (PG) scanning. Its sensitivity is 99% and its specificity 86%, whereas those of oral cholecystography are 75% and 82%, respectively, and those of ultrasonography are 54% and 62%, respectively. However, estimation of plasma liver enzymes is essential to exclude acute hepatitis before proceeding to early cholecystectomy.

Do surgical packs cause peritoneal adhesions?

In spite of the growing variety of materials being used in the manufacture of intraabdominal packs (sponges), no data have been published on their adhesion-producing properties. We have shown that the Porton rat will reliably produce peritoneal adhesions in response to ischaemia and glove powder. In a randomized control trial using this rat model, we tested the adhesogenic potential of two commercially available surgical packs. Both brands of pack were shown to cause a significant incidence of postoperative peritoneal adhesions (P is less than 0.005), irrespective of whether the packs were used wet or dry. It is recommended that the adhesogenic potential of all products for use within the peritoneal cavity be established in an animal model prior to marketing.