Expectant management of patients with gallbladder stones diagnosed at planned investigation. A prospective 5- to 7-year follow-up study of 153 patients.

BACKGROUND: Few studies have been done on the expectant management of patients with cholelithiasis diagnosed by planned investigation, and results are conflicting. METHODS: A prospective 6-year follow-up study of 153 patients with cholelithiasis diagnosed by oral cholecystography was carried out. RESULTS: An acute gallstone complication occurred during the follow-up period in 23 patients (15%)-that is, acute cholecystitis (n = 18), acute pancreatitis (n = 2), and jaundice (n = 3). The annual risk of developing an acute biliary complication was 3.1%. A history of a gallstone complication predicted further gallstone complications during follow-up. The overall cholecystectomy rate was 20 % during the 1st year but fell to about 3% during the 5th year of follow-up. Young age and frequent attacks of biliary pain episodes predicted the need for gallstone surgery. CONCLUSIONS: Expectant management of patients with electively diagnosed cholelithiasis may be justified, especially in those with only occasional biliary symptoms and no history of gallstone complications.

Changes in the surgical treatment of gallstones during a 10 year period.

OBJECTIVE: To investigate changes in the surgical treatment of gallstones during a 10 year period. DESIGN: A retrospective study of medical records. SETTING: A community hospital serving a population of 108,000 inhabitants. SUBJECTS: All patients having their first operation for gallstones during the periods 1976-1978 and 1986-1988. RESULTS: The annual frequency of operations for gallstones decreased from 2.01 to 1.13/1,000 inhabitants, and the corresponding frequency of operations on the common duct decreased from 0.39 to 0.28. The percentage of urgent operations increased from 19 to 47. CONCLUSION: A decline in the prevalence of cholelithiasis or a more restrictive attitude of elective operations for gallstones, or both, would explain the overall reduction in surgery for gallstones. The introduction of endoscopic sphincterotomy has considerably changed the treatment of cholelithiasis. The increased age of the patients and higher percentage of urgent operations has not resulted in any increase in postoperative morbidity and mortality.

Prevalence of gallstone disease in patients with diabetes mellitus. A case-control study.

The prevalence of gallstone disease was analysed in 360 diabetic patients and in 359 control subjects. In 61 (17%) of the diabetic patients and 50 (14%) of the control subjects gallstone disease was verified by previous cholecystography, ultrasonography, or cholecystectomy. The remaining 608 with no history of gallstone disease were invited to have an ultrasound scan of the gallbladder; the prevalence of cholelithiasis was similar among diabetic patients (14.4% n = 28) and control subjects (12.5%, n = 26).

Physical constitution and biochemical characteristics of patients with electively diagnosed gallstone disease.

Physical characteristics and blood glucose and serum lipid concentrations were analysed in 196 patients with electively diagnosed cholelithiasis and 187 age and sex matched controls. A logistic regression analysis showed that women with cholelithiasis had more total body fat and were shorter than the female controls. There were no differences in anthropometric measurements between the men with gallstones and their controls. Patients of both sexes, however, had increased serum triglyceride and decreased serum cholesterol concentrations compared with control subjects.

Cancer of aberrant pancreas in jejunum. Case report.

One case of cancer originating in aberrant pancreatic tissue is presented. The literature is reviewed and the case is believed to be the first described located in the jejunum.