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Metabolic syndrome among patients with gallstone disease   a strong risk factor for postoperative wound infection after cholecystectomy,   a study from northeast India

Metabolic syndrome among patients with gallstone disease a strong risk factor for postoperative wound infection after cholecystectomy, a study from northeast India

Three components of metabolic syndrome were present in 27% of cases. All 5 components were present in 2% of cases. None of the components were associated in 31% of patients with gallstone disease. Only one patient had bile duct injury during operation which was diagnosed in the first postoperative day. Severe adhesions were noted intaoperatively around the gall bladder and Calot’s triangle. Patient later developed cutaneous biliary fistula and went into septic shock. She was managed aggressively and bile duct injury managed conservatively. Later SLE (Systemic Lupus Erethematosus) was diagnosed and revised treatment started. Patient improved and was discharged after 2 months. Nine out of 100 (9%) developed mild or less severe post operative wound infection out of which 8% had metabolic syndrome. This is discussed later in this section. Other complications were 3 patients developed post operative pyrexia which was treated with paracetamol and one patient developed cutaneous biliary fistula which was mentioned earlier. Majority of the patients had multiple stones(65%). Solitary stone were present among 20% and stones were double among 15%. Most common type of stone in our study was mixed type comprising 53%. It is followed by cholesterol stones and pigment stones which constitute 36% and 11% respectively.
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Comorbidity of the Metabolic Syndrome: Hyperuricemia, Gallstone Disease, Hormonal Disorders

Comorbidity of the Metabolic Syndrome: Hyperuricemia, Gallstone Disease, Hormonal Disorders

This article presents relationships between metabolic syndrome and gallstone disease, hyperuricemia, hormonal disorders and point out the most relevant picture for today. In the review the general pathogenetic mechanism of endothelial dysfunction formation in metabolic syndrome and hyperuricemia is revealed and described. Shown, that hyperuricemia is a marker of the metabolic syndrome. The symptoms of metabolic syndrome increase with increasing levels of hyperuricemia. The review found that it is obesity and insulin resistance are common leading risk factors for progression metabolic syndrome and gallstone disease. No association between gallstone disease and dyslipidemia unlike metabolic syndrome. Obesity is a common factor in the relationship between metabolic syndrome, gallstone disease and hormonal disorders. Insulin resistance is a common factor metabolic syndrome and polycystic ovary syndrome, the leading factor in the course of metabolic syndrome in menopause, hypopituitarism, and gallstone disease. Also, insulin resistance is a common factor in the comorbidity of gallstone disease and postmenopausal conditions. Obesity and insulin resistance are common factors of metabolic syndrome and benign prostate hyperplasia.
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Epidemiology of Gallstone Disease among Pregnant women in Egypt: Multicenter Study

Epidemiology of Gallstone Disease among Pregnant women in Egypt: Multicenter Study

Excessive energy, total fat, cholesterol, table sugar, saturated fat intake were significantly higher among pregnant women with gallstone disease. This may be primarily explained by contributing to obesity [9]. Insoluble fiber may protect against gallstone occurrence by speeding intestinal transit and reducing the generation of secondary bile acids such as deoxycholate, which has been associated with increased cholesterol saturation of the bile [20]. From the present work, significant higher mean daily nutrient intakes of monounsaturated fat, polyunsaturated fat, dietary fiber, vitamin C were among pregnant women without gallstone disease than cases. Dietary factors that may prevent the development of gallstones include polyunsaturated fat, monounsaturated fat, fiber and vitamin c, calcium and iron [9,21].
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Biliary lipid secretion in cholesterol gallstone disease  The effect of cholecystectomy and obesity

Biliary lipid secretion in cholesterol gallstone disease The effect of cholecystectomy and obesity

Cholesterol gallstone disease is initiated in a liver which produces abnormal bile with excess cholesterol relative to bile salts and phospholipid. To define the responsible secretory mechanism(s), the rate of biliary lipid secretion was measured by a duodenal marker perfusion technique, while the bile salt pool was simultaneously estimated by isotope dilution. Two groups of control patients expected to have normal biliary lipid composition--14 subjects without hepatobiliary disease and 6 patients with pigment

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Epidemiology and Risk Factor of the Gallstone Disease in a Southern Tropical Country

Epidemiology and Risk Factor of the Gallstone Disease in a Southern Tropical Country

Gallstone is a common medical and surgical problem in both developed and non-developed countries [1, 2]. Gallstone is a potentially serious pathology by its numerous complications, but especially, studies had shown the association between the carcinoma of gall bladder and the gallstones [3, 4]. This pathology deserves a particular attention because of their increasing frequency, which varies from country to country [5]. The development of cholelithiasis is multifactorial. It has been well documented that the presence of gallstones increases with age and that predisposing risk factors for gallstone formation include obesity, diabetes mellitus, estrogen and pregnancy, hemolytic diseases and cirrhosis [6]. Furthermore, diet can be a modifiable risk factor to prevent gallstone disease [7-9]. And in our country, despite the impact of globalization on dietary habits and lifestyle, the Malagasy culture keeps its features.
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Role of the ABCG8 19H risk allele in cholesterol absorption and gallstone disease

Role of the ABCG8 19H risk allele in cholesterol absorption and gallstone disease

The present study was performed to assess the role of cholesterol metabolism and intestinal transporters as related to the ABCG8 19H risk allele in gallstone disease. Four major observations were made: first, cholesterol absorption was decreased in gallstone carriers but chol- esterol synthesis was not significantly different between individuals with gallstones and controls. Second, the ileal expression of the sterol transporters ABGG5, ABCG8 and NPC1L1 as well as of their relevant transcription factors is similar between gallstone carriers and controls. Third, in the cohort of gallstone carriers and controls the D19H polymorphism of the ABCG8 gene was asso- ciated with a low cholesterol absorption but not with altered de novo synthesis. Fourth, the ileal expression of the ABCG8 gene is not influenced by the presence of the mutated allele 19H.
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Immunosuppressants and new onset gallstone disease in patients having undergone renal transplantation

Immunosuppressants and new onset gallstone disease in patients having undergone renal transplantation

Patients and methods: Renal transplantation (RT) recipients were identified from the National Health Insurance Research Database of Taiwan during January 1998–December 2012. In total, 2,630 adult patients, who had neither been diagnosed with gallstone disease (GSD) nor undergone cholecystectomy, were included in this study. These patients underwent follow-up till the diagnosis of GSDART was established. Risk factors and post-RT immunosuppressant treatments were investigated and analyzed using Cox regression analysis. The cumulative mortality in patients with and without GSDART was also evaluated.
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Comparative study of morbidity of laparoscopic versus open cholecystectomy in complicated gallstone disease

Comparative study of morbidity of laparoscopic versus open cholecystectomy in complicated gallstone disease

All patients underwent base line and specific investigations especially ultrasound of abdomen as diagnostic modality and for assessment of com- plicated gallstone disease. Inclusion criteria were all patients diagnosed as cases of complicated gallstone disease on the basis of history, clinical examination and investigations. Complicated gall- stone disease included cases of acute cholecysti- tis with phlegm, chronic cholecystitis with muco- cele, empyema and perforation with perichole- cystic abscess. Exclusion criteria included unfit patients for general anesthesia, pregnancy, patients with carcinoma of gall bladder, patients with acute pancreatitis and patients with obstructive jaundice. Follow up of all these patients was done at 6 month and one year to assess any complication and inquiry about resumption to work. The data was analyzed on SPSS software.
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Nationwide epidemiological study of severe gallstone disease in Taiwan

Nationwide epidemiological study of severe gallstone disease in Taiwan

The strengths of our study were use of a nationwide data with large sample size, presentation of incidence trends in the recent decade, and attention to all gallstone-related complications and procedures. However, it also had sev- eral limitations. First, in this study as in several large data- base studies conducted in the UK, US, and Canada, patients with severe gallstone disease were identified by ICD-9-CM codes. Consequently, we could not exclude the possibility of an increasing tendency to code biliary colic as acute cholecystitis among younger patients. However, it is less likely because the incidence of elective and non- elective cholecystectomy as well as admissions for ERCP tended to increase in this age group. Second, the propor- tion of patients with comorbidities was likely to be under- estimated because these were probably under-reported in the discharge diagnoses. Third, the outcome of interest in this study was hospitalization for severe gallstone disease and related complications. Patients visiting the emergency department were not counted due to lack of data from ambulatory care records. And finally trends relating to gallstone location and composition could not be analyzed because this information was not available in the data- base.
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Clinical predictors of incident gallstone disease in a Chinese population in Taipei, Taiwan

Clinical predictors of incident gallstone disease in a Chinese population in Taipei, Taiwan

The estimated incidence of GSD in this study was higher in females compared with males, and increased as age increased. This finding is consistent with the re- ports of other studies conducted elsewhere [2,13]. GSD is rare in neonates and young children [5]; thus, long- term exposure to risk factors may explain the increased probability of developing GSD in old age. The morbidity of GSD increases as age increases, noticeably elevating after age 40 and becoming 4- to 10-fold more likely [15]. Although GSD patients are often clinically silent, the symptoms of GSD and number of severe complications increase as age increases, leading to cholecystectomy in more than 40% of patients older than 40 [5,16]. In addition, gender is a substantial factor in GSD and fe- males are almost twice as likely as males to develop stones [15]. Female sex hormones adversely influence hepatic bile secretion and gallbladder function and estro- gens increase cholesterol secretion and diminish bile salt secretion [5]. Thus, females do not have a significantly Table 1 The attendance rate of gallstone disease
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Development of a duodenal gallstone ileus with gastric outlet obstruction (Bouveret syndrome) four months after successful treatment of symptomatic gallstone disease with cholecystitis and cholangitis: a case report

Development of a duodenal gallstone ileus with gastric outlet obstruction (Bouveret syndrome) four months after successful treatment of symptomatic gallstone disease with cholecystitis and cholangitis: a case report

Gallstone ileus accounts for approximately 1% to 4% of all cases of mechanical bowel obstruction. However, in the population over the age of 65 it is the cause of 25% of non-strangulated small bowel obstructions. Diagnosis is often delayed and mortality is high, ranging at 15% to 18%, which may also reflect the age and comorbidity of affected patients [1]. Gallstones usually enter the bowel through a biliary enteric fistula, which complicates 2% to 3% of cases of cholecystolithiasis with associated epi- sodes of cholecystitis [2]. Due to the sedimentation of intestinal content, gallstones increase in diameter as they pass the bowel. The majority of obstructing gall- stones are located in the terminal ileum (50% to 75%), followed by the proximal ileum and jejunum (20% to 40%). Gallstones impacted in the duodenum account for less than 10% [3]. A gastric outlet obstruction secondary to an impacted gallstone in the duodenum or pylorus is called Bouveret syndrome. It was first described in 1896 by the French internist Leon Bouveret, and up to 1999 only 175 cases had been described in the medical litera- ture [4]. Our case is a rare description of Bouveret syn- drome developing four months after successful treatment of symptomatic gallstone disease and after a four-month period with no symptoms.
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Relation of cholesterol metabolism to pediatric gallstone disease: a retrospective controlled study

Relation of cholesterol metabolism to pediatric gallstone disease: a retrospective controlled study

cholestanol, of which solely the latter one reflects chole- stasis. This findings support the view that plant sterols may be involved in the pathogenesis of BPS. Further research is needed to evaluate whether screening for high serum cholestanol ratios could be helpful in early detec- tion of gallstones at high risk groups. Cholesterol homeo- stasis with increased cholesterol synthesis and low cholesterol absorption together with high ISO-BMI in the pediatric CS group resembles those risk factors associated with CS disease described in adults and with the metabolic syndrome. Identification of this clinical connection gives tools to decrease the risk for the pediatric CS disease. High cholesterol synthesis in both stone subclasses sup- port the view of increased biliary cholesterol secretion, which consequently enables cholesterol supersaturation in bile. This phenomenon displays that these two stone sub- classes share a similarity with this respect in the pathogen- esis of gallstone formation.
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A study of gallstone disease

A study of gallstone disease

OPERATIVE BILIARY ENDOSCOPY (CHOLEDOCHOSCOPY) At operation, a flexible fibreoptic endoscope can be passed down the cystic duct into the common bile duct enabling stone identification and removal under direct vision. The technique can be combined with an X ray image intensifier to ensure complete clearance of the biliary tree. After exploration of the bile duct, a tube can be left in the cystic duct remnant or in the common bile duct (a T tube) and drainage of the biliary tree established. After 7 to 10 days a track will be established. This track can be used for the passage of a choledochoscope to remove residual stone in awake patients. This technique is invaluable in the management of difficult stone disease and prevents the excessive prolongation of an operative exploration of the common bile duct.
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Strong association between metabolically-abnormal obesity and gallstone disease in adults under 50 years

Strong association between metabolically-abnormal obesity and gallstone disease in adults under 50 years

Many studies have reported age as a major risk fac- tor for gallstones [8, 26 – 28]. In addition, the elderly population has been shown to have a higher rate of gallstone-associated complications, such as cholecyst- itis and gallstone pancreatitis, and a higher rate of surgical complications after cholecystectomy [29, 30]. A study by Li et al. revealed HCV to be a substantial risk factor for gallstones in populations older than 60 (adjusted OR: 2.394 (1.066–5.375)) [31]. We found a similar result in our study: in the older groups (≥50 years old), HCV infection was the only significant risk factor for gallstones. However, this effect was not seen in the younger group (< 50 years old). The preva- lence of gallstones in younger participants (< 50 years old) with both metabolic syndrome and obesity was similar to that observed in metabolically healthy and non-obese older participants ( ≥ 50 years old) (7.2% vs. 6.8%; P = 0.837). Therefore, the effect of metabolic syndrome and obesity on gallstones in younger partic- ipants was similar to the effect of age on gallstones in older participants without metabolic syndrome and obesity. The HCV infection rate was lower in the younger population, with the prevalence of both metabolic syndrome and obesity in young adults increasing gradually in Taiwan. HCV may also have a close association with insulin resistance and hepatic steatosis [32, 33]. All these factors (HCV infection, insulin resistance, or hepatic steatosis) were positively correlated with gallstones [31, 34]. Whether the rela- tionship between HCV and metabolic syndrome has a synergistic effect or a causal relationship on gallstone formation requires further study [35]. Our study also showed that the effect of metabolic syndrome and
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A comparative study between open and Laparoscopic cholecystectomy in gallstone disease

A comparative study between open and Laparoscopic cholecystectomy in gallstone disease

Most series quote a major bile duct injury rate of around 0.2% during OC, whereas the incidence of bile duct injuries during LC is 0.40% or higher.10 These injuries can cause major morbi[r]

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Disorders of bile acid metabolism in cholesterol gallstone disease

Disorders of bile acid metabolism in cholesterol gallstone disease

deoxycholic (DCA), cholic (CA), and chenodeoxycholic acid (CDCA) in 23 female gallstone patients classified according to their gallbladder function and in 15 healthy female controls. Gallstone patients had normal hepatic bile acid synthesis, but, depending on gallbladder function, differed with respect to turnover and size of the bile acid pools: Patients with well- emptying gallbladder (group A, n = 9) had enhanced turnover and reduced pools of CA (- 46%; P less than 0.01 vs. controls) and CDCA (-24%; P less than 0.05), but normal input and size of the DCA pool. With reduced gallbladder emptying (less than 50% of volume; group B, n = 6), turnover and pools of CA, CDCA, and DCA were similar as in controls. Patients with loss of gallbladder reservoir (group C, n = 8) had increased input (+100%; P less than 0.01) and pool size of DCA (+45%; P = 0.07) caused by rapid conversion of CA to DCA, while the pools of CA (-71%; P less than 0.001 vs. controls) and CDCA (-36%; P less than 0.05) were reduced by enhanced turnover. Thus, in patients with cholesterol
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Obesity Not Necessary, Risk of Symptomatic Cholelithiasis Increases as a Function of BMI

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Female patients outnumbered male patients in cholelithiasis group (male to female ratio 1/1.8), while the opposite was the case in non- cholelithiasis group (male to female ratio 1.14/1). However, overall male to female ratio was in favour of female patients (male to female ratio 1/1.16). The mean age of total population was 35.89years with a maximum number of patients in 31-40years of age group. Patients in non-cholelithiasis group (mean age 35.1years) were almost 2 years younger than the patients in cholelithiasis group (mean age 37.09years). In the cholelithiasis group, female patients had gallstone disease at a little younger age (36.6years) compared to male patients (37.97years). Nepali patients were around 18 to 24-month-older (37.03years) than the rest of their counterparts (between 35 and 35.5years).
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A Study on Knowledge, Perceptions and Attitudes about Screening and Diagnosis of Diabetes in Saudi Population

A Study on Knowledge, Perceptions and Attitudes about Screening and Diagnosis of Diabetes in Saudi Population

Our study concludes that the gold standard in the management of symptomatic cholelithiasis is laparoscopic cholecystectomy. To prevent postoperative infection related complications in low-risk patients with symptomatic gallstone disease undergoing elective laparoscopic cholecystectomy one single dose of prophylactic antibiotic injected at induction of anesthesia antibiotic prophylaxis is sufficient. Post-operative infective complications after elective laparoscopic cholecystectomy for cholelithiasis do not reduced by post-operative antibiotics.
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A Study on Clinical Profile and Short Term Follow Up of Acute Cholecystitis

A Study on Clinical Profile and Short Term Follow Up of Acute Cholecystitis

Acute cholecystitis is considered the most frequent complication of gallstone disease. Inflammation of the gallbladder wall that is associated with a clinical picture of abdominal pain, right upper quadrant tenderness, fever, and leukocytosis is the hallmark of acute cholecystitis. In 90% of acute cholecystitis, the cause is a gallstone that obstructs the cystic duct. In 10% of cases, cholecystitis occurs in the absence of gallstones and is termed acute acalculous cholecystitis. Although it is classical, it is inappropriate to divide cholecyctitis in acute and chronic forms as they are part of spectrum of same disease.
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Overexpression of Sterol Carrier Protein 2 in Patients with Hereditary Cholesterol Gallstones

Overexpression of Sterol Carrier Protein 2 in Patients with Hereditary Cholesterol Gallstones

Cholesterol gallstone formation is a complicated process involving a variety of factors. The abnormal metabolism of liver cholesterol and supersaturation of bile cholesterol are the major causes of stone formation. In recent years, some scholars have finished a series of epidemiological studies in high-risk populations about cholelithiasis [16-18] and have made some interesting findings. The gallstone disease is a genetic disease involving multiple genes and having the genetic characteristic of autosomal dominant delay. Gallstone formation is caused by com- mon genetic factors along with multiple environmental factors. Interactions between related genes and environ- mental factors play an important role in the pathogenesis of gallstone formation.
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