Chronic Gallstone Research Articles

From Chronic Gallstone to Acute Ileus: A Case Report

From Chronic Gallstone to Acute Ileus: A Case Report

Chronic Gallstone Ileus Presenting as Acute Small Bowel Obstruction: A Case Study

Chronic Gallstone Ileus Presenting as Acute Small Bowel Obstruction: A Case Study

Cholecystocolonic Fistula (CCF) Case Report

Introduction: Gallbladder disease is one of the most common conditions affecting the digestive tract. Autopsy reports have shown a prevalence of gallstones ranging from 11-36%, with cholecystitis being one of the most prevalent complications. Although cholecystoenteric fistulas are rare, with an incidence of 0.15-0.5% among patients undergoing cholecystectomy, they can present significant diagnostic and therapeutic challenges. The transverse colon is the second most common site for these fistulas after the duodenum. A high degree of suspicion is required to diagnose it preoperatively. Here, we present a noteworthy case of a 65-year-old male patient with a fistula between the gallbladder and transverse colon, complicated by severe adhesions and a large stone, underscoring the complexities associated with this condition. Case Presentation: The patient had a history of hypertension and gallbladder stones when he was admitted during the COVID-19 pandemic with acute cholecystitis. Two years later, he had an elective laparoscopic cholecystectomy and, during surgery, the surgical team noticed significant adhesions around the gallbladder. Further inspection during dissection of the gallbladder bed revealed a fistula between the transverse colon and the gallbladder, and a single large stone was identified. The patient’s surgical procedure was successful, and his postoperative recovery was uncomplicated. Conclusion: A fistula between the gallbladder and transverse colon is a rare complication of gallbladder disease, and the transverse colon is the second most common cholecystoenteric fistula after the duodenum. The presence of a fistula is usually a late sequence of chronic gallstone disease that requires appropriate diagnosis and correct treatment. In this case, the surgery was complicated by extensive adhesions around the gallbladder with an adjacent colon and a large stone with a fistula noted between the transverse colon and the gallbladder. However, through careful planning, correct surgical procedures, and skilled surgical expertise, the patient’s condition after surgery lacked complications. This case focuses on the importance of addressing all possible complications of gallbladder disease and adjusting surgical procedures accordingly.

S1676 The Great Escape: The Rare Type V Mirizzi Syndrome

Introduction: Mirizzi syndrome is a rare complication of chronic gallstone disease, defined as the obstruction of the common bile duct (CBD) or common hepatic duct (CHD) secondary to compression from gallstone impaction Hartmann’s pouch. It is categorized based on the presence and degree of cholecystobiliary fistula formation; however resultant cholocystoenteric fistulas are rare. We discuss the case of a patient who presented to the outpatient clinic with evidence of painless jaundice and on further evaluation, was found to have type Vb Mirizzi syndrome. Case Description/Methods: A 44-year-old male currently on suboxone for previous opioid use disorder presented for evaluation of painless jaundice. He denied fevers, chills, abdominal pain, nausea, or vomiting. Laboratory investigations noted AST 65 IU/L, ALT 46 IU/L, ALP 347 IU/L, total bilirubin 16.9 mg/dL (direct bilirubin 13 mg/dL), albumin 3.4 g/dL, INR 1.1, negative viral serologies and acetaminophen level < 5 mcg/mL. CT abdomen with contrast showed pneumobilia, smooth hepatic contour, and splenomegaly [Figure 1A]. Endoscopic retrograde cholangiopancreatography (ERCP) showed spontaneous air in the biliary tree with bile emanating from a fistulous tract in the duodenal bulb [Figure 1B]. Contrast dye injection filled up the gallbladder thus confirming the presence of cholecystoduodenal fistula. Cholangiogram demonstrated an obstruction in the mid-CBD caused by a 22 mm stone in the gallbladder, protruding into the bile duct [Figure 1C]. The bile duct was stented and the patient underwent open cholecystectomy with CBD stone removal and repair, along with cholecsytoduodenal fistula disconnection and closure. Discussion: Mirizzi syndrome is uncommon with an incidence of < 1% per year. While previously classified as type I (extrinsic compression of the CHD or CBD without a cholecystobiliary fistula) or type II-IV (including a cholecystobiliary fistula), more recently, an extended classification has introduced type V Mirizzi syndrome encompassing types I-IV with the concomitant identification of a cholecystoenteric fistula. It is further subclassified as type Va and Vb (i.e., without and with gallstone ileus, respectively). Given that it encompasses the other subtypes, the treatment option primarily depends on the obstructing biliary lesion type. It is crucial to carefully evaluate and correctly identify patients' chronic gallstone disease complications as they can affect further endoscopic and surgical management.Figure 1.: Figure 1A: CT abdomen with contrast showing pneumobilia (red arrows); Figure 1B: Fistulous tract noted in the duodenal bulb on direct visualization (yellow arrow); Figure 1C: Cholangiogram demonstrating an obstruction in the mid common bile duct consistent with a large, approximately 22 mm bile duct stone in the gallbladder, protruding into the bile duct (red circle).

Comparative Study Of Open Cholecystectomy In Acute And Chronic Cholelithiasis In Rural Centre Of India.

The incidence of cholecystitis with cholelithiasis is increasing day by day either acute or chronic cases. Gall stones are the most common cause of acute cholecystitis in 90-95% of the cases. The management of acute cholecystitis is still laparoscopic cholecystectomy in urban area of India but in rural area open cholecystectomy is still preferred method of surgery for acute as well as chronic gall stone. Our study was conducted on 100 patients divided into two groups of 50 of each to compare the results of open cholecystectomy between acute and chronic cases. The overall post-operative morbidity was more in acute cases. But there was significant difference in the total hospital stay and total cost of the therapy in both the groups. drain output was also high in first three days in acute case so, acute case cholecystectomy was found to be more expensive overall and higher length stay and more co morbidities than chronic cases.

Features of the course of rheumatoid arthritis and osteoarthritis in patients with asymptomatic hyperuricemia

Introduction. According to numerous studies, the prevalence of asymptomatic hyperuricemia has increased in most countries. Uric acid is an important biomarker of the cardiovascular system, and there are now quite a big number of sources indicating its role in the development of a some chronic metabolic conditions, cardiovascular disease and associated mortality. At present, there is no consensus on the need for urate-lowering therapy in patients with asymptomatic hyperuricemia. There is a limited number of studies examining the problem of asymptomatic hyperuricemia in patients with rheumatic diseases, the features of comorbidity in these conditions, the frequency and effectiveness of urate-lowering therapy.&#x0D; Purpose. To study the peculiarities of the course of rheumatoid arthritis and osteoarthritis with associated asymptomatic hyperuricemia and compare them with the ones associated with arthragra.&#x0D; Materials and methods. The analysis was performed on the basis of the data collected from the city register of the patients with arthragra and asymptomatic hyperuricemia in St. Petersburg. The data collected included the medical records of 1725 patients with arthragra, 433 patients with rheumatoid arthritis and hyperuricemia and 355 patients with osteoarthritis and hyperuricemia.&#x0D; Results. The patients with rheumatoid arthritis and hyperuricemia were more likely to have increased erythrocyte sedimentation rate and C-reactive protein, the highest medium level of erythrocyte sedimentation rate; acute myocardial infarction, chronic heart failure, gallstone disease and non-alcoholic fatty liver disease were more frequently detected. The patients with osteoarthritis and hyperuricemia were more likely to have high total cholesterol, at its highest medium level; stable angina, arrhythmia, varicosity, obesity, prediabetes and type 2 diabetes mellitus were more likely to be detected. Kidney damage was detected more frequently in the patients with arthragra. In the group of rheumatoid arthritis and hyperuricemia urate-lowering therapy was started in 30.95% of the patients, in the group of osteoarthritis and hyperuricemia in 36.06%.&#x0D; Conclusions. In rheumatic diseases, hyperuricemia is a common associated condition. Their combination leads to increased risk and frequency of cardiovascular, metabolic and gastroenterological comorbidity. The prescription of urate-lowering therapy to the patients with rheumatic diseases and asymptomatic hyperuricemia with high cardiovascular risk led to the target uric acid levels in 34.58% of the patients with rheumatoid arthritis and 52.08% of the patients with osteoarthritis.

When endoscopy pulls chestnuts out of the fire: a rare case of Mirizzi's syndrome treated with laser lithotripsy by direct peroral cholangioscopy.

Mirizzi’s syndrome is a possible complication of chronic gallstone disease and surgery remains the preferred approach for treatment in symptomatic patients [1]. An endoscopic approach is usually considered only a “bridge-to-surgery” treatment for decompressing the common bile duct (CBD) by papillotomy and stent (or nasal bile drainage) placement [2]. Here we describe the potential role of holmium laser lithotripsy under direct peroral cholangioscopy in a singular case of Mirizzi’s syndrome ([Video 1]).

Gallstones and Biliary Tract Disease

Gallstones (cholelithiasis) are hardened deposits of digestive fluid that can form in the gallbladder and bile ducts. Gallstones range in size from as small as a grain of sand to as large as a billiard ball. Some people develop a single gallstone, whereas others develop many. Gallstone disease or disorders may encompass biliary pain, acute and chronic cholecystitis, choledocholithiasis, and gallstone pancreatitis. Gallstones (cholelithiasis) and biliary tract diseases constitute a common and costly health problem in the United States. This chapter reviews the formation of the two principal types of stone, the cholesterol stone and the pigment stone, that form in the gallbladder and biliary tract. The prevention of gallstones is discussed. The diagnosis, differential diagnosis, treatment, and complications of acute cholecystitis are presented. Diagnosis and treatment of chronic cholecystitis, asymptomatic cholelithiasis, choledocholithiasis, Mirizzi syndrome, and gallbladder polyps are also discussed. Common bile duct stricture, primary sclerosing cholangitis, recurrent pyogenic cholangitis, choledochal cyst, and sphincter of Oddi dysfunction are summarized. This review contains 6 figures, 19 tables, and 111 references. Keywords: Gallbladder, gallstones, cholecystectomy, biliary sludge, cholangitis, choledocholithiasis, cholecystitis, endoscopic retrograde cholangiopancreatography

Clinical pathway combined with enhanced recovery after surgery in patients with chronic cholecystitis and gallstones

Objective To investigate the effect of enhanced recovery after surgery (ERAS) on the clinical pathway of laparoscopic cholecystectomy in patients with chronic cholecystitis and gallstones. Methods From June 2017 to December 2017, 94 patients with chronic cholecystitis and cholecystolithiasis underwent laparoscopic cholecystectomy in the Department of General Surgery of First Hospltal of Huainan City were analyzed retrospectively. All patients were included in clinical pathway management. According to whether the perioperative period was combined with ERAS, there were 45 cases in the study group and 49 cases in the control group. The study group was combined with ERAS during perioperative period, while the control group received traditional perioperative management. The preoperative hospitalization days, operative time, intraoperative bleeding volume, total hospitalization days, postoperative complications, hospitalization costs, postoperative hospitalization days, clinical pathway completion rate and positive and negative variation rates were compared between the two groups. The measurement data were expressed by (Mean±SD), and the comparisons between groups were performed by t test; Comparisons of count data were analyzed using chi-square test or Fisher exact probability. Results Preoperative hospitalization days, operation time, intraoperative bleeding volume, total hospitalization days and postoperative complications in the study group were (3.3±1.2) d, (63.1±24.3) min, (9.4±3.9) ml, (7.1±1.5) d and 1 case respectively, while those in the control group were (3.2±1.5) d, (68.4±25.4) min, (9.5±2.9) ml, (8.4±1.8) d and 2 cases respectively, and the differences between the two groups ware not statistically significant (P>0.05). Postoperative hospitalization days, hospitalization expenses and shortened hospitalization days in the study group were (2.9±0.8) d, (9 407.2±500.9) yuan and 64.4%(29/45) respectively, while those in the control group were (4.5±1.1) d, (10 594.9±792.3) yuan and 36.7%(18/49) respectively. The difference between the two groups was statistically significant (P<0.05). Conclusion Laparoscopic cholecystectomy for chronic cholecystitis with cholecystolithiasis combined with ERAS during the implementation of clinical pathway can shorten postoperative hospital stay, reduce hospitalization costs, increase the positive variation rate of clinical pathway without increasing postoperative complications. Key words: Enhanced recovery after surgery; Cholecystolithiasis; Clinical pathway

Case of thrombosis of the portal vein and its branches in a patient seropositive for Borrelia antigens

Borreliosis after sucking ticks is an acute problem in the world. People do not go to doctors after that often, which leads to the development of various complications. Thrombosis of veins of various localization can be one of them. Thrombosis of the portal vein represents a significant problem too with high morbidity and mortality. The risk factors for splanchnic vein thrombosis include infections, but its relationship with borreliosis has not been studied. А 34-year-old man with chronic helicobacter-associated gastritis and gallstones was hospitalized due to development during the last 11 days of epigastric pain and fever to 38.7 °C after a picnic at the forest without a registered tick bite. The blood leukocytes were increased to 11.2*109/l, lymphocytes 70%, C-reactive protein 34.6 mg/l, procalcitonin 0.195 ng/ml. The multispiral computed tomography of the abdominal cavity revealed thrombosis of portal, lienalis and superior mesenteric veins. D-dimer was 1.98 mcg/ml, antithrombin III 75%. JACK2V617F, oncological, rheumatic, thrombophilia markers, blood and urine cultures were negative. A high concentration of anti-Borrelia burgdorferi IgM 62.2 U/ml and its increasing to 190 U/ml in dynamics was revealed at the immunofluorescence assay. Anti-Borrelia IgM to OspA, p31 and OspC, p25 were detected at the immunoblotting assay. Anticoagulation, doxycycline, detoxification therapy reduced pain and normalized temperature and inflammation markers. Vein thrombosis was not detected at the control tomography after 2 weeks. Despite that the combination of thrombosis and borreliosis is rare, it is necessary to screen for Borrelia antigens in patients with splanchnic vein thrombosis and fever.

Cholecystocutaneous abscess: A rare presentation of a common problem

Fistulating cholecystocutaneous abscess is a known rare complication of chronic gallstones disease. In these modern days, this complication is exceedingly rare due to early diagnosis with radiological imaging, use of broad spectrum antibiotics and early surgical management of biliary tract disease. Here we present a case of an 89-yearold with cholecystocutaneous abscess that was mistaken for simple subcutaneous abscess. The management include initial control of subcutaneous abscess and use of antibiotics followed by definitive surgical excision of gall bladder and the fistula tract.

Spectral and morphological classification of different chronic and acute Taiwanese gallstones via FTIR, SEM and ESEM-EDX microanalyses

BackgroundGallstone disease is one of the leading upper gastrointestinal surgical problems in different countries. AimsTo analyze the chronic gallstones and acute gallbladder sludge retrieved from 36 Taiwanese patients. MethodsFTIR microspectroscopy was used to classify the types of gallstones, and an ESEM-EDX microanalysis was first applied to determine the microstructural features and elemental compositions of the various gallstones. Bacteria presented on the surface of gallstones were also detected by SEM. ResultsFour types of gallstones were obtained from these 36 Taiwanese patients: calcium bilirubinate (CaBR) stones (30.6%), cholesterol stones (19.4%), mixed stones including 6 subtypes (47.2%), and acute gallbladder sludge (2.8%) made of CaBR and protein/insoluble biomaterials. Bacteria imprints and bacterial discharges or bacterial biofilms were also found on the surface of gallstones and acute sludge under a SEM observation. ESEM-EDX results revealed that calcium was found to be the main constituent of all of the types of stones except cholesterol stones, and aluminum was also presented in most of the stones and sludge samples. Chloride was only detected in the acute gallbladder sludge. ConclusionFTIR spectra, morphological features, and elemental compositions of the acute gallbladder sludge were different from those of the chronic gallstones.

Comparative analysis of MDCT and MRI in diagnosing chronic gallstone perforation and ileus

ObjectTo evaluate MDCT and MRI in identifying chronic gallstone perforation (GSP) and ileus, even the risk factors prior to perforation. MethodsTwenty-three cases of gallstone ileus (GSI) and three cases of calculus gallbladder–choledochus perforation were scanned by MDCT before treatment. Meanwhile, twelve patients received two-view abdominal X-ray film and eight patients received MRI examination. All images were analyzed respectively and blindly to the results of surgery or interventional endoscopy, besides five cases of MDCT and one case of MRI images scanned before GSP were analyzed comparatively. ResultsMDCT could identify 100.0% of intestinal obstruction and pneumobilia of GSI, it had not statistical difference with abdominal X-ray film. But MDCT could differenciate and precisely locate 88.5% of the ectopic stone, higher than that of abdominal X-ray film (50%), p value˂0.05, moreover it presented cholecystitis, edema or discontinuous walls of gallbladder and intestine and bilio-enteral fistula (26.9%). MRI and MRCP could precisely visualize the fistula (100%) and the ruptured bile duct. Abnormal edema or thin gallbladder wall, large stone size (>2cm) and incarceration in the neck of gallbladder, the blurring fat line between gallbladder and duodenum were considered main risk signs prior to GSP. ConclusionMDCT is being considered as an effective and reliable technique to identify GSP and GSI early, however MRI and MRCP will aid to differentiate the complex GSP. It will be a considerable prospective for MDCT and MRI to estimate the risk factors prior to gallbladder perforation.

Diagnosis and clinical characteristics of acute gallbladder sludge in a patient with acute myocarditis and acute cholecystitis, as compared with common chronic gallstones

Diagnosis and clinical characteristics of acute gallbladder sludge in a patient with acute myocarditis and acute cholecystitis, as compared with common chronic gallstones

Successful simultaneous laparoscopic management of large retroperitoneal lipoma and chronic gallstone cholecystitis

Successful simultaneous laparoscopic management of large retroperitoneal lipoma and chronic gallstone cholecystitis

Simultaneous surgeries in patients with chronic gallstone disease

Simultaneous surgeries in patients with chronic gallstone disease

Mo1675 Learning Curve of Direct PerOral Cholangioscopy Using Ultra Slim Gastroscopes

Mo1675 Learning Curve of Direct PerOral Cholangioscopy Using Ultra Slim Gastroscopes Jochen Weigt*, Arne Kandulski, Peter Malfertheiner Gastroenterology, Hepatology and Infectious Diseases, University Magdeburg, Magdeburg, Germany Direct peroral cholangioscopy (POCS) is an emerging technique complementing ERCP. Unless several data show the feasibility and clinical relevance of POCS, only few data about the learning process of this technique are available. Aim: To investigate the technical success rate and learning process of POCS in a tertiary center. Methods: All patients were investigated with standard ERCP and biliary sphincterotomy directly prior to cholangioscopy. After removal of the duodenoscope, an ultra slim gastroscope was directly advanced to the duodenum. The common bile duct was intubated using the balloon anchor technique. All POCS procedures were performed with water irrigation. Histology was taken from suspicious lesions. The investigation times and the success rates were calculated. Special caution was given to the time from oral intubation until visualization of the bile ducts, that served as a key technical parameter. Results: A total of 28 POCS were performed. Intubation was successful in 24/28 (86%). Reasons for failed intubation were small caliber bile ducts, duodenal diverticulum and papillary adenoma. The mean intubation time was 9.5 min (3-23 min). The average intubation time did not change significantly over time (R*2 -0.05). The variance of intubation times changed over time and was 35,7 min in the first half of investigations and 13,5 min in the second half. Complications did not occur. Conclusions: The technique of direct peroral cholangioscopy using the balloon anchor technique in combination with ultra-slim gastroscopes is technically demanding but learning does not show a long learning period at last in a tertiary center. However the technical measures present signs of adaptation and learning of the technique.Nevertheless, as POCS is not yet a standard technique, we suggest that POCS may only be performed by experienced endoscopists. Mo1676 Evaluated Experimental Model of Gallstone Cholecystitis Available for Miniinvasive Surgical Procedures Ondrej Ryska*, Zuzana Serclova, Jan Martinek, Radek Dolezel, Stefan Juhas, Jana Juhasova, Bohus Bunganic, Miroslav Ryska Department of Surgery and 2nd Medical Faculty, Central Military Hospital, Prague 6, Czech Republic; Hepatogastroenterology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Department of Internal Medicine, Central Military Hospital, Prague, Czech Republic; Institute of Animal Physiology and Genetics, Academy of Sciences, Libechov, Czech Republic Background: Natural orifice transluminal endoscopic surgery (NOTES), single port laparoscopy (SILS) and other miniinvasive surgical techniques are recently under the experimental investigation. Cholecystectomy as a most frequent laparoscopic procedure is usually the subject of evaluation where the clear benefits of new approaches should be proved. Experimental studies using healthy animals with physiological finding on gallbladder are lacking for the clinical relevance. The aim of the experimental study was to create and evaluate surgical model of gallstone cholecystitis in large animal. Material And Method: Model creation: 14 pigs weighing 40.3 10.0 kg were included. Laparoscopy (3 ports) was performed under general anesthesia. Bile from the gallbladder was aspirated and cholecystotomy was done. Three to five gallstones obtained by human cholecystectomy were inserted and incision was closed. Evaluation: 11 pigs with artificial cholelithiasis the laparoscopic cholecystectomy (3-port access) was performed. This group was compared to 10 cholecystemies in pigs without lithiasis. All pigs were euthanized 30th postoperative day (POD) and the autopsy performed. The protocol was approved by committee for the protection of the animals. Results: All animals survived without severe complications. Model procedure took 42 (35-150) minutes. White blood cells (WBC) count increased 1.POD and 2.POD markedly; 18.7 (10.4-23.7)x109/l and 16.7 (8.3-27.8)x109/l); and remained slightly higher till 7.POD 15.4 (9.2-22.8)x109/l. CRP levels were higher on 1st, 2nd and 3rd POD 12.4 (6.9-21.4, 13.3 (1.4-35.7) and 13.0 (8.117.8)mg/l) and decreased to normal levels till 7.POD. Levels of interleukin 6 were the highest 2 hours after surgery 472.7 (50.9-1286) and decreased the 1.POD 80.8 (36.4-153) and the 2.POD 35.6 (8.257.2) pg/ml. The ultrasound signs of chronic gallstone cholecystitis were observed 4 weeks after intervention, which was also confirmed by histology. Laparoscopic cholecystectomy in gallstone model took longer time compare to healthy animals: 63 (42-91) minutes vs. 46 (31-62) minutes (p 0,0182). The perioperative gallbladder perforation was significantly less more frequent in healthy pigs 1/10 vs. 8/11 (RR: 7,27; CI95%: 1,09-48,3; p 0,04) as well as postoperative complications rate nonsignificantly lower 0/10 vs. 2/11 (2 abscesses in gallbladder bed) at autopsy (RR: 4,58; Cl95%: 0,25-85,3; p 0,307). Conclusion: Simple surgical model of gallstone cholecystitis was created as a reliable tool for accurate evaluation of NOTES and other miniinvasive procedures. Sonographic and histological signs of inflammation with no elevation of inflammatory markers were observed 4 weeks after intervention. The laparoscopic cholecystectomy was technically more difficult in cholecystitis model than in healthy animals. Supported by a grant from IGA NT12250-4

924 Long-Term Outcomes in Antimitochondrial Antibody Negative Primary Biliary Cirrhosis

were hazard ratios (HRs) for later hepatobiliary disease in women with ICP at ,1 year, 15 years, .5 years after delivery and odds ratios (ORs) for developing ICP in preexisting hepatobiliary disease. Risk estimates were calculated through Cox regression and logistic regression analysis. Results:Womenwith ICP were more often diagnosed with later hepatobiliary disease (HR 2.62; 95% CI 2.47-2.77; increment at 1% per year), hepatitis C or chronic hepatitis (HR 4.16; 3.14-5.51 and 5.96; 3.43-10.33, respectively), fibrosis/cirrhosis (HR 5.11; 3.29 -7.96), gallstone disease or cholangitis (HR 2.72; 2.55-2.91, and 4.22; 3.13-5.69, respectively) as compared to women without ICP (p,0.0001 for all HRs). Later ICP was more common in women with prepregnancy hepatitis C (OR 5.76; 1.30-25.44; p=0.021), chronic hepatitis (OR 8.66; 1.05-71.48; p=0.045), and gallstone disease, (OR 3.29; 2.025.36; p,0.0001). Conclusions: Women with ICP have substantially increased risk for later hepatobiliary disease. We found beyond gallstone-related morbidity a strong positive association between ICP and hepatitis C both before and after ICP diagnosis. Thus, we advocate testing for hepatitis C in women with ICP, in particular, since this potentially life-threatening infection can be treated successfully in the majority of patients.

Value of serum5' nt and hepatic enzyme in diagnosing biliary tract carcinoma and benign biliary lesion

Objective To evaluate the value of serum 5' NT and hepatic enzyme in diagnosing biliary tract carcinoma and benign biliary lesion. Methods Serum 5 ' NT, TBIL, DBIL, IBIL, ALP and GGT were detected in 74 patients with biliary tract carcinoma,70 with chronic cholecystitis,68 with chronic cholecystitis and gallstone, which had been confirmed by operation or pathologic diagnosis, and 70 with normal control. Results Serum 5' NT in patients with carcinoma of gallbladder and cholangiocarcinoma was significantly higher than their benign and normal controls (P ＜ 0. 05) , but there was no significant difference between group with obstruction and without obstruction(P ＞ 0. 05) , neither between benign biliary tract disease and normal(P ＞0. 05). Signifi cant positive correlation was observed between 5' NT and ALP, GGT (r = 0. 665, r = 0. 519; F = 57.16, F =26. 588, P ＜ 0.05). The specificity and sensitivity of 5' NT and ALP, GGT in diagnosing biliary tract carcinoma were 95.65% and 94. 59%. Conclusion Combined detection of serum 5' NT and ALP, GGT is a sensitive and effective biochemical indicator in diagnosing biliary tract carcinoma. Key words: Neoplasm of biliary tract; Benign biliary lesion; 5' NT; ALP; GGT

Expression of CCL3 and its receptor CCR1 in gallbladder adenocarcinoma and its benign lesions and its clinico-pathological significance

Objective To study the expression of CCL3 and its receptor CCR1 in gallbladder adenoearcinoma and gallstone tissues and explore its clinicopathological significance. Methods SP im-munohistochemical method was used to detect expression of CCL3 and CCR1 in routinely paraffin-em-bedded sections from 108 cases of gallbladder adenocarcinoma, 15 of chronic choleeystitis and 20 of gallstone. Results The positive rates and scores of CCL3 and CCR1 were significantly higher in gall-bladder adenocarcinoma than in chronic cholecystitis and gallstones (P<0. 01). Meanwhile, they were markedly lower in the cases of adenomatous canceration or highly differentiated adenoearcinoma, the maximal diameter of mass <2 cm,without lymph node metastasis or without infiltration of regional tissues than in those of lowly differentiated adenocarcinoma, maximal diameter of mass ≥2 cm, with lymph node metastasis or with infiltration of regional tissue (P<0. 05 or 0. 01). Conclusion The CCL3 and its receptor CCR1 might be important biological markers for reflecting the carcinogenesis, progression,biological behaviors and prognosis of gallbladder adenocarcinorna. Key words: Gallbladder neoplasm; Chemokines; C-C chmokine receptor-1; Immunohisto-chemistry