Different Types Of Gallstones Research Articles

Integration of bile proteomics and metabolomics analyses reveals novel insights into different types of gallstones in a high-altitude area

BackgroundTo explore the pathogenesis of different subtypes of gallstones in high-altitude populations from a molecular perspective.MethodsWe collected bile samples from 20 cholesterol gallstone disease (CGD) patients and 20 pigment gallstone disease (PGD) patients. Proteomics analysis was performed by LC/MS DIA, while metabolomics analysis was performed by UPLC- Q-TOF/MS.ResultsWe identified 154 up-regulated and 196 down-regulated differentially expressed proteins, which were significantly enriched in neurodegenerative diseases, energy metabolism, amino acid metabolism etc. In metabolomics analysis, 20 up-regulated and 63 down-regulated differentially expressed metabolites were identified, and they were significantly enriched in vitamin B6 metabolism. Three pathways of integrated proteomics and metabolomics were significantly enriched: porphyrin and chlorophyll metabolism, riboflavin metabolism and aminoacyl-tRNA biosynthesis. Remarkably, 7 differentially expressed proteins and metabolites showed excellent predictive performance and were selected as potential biomarkers.ConclusionThe findings of our metabolomics and proteomics analyses help to elucidate the underlying mechanisms of gallstone formation in high-altitude populations.

Gallbladder microbial species and host bile acids biosynthesis linked to cholesterol gallstone comparing to pigment individuals.

Gallstones are crystalline deposits in the gallbladder that are traditionally classified as cholesterol, pigment, or mixed stones based on their composition. Microbiota and host metabolism variances among the different types of gallstones remain largely unclear. Here, the bile and gallstone microbial species spectra of 29 subjects with gallstone disease (GSD, 24 cholesterol and 5 pigment) were revealed by type IIB restriction site-associated DNA microbiome sequencing (2bRAD-M). Among them (21 subjects: 18 cholesterol and 3 pigment), plasma samples were subjected to liquid chromatography-mass spectrometry (LC-MS) untargeted metabolomics. The microbiome yielded 896 species comprising 882 bacteria, 13 fungi, and 1 archaeon. Microbial profiling revealed significant enrichment of Cutibacterium acnes and Microbacterium sp005774735 in gallstone and Agrobacterium pusense and Enterovirga sp013044135 in the bile of cholesterol GSD subjects. The metabolome revealed 2296 metabolites, in which malvidin 3-(6''-malonylglucoside), 2-Methylpropyl glucosinolate, and ergothioneine were markedly enriched in cholesterol GSD subjects. Metabolite set enrichment analysis (MSEA) demonstrated enriched bile acids biosynthesis in individuals with cholesterol GSD. Overall, the multi-omics analysis revealed that microbiota and host metabolism interaction perturbations differ depending on the disease type. Perturbed gallstone type-related microbiota may contribute to unbalanced bile acids metabolism in the gallbladder and host, representing a potential early diagnostic marker and therapeutic target for GSD.

Evaluation of Different Types of Gallstones Extracted by Endoscopic Retrograde Cholangiopancreatography

Objective: To study frequency of various types of gall stones extracted from bile duct using ERCP Study design: This is a cross sectional study Study place and duration: Study was conducted in the department of Gastroenterology Sir Ganga Ram Hospital Lahore. Study was completed in six months duration from January 2022 to June 2022. Materials and methods: Diagnosed cases of bile duct stones were underwent ERCP and extracted stones were analyzed to determine their composition. Ages of the patients were 20-70 years. Cases of either gender irrespective of residential area were included in this study. Patients with ischemic heart disease, asthma, liver cirrhosis, malignancy, tuberculosis, chronic obstructive pulmonary disease, interstitial lung disease and pregnancy were excluded from the study. During ERCP gross findings of the stones were noted. Results: Total 140 cases were studied having bile duct stones including 55(39.3%) male and 85(60.7%) females. There were 80(57%) cases with the age ≤50 years and 60(42.9%) cases above 50 years. Mean age of the patients was 46 ± 4.72 years. 58(41.4%) cases were from rural area and 82(58.6%) from urban area. Diabetes, hypertension and obesity was found in 38(27%), 47(33.6%) and 49(35%) cases respectively. Cholesterol stones were found in 51(36.4%), mixed stones in 70(50%) and brown pigmented stones in 19(13.6%) cases. Conclusion: Mixed cholesterol gall stones were most commonly found followed by pure cholesterol and brown pigmented stones. Keywords: Gallstones, Bile duct stones, ERCP, Endocscopy, Cholesterol stones,

Evaluation of bile duct stones extracted by ERCP (Endoscopic Retrograde Cholangio-Pancreatography).

Objective: To determine the frequency of different types of gallstones on ERCP stone extraction from bile duct. Study Design: Cross Sectional study. Setting: Department of Gastroenterology of the Nishtar Hospital Multan. Period: September 2019 to October 2020. Material & Methods: Patients with bile duct stones on imaging of either sex aged 18 – 70 years were included in our study while patients with IHD, malignancies, liver cirrhosis, asthma, TB, COPD, ILD and pregnant women were excluded from our study. During ERCP the gross appearance of extracted stones and related findings were noted. Results: Our study included 139 patients meeting inclusion criteria, of these 139 study cases, 49 (35.3%) were male and 90 (64.7%) were female patients with bile duct stone. Mean age was 45.78 ± 12.05 year (range; 27 – 68 years). Of these 139 study cases, 56 (40.3%) were from rural areas, 83 (59.7 %) were from urban areas, 52 (37.4%) had poor socioeconomic status and 87 (62.6%) were from middle income family background. Diabetes was noted in 35 (25.2%), hypertension in 53 (38.1%) and obesity in 32 (23 %) (Mean BMI was 26.53±214kg/m2). Mean stone size in our study was 15.82 ± 6.34 mm while 78 (56.12 %) had single stones. Pure cholesterol gallstones were noted in 47 (33.8%), mixed cholesterol stones in 71 (51.1%) and brown pigmented gall stones in 21 (15.1%). Conclusion: Mixed cholesterol stones were more frequent followed by pure cholesterol and brown pigmented stones in bile duct gallstones patients. Mixed cholesterol stones were significantly associated with rural residential status and hypertension while brown pigmented stones were residential status, hypertension and obesity.

Demographic, Chemical, and Helicobacter pylori Positivity Assessment in Different Types of Gallstones and the Bile in a Random Sample of Cholecystectomied Iranian Patients with Cholelithiasis.

Background The occurrence of stones in the gallbladder or common bile duct and the symptoms and complications they cause is called gallstone disease. The symptoms of gallstone disease range from mild, nonspecific symptoms to a severe right quadrant abdominal pain. Characteristics of gallstone types in an Iranian population have not been well studied before and there are very limited studies on the demographic pattern of stone types in our country, so this study is one of the first studies on its kind on the epidemiology of gallstone types in Iran. As information on chemical components of the stone will help in the management and prevention of gallstones, in this study, we aimed to do chemical component analysis of gallstones including cholesterol, bilirubin, and calcium. Given the conflicting reports about the relationship between H. pylori infections and gallstone formation, this study aimed to investigate the relationship between H. pylori positivity in the bile specimen of Iranian patients with cholelithiasis and formation and type of stone. Methods This prospective study reviewed a total of 196 patients who underwent cholecystectomy for symptomatic cholelithiasis at Shahid Beheshti Training and Research Hospital affiliated to the Yasuj University of Medical Sciences between September 2015 and May 2018. Chemical analysis of gallstone components performed using the colorimetry method. Microbiological analysis for H. pylori was done using the OnSite H. pylori Ag Rapid Test on the bile sample. For the validation test of bile, the H. pylori Rapid Stool Ag Test on stool was used, and Cohen's Kappa statistical analysis was done next. Results There were significant associations between the stone types and age, chemical composition of the stones such as calcium, cholesterol, and bilirubin levels, and also H. pylori positivity and cholesterol and bilirubin levels; however, no significant association was found between the stone types and sex, H. pylori positivity and age, sex, stone types, and calcium level. The main bile and validity tests were matched to the substantial agreement according to Cohen's Kappa analysis. The most common drugs used were proton pump inhibitors, nonsteroidal anti-inflammatory drugs, antihypertensive drugs, and oral contraceptives. Conclusions This study suggested that the chemical composition of the stones could predict the presence of bacteria, there is no correlation between H. pylori and gallstone formation, and some of the drugs could be predisposing factors for gallstones. This work provides an objective basis for further research into gallbladder stone formation; meanwhile, it has great significance in the treatment and prevention of gallbladder stones. Trial registration. The project was found to be in accordance to the ethical principles and the national norms and standards for conducting research in Iran with the approval ID IR.YUMS.REC.1399.147 and date 2020.09.23, and this project is the result of a residency dissertation to obtain the specialty in general surgery, which has been registered with the research project number 960159 in the Vice Chancellor for Research and Technology Development of the Yasuj University of Medical Sciences, Yasuj, Iran, URL: https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=160634.

Histopathologic Spectrum of Gallbladder in Cholecystectomy Specimens

Background: Cholecystitis is a common problem in adult population. Gross and microscopic examination of gall bladder has multiple findings. Presence of stones is one of the known etiologic factors to produce histopathological changes in gallbladder. It is also one of the predisposing factors for the development of gallbladder carcinoma. This study aims to find the histopathologic spectrum of gall bladder specimens received in pathology department after undergoing surgical intervention. Objective: To analyze the morphological spectrum of cholecystitis due to stones. To find out the possible risk factors for gall stone formation. To find out the frequency / prevalence of different types of gall stones. Study Design: Retrospective Study. Settings: Department of pathology, UMDC Faisalabad and at Meezan Lab Faisalabad-Pakistan. Duration: From January 15, 2015 to May 14, 2017. Methodology: This study was conducted on cholecystectomy specimens. All clinical data was taken from patient’s histopathology request form and from patient’s clinical record gross and microscopic features of gall bladder specimens were studied in correlation with presence or absence of gall stones. Results: The total number of cholecystectomy specimens studied were 664. There were 633 cases of chronic calculous cholecystitis, the highest incidence of these being in the age group of 31-40 years. In this, males were 132 and females were 532. All patients underwent ultrasonography to confirm the diagnosis. There were 31 cases of a calculus cholecystitis. On morphological analysis, the commonest gall stones were cholesterol stones and the commonest lesion was chronic cholecystitis by histopathology. Conclusion: This study concludes the predominance of chronic calculous cholecystitis in our study population. Among these cholesterol stones are more prevalent.

Comparative analysis of bile components in patients with different types of gallstones

Objective To study the relationship among bile components and different gallstone types through comparing and analyzing gallbladder bile contents in patients with different types of gallstones. Methods A retrospective study of 542 consecutive patients with gallstones or gallbladder polyps was conducted. The stone composition type and 14 kinds of bile components from these patients were analyzed. The bile parameters consisted of potassium (K+ ), sodium (Na+ ), chlorine (Cl-), calcium (Ca2+ ), bicarbonate (HCO3-), magnesium (Mg2+ ), aspartate aminotransferase (AST), glutamyltranspeptidase (GGT), alkaline phosphatase (ALP), total bilirubin (TBIL), total bile acid (TBA), cholesterol (CHO), lactate dehydrogenase (LDH) and pH. Finally, the content of these bile components among the different types of stones and gallbladder polyps were compared. According to the composition determined by Fourier transform infrared spectroscopy (FTIR), the gallstone patients were divided into five groups. Results Compared with other groups, the content of K+ , GGT, ALP, TBIL, TBA and CHO in the calcium carbonate stone group were lower (P 0.05). In addition, there was no difference in bile contents among the pigment gallstone group, mixed stone group and polyp group (P>0.05). Conclusions In gallstone patients, the bile components of patients with calcium carbonate stones is significantly different. The high cholesterol content in bile is the main feature of cholesterol stone patients, and there is no significant difference in bile composition between patients with pigment stones and mixed stones. Key words: Cholecystolithiasis; Bile; Gallbladder polyps; Cholesterol; Bile acid; Calcium carbonate stones

GALL STONES;

Objectives: Recognition of various gall stones in the patients attending surgicalOPD by biochemical analysis of gall stones. Study design: Cross sectional study. Place &duration of study: ISRA Hospital, Hyderabad and Institute of Biochemistry Sindh UniversityJamshoro. Duration of study was 18 months. Methods: Cases were patients with gall stones whowere diagnosed on ultrasonography. Gall stone analysis was done from Institute of BiochemistrySindh University Jamshoro. A total of sixty nine subjects were included in the study. Results: Inthe present study the mean Age was 35.81+ 8.12 years. Frequencies in different age groups are15-24 (11.60%), 25-34 (24.64%), 35-44 (53.63%), 45-54 (8.69%), 55-64 (01.45%). Age distributionis shown in Graph III-1. In the present study 49(71.0%) were females and 20(29%) were maleswith the female to male ration of 2.45:1. gender distribution is shown in Graph III-2. In the presentfrequencies of different types of gall stones was, cholesterol stones 38(55.07%), pigmentedstones 20(28.99%) and mixed type of stones 11(15.94%). Frequencies of different types of gallstones is shown in Graph III-3. Conclusions: In our study the frequency of cholesterol gall stoneis more as compared to pigmented and mixed gall stones. A total of 55.07% of cholesterolgallstones were found in our study with the female predominance.

A deep learning model for predicting chemical composition of gallstones with big data in medical Internet of Things

In this paper, we present a deep learning model for potentially diagnosing gallbladder stone with big data from medical Internet of Things. With the increasing trend of population aging and the change of people’s living habits, gallbladder stone is increasingly common around the world. Specially, gallstones can be classified into four types, i.e., cholesterol stones, bile pigment stones, mixed stones and other rare stones, based on the chemical composition of gallstones. Furthermore, the chemical composition directly determines the treatment options. Currently, medical Internet of Things enables the collection of big medical data from massive ultrasonic images, computed tomography and magnetic resonance imaging of gallstones. However, it is a challenging issue to determine the exact chemical composition of gallstones from the collected big medical data. To tackle this issue, this paper presents a convolutional neural network to potentially learn the features of the collected data. Furthermore, we describe an effective learning approach for training the developed convolutional neural network. Finally, we analyze the characteristics of different types of gallstones, which can help improve our presented model to potentially determine the chemical composition of gallstones. The presented model can potentially obtain smart medical data from medical Internet of Things for assisted diagnose and treatment recommendation of gallbladder stones, aiming to build smart Internet of Things, especially smart health.

Structural Characterization of Gallbladder Stones Using Energy Dispersive X-ray Spectroscopy and X-ray Diffraction.

Formation of the gallbladder stones is a common disease and a major health problem. The present study aimed to identify the structures of the most common types of gallbladder stones using X-ray spectroscopic techniques, which provide information about the process of stone formation. Phase and elemental compositions of pure cholesterol and mixed gallstones removed from gallbladders of patients were studied using energy-dispersive X-ray spectroscopy combined with scanning electron microscopy analysis and X-ray diffraction. The crystal structures of gallstones which coincide with standard patterns were confirmed by X-ray diffraction. Plate-like cholesterol crystals with laminar shaped and thin layered structures were clearly observed for gallstone of pure cholesterol by scanning electron microscopy; it also revealed different morphologies from mixed cholesterol stones. Elemental analysis of pure cholesterol and mixed gallstones using energy-dispersive X-ray spectroscopy confirmed the different formation processes of the different types of gallstones. The method of fast and reliable X-ray spectroscopic techniques has numerous advantages over the traditional chemical analysis and other analytical techniques. The results also revealed that the X-ray spectroscopy technique is a promising technique that can aid in understanding the pathogenesis of gallstone disease.

New insights into the metal partitioning in different microphases of human gallstones

Chronic metal exposure, e.g. from metal mining, may cause accumulation of metals in soft and hard tissues, and in developing biomineralizations in the human body. Gallstones are biomineralizations formed in the gallbladder which are able to trap trace elements from the bile. Laser Ablation-Inductively Coupled Plasma-Mass Spectrometry (LA-ICP-MS) was used to analyze gallstone cross-sections to trace the elemental abundances and correlate them with the principal phases constituting gallstones, namely cholesterol, Ca bilirubinate salts, Ca carbonate, and Ca phosphate. Five different types of gallstones (pure, mixed, and composite cholesterol stones, pigment stone, and carbonate stone) were chosen according to a previous classification based on phase characterization by different spectroscopic and microscopic techniques. These data were combined with bulk solution ICP-MS/OES analyses for total elemental concentrations. The results indicated that cholesterol has a zero capacity to retain elements except for Ca. Hence, pure cholesterol stones contained the lowest bulk metal concentrations, and the metals were found in the scarce carbonate and phosphate phases in these calculi. Calcium and trace element concentrations increased in other types of gallstones along with increasing amount of bilirubinate, carbonates and phosphates; pigment stones being the most enriched in metals. Phosphates were the principal carriers of Ca, P, Na, Mg, Mn, Fe, Pb, and Cd, whereas carbonate phases were enriched in Ca, Mg, Na, and Mn in order of decreasing abundance. Bilirubinate on the other hand was enriched in Ca, Cu, Ag, and Ni. The higher trace metal affinities of bilirubinate and phosphate explain the elevated metal concentrations observed in the pigment stones. These results give new insight to the trace metal behavior in the gallstone formation and the metal accumulation in the human body, validating the possible use of these biomineralizations as a proxy for exposure to metal pollution.

Variation of calcium, copper and iron levels in serum, bile and stone samples of patients having different types of gallstone: A comparative study

BackgroundEpidemiological data among the human population has shown a significantly increased incidence of gallstone (GS) disease worldwide. It was studied that some essential (calcium) and transition elements (iron and copper) in bile play an important role in the development of GS. MethodThe estimation of calcium, copper and iron were carried out in the serum, gall bladder bile and different types of GS (cholesterol, mixed and pigmented) of 172 patients, age ranged 20–55years. For comparative purpose age matched referents not suffering from GS diseases were also selected. Biliary concentrations of calcium (Ca), iron (Fe) and copper (Cu) were correlated with their concentrations in serum and different types of GS samples. The ratio of Ca, Fe and Cu in bile with serum was also calculated. Understudy metals were determined by flame atomic absorption spectroscopy after acid decomposition of matrices of selected samples. ResultsThe Ca concentrations in serum samples were significantly higher in patients with pigmented GS as compared to controls (p<0.005), whereas for patients having cholesterol and mixed GS the concentrations were on the lower side. Biliary Ca concentrations of patients were found to be higher than controls, but difference was significant for pigmented GS patients (p>0.001). The contents of Cu and Fe in serum and bile of all patients (except female cholesterol GS patient have low serum iron concentration) were found to be higher than control, but difference was significant in those patients who have pigmented GS. The concentration of Ca, Fe and Cu in different types GS were found in the order, Pigmented>mixed>cholesterol. The bile/serum ratio for Ca, Cu and Fe was found to be significantly higher in pigmented GS patients. Gall bladder bile was slightly alkaline in patients as compared to referents. The density of bile was found to be higher in patients as compared to the referents. Various functional groups present in different types of GS samples were confirmed by Fourier transform infra-red spectroscopy. ConclusionThe higher density and pH of bile, elevated concentrations of transition elements in all types of biological samples (serum, bile and GS), could be an important factor for the formation of different types of GS.

Gallstone disease; a different disease in Sri Lanka. A Study to determine the prevalence of different types of gallstones in Sri Lanka

Gallstone disease; a different disease in Sri Lanka. A Study to determine the prevalence of different types of gallstones in Sri Lanka

English

The aim of this study was to identify the microflora in the gallbladder of patients undergoing cholecystectomy for different types of gallstones and the antibiotic susceptibility pattern of the isolates. Between January 2005 and December 2008, 136 samples of bile [cholesterol stones (CS)] and 175 pigment stones (PS) were collected from 213 women and 98 men, who were between 18-95 years (median age: 52.5&plusmn;12.0) by laparoscopic or open cholecystectomy at the University Surgical Unit Duzce in Turkey. The bile samples were aerobically cultured to assess microflora and their antibiotic susceptibility. 210 (54%) of the 311 patients with gallstones had bacterial isolates; 78 isolates (37.2%) were from cholesterol stone-containing bile and 132 isolates (62.8%) from pigment stone-containing bile (P&lt;0.01). The overall bacterial isolates from bile samples revealed Escherichia coli (E. coli) predominantly, followed by Pseudomonas aeruginosa (P. aeruginosa) and Enterococcus spp. In one sample, we found Candida lusitaniae (C. lusitaniae). None of the Gram negative strains were resistant to antibiotics but Gram positive strains were highly resistant to penicillins (100%). Looking at the microflora of the gallbladder and the susceptibility pattern of our isolates, we would suggest that antibiotic prophylaxis recommended for laparoscopic or open cholecystectomy for gallstones be reviewed and the role of &nbsp;bacteribilia in the surgical management of cholelithiasis requires further study. &nbsp; Key words: Microflora, bile culture, gallstones, cholecystectomy. &nbsp

Prevalence of different Types of Gallstone in the Patients with Cholelithiasis at Rohilkhand Medical College and Hospital, Bareilly, U P, India

Gallstone disease known as cholelithiasis is the most common digestive surgical disorder and account for an important part of health care expenditure. Attempt was made to analyse the gallstone for typing depending upon the composition. The main objective of this study was to see the prevalence of different types of gallstone and to correlate them with the clinical findings. Gallstones of 141 different patients who underwent cholecystectomy for cholelithiasis were collected from January 2013 to December 2013 in Rohilkhand Medical College and Hospital. Detailed history was taken. Stones were analyzed with chemical and enzymatic methods using clinical spectrophotometer.

Extensive Quantitative Analysis of Gallstones

Background: The chemical composition of gallstones is essential to study aetiopathogenesis of gallstone disease. Objective: To determine the composition of gallstones in a Sudanese population. Patients and methods: It describes an extensive quantitative analysis of gallstones from patients presented with symptomatic gall stone disease and treated by cholecystectomy after the acceptance of the pre-given informed consent in Khartoum teaching hospital in the period between Jan 2010 and Dec 2010. Using a pretested questionnaire data collected from and analyzed statistically by SPSS computer program version 21. Results: Data are analyzed from 94 patients (six males and 88 females). Cholesterol stones showed a significantly higher cholesterol content than pigment stones (p = 0.0042), though not significantly higher than mixed stones. Their phospholipids content and inorganic phosphates were higher than in the other types of stones and oxalate content was significantly elevated in comparison with mixed stones (p = 0.0402). In mixed stones, the cholesterol, bile acids, and bilirubin were intermediate between cholesterol and pigment stones, whereas triglycerides were significantly more than pigment stones (p = 0.0007). Bilirubin (p = 0.0021) and bile acids (p = 0.0016) were significantly higher than cholesterol stones (p = 0.0001) and (p = 0.0001) respectively. However, they contained the lowest amounts of sodium, potassium, magnesium, and oxalate. In pigment stones, bilirubin was significantly higher (p = 0.0001) than both groups. Conclusion: Collaborations between surgeons, nutritionists, biochemists, and physicians should be stimulated in future studies to define the different types of gall stones in different areas in Sudan and the relevancy of such types with diets’ traditions.

Fixed‐point and stratified analysis of the fine structure and composition of five gallstones with Fourier transform infrared (FT‐IR) specular reflection spectroscopy

By investigating the identities, amounts, and distributions of the major components of human gallstones, the formation mechanism of calculi may be elucidated. Using FT-IR specular reflection spectroscopy, the compositions of five common types of gallstones, including cholesterol calculus, bile pigment calculus, cholesterol-bilirubin calculus, mixed calculus, and black stones, were positionally, qualitatively, and quantitatively analyzed. Several organic and inorganic substances were found in human gallstones, including cholesterol, calcium bilirubinate, calcium carbonate, calcium phosphate, and calcium stearate. Among them, cholesterol and calcium bilirubinate were the main components. The amounts of these substances varied in different types of gallstone. The distributions of cholesterol and calcium salts (with the exception of calcium bilirubinate) were also closely associated with location. In the various calculi, the amounts of cholesterol and calcium bilirubinate in the cores, the layered structures outside the cores, and the outer shells were higher than those of other substances. The identities of the major components of calculi were similar in different types of gallstones, but their amounts and distributions were significantly different. The analytical method used in this study, which was able to accurately determine the location, quality, and quantity of the major components of gallstones, would be an effective tool to study the formation mechanism of calculi.

Hepatobiliary and pancreatic: Commentary.

Journal of Gastroenterology and HepatologyVolume 16, Issue 2 p. 228-229 Free Access Hepatobiliary and pancreatic: Commentary First published: 21 December 2001 https://doi.org/10.1046/j.1440-1746.2001.2436b.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat INTERPRETATION OF FIG. 1 (SEE PAGE 225) This sonogram shows an ill-defined gallbladder. The gallbladder wall is not clearly discerned, but the anterior portion of the bladder is hyperechoic, suggesting calcification or calcific stones. There is acoustic shadowing (S). The distinct finding is two parallel hyperechoic lines (arrow) that disappeared when the transducer was angled slightly to either side, a characteristic echo feature of a stone with fissures within it. Such fissures contain gas or fluid. The anterior line is the reflection from the stone surface, and the posterior line the reflection from the interface of stone and gas as illustrated in Fig. 2. Note that these two linear echoes are also casting a shadow. Gas reduces specific gravity and the stone floats toward the anterior surface in the supine position as seen on the CT (Fig. 3, thick arrow). This CT also shows several smaller ill-defined stones (thin arrow) posterior to the gas-containing stone. They are not calcific and perhaps represent pigment stones. Figure 2Open in figure viewerPowerPoint Stone fissures and sonogram (reproduced with permission4). Figure 3Open in figure viewerPowerPoint Computed tomography. Gas-containing stone (thick arrow) located anteriorly (floating) and posteriorly located non-calcific stones (thin arrow) are recognized. DIAGNOSIS: GAS-CONTAINING GALLSTONE Gas-containing stones are not uncommon. Hinkel studied 100 consecutive cholecystectomies and found fissures in the associated gallstones in 48 cases; 15 of them contained gas.1 The gas consists of 0.5% O2, 6–7.5% CO2 and the remainder N2.2 Radiating fissures occur in non-opaque stones within a radiating crystalline structure (Fig. 2a,b). The fissure is believed to develop as the crystalline structure shrinks, but bacteria can possibly be involved in other types of gas-containing stones. The fissures may be recognized on a plain film as the Mercedes–Benz sign3 and, in fact, plain abdominal film of this patient demonstrated indiscrete, but recognizable air. A lateral film did not show a fluid level, confirming gas rather than fluid. The outer layer of the stone can be calcific as in this patient. The form of the gas-containing lumen is not necessarily stellate, and in this patient two more stones with a calcific surface contained non-stellate gas. According to Tsuchiya, the interface between the stone and gas produces a reverberation that may be parallel to the surface reflection of the stone, producing two strong linear echoes, sometimes with multiple reflections as an artefact shown in Fig. 2c.4 Thus, this patient had two different types of gallstones, non-opaque pigment stones and mixed stones with a calcific outer-layer and gas-containing cracks or a cavity. REFERENCES 1 Hinkel CL. Fissures in biliary calculi. Am. J. Roentgenol. 1954; 71: 979 – 87. 2 Fulton H. Gas-containing gall stones. Gastroenterology 1955; 28: 862 – 6. 3 Meyers MA & O'Donohue N. The Mercedes-Benz sign: insight into the dynamics of formation and disappearance of gallstones. Am. J. Roentgenol. 1973; 119: 63 – 70. 4 Tsuchiya Y. Treatment of gallstones—Fragmentation and dissolution (in Japanese). Tokyo: Igaku-Shoin, 1997; 16 – 41. Volume16, Issue2February 2001Pages 228-229 FiguresReferencesRelatedInformation

Bacterial DNA in mixed cholesterol gallstones.

Numerous investigators have proposed a role for bacteria in biliary lithogenesis. We hypothesized that bacterial DNA is present in gallstones, and that categorical differences exist between gallstone type and the frequency of bacterial sequences. Polymerase chain reaction (PCR) was used to amplify bacterial 16S rRNA and uidA (encoding Escherichia coli [E. coli] beta-glucuronidase) genes in different types of gallstones. PCR products were sequenced. Bacterial 16S rRNA and uidA DNA sequences in E. coli were detected in all brown pigment, common bile duct, and mixed cholesterol gallstones (n = 14). In contrast, only one (14%) of seven pure cholesterol gallstones yielded a PCR product. Most (88%) mixed cholesterol gallstones yielded PCR amplification products from their central, as well as their outer, portions. Sequenced products possessed 88-98% identity to 16S rRNA genes of E. coli and Pseudomonas species. Bacterial DNA sequences are usually present in mixed cholesterol (to 95% cholesterol content), brown pigment, and common bile duct, but rarely in pure cholesterol gallstones. The presence of bacterial beta-glucuronidase is also suggested. The role of bacteria and their products in the formation of mixed cholesterol gallstones, which comprise the majority of cholesterol gallstones, warrants further study.

Bacterial DNA in mixed cholesterol gallstones

OBJECTIVE: Numerous investigators have proposed a role for bacteria in biliary lithogenesis. We hypothesized that bacterial DNA is present in gallstones, and that categorical differences exist between gallstone type and the frequency of bacterial sequences. METHODS: Polymerase chain reaction (PCR) was used to amplify bacterial 16S rRNA and uidA (encoding Escherichia coli [E. coli] β-glucuronidase) genes in different types of gallstones. PCR products were sequenced. RESULTS: Bacterial 16S rRNA and uidA DNA sequences in E. coliwere detected in all brown pigment, common bile duct, and mixed cholesterol gallstones (n = 14). In contrast, only one (14%) of seven pure cholesterol gallstones yielded a PCR product. Most (88%) mixed cholesterol gallstones yielded PCR amplification products from their central, as well as their outer, portions. Sequenced products possessed 88–98% identity to 16S rRNA genes of E. coli and Pseudomonas species. CONCLUSIONS: Bacterial DNA sequences are usually present in mixed cholesterol (to 95% cholesterol content), brown pigment, and common bile duct, but rarely in pure cholesterol gallstones. The presence of bacterial β-glucuronidase is also suggested. The role of bacteria and their products in the formation of mixed cholesterol gallstones, which comprise the majority of cholesterol gallstones, warrants further study.