Gallbladder Stones In Patients Research Articles

Age and incidence of occult pancreaticobiliary reflux in patients with benign gallbladder diseases

Background: Occult pancreaticobiliary reflux (OPBR) has a significant correlation with diseases of the gallbladder and biliary system. This study examined the incidence of OPBR by age in patients with benign gallbladder diseases. Methods: We assessed 475 patients with benign gallbladder diseases who underwent surgery at Shanghai East Hospital from December 2020 to December 2021. Bile samples collected during surgery were tested for amylase. Patients with bile amylase >110 U/L (n = 64) were classified as the OPBR group; the rest (n = 411) as controls. Results: Of the participants, 375 had gallbladder stone (GS), 170 had gallbladder polyp (GP), and 49 had gallbladder adenomyomatosis (GA). The OPBR group was generally older, with OPBR incidence increasing with age, peaking post-45. Rates by age were: 4.9% (<35), 5.2% (35–44), 20.7% (45–54), 22.5% (55–64) and 17.6% (≥65), mainly in GS patients. ROC analysis for predicting OPBR by age yielded an area under the curve of 0.656, optimal cut-off at 45 years. Logistic regression indicated age > 45, GP, male gender, and BMI ≥ 24 kg*m−2 as independent OPBR predictors in GS patients. Based on these variables, a predictive nomogram was constructed, and its effectiveness was validated using the ROC curve, calibration curve and decision curve analysis (DCA). Further stratification revealed that among GS patients ≤ 45, concurrent GA was an OPBR risk; for > 45, it was GP and male gender. Conclusions: The incidence of OPBR in GS patients is notably influenced by age, with those over 45, especially males without GP, being at heightened risk.

Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC

BackgroundIn the past quite a long time, intraoperative cholangiography(IOC)was necessary during laparoscopic cholecystectomy (LC). Now magnetic resonance cholangiopancreatography (MRCP) is the main method for diagnosing common bile duct stones (CBDS). Whether MRCP can replace IOC as routine examination before LC is still inconclusive. The aim of this study was to analyze the clinical data of patients undergoing LC for cholecystolithiasis, and to explore the necessity and feasibility of preoperative routine MRCP in patients with cholecystolithiasis.MethodsAccording to whether MRCP was performed before operation, 184 patients undergoing LC for cholecystolithiasis in the Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University from January 1, 2017 to December 31, 2018 were divided into non-MRCP group and MRCP group for this retrospective study. The results of preoperative laboratory test, abdominal ultrasound and MRCP, biliary related comorbidities, surgical complications, hospital stay and hospitalization expenses were compared between the two groups.ResultsAmong the 184 patients, there were 83 patients in non-MRCP group and 101 patients in MRCP group. In MRCP group, the detection rates of cholecystolithiasis combined with CBDS and common bile duct dilatation by MRCP were higher than those by abdominal ultrasound (P < 0.05). The incidence of postoperative complications in non-MRCP group (8.43%) was significantly higher (P < 0.05) than that in MRCP group (0%). There was no significant difference in hospital stay (P > 0.05), but there was significant difference in hospitalization expenses (P < 0.05) between the two groups. According to the stratification of gallbladder stone patients with CBDS, hospital stay and hospitalization expenses were compared, and there was no significant difference between the two groups (P > 0.05).ConclusionsThe preoperative MRCP can detect CBDS, cystic duct stones and anatomical variants of biliary tract that cannot be diagnosed by abdominal ultrasound, which is helpful to plan the surgical methods and reduce the surgical complications. From the perspective of health economics, routine MRCP in patients with cholecystolithiasis before LC does not increase hospitalization costs, and is necessary and feasible.

Impact of cholecystectomy on acute coronary syndrome according to metabolic condition: a nationwide population-based cohort study

Gallbladder stones (GS) is associated with an increased risk of cardiovascular disease. However, the relationship between cholecystectomy for GS and acute coronary syndrome (ACS) is unknown. We investigated the ACS risk in patients with GS and its association with cholecystectomy. Data from the Korean National Health Insurance Service-National Sample Cohort from 2002 to 2013 was extracted. Overall, 64,370 individuals were selected through a 1:3 propensity score matching. Patients were stratified into two groups for comparison: the gallstone group, GS patients with or without cholecystectomy; and the control group, patients without GS or cholecystectomy. The gallstone group exhibited a higher risk of ACS than the control group (hazard ratio [HR], 1.30; 95% confidence interval [CI] 1.15–1.47; P < 0.0001). In the gallstone group, individuals without cholecystectomy had a higher risk of ACS development (HR: 1.35, 95% CI 1.17–1.55, P < 0.0001). Patients with GS with diabetes, hypertension, or dyslipidemia, had a higher risk of developing ACS than GS patients without the metabolic diseases (HR: 1.29, P < 0.001). The risk did not significantly differ after cholecystectomy compared to those without GS (HR: 1.15, P = 0.1924), but without cholecystectomy, the risk of ACS development was significantly higher than control group (1.30, 95% CI 1.13–1.50, P = 0.0004). Among patients without above metabolic disorders, cholecystectomy was still associated with increased ACS risk in the gallstone group (HR: 2.93, 95% CI 1.27–6.76, P = 0.0116). GS increased the risk of ACS. The effect of cholecystectomy on ACS risk differs according to the presence or absence of metabolic disorders. Thus, the decision to perform cholecystectomy for GS should consider both the ACS risk and the underlying disorders.

Gut Microbial Profile Changes in Patients with Gallbladder Stones after UDCA/CDCA Treatment.

Background: Ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) are used to treat patients with asymptomatic or mildly symptomatic gallstone disease. This study was conducted to evaluate the efficacy of gallbladder (GB) stone dissolution by UDCA/CDCA and the impact of treatment on gut microbial profiles. Methods: Fifteen treatment-naive patients with GB stones were initially included, but two dropped out during the treatment period. UDCA/CDCA was administered for 6 months. Abdominal ultrasonography was performed to evaluate response to treatment. In addition, fecal samples were collected before and after treatment for gut microbiome profiling. Then, 16S ribosomal RNA gene sequencing was carried out on fecal samples obtained before and after treatment, and results were compared with those of forty healthy controls. Results: Eight (62%) of the thirteen evaluable patients treated with UDCA/CDCA responded to treatment (four achieved complete GB stone resolution and four partial dissolution). Taxonomic compositions of fecal samples at the phylum level showed a significantly lower relative abundance of the Proteobacteria phylum in the pre-UDCA/CDCA group than in the healthy control group (p = 0.024). At the genus level, the relative abundances of five bacteria (Faecalibacterium, Roseburia, Lachnospira, Streptococcus, and Alistipes) differed in the control and pre-UDCA/CDCA group. Interestingly, the abundance of Roseburia was restored after 6 months of UDCA/CDCA treatment. Conclusion: Gut microbial dysbiosis was observed in GB stone patients and partially reversed by UDCA/CDCA treatment, which also effectively dissolved GB stones.

Incidence, Risk Factors and Outcome of Gallbladder Perforation during Laparoscopic Cholecystectomy

Background and Aim: Gallbladder perforation has been recorded in patients undergoing laparoscopic cholecystectomy and associated with the development of gallstones and bile leakage. The present study investigated the incidence, risk factors, and outcome of gallbladder perforation in patients undergoing elective laparoscopic cholecystectomy. Patients and Methods: This prospective study was conducted on 156 patients who underwent laparoscopic cholecystectomy in the department of General Surgery, Federal Government Polyclinic Hospital, Islamabad from January 2021 to July 2022. Gallbladder stone patients with chronic symptoms such as vomiting, recurrent episodes of epigastric, nausea, and hypochondrial pain on right side were included. Acute cholecystitis patients with single or multiple gallstone disease were also enrolled. All the patients were prepared for laparoscopic cholecystectomy and investigations such as blood sugar, liver function test, CBC, blood urea and creatinine, ultrasound of gallbladder, and ECG were done. SPSS version 26 was used for data analysis. Results: Of the total 156 patients, there were 126 (80.8%) females and 30 (19.2%) male. Age-wise distribution of patients were as follows: 66 (42.3%) in 20-35 years, 52 (33.3%) in 36-50 years, and 38 (24.4%) in 51-65 years. The incidence of single gall stone (SGS), multi gallstones (MGS), and acute cholecystitis was 48 (30.8%), 88 (56.4%), and 20 (12.8%) respectively. The overall mean age was 36 years. The incidence of gallbladder perforation was 26.9% (n=42) among all patients. Patients distribution based on gallbladder perforation were as follows: 17 (10.9%) in MGS, 14 (9.0%) in SGS, and 11 (7.1%) in acute cholecystitis cases. Conclusion: The present study found that the prevalence of gallbladder perforation was 26.9% among SGS, MGS, and acute cholecystitis. Majority of GB perforation occurred during gallbladder bed dissection. Acute cholecystitis patients are more prone to GB perforation. GB perforation can be reduced by utilization of harmonic scalpel in laparoscopic cholecystitis. Keywords: Elective laparoscopic cholecystectomy, Gallbladder perforation, Outcomes

Pretreatment-free SERS analysis of raw bile juice for identification of gall bladder disease using paper-coupled Au nanodendrite-encaged nickel foam

For pretreatment-free SERS measurement of raw bile juice for the identification of gall bladder (GB) disease, a paper strip bridging Au nanodendrite-encaged nickel foam (PS-AuND@NF) was demonstrated. To build a medium for facile sample diffusion as well as SERS generation, Au nanodendrite (AuND) with a high SERS efficiency was constructed on the porous frame of the NF (AuND@NF). Then, the PS-AuND@NF was built by simply positioning AuND@NF on a paper strip, which functioned as a channel for sample introduction to AuND@NF and a subsequent sample drain. With the continuous elution of raw bile juice, non-specific adsorption of SERS-inactive constituents such as lipids on the Au surface could be minimized. Using the PS-AuND@NF, raw bile juice samples obtained from 6 GB polyp and 21 GB stone patients were measured. Since only a few components in bile juice are expected to be SERS-active such as bilirubin-containing metabolites, the information obtained from the SERS spectra is not descriptive enough for the discrimination of both GB diseases. Therefore, two-trace two-dimensional (2T2D) correlation analysis, which is able to effectively feature out asynchronous (dissimilar) spectral behaviors in the comparison of two spectra, was carried out in parallel. When the principal component (PC) scores obtained from the 2T2D slice spectra were used for the k-nearest neighbor (k-NN), the discrimination accuracy improved to 88.9 % from 81.5 % obtained when using the PC scores of the raw spectra. Overall, the PS-AuND@NF enabled simple pretreatment-free SERS analysis of complex and viscous bile juice without interference from other existing components.

The effect of cholecystectomy on the risk of acute myocardial infarction in patients with gallbladder stones

ABSTRACT Objectives: To investigate the effect of cholecystectomy on the subsequent risk of acute myocardial infarction (AMI) in patients with gallbladder stones (GBS). Methods: We used the Taiwan National Health Insurance Research Database (NHIRD) for hospitalization to conduct a retrospective nationwide population-based cohort study. The study cohort consisted of a total of 122,421 patients aged ≥20 years with cholecystectomy for GBS between 2000 and 2010. The control cohort consisted of the GBS patients without cholecystectomy and they were randomly selected by propensity score matching with the study cohort at a 1:1 ratio according to age, sex, occupation category, urbanization level, comorbidities, and year of the index date for cholecystectomy. We measured the incidence of AMI for both cohorts. Results: The cumulative incidence of AMI was lower in GB patients with cholecystectomy than that in those without cholecystectomy (2.26 vs 3.28 per 1000 person-years, adjusted hazard ratio [aHR] = 0.65, 95% confidence interval [CI] = 0.61–0.69). Compared to those without cholecystectomy, the risk of developing AMI after cholecystectomy was 0.69 (95% CI = 0.63–0.76) for the first year, 0.69 (95% CI = 0.63–0.77) for 2–5 years, and 0.59 (95% CI = 0.53–0.66) for ≥5 years, respectively. Conclusions: Our findings indicate cholecystectomy ameliorates the risk of AMI in patients with GBS, and the protective effect tends to increase with incremental duration of follow-up. However, it needs more studies to ascertain the protective mechanisms of cholecystectomy against AMI.

The Effect of Cholecystectomy on the Risk of Colorectal Cancer in Patients with Gallbladder Stones.

To evaluate the risk of colorectal cancer (CRC) after cholecystectomy for gallbladder stones (GBS). Methods: This nationwide population-based cohort study analyzed the inpatient data from the Taiwan National Health Insurance Research Database. The study cohort comprised of 83,963 patients aged ≥ 20 years undergoing cholecystectomy for GBS between 2000 and 2010. The control cohort comprised the GBS patients without cholecystectomy, who were propensity matched with the study cohort at a 1:1 ratio based on age, sex, comorbidities, and the index date for cholecystectomy. Results: The cumulative incidence of CRC within 6 months of follow-up was higher in the cholecystectomy cohort than that in the non-cholecystectomy cohort (aHR (adjusted hazard ratio) = 7.90, 95% confidence interval (CI) = 6.27–9.94; log-rank test, p < 0.001). The cumulative incidence of CRC after 6 months of follow-up was lower in the cholecystectomy cohort than that in the non-cholecystectomy cohort (aHR = 0.66, 95% CI = 0.60–0.73; log-rank test, p < 0.001), but the reduced risk of CRC for the cholecystectomy cohort was statistically significant only in rectal cancer after separately considering females (aHR = 0.64, 95% CI = 0.46–0.88) and males (aHR = 0.59, 95% CI = 0.44–0.79). Conclusions: The positive association between cholecystectomy and the CRC risk within the first 6 months after cholecystectomy might be due to a detection bias or pre-existing CRC. However, cholecystectomy is associated with a decreased risk of rectal cancer, rather than proximal or distal colon cancer, after more than 6 months of follow-up.

Risk factors of systematic biliary complications in patients with gallbladder stones.

Gallbladder stone with symptom is an indication of cholecystectomy according to the current guideline. However, about 80% of gallstone patients are asymptomatic. The identification of gallbladder stone patients likely to develop symptomatic complications would be of benefit in clinical practice. The aim of this study was to investigate the risk factors for asymptomatic gallstone diseases developing into a gallstone-related biliary event. This retrospective study evaluated 1284 patients with gallstones and received laparoscopic cholecystectomy (LC) in Peking Union Medical College Hospital. The age-gender-matched patients were divided into the acute cholecystitis group (group A), biliary colic group (group B), and asymptomatic gallstone group (group C). Baseline clinical characteristics and serum biochemical indexes were recorded and analyzed among the groups. Univariate logistic regression and multivariate Cox proportional hazard regression analysis were performed to determine the risk factors. The incidence of diabetes, hypertension, and sludge was higher in group A than in group B and in group C. The concentrations of plasma HDL in group A were lower than those in group B and group C (P <0.05, 1.12 ± 0.19, vs. 1.21 ± 0.22, vs. 1.21 ± 0.21). Logistic regression analysis showed that diabetes (OR = 1.39, 95% CI 1.07-1.56, P =0.028), sludge (OR = 1.09, 95% CI 1.01-1.18, P =0.022), HDL (OR = 0.85, 95% CI 0.70-1.02, P =0.045), and FBG (1.91, 95% CI 1.26-2.90, P =0.034) were significantly associated with biliary events. Diabetes, sludge, and lower blood HDL level are risk factors for symptomatic gallstone diseases.

Evaluation of Histopathogical Changes in Gallbladder Mucosa in Gallbladder Stone Patients: An Institutional Based Prospective Study

Evaluation of Histopathogical Changes in Gallbladder Mucosa in Gallbladder Stone Patients: An Institutional Based Prospective Study

Sonographic Diagnosis and Clinical Correlates of Gallbladder Stones in Patients with Sickle Cell Disease in Calabar, Nigeria.

BACKGROUND:Sickle Cell Disease (SCD) causes chronic haemolysis which is a risk factor for cholelithiasis.AIM:To determine the prevalence and clinical correlates of cholelithiasis in SCD patients in steady state treated at the University of Calabar Teaching Hospital.METHODS:This was a prospective study that took place at the Haematology and sickle cell disease clinics, University of Calabar Teaching Hospital, Calabar, Nigeria between January and June 2018. The study population were aged between 1.5-5.5 years and confirmed to have SCD through haemoglobin electrophoresis. A brief history was obtained, and all the patients had a physical examination. Ultrasound examination was performed using a B-mode mind-ray ultrasound machine using a 3.5-5.0 MHz probe after an overnight fast. A Calculus is diagnosed when a highly echogenic structure casting a concrete shadow is detected in the lumen of the gallbladder.RESULTS:One hundred and twenty confirmed SCD patients aged between 1.5-55 years were recruited in the study, 69 (57.5%) were males, while 51 (42.5%) were females. The overall prevalence of cholelithiasis was 10%, and it increased with age. The youngest patient with cholelithiasis was 13 years old. All the patients were asymptomatic at the time of examination. At the multivariate level, age, gender, weight and gallbladder volume were associated with gallbladder stones.CONCLUSION:The prevalence of cholelithiasis in patients treated at the Sickle Cell Clinic at the University of Calabar Teaching Hospital, Calabar is fairly high. The patients were largely asymptomatic, and cholelithiasis is more common in females than males. This study showed a weak association between blood transfusion and gallbladder stone. It is recommended that routine abdominal ultrasound scan for gallbladder be done for SCD patients from the second decade of life in our environment.

Association of APOE − 219G > T and −427T > C polymorphic variants in transcriptional regulatory region of APOE gene with gallbladder stone: A north Indian case-control study

Gallbladder stone (GBS) is a major cause of morbidity and mortality throughout the world including India. The significant role of APO E in the regulation of lipid metabolism raises the possibility that APO E promoter gene polymorphisms may be a predisposing factor for GBS formation. In this case control study total 358 subjects (n = 102 GBS subjects and n = 256 healthy control) between the age group of 18 to 70 years were enrolled. Three APO E promoter gene polymorphisms [−219G > T (rs.405509), −427T > C (rs.769446) and −491A > T (rs.449647)] were genotyped by using nested PCR-RFLP method. Out of three investigated polymorphisms, −219G > T and −427T > C were significantly associated with the risk of GBS. The frequency of mutant allele −219G was significantly higher and mutant allele −427C was significantly lower among GBS patients compared to the controls. Out of seven obtained haplotypes, the higher frequency of TCG and TTG haplotypes as well as lower frequency of TCT and ACT haplotypes of APO E gene polymorphisms was significantly associated with GBS patients. Thus we concluded that, the higher frequency of mutant allele −219G; haplotypes TCG and TTG, and lower of frequency of mutant allele −427C; haplotypes TCT and ACT of APO E gene polymorphism may be a predisposing genetic risk factor for the susceptibility of GBS among the north Indian population.

Gallbladder stones in patients with severe fatty liver: Ultrasound diagnosis and influencing factors

Gallbladder stones in patients with severe fatty liver: Ultrasound diagnosis and influencing factors

Is Concomitant Cholecystectomy Necessary for Asymptomatic Cholelithiasis During Laparoscopic Sleeve Gastrectomy?

There is not any consensus on concomitant cholecystectomy for asymptomatic gallbladder stones during laparoscopic sleeve gastrectomy (LSG). The aim of this study was to evaluate the surveillance results of the LSG patients who have asymptomatic gallbladder stones and did not undergo cholecystectomy. Patients who underwent laparoscopic sleeve gastrectomy with preoperatively detected gallbladder stones and completed at least 6months follow-up were included in the study. Concomitant cholecystectomy was performed for symptomatic patients while it was not performed for asymptomatic subjects. At the end of the follow-up time, symptoms and signs related to gallbladder disease were recorded. Clinical and demographic characteristics were compared between symptomatic and asymptomatic patients. Between February 2012 and October 2016, 312 laparoscopic sleeve gastrectomies were performed. Among the patients, 24 were regarded as asymptomatic cholelithiasis, and cholecystectomy was not performed. The mean follow-up period was 27 (6-58)months. The mean preoperative BMI was 50.0±7.6kg/m2, and at the end of the follow-up time, it decreased to 35.6±8.8kg/m2. Five (20.8%) patients experienced biliary colic. Acute cholecystitis or obstructive jaundice was not observed in any of the patients. Characteristics of patients who developed symptomatic gallbladder disease (n=5) were not significantly different from those of patients who remained asymptomatic (n=19). The risk of becoming symptomatic for asymptomatic cholelithiasis is very close to the healthy population after sleeve gastrectomy. Although further studies with a high number of cases are needed, we suggest only observation for asymptomatic gallbladder stones in patients who will undergo sleeve gastrectomy.

Clinical effects of continued nursing intervention after laparoscopic cholecystectomy for gallbladder stones in patients with cirrhotic portal hypertension

Clinical effects of continued nursing intervention after laparoscopic cholecystectomy for gallbladder stones in patients with cirrhotic portal hypertension

8- LAPAROSCOPIC CHOLECYSTECTOMY IN SICKLE CELL DISEASE: IS IT A SAFE PROCEDURE?

The aim of this trial is to determine the safety of laparoscopic cholecystectomy for treatment of gall bladder stones in patients with sickle cell anemia (a controversial issue). Sixty patients from both sexes, between 19-35 years old with sickle cell anemia, all of them having gall bladder stones were included in this study in Endosurgery Center in Basrah General Hospital. The patients were divided into three groups, group one (19 patients) were selected for laparoscopic cholecystectomy on random preoperative background, the same thing was applied in group two (21 patients) whose patients were subjected to open cholecystectomy while patients in group three (20 patients) were selected for laparoscopic cholecystectomy on conditioned selection. Three mortalities and two serious morbidities were encountered in the group one and one mild morbidity seen in group two and no mortalities or morbidities in group three. Laparoscopic cholecystectomy in sickle cell patients is a debatable issue, an increasing controversy about serious perioperative and postoperative morbidity were mentioned. The procedure itself was accused and an entirely opposed results were emerged from different studies all are debatable. In this study we noticed the big influence of the risk factors, preparation of patients for surgery and the adherence to the principle anesthetic rules on the outcome after laparoscopic cholecystectomy in patients with sickle cell disease. This influence was limited in open procedure. The controversy in the different trials lies on wither the problem is confined to the disease itself or to the surgical method used for cholecystectomy or both. According to the results obtained from our study we believe that both the severity of the disease and the surgical procedure affecting the results, application of intra and post operative protocol (blood transfusion if Hb less than 9gm/dI, rehydration, oxygenation and respecting general anesthesia rules are mandatory for the safety of the patients.

Bile duct stone procedures are more frequent in patients with hypothyroidism. A large, registry-based, cohort study in Finland

Objective. Delayed bile flow may induce the formation/accumulation of common bile duct stones (CBDS). Bile flow is delayed in hypothyroidism, partly due to insufficient sphincter of Oddi relaxation. Patients with CBDS have higher incidences of clinical and subclinical hypothyroidism compared to healthy controls and gallbladder stone patients. The aim of this large registry-based study was to investigate the prevalence of CBDS in patients with diagnosed hypothyroidism compared to age-, sex- and living area-adjusted glaucoma (control) patients. Material and methods. Between 1987 and 2001, all patients with approved Special Medical Coverage (SMC) for hypothyroidism or glaucoma, and without other SMC approvals, were included. The glaucoma (control) cohort was adjusted for age, sex and area of residence. For each patient, onset of SMC, all prescription drugs and treatments for CBDS were noted. Results. A total of 14,334 patients in each group met the inclusion criteria. Thirty-three patients (0.23%) in the hypothyroidism cohort and 23 (0.16%) in the glaucoma cohort had been treated for CBDS (p = 0.018). The groups did not differ in the number of CBDS treatments before the diagnosis of hypothyroidism or glaucoma. However, after the diagnosis of hypothyroidism or glaucoma there were significantly more CBD stone patients in the hypothyroid cohort (n = 25) than in the glaucoma cohort (n = 14) (p < 0.05). Conclusions. Diagnosed hypothyroidism is a significant risk factor for CBDS. We hypothesize that CBD stone formation begins during the untreated period and develops/matures even after the medication has been initiated, raising the question of the efficiency of treatment in this respect. When treating CBDS patients, one should be aware of the possible hypothyroid background.

The Risk of Gallbladder Stone Formation Is Increased in Patients with Predialysis Chronic Kidney Disease but Not Those Undergoing Chronic Hemodialysis Therapy

Background: It is unclear whether the prevalence of gallbladder stones (GBS) is higher in patients with chronic kidney disease (CKD). Methods: A total of 398 patients with CKD of each of the 5 disease stages [CKD1: 26; CKD2: 52; CKD3: 58; CKD4: 48; CKD5: 214, of whom 61 were predialysis and 153 were on dialysis (CKD5D)] were included in this study. Those in whom GBS were detected by ultrasonographic examination or who had a history of cholecystectomy owing to GBS were considered GBS patients. Results: In comparison to the GBS prevalence of 5.9% in the control group, that in CKD patients increased with the advancement of the disease stage (CKD1: 7.7%; CKD2: 15.4%; CKD3: 19.0%; CKD4: 20.8%; CKD5 predialysis: 21.3%; CKD5D: 22.9%). The prevalence was significantly greater in CKD5 patients than in the control group. CKD5 is a risk factor for GBS independent of age or sex. However, no significant relationship was found between the prevalence of GBS and the duration of hemodialysis therapy in CKD5D patients. Age was the only factor that was associated with GBS in predialysis CKD patients. Conclusion: The risk of GBS formation was high in predialysis CKD patients. Although the risk disappeared in CKD5D patients, the prevalence of GBS was still significantly higher than in the control population. Factors that promote GBS formation in predialysis CKD patients and/or that inhibit GBS formation in CKD5D patients remain unknown.

Prevalence of Gall Bladder Stones Among Type 2 Diabetic Patients in Benghazi Libya: A Case-Control Study

Background: Diabetes mellitus and gall bladder stones are both common and costly diseases. Increasing age, female gender, overweight, familial history of the disease and type 2 diabetes mellitus is all associated with an increased risk of gallstones. Several studies from around the world reported an increased prevalence of gall bladder stones in patients with diabetes mellitus. Aims and objectives: The aim of this study was to define the frequency of gall bladder stones among Libyan diabetics and to evaluate the possible associated risk factors in these patients. Patients and methods: A case-control study was performed during 2007 at Benghazi Diabetes and endocrinology Center. The study involved 161 randomly selected type-2 diabetic patients under regular follow up at the center, and 166 age and sex matched non-diabetic outpatients at the 7th of October teaching hospital. Real-time abdominal ultrasound was performed by two radiologists to examine the abdomen after an overnight fast. Results: About 40% of the diabetic cohort had gall bladder stones as compared to 17.5% of non-diabetic patients. Females were significantly more affected than males. Patients with gall bladder stones were significantly older and had a significantly higher body mass index than those without stones. Conclusion: The prevalence of gallstones in Libyan diabetic patients is higher than the rates reported in other parts of the world. Libyan diabetic patients with gallstones tend to be older and more obese than those without gallstones. Duration of diabetes mellitus and type of treatment does not seem to influence the frequency of gall bladder stones among Libyan diabetics.

Quantitative Analysis Of Copper And Zinc In Gallstone Patients

INTRODUCTION: Gallstones affect 10% to 20% of the adult population worldwide. High levels of trace metals in patients of cholelithiasis may be associated with formation of gallbladder stones.AIM: To quantitatively analyse the levels of the trace metals copper and zinc in bile and serum of patients of gallbladder stones and normal population without stones.METHOD: Serum and bile obtained from 31 patients of gallbladder stones and 11 controls without stones were analysed for levels of copper, magnesium and zinc by atomic absorption spectrophotometer, make Perkin Elmer, Model AAnalyst 300.RESULTS: Copper level was increased in cases as compared to controls in both bile(3.91 times) and serum (1.25 times) when compared with each other. Zinc was 12.43 times more elevated in serum of cases than controls and 4.21 times in bile of cases than controls.CONCLUSION: Copper and zinc levels are increased in gallbladder-stone patients. There is increased excretion of copper in bile suggesting increased hepatic excretion in persons affected by gallbladder stones. There is an increase in the zinc level in serum leading to a secondary increase in the zinc level in bile in these cases.