Healthy Gallbladder Research Articles

Is gallbladder PoCUS diagnostic accuracy accessible to medical students after PoCUS training exclusively on healthy volunteers? A pilot randomized control trial

BackgroundPoint-of-care ultrasound (PoCUS) is increasingly used in clinical practice and is now included in many undergraduate curricula. Here, we aimed to determine whether medical students who participated in a PoCUS teaching program with several practical training sessions involving healthy volunteers could achieve a good level of diagnostic accuracy in identifying gallbladder pathologies. The intervention group (IG) was trained exclusively on volunteers with a healthy gallbladder, whereas the control group (CG) had access to volunteers with a pathological gallbladder as recommended in most PoCUS curricula.Materials and methodsTwenty medical students were randomly assigned to the IG and CG. After completing the training program over 2 months, students were evaluated by three independent examiners. Students and examiners were blind to group allocation and study outcome. Sensitivity and specificity of students’ PoCUS gallstone diagnosis were assessed. Secondary outcomes were students’ confidence, image quality, acquisition time, and PoCUS skills.ResultsSensitivity and specificity for gallstone diagnosis were, respectively, 0.85 and 0.97 in the IG and 0.80 and 0.83 in the CG. Areas under the curve (AUC) based on the receiver operating characteristic curve analysis were 0.91 and 0.82 in the IG and CG, respectively, with no significant difference (p = 0.271) and an AUC difference of -0.092. No significant between-group difference was found for the secondary outcomes.ConclusionsOur pilot study showed that medical students can develop PoCUS diagnostic accuracy after training on healthy volunteers. If these findings are confirmed in a larger sample, this could favor the delivery of large practical teaching sessions without the need to include patients with pathology, thus facilitating PoCUS training for students.

Ultrasound evaluation of gallbladder dimensions in healthy adults

Background and objective: The gallbladder size, volume, and wall thickness can be affected by many disease processes. Therefore, there is a need to establish a baseline sonographic normogram of gallbladder dimensions and volume for early detection and follow-up of a diseased gallbladder. This study aimed to establish a baseline sonographic normogram for gallbladder volume and wall thickness in normal adults and its relationship with age, gender, and body mass index. Methods: This prospective cross-sectional study was conducted on 400 normal adult subjects aged 18-73 years at the Radiology Department of Rizgary Teaching Hospital and Private Clinic in Erbil city, Kurdistan Region of Iraq. Gallbladder dimensions, including height, length, width, volume, and wall thickness, were measured by sonographic scanning of the subjects' gallbladder after an overnight fasting. Results: Out of 400 subjects, 248 (62%) were male, and 152 (38%) were female. There was a slight difference between male and female gallbladder volume (29.87 ml for males and 26.5 ml for females) and wall thickness (2.53 mm for males and 2.46 mm for females), with the measurements slightly higher in males. A statistically significant variation was found between gender and age of participants with gallbladder height (ranging 2.4-3.06 cm), width (ranging 2.41-3.38 cm), volume (ranging 21.03-38.39 ml), and wall thickness (ranging 2.16-2.96 mm). A non significant correlation was found between the age and gender of participants with the length of the gallbladder (ranging 6.33-6.61 cm). A moderately significant correlation was found between gallbladder volume with height and weight of participants. A weak significant statistical relation was found between gallbladder volume and the body mass index of participants. Conclusion: Normal gallbladder sonographic dimensions have been established in our locality to be used as a reference value for evaluating the healthy and diseased gallbladder. The mean volume for males was 29.87cm3, and for females was 26.57cm3. The mean wall thickness for males was 2.53mm and 2.46 mm for females. The mean height was 2.92cm for males and 2.76cm for females. The mean width was 2.93 cm for males and 2.78cm for females. The mean length was 6.54 cm for males and 6.46 cm for females.

The clinical significance of preoperative serum fibrinogen levels and platelet counts in patients with gallbladder carcinoma

BackgroundGallbladder carcinoma (GBC) was the most common malignancy of biliary tract. Patients with malignancies frequently present with activated coagulation pathways, which might potentially related to tumor progression and prognosis. The purpose of the study was to investigate the clinical significance of preoperative serum fibrinogen levels and platelet counts in GBC patients.Methods The preoperative fasting serum fibrinogen levels and platelet counts of 58 patients with GBC were measured by AUV2700 automatic biochemical analyzer, as well as 60 patients with cholesterol polyps and 60 healthy volunteers. Kaplan–Meier survival analysis was applied to show the correction between fibrinogen levels and outcome after surgery.ResultsThe fibrinogen levels of patients with GBC were significantly higher than healthy gallbladder and cholesterol polyp of gallbladder (p < 0.001 and p < 0.001, respectively). In GBC, fibrinogen levels were associated with tumor depth (p = 0.001), lymph node metastasis (p = 0.002), distant metastasis (p < 0.001) and Tumor Node Metastasis (TNM) stage (p < 0.001). The levels in TNM stage IV disease were significantly higher than stage III or stage I + II disease (p = 0.048 and p < 0.001, respectively), and in TNM stage III disease were significantly higher than stage I + II disease (p = 0.002). Furthermore, the overall survival was better in low fibrinogen level group than in high fibrinogen level group (p < 0.001). However, thrombocytosis was not significantly associated with overall survivals (p > 0.05) in multivariate analysis.ConclusionsThe preoperative serum fibrinogen levels and platelet counts might be reliable biomarkers for the occurance of disease, tumor depth, lymph node metastasis, distant metastasis and advanced TNM stage in patients with GBC. The serum fibrinogen levels might be a prognostic factor to predict outcome for GBC patients suffering from surgery treatment. Anticoagulation therapy might be considered to control cancer progression in future studies.

Differential diagnosis of gallbladder opisthorchiasis and cholelithiasis in a teenager

Relevance. Parasitic invasions of the biliary tract, such as opisthorchiasis, are one of the significant causes of the formation of pigment calculi in the gallbladder, which is known in territories endemic for these diseases. However, visualization of the dynamics of the development of the pathological process using ultrasonography does not allow differentiating gall stones with a high degree of accuracy from the stages of development of the feline fluke. In the absence of an epidemiological history, this invasion can proceed under the guise of gallstone disease, which leads to an unjustified surgical intervention with the removal of a practically healthy gallbladder from a child. Before surgery, differentiation of calculi in the gallbladder from the stage of opisthorchiasis will significantly improve the quality of life of the child.The aim of the study was to demonstrate a clinical case of opisthorchiasis invasion in a child in a non-endemic territory, proceeding under the guise of cholelithiasis.Material and methods: the case history of a 17‑year-old girl with opistochiasis invasion is presented.Discussion. Parasitic invasion (opisthorchiasis) caused the formation of «calculi» of the gallbladder in the child. Not every hyperechoic formation of the gallbladder with the presence of a sound track is a «calculus». Timely diagnosis of the cause of cholelithiasis is important, as well as timely treatment of parasitic invasion to avoid relapse of the disease and errors in treatment, including surgical treatment.

Genotoxic Effect of Salmonella Paratyphi A Infection on Human Primary Gallbladder Cells.

Carcinoma of the gallbladder (GBC) is the most frequent tumor of the biliary tract. Despite epidemiological studies showing a correlation between chronic infection with Salmonella enterica Typhi/Paratyphi A and GBC, the underlying molecular mechanisms of this fatal connection are still uncertain. The murine serovar Salmonella Typhimurium has been shown to promote transformation of genetically predisposed cells by driving mitogenic signaling. However, insights from this strain remain limited as it lacks the typhoid toxin produced by the human serovars Typhi and Paratyphi A. In particular, the CdtB subunit of the typhoid toxin directly induces DNA breaks in host cells, likely promoting transformation. To assess the underlying principles of transformation, we used gallbladder organoids as an infection model for Salmonella Paratyphi A. In this model, bacteria can invade epithelial cells, and we observed host cell DNA damage. The induction of DNA double-strand breaks after infection depended on the typhoid toxin CdtB subunit and extended to neighboring, non-infected cells. By cultivating the organoid derived cells into polarized monolayers in air-liquid interphase, we could extend the duration of the infection, and we observed an initial arrest of the cell cycle that does not depend on the typhoid toxin. Non-infected intoxicated cells instead continued to proliferate despite the DNA damage. Our study highlights the importance of the typhoid toxin in causing genomic instability and corroborates the epidemiological link between Salmonella infection and GBC.IMPORTANCE Bacterial infections are increasingly being recognized as risk factors for the development of adenocarcinomas. The strong epidemiological evidence linking Helicobacter pylori infection to stomach cancer has paved the way to the demonstration that bacterial infections cause DNA damage in the host cells, initiating transformation. In this regard, the role of bacterial genotoxins has become more relevant. Salmonella enterica serovars Typhi and Paratyphi A have been clinically associated with gallbladder cancer. By harnessing the stem cell potential of cells from healthy human gallbladder explant, we regenerated and propagated the epithelium of this organ in vitro and used these cultures to model S. Paratyphi A infection. This study demonstrates the importance of the typhoid toxin, encoded only by these specific serovars, in causing genomic instability in healthy gallbladder cells, posing intoxicated cells at risk of malignant transformation.

Spontaneous Healthy Gallbladder Perforation, Case Report and Literature Review

&lt;p&gt;La perforación espontánea de la vesícula biliar es una entidad poco común y está relacionada principalmente con la colecistitis alitiásica; sin embargo, tiene una alta tasa de mortalidad en comparación con las muertes causadas por colecistitis litiásica, que solo representan 1%. Los datos clínicos y paraclínicos no son específicos, por lo que el diagnóstico oportuno es importante para proporcionar un tratamiento inmediato y evitar complicaciones con el propósito de mejorar el pronóstico del paciente.&lt;/p&gt;

Identification of microRNAs associated with the survival of patients with gallbladder carcinoma.

ObjectiveThis study investigated micro (mi)RNAs associated with the survival of patients with gallbladder carcinoma (GBC).MethodsmiRNA expression profiling was carried out of 40 cancerous tissues from GBC patients with long-term (n = 20) and short-term (n = 20) survival and eight healthy gallbladder tissues from the Gene Expression Omnibus database. miRNAs dysregulated in GBC patients with long-term or short-term survival were identified using GEO2R and VennDiagram packages, and analyzed by miRNA target prediction tools and the clusterProfiler package.ResultsCompared with healthy gallbladder tissues, 104 and 124 miRNAs were dysregulated in cancerous tissues of GBC patients with long-term survival and short-term survival, respectively. Two miRNAs (hsa-miR-142-5p and hsa-miR-146b-5p) and 22 miRNAs (such as hsa-miR-30a-3p, hsa-miR-660-5p, and hsa-miR-338-3p) were exclusively dysregulated in GBC patients with long-term and short-term survival, respectively. Enrichment analysis revealed that miRNAs exclusively dysregulated in GBC patients with short-term survival were involved in 46 biological processes, 10 cellular components, 11 molecular functions, and 44 pathways such as morphogenesis of an epithelium, response to transforming growth factor beta, heterochromatin, and phosphatase binding.ConclusionThis study not only identified some promising biomarkers for predicting survival in GBC patients, but also contributed to our understanding of the pathogenesis and prognosis of GBC.

A Whole-Food-Based Health Product (A-F Betafood®) Improves Gallbladder Function in Humans at Risk of Gallbladder Insufficiency: A Randomized, Placebo-Controlled Clinical Trial.

A-F Betafood® is a whole food-based health product. The product contains phytonutrients and bioactives with antioxidant properties that may support gallbladder and liver function. Herein, we investigated the efficacy of A-F Betafood® on gallbladder and liver function. In this randomized, placebo-controlled, parallel study fifty overweight but otherwise healthy adults received A-F Betafood® or placebo for 12 weeks. Gallbladder function as assessed by gallbladder volume, ejection fraction (GBEF), ejection rate, wall thickness and liver function determined via aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltransferase, and high-sensitivity c-reactive protein analysis at baseline and week 12 were the primary outcomes. Total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglycerides, and oxidative stress markers including oxidized low-density lipoprotein, tumor necrosis factor-α, adiponectin and malonyldialdehyde (MDA) were assessed as secondary outcomes. A-F Betafood®-supplementation significantly reduced gallbladder wall thickness (p = 0.049) by 9% compared to placebo from baseline to week 12. The A-F Betafood® group alone had significant improvements in gallbladder volume (32%; p = 0.044) and GBEF (19%; p = 0.047) at week 12. There were no changes in liver function, oxidative stress markers or blood lipid concentrations, though MDA concentrations decreased in both groups. Our findings demonstrate A-F Betafood®-supplementation significantly improves measures of gallbladder function and support healthy gallbladder function in the individuals with gall bladder condition.

MPZL1 is highly expressed in advanced gallbladder carcinoma and promotes the aggressive behavior of human gallbladder carcinoma GBC‑SD cells.

Myelin protein 0-like 1 (MPZL1) has been reported to have a role in hepatocellular carcinoma. However, to the best of our knowledge, there have been no studies on the function and molecular mechanism of MPZL1 gene in gallbladder carcinoma. The present study confirmed that MPZL1 was upregulated in four gallbladder carcinoma tissues according to the mRNA microarray analysis. The results of the immunohistochemical analysis of tissues from 82 patients with gallbladder carcinoma demonstrated that patients with advanced tumor stages (both T and N stage) had higher positive expression of MPZL1. Moreover, a total of 20 cases of gallbladder carcinoma and matched paired paracarcinoma tissues along with 20 samples of healthy gallbladder tissue from patients with cholecystitis were analyzed using reverse transcription-quantitative PCR and western blotting. The results demonstrated that the expression of MPZL1 in gallbladder carcinoma tissues was significantly higher than that of paired paracarcinoma tissues and randomly matched normal gallbladder epithelial tissues. According to the Tumor-Node-Metastasis classification, the expression level of MPZL1 protein in stage IV gallbladder carcinoma was significantly higher than that in stage III gallbladder carcinoma. The enhanced expression of MPZL1 gene appeared to improve the migration ability of GBC-SD cells. Conversely, GBC-SD cells that transfected with MPZL1 siRNA exhibited decreased migration ability. The results of proliferation experiments showed that the knockdown of MPZL1 siRNA caused impairments in GBC-SD cell proliferation. On the contrary, the overexpression of MPZL1 increased the proliferation ability of GBC-SD cells. The results of flow cytometry analyses indicated that the upregulation of MPZL1 had an anti-apoptotic effect on GBC-SD cells. In conclusion, the present study showed that the expression and protein levels of MPZL1 were significantly higher in gallbladder carcinoma tissues, especially in patients diagnosed with advanced tumor stages. Overexpression of MPZL1 may have promoted the invasion, metastasis, proliferation and survival of GBC-SD cells.

Constitutive law of healthy gallbladder walls in passive state with damage effect.

Biomechanical properties of human gallbladder (GB) wall in passive state can be valuable to diagnosis of GB diseases. In the article, an approach for identifying damage effect in GB walls during uniaxial tensile test was proposed and a strain energy function with the damage effect was devised as a constitutive law phenomenologically. Scalar damage variables were introduced respectively into the matrix and two families of fibres to assess the damage degree in GB walls. The parameters in the constitutive law with the damage effect were determined with a custom MATLAB code based on two sets of existing uniaxial tensile test data on human and porcine GB walls in passive state. It turned out that the uniaxial tensile test data for GB walls could not be fitted properly by using the existing strain energy function without the damage effect, but could be done by means of the proposed strain energy function with the damage effect involved. The stresses and Young moduli developed in two families of fibres were more than thousands higher than the stresses and Young's moduli in the matrix. According to the damage variables estimated, the damage effect occurred in two families of fibres only. Once the damage occurs, the value of the strain energy function will decrease. The proposed constitutive laws are meaningful for finite element analysis on human GB walls.

Dietary Intake and Cholelithiasis: A Review.

Gallbladder disease (GBD) is one of the most prevalent gastrointestinal disorders in western societies. Etiology is multifactorial and may follow complex interaction between genetic and environmental factors. Dietary intake has been considered as a potentially modifiable risk factor for GBD, because a number of dietary factors have been involved in cholelithiasis pathogenesis. In our aim to evaluate potential usefulness of diet pattern modification for GBD prevention, we perform a systematic review of related epidemiological studies. We define GBD as a disorder in which a patient bears gallstones and/or undergoes surgery for gallstones. We review English-language studies found in the Med-line database that occurred from 1973 to 2018. We searched for epidemiological evidence of the role of diet as a potential risk factor for gallstone formation. In particular, we thoroughly inspected intake of fatty acid, cholesterol, carbohydrate, protein, fiber, alcohol, nuts, and coffee and vegetarian eating-pattern effects. Our results show that simple sugar (simple carbohydrate) and saturated fat consumption suggests a positive association with the risk for gallstone formation. Protein, fiber, nuts, coffee, and moderate alcohol intake consistently reduces that probability. Different studies found that fat and cholesterol intake are variable risk factors for GBD; therefore, additional analyses are necessary to clarify their relevance in gallstone formation pathogenesis. GBD is a multifactorial disorder that can be affected both positively and negatively by diet. Although no specific dietary recommendations can be addressed to reduce risk for gallstone formation, healthy diet patterns can be expected to improve prospects for healthy gallbladder function.

Measurement of the mechanical properties of the human gallbladder

Gallbladder is a small organ of the body which is located in the right side of the liver. It is responsible of storing the bile and releasing it to the intestine. The gallbladder can subject to the mechanical deformation/loading as a result of the cholecystitis, cholesterolosis of the gallbladder, etc. However, so far the mechanical properties of the human gallbladder have not been measured. This study was aimed at conducting an experimental study to measure the mechanical properties of the human gallbladder under the axial and transversal tensile loadings. To do that, the gallbladder tissue of 16 male individuals was excised during the autopsy and subjected to a series of axial and transversal loadings under the strain rate of 5 mm/min. The amount of elastic modulus as well as the maximum/failure stress of the tissues were calculated via the resulted stress–strain diagrams and reported. The results revealed that the axial and transversal elastic modulus were 641.20 ± 28.12 (mean ± SD) and 255 ± 24.55 kPa, respectively. The amount of maximum stresses was also 1240 ± 99.94 and 348 ± 66.75 kPa under the axial and transversal loadings, respectively. The results revealed a significantly higher axial stiffness (p < .05, post hoc Scheffe method) compared to the transversal one. These findings have implications not only for understanding the axial and transversal mechanical properties of the human gallbladder tissue, but also for providing a diagnosis tool for the doctors to have a suitable threshold value of the healthy gallbladder tissue.

A new experimental model of calculous cholecystitis suitable for the evaluation and training of minimally invasive approaches to cholecystectomy.

Novel, less invasive approaches such as single-incision laparoscopic cholecystectomy or natural orifice transluminal endoscopic surgery require preclinical evaluation and training. Therefore, there is a need for an experimental model closely mimicking the clinical situation. The aim of our study was to create an experimental model of calculous cholecystitis in a large laboratory animal and test its feasibility for the evaluation of different techniques of cholecystectomy. In 11 laboratory pigs, gallstones were placed inside the gallbladder laparoscopically. Levels of inflammatory markers-leucocytes (WBC), C-reactive protein (CRP) and interleukin 6 (IL-6)-were monitored on the postoperative days (POD) 1, 2, 3, 7 and 30. Abdominal ultrasound was performed 2 and 4weeks after the operation. Four weeks after the lithiasis induction, laparoscopic cholecystectomy was performed. The control group consisted of ten healthy animals in which a cholecystectomy was performed. The pigs were monitored for 30days after surgery. All removed gallbladders were assessed histologically. The induction of lithiasis took 42 (35-52) min with no morbidity and mortality. The values of WBC, CRP and IL-6 increased significantly (vs. baseline) on POD 1, 2 and 3 (p<0.05) and then normalised. Ultrasonography confirmed the presence of chronic calculous cholecystitis in all cases after 4weeks. Laparoscopic cholecystectomy was significantly longer in animals with lithiasis, 63 (42-91) versus 46 (31-62) min (p=0.018). Perioperative gallbladder wall perforation was significantly more frequent in the model group (8/11 vs. 1/10; p=0.04). In contrast to healthy animals, all gallbladders with stones showed histological signs of chronic inflammation. A new animal model of calculous cholecystitis was created. Laparoscopic cholecystectomy was more technically difficult compared to operating on a healthy gallbladder. This model may be a suitable tool for effective preclinical training and also for the evaluation of different techniques of cholecystectomy.

CT Findings for Detecting the Presence of Gangrenous Ischemia in Cholecystitis.

The objective of our study was to evaluate the diagnostic accuracy of CT in differentiating gangrenous cholecystitis from uncomplicated cholecystitis and healthy gallbladders. We performed a retrospective review of 308 patients with histologically proven gangrenous cholecystitis who underwent preoperative CT 1 month before gallbladder removal over a 4-year period. Two readers who were blinded to the histologic diagnosis independently recorded CT features of and overall likelihood of gangrenous cholecystitis on a 5-point scale (1, definitely absent; 5, definitely present). Ratings were dichotomized such that a diagnosis was considered present at a rating of 4 or 5 and considered absent at lower ratings. Interobserver variability for individual CT findings was also assessed. Patients had gangrenous cholecystitis (n = 28), acute cholecystitis (n = 98), chronic cholecystitis (n = 118), or healthy gallbladders (n = 64). Multivariate analysis showed that CT findings of gallbladder distention greater than 4.0 cm (odds ratio [OR], 9.63; p < 0.01), mural striation (OR, 11.39; p < 0.01), and decreased mural enhancement (OR, 3.55; p < 0.05) independently predicted gangrenous cholecystitis. Using these CT features, the diagnosis of gangrenous cholecystitis was made with a specificity of 93.9% and 89.6% for readers 1 and 2, respectively, and accuracy of 90.9% and 87.0%, respectively. Good agreement was seen between the two readers with respect to gallbladder distention greater than 4.0 cm (κ = 0.77) and decreased mural enhancement (κ = 0.64). A markedly distended gallbladder associated with decreased wall enhancement is highly specific for gangrenous cholecystitis.

R-spondin 1 and noggin facilitate expansion of resident stem cells from non-damaged gallbladders.

Pioneering studies within the last few years have allowed the in vitro expansion of tissue‐specific adult stem cells from a variety of endoderm‐derived organs, including the stomach, small intestine, and colon. Expansion of these cells requires activation of the receptor Lgr5 by its ligand R‐spondin 1 and is likely facilitated by the fact that in healthy adults the stem cells in these organs are highly proliferative. In many other adult organs, such as the liver, proliferating cells are normally not abundant in adulthood. However, upon injury, the liver has a strong regenerative potential that is accompanied by the emergence of Lgr5‐positive stem cells; these cells can be isolated and expanded in vitro as organoids. In an effort to isolate stem cells from non‐regenerating mouse livers, we discovered that healthy gallbladders are a rich source of stem/progenitor cells that can be propagated in culture as organoids for more than a year. Growth of these organoids was stimulated by R‐spondin 1 and noggin, whereas in the absence of these growth factors, the organoids differentiated partially toward the hepatocyte fate. When transplanted under the liver capsule, gallbladder‐derived organoids maintained their architecture for 2 weeks. Furthermore, single cells prepared from dissociated organoids and injected into the mesenteric vein populated the liver parenchyma of carbon tetrachloride‐treated mice. Human gallbladders were also a source of organoid‐forming stem cells. Thus, under specific growth conditions, stem cells can be isolated from healthy gallbladders, expanded almost indefinitely in vitro, and induced to differentiate toward the hepatocyte lineage.

Serum vascular endothelial growth factors C and D as forecast tools for patients with gallbladder carcinoma.

Gallbladder carcinoma (GBC) is the most common cancer of the biliary tract. Lymph node metastasis (LNM) is the major diffusion route of GBC and is a prognosis factor. The aim of study was to assess the potential of the serum VEGF-C and VEGF-D (sVEGF-C/D) levels to predict the presence of LNM and the survival of GBC patients. The preoperative sVEGF-C/D levels of 31 patients with GBC, 10 patients with cholesterol polyps, and 10 healthy volunteers were measured by enzyme-linked immunoadsorbent assay (ELISA). The sVEGF-C/D levels of patients with GBC were significantly higher than those of people with healthy gallbladders (p < 0.001 and p = 0.001, respectively) and cholesterol polyp (p = 0.032 and p = 0.004, respectively). In GBC, the sVEGF-C levels were associated with LNM (p = 0.011), distant metastasis (p = 0.018), and stage (p = 0.045), but the sVEGF-D levels had a significant association with the tumor depth (p = 0.001), LNM (p = 0.001), distant metastasis (p = 0.047), and stage (p = 0.002). The sVEGF-C/D diagnostic values for the presence of GBC were sensitivity of 71.0 and 74.2 % and specificity of 80.0 and 85.0 %, respectively. With respect to the diagnosis of LNM, the diagnostic values of sVEGF-C/D were as follows: sensitivity 81.2 and 87.5 % and specificity 73.3 and 80.0 %, respectively. The mean survival time with high sVEGF-C was significantly shorter than that with low sVEGF-C (p < 0.001), which was also true for low sVEGF-D (p = 0.032). The preoperative sVEGF-C/D levels might be reliable biomarkers for the presence of disease and LNM in patients with GBC. The sVEGF-C/D levels may be prognosis factors that can predict a poor outcome for GBC patients.

Combined cholecystectomy in gastric cancer surgery

BackgroundMany studies have described the risk factors of gallstone formation in gastric cancer patients after gastrectomy, but few studies focus on the management of asymptomatic gallstones. Our goal is to examine the rationale of simultaneous cholecystectomy during gastric cancer surgery, and influence of surgical mortality, morbidity and overall survival after combined cholecystectomy and gastrectomy. MethodsWe retrospectively reviewed 445 gastric cancer patients and the gallbladders evaluated by abdominal ultrasound or computed tomography preoperatively and postoperatively. Clinicopathologic factors, including surgical morbidity, mortality and overall survival of combined surgery, were compared between patients receiving gastrectomy with simultaneous cholecystectomy and patients receiving gastrectomy only. We also evaluated the risk factors of gallstone formation after gastrectomy and the probability of subsequent cholecystectomy after gastrectomy in gastric cancer patients with or without asymptomatic gallstones. ResultsOf 445 gastric cancer patients, 52 (11.7%) patients had asymptomatic gallstones upon diagnosis of gastric cancer. Among patients with healthy gallbladders, 15.2% developed gallstones after gastrectomy. Men and older patients (age over 60) had significantly higher risk of gallstone formation. Rate of subsequent cholecystectomy in patients with and without preoperative asymptomatic gallstones was 30.8% and 4.5%, respectively (p = 0.005). The rates of mortality and morbidity were not significantly different between combined surgery (3.4%, 24.2%) and gastrectomy only (3.1%, 22%). There was also no significant difference in 5-year survival between combined surgery (61%) and gastrectomy only (63%) groups. ConclusionCombined cholecystectomy for asymptomatic gallstone in gastric cancer surgery may be considered. It was not associated with increased surgical morbidity or mortality, and had no significant effect on overall survival.

Hepatic Portocholecystostomy (HPC) is Ineffective in the Treatment of Biliary Atresia with Patent Distal Extrahepatic Bile Ducts

ABSTRACTObjective: To compare the effects of hepatic portocholecystostomy (HPC) and the Kasai procedure for the treatment of biliary atresia with patent distal extrahepatic bile ducts (BA with PDEBD) and to determine the reasons for the differences between the two procedures. Methods: The case files of 29 patients with BA with PDEBD were reviewed retrospectively. Twenty patients were treated with the Kasai procedure, and 9 patients were treated with HPC. We compared the rate of jaundice clearance, the incidence of cholangitis, survival rates of the native liver, and clinical outcomes between the two groups. Healthy gallbladders were collected for comparison with the pathologic specimens. Van-Gieson stains were used to detect the severity of fibrosis, and immunohistochemical methods were used to investigate the expression of CD68. Image analysis technology was used to quantitatively analyze the results. Results: Six months after surgery, the rate of jaundice clearance was 85% in the Kasai group and 33.3% in the HPC group (p = .01). The three-year survival rates of the two groups were 73.68% and 33.3%, respectively (p = .009). According to the criteria that define a cured state, there was an obvious difference between the two groups (p = .0056). The fibrosis and CD68+ cell infiltration were more severe in the gallbladders of patients with BA than in controls (p < .05). Conclusion: HPC was inferior to the Kasai procedure in the treatment of BA with PDEBD. This result may be due to the progressive inflammation and fibrosis of the extrahepatic bile duct.

Reflujo pancreáticobiliar en pacientes con colelitiasis y sin colelitiasis: Estudio comparativo

Pancreaticobiliary refl ux in patients with cholelithiasis and without cholelithiasis. A comparative study Background. Pancreaticobiliary refl ux is a pathologic phenomenon occurring in patients with gallsto- nes. However, the occurrence of pancreaticobiliary refl ux has not been studied in patients without gallstones. The objective of this study was to measure the bile levels of amylase and lipase in patients without gallstones submitted to cholecystectomy as part of another surgical procedure, and to compare these values with patients submitted to cholecystectomy for gallstone disease. Patients and Methods. A prospective observational comparative study was designed. A sample of 136 consecutive patients was included. Amylase and lipase levels were measured in bile. Normal serum amylase levels at our institution are 28-100 U/L and for lipase are 13-60 U/L. There are no established normal levels for pancreatic enzymes in bile. However, we considered elevated the bile amylase and lipase levels whenever they were higher than normal plasma levels. Results. One-hundred three patients (76%) had gallstones and 33 (24%) had healthy gallbladders without gallstones. According to normal plasma levels for amylase and lipase, these enzymes in bile were elevated in 83.5% pa- tients with gallstones, compared to elevated levels of amylase in 6% patients and lipase in 3% patients without gallstones. Conclusions. Pancreaticobiliary refl ux is a common phenomenon in patients with gallstones and occurs sporadically in patients without gallstones.

Pancreaticobiliary Reflux in Patients with and without Cholelithiasis: Is It a Normal Phenomenon?

Pancreaticobiliary reflux is a pathologic phenomenon occurring in patients with gallstones. However, the occurrence of pancreaticobiliary reflux has not been studied in patients without gallstones. The objective of the present study was to measure the bile levels of amylase and lipase in patients without gallstones submitted to cholecystectomy as part of another surgical procedure, and to compare these values with the bile levels of amylase and lipase of patients submitted to cholecystectomy for gallstone disease. A prospective observational and comparative study was designed. A sample of 136 consecutive patients was included. Amylase and lipase levels were measured in bile. At our institution, normal plasma concentrations of amylase are 28-100IU/l and lipase 13-60IU/l. Normal values for pancreatic enzyme concentrations in bile have not been established. Therefore, bile amylase and lipase concentrations exceeding normal plasma concentrations were deemed to be elevated. Of the patients in the present study, 103 (76%) had gallstones and 33 (24%) had healthy gallbladders without gallstones. According to normal plasma levels for amylase and lipase, these enzymes in bile were elevated in 83.5% patients with gallstones, compared to elevated levels of amylase in 6% patients and lipase in 3% patients without gallstones (P<0.0001). Pancreaticobiliary reflux is a common phenomenon in patients with gallstones and an uncommon phenomenon in patients with healthy gallbladders without gallstone disease.