Two findings of gallstones in archaeological mummies from Colombia.

Results involving the analysis of gallstones found in two pre-Hispanic Colombian mummies are presented. By applying SEM, X-ray diffraction (XRD), sectioning, and CT-scan Hounsfield Units, we were able to identify these choleliths as mainly formed by cholesterol. The number of reports on gallstones in archaeological human remains from South America is very small, making these two cases an important addition to what little is known about ancient gallstone disease on the continent.

"Aged" autopsy gallstones simulating dry bone context: A morphological, histological and SEM-EDS analysis.

OBJECTIVE: The aim of this paper is to provide information on the morphology and composition of gallstones based on clinical samples in order to assist paleopathologists and bioarchaeologists in recognizing their presence in archaeological contexts. MATERIALS AND METHODS: 270 gallstones were extracted and macerated from autopsies conducted at the Istituto di Medicina Legale in Milan (Italy) in order to simulate a dry bone recovered from archaeological contexts. Morphological, histological, and elemental variation was documented. RESULTS: Gallstones vary in size, shape, color and texture. The cross-sectional surface correlates with chemical composition and is a valuable tool for classification into subcategories of stones. Histological analysis can confirm the classification. Elemental analysis yielded a higher frequency of carbon, calcium and phosphorus. CONCLUSIONS: Although identification of gallstones in archaeological contexts can be challenging, familiarity with morphological, histological, and elemental variation can assist researchers in the field and laboratory. SIGNIFICANCE: Identifying gallstones in archaeological populations will assist researchers in estimating their frequency in the past and the environmental, cultural, and biological conditions leading to their presence. LIMITATIONS: Small sample size derived from a modern and limited autopsy population may minimize the types and degree of variation present in the past. Effects of climate, soil, and taphonomy were not evaluated. SUGGESTIONS FOR FURTHER RESEARCH: Examination of larger samples derived from diverse populations may reveal greater variation or more diagnostic aspects of stones.

[Gallstones and "liver obstruction" in medical texts of antiquity]. / Gallensteine und "Leberverstopfung" in den medizinischen Fachschriften der Antike.

INTRODUCTION: Gallstones are rarely mentioned in the medical texts of antiquity. The physician, Alexander of Tralles mentions-for the first time-stones in the gallbladder as a possible cause for obstructive jaundice. This designation is found in his textbook on medicine under the heading "obstruction of the liver". Based on that observation, we describe the ancient history of hepatic obstruction and investigate the connection with the rare reference of gallstones in the medical texts of antiquity. METHODS: First, we evaluated the medico-historical literature on bile-stones and liver obstruction in antiquity, which has been published since 1900. The identified ancient sources we have analyzed for the purposes of etiology, diagnostics and therapy. Second, we searched for additional ancient sources with a combined keyword search in Greek and Latin text databases to check the completeness of the mentions of gallstones and liver obstructions known from the research literature. RESULTS: There are two mentions of stones in the liver and gallbladder: Aristotle probably describes stones in the liver of slaughtered sacrificial animals and the late-antique physician, Alexander of Tralles, in the gallbladder of humans. The mechanical obstruction of the bile ducts as a cause of jaundice has been known since Diocles of Karystos (4th century BC). For the first time, Galen of Pergamon describes the disease pattern of a liver obstruction (2nd century AC). This was due to the coagulation of the yellow bile, one of the four humors of ancient humoral pathology. CONCLUSION: Although gallstones were rarely mentioned, the clinical presentation of gallstone disease was known to ancient authors of medical texts and was referred to as liver obstruction.

Kitchen surgery and house calls in old Fort Smith.

Medical practice in the late nineteenth and early twentieth centuries consisted largely of kitchen surgery and house calls. The practices of Dr. St. Cloud Cooper and other Fort Smith doctors reflected the standards of practice in Arkansas and the nation as the principles of aseptic surgery gradually gained acceptance. The doctor's black bag used on house calls still lacked the effective agents which became available during the mid-twentieth century, leaving the physician to rely on personal inner resources in order to perform a useful service.

John Stough Bobbs: father of gall bladder surgery.

This year marks the 200th anniversary of the birth of John Stough Bobbs (1809-1870), who was the first surgeon to carry out an elective operation on the gall bladder for gall stones.

Extracorporeal shock wave lithotripsy of gallstones: 20th anniversary of the first treatment.

Twenty years ago, in January 1985, extracorporeal shock wave lithotripsy (ESWL) was first applied successfully in a patient with gallbladder stones. In the following years, the conditions which influence the success rate of ESWL have been extensively investigated. It was shown that the characteristics of the stones, gallbladder emptying and the degree of stone fragmentation are the most important factors which determine the clearance of all fragments from the gallbladder after ESWL. Severe side effects, such as biliary pancreatitis and liver haematoma, were found to be rare and no deaths related to the procedure have been reported. One or more episodes of biliary pain were observed in about one third of patients within the first 3-4 months after ESWL. Follow-up studies after successful treatment, however, have shown that stone recurrence is considerable, limiting the use of ESWL as a non-invasive therapeutic option. Stone recurrence varies between different subgroups of patients indicating that gallbladder motor function and other less well defined factors may be of importance. The recurrence of stones after ESWL is one of the reasons why laparoscopic cholecystectomy has become the standard treatment of symptomatic gallbladder stones today. ESWL has kept its role only in the treatment of bile duct stones resistant to endoscopic extraction. Unless stone recurrence can be decreased by better patient selection and/or other measures to prevent gallstone recurrence, ESWL of gallbladder stones has little chance of surviving.

From gallstones to genes: two hundred years of sterol research. A tribute to George J. Schroepfer Jr.

The origins of cholesterol research can be traced to prerevolutionary France. The discovery of cholesterol as a single substance, present in human gallstones, owes much to the scientists of l'Académie Française, including Lavoisier, who contributed so much to the emergence of chemistry as a modern scientific discipline. Since that time, cholesterol probably has been the most intensively scrutinized natural product of all time, and it has been the subject of Nobel Prizes for several who have studied its structure, biosynthesis, and regulation. The pace of research into cholesterol shows no sign of diminishing, and recent discoveries have led to the recognition that the regulation of cholesterol metabolism is intimately linked with that of other metabolic pathways. Details of these interactions are only just emerging, but it is becoming apparent that under some circumstances it is difficult to reconcile, in a conventional manner, changes in regulatory gene expression with corresponding changes in pathway carbon flux. The present review includes some of our studies on the roles of the transcription factors sterol regulatory element-binding protein, liver X-receptor alpha, and peroxisome proliferator activated receptor a in the coordination of cholesterol and fatty acid synthesis and describes how some of the results obtained can best be interpreted from a Metabolic Control Analysis perspective of the regulation of pathway carbon fluxes.