[Change in the ratio of blood saturated to unsaturated fatty acids is a universal marker of lipid metabolic disorder in patients with cholelithiasis]. / Izmenenie sootnosheniya nasyshchennykh i nenasyshchennykh zhirnykh kislot v krovi ­ universal'nyi marker narusheniya lipidnogo obmena u bol'nykh kholelitiazom.

AIM: To study the spectrum of serum fatty acids (SSFA) and the composition of blood lipids in cholelithiasis (CL) in various ethnic groups of East Siberia. SUBJECTS AND METHODS: A clinical and epidemiological study was conducted, during which ultrasonography and oral cholecystography were used to examine 991 Khakases and 934 Europoids in Khakassia and 652 Evenks and 996 Europoids in Evenkia. Biochemical tests were performed to determine serum lipids in 20% of the random sample. Gas liquid chromatography was applied to investigate ASSFA in 220 patients in Khakassia and 157 people in Evenkia. RESULTS: The manifestations of hyperlipidemia were detected in the Europoids with CL in Evenkia and Khakassia. These changes were less pronounced in the Evenks with CL and absent in the Khakases with CL. In all populations, the blood levels of saturated FAs and ratios of saturated to unsaturated FAs were considerably higher in the patients with CL than in the healthy individuals. CONCLUSION: The higher levels of saturated FAs and the lower proportion of serum unsaturated FAs are a universal marker of lipid metabolic disturbances in patients with CL in genetically different populations.

Interval increase in the prevalence of symptomatic cholelithiasis-associated non-alcoholic fatty liver disease over a ten-year period in an Asian population.

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is frequently associated with cholelithiasis. The prevalence of NAFLD in Asia has been on the rise, but the magnitude of this increase had not been studied previously. METHODS: A retrospective cohort study was conducted on consecutive patients who underwent laparoscopic or open cholecystectomy from November 2001 to November 2004 (Cohort 1) and from November 2011 to November 2014 (Cohort 2) at Singapore General Hospital. Preoperative diagnostic scans (e.g. ultrasonography, computed tomography and magnetic resonance imaging) and clinical data were reviewed for the presence of fatty liver. Statistical analysis was performed. RESULTS: In Cohorts 1 and 2, 127 patients and 99 patients were operated on, respectively. Cohort 2 had significantly higher proportions of patients with NAFLD (56.6% vs. 40.2%; p < 0.015) and hyperlipidaemia (45.5% vs. 18.9%; p < 0.001) as compared to Cohort 1. Binary logistic regression analysis showed that hypertension (odds ratio [OR] 2.558; p < 0.004) and Indian ethnicity (OR 5.448; p < 0.043) were significantly associated with NAFLD. CONCLUSION: Similar to other international studies, we found a significant increase in the prevalence of patients with NAFLD presenting symptomatically for cholecystectomy over an interval of ten years in Singapore. Hypertension and Indian ethnicity were significantly associated with NAFLD in both time periods. This trend supports the need for concerted public health intervention to stem the increasing incidence of NAFLD and prevent its progression to more advanced liver disease.

The Lowest Prevalence of Cholelithiasis in the Americas - An Autopsy-based Study.

OBJECTIVES: This study used autopsy to evaluate the prevalence of cholelithiasis and its associated risk factors in a population of healthy, young subjects who suffered a violent or natural death. METHODS: This study is a prospective evaluation of autopsies of 446 individuals from 2011 to 2013 in Brazil. Of that sample, 330 (74%) subjects died from violent deaths and 116 (26%) died naturally. The presence of biliary calculi, previous cholecystectomy, gender, age, ethnicity, body mass index (BMI) and alcohol use were evaluated. RESULTS: In the natural death group, 6.9% (95% CI 3.39 to 13.28) (3.08% of the male subjects and 11.76% of the female subjects) exhibited evidence of gallbladder disease. In the violent death group, only 2.12% (95% CI 0.96 to 4.43) (2.17% of the male subjects and 1.85% of the female subjects) of the subjects exhibited evidence of gallbladder disease. Age was correlated with the prevalence of gallbladder disease, but BMI was correlated with only gallbladder disease in the natural death group. CONCLUSIONS: This population has the lowest prevalence of cholelithiasis in the Americas. Dietary habits, physical activity, ethnicity, alcohol consumption and genetic factors may be responsible for this low prevalence.

The Lowest Prevalence of Cholelithiasis in the Americas - An Autopsy-based Study

OBJECTIVES: This study used autopsy to evaluate the prevalence of cholelithiasis and its associated risk factors in a population of healthy, young subjects who suffered a violent or natural death. METHODS: This study is a prospective evaluation of autopsies of 446 individuals from 2011 to 2013 in Brazil. Of that sample, 330 (74%) subjects died from violent deaths and 116 (26%) died naturally. The presence of biliary calculi, previous cholecystectomy, gender, age, ethnicity, body mass index (BMI) and alcohol use were evaluated. RESULTS: In the natural death group, 6.9% (95% CI 3.39 to 13.28) (3.08% of the male subjects and 11.76% of the female subjects) exhibited evidence of gallbladder disease. In the violent death group, only 2.12% (95% CI 0.96 to 4.43) (2.17% of the male subjects and 1.85% of the female subjects) of the subjects exhibited evidence of gallbladder disease. Age was correlated with the prevalence of gallbladder disease, but BMI was correlated with only gallbladder disease in the natural death group. CONCLUSIONS: This population has the lowest prevalence of cholelithiasis in the Americas. Dietary habits, physical activity, ethnicity, alcohol consumption and genetic factors may be responsible for this low prevalence.

Association between the APOB XbaI and EcoRI polymorphisms and lipids in Chinese: a meta-analysis.

BACKGROUND: No previous meta-analysis was to report the association between the apolipoprotein B (APOB) XbaI and EcoRI polymorphisms and serum lipids in Chinese. We performed the study to investigate their potentially association. METHODS AND RESULTS: Studies in English and Chinese were found via a systematic search of Pubmed, Embase, CNKI and Wanfang databases. The dominant genetic model and random-effects model were used to pool data from individual studies. As a result, a total of 30 articles with 5611 subjects for XbaI and 2653 subjects for EcoRI were included in the current study. For the XbaI polymorphism, overall, subjects carrying X+ allele were significantly associated with higher TC,TG and LDL compared with X-X- genotype (Pvalue = 0.0006, OR (95 %) = -0.55 (-0.86,-0.23); Pvalue = 0.0004, OR (95 %) = -0.30 (-0.47,-0.14); (Pvalue = 0.05, OR (95 %) = -0.23(-0.46,-0.00), respectively). Similar results were observed in the subgroups of Han, healthy individuals (HT), coronary heart disease (CHD), cerebral infarction (CI), and cholelithiasis. For HDL, positive association between X+ allele with Lower lipid value was found in CHD and CI subgroups. For EcoRI polymorphism, overall, the E- allele carriers were found to be obviously linked with elevated LDL and lower HDL compared with E + E+ genotype (Pvalue = 0.02,OR (95 %) = -0.27 (-0.49,-0.05); Pvalue = 0.01, OR (95 %) = 0.17 (0.03, 0.30), respectively). TC was significantly high in subjects carrying E- allele in the subgroup of hyperlipidemia. No evidence of publication bias was observed. CONCLUSIONS: The two genetic variants of APOB may be associated with serum lipids in Chinese.

Relationship between gallbladder surgery and ethnic admixture in African American and Hispanic American women.

OBJECTIVES: The objective of this study was to investigate whether differences in admixture in African American and Hispanic American adult women are associated with differences in gallbladder surgery. METHODS: Gallbladder surgery history on entry to the Women's Health Initiative's (WHI) study was used as a dichotomous outcome measure for this study. The proportion of European, sub-Saharan African, and Amerindian (AMI) admixture was estimated for 10,841 African American and 4,620 Hispanic American women in WHI using 92 ancestry informative markers. Logistic regression analyses assessed the relationship between admixture and gallbladder surgery in WHI women (enrollment at ages >50, mean age 61 years) with or without adjusting for multiple covariates, including measures of adiposity, parity, alcohol use, and education. RESULTS: There was a significant positive association between AMI admixture and the frequency of gallbladder surgery in Hispanic Americans. The odds ratio (OR) and 95% confidence intervals (CIs) for AMI admixture group was OR=2.97, CI=2.01-4.38, P<10(-4). Although there were strong positive associations with parity and adiposity, and negative associations with alcohol consumption and education, accounting for these covariates did not remove the admixture association (OR=2.46, CI=1.62-3.73). In contrast, the effect of African admixture was nearly indistinguishable from that of the European admixture, both of which were protective in the Hispanic American group, and African admixture had a marginal association with decreased gallbladder surgery in the African American group. Measures of adiposity were associated with increased risk for gallbladder surgery and remained significant after accounting for admixture and each of the other covariates. Education level and alcohol use were associated with decreased risk for gallbladder disease. However, after accounting for the other covariates these variably remained significant. CONCLUSIONS: AMI admixture is strongly associated with gallbladder surgery in women, even after adjustment for selected risk factors for cholelithiasis. Additional studies to ascertain the specific genetic risk factors underlying these associations are warranted.

Hepatolithiasis and the syndrome of recurrent pyogenic cholangitis: clinical, radiologic, and pathologic features.

Primary hepatothiasis (HL) and recurrent pyogenic cholangitis (RPC) are two terms describing the different aspects of the same disease, with HL emphasizing the pathologic changes and RPC emphasizing the clinical presentation and suppurative inflammation. It is predominantly a disease of the Far East. In the 1960s, it was the third most common cause of emergency abdominal surgery at a university hospital in Hong Kong. Thereafter, its incidence has decreased considerably, possibly due to improved standards of living and Westernized diet. Clinically, patients may present acutely with recurrent bacterial cholangitis and its possible complications, such as liver abscess and septicemic shock, or with chronic complications, such as cholangiocarcinoma. Pathologically, it is characterized by pigmented calcium bilirubinate stones within dilated intrahepatic bile ducts featuring chronic inflammation, mural fibrosis, and proliferation of peribiliary glands, without extrahepatic biliary obstruction. Episodes of suppurative inflammation cumulate in sclerosing cholangitis of peripheral ducts and parenchymal fibrosis resulting from collapse and scarring. Mass-forming inflammatory pseudotumor and neoplasms like intraductal papillary neoplasms and cholangiocarcinoma are increasingly recognized complications. Modern imaging techniques allow definitive diagnosis, accurate assessment for treatment planning, and detection of complications. A multidisciplinary team approach (interventional endoscopist, interventional radiologist, hepatobiliary surgeon, and intensivists) is important for optimal patient outcome.

A high cholecystectomy rate in a cohort of Mexican American women who are postpartum at the time of oral contraceptive pill initiation.

BACKGROUND: Opinions regarding the association between gallbladder disease and oral contraceptive (OCs) differ. The objective of this article is to quantify cholecystectomy rate among women initiating OCs. STUDY DESIGN: Women under the age of 25 years were enrolled at four sites in a randomized trial evaluating initiation of OCs. Hospitalizations while enrolled were elicited during follow-up interviews, and medical records of women who underwent cholecystectomy were reviewed. RESULTS: Of 757 women enrolled at University of Texas Southwestern Medical Center (UTSW), 8 underwent cholecystectomy, a rate of 25.3/1000 woman-years (95% CI=8.1, 42.5). All eight were Mexican American and postpartum when they initiated OCs. The expected rate is 4.2/1000 woman-years for U.S. women aged 15-44. CONCLUSIONS: Women enrolled at the UTSW site had an increased rate of cholecystectomy and were more likely to be postpartum and Mexican American than women enrolled at the other sites.

[The mechanism of reverse cholesterol transport and cholelithiasis in Northern ethnic groups].

The aim of the study was to investigate metabolic factors that protect the human organism from cholelithiasis and coronary artery disease (CAD). An epidemiological study was carried out to determine the prevalence of cholelithiasis and CAD in eight settlements of Yakutia and Evenkia. The subjects were 1154 Evens and Evenks, and 1591 Europoids. The parameters under study were the lipid composition and bile acid (BA) spectrum as well as the level of lipids, the spectrum of lipoproteins, neutral lipids, and phospholipids in the serum and blood plasma. Among Europoids, the prevalence of cholelithiasis was 8.8%, and the prevalence of CAD was 18.8%, while among Mongoloids they were 1.5% (p < 0.001) and 10.2% (p < 0.001), respectively. Serum levels of total cholesterol (CH) were significantly higher in Europoids than in Evens and Evenks, whereas CH, BA, and primary cholates prevailed in bile of Mongoloids. The levels of main LCHAT-reactive substrates evidence a significantly higher efficiency of CH esterification in Evens and Evenks vs. Europoids. Highly effective mechanism of CH return transport, an important component of which is active BA synthesis and transport of sterins into bile should be considered the leading factor that protects high latitude Mongoloids from cholelithiasis and CAD.

Association of APOE-C1 gene cluster polymorphisms with gallstone disease.

BACKGROUND: Genetic polymorphisms in apolipoprotein genes may be associated with alteration in lipid profile and susceptibility to gallstone disease. AIM: To find out the association of APOE HhaI and APOC1 HpaI polymorphisms with gallstone disease. SUBJECTS: HhaI polymorphism of APOE and HpaI polymorphism of APOC1 were analysed in DNA samples of 214 gallstone patients and 322 age- and sex-matched healthy controls. METHODS: For genotyping DNA samples of all study subjects were amplified using polymerase chain reaction, followed by restriction digestion. All statistical analyses were done using SPSS v11.5 and ARLEQUIN v2.0 softwares. RESULT: APOC1 HpaI polymorphism was found to be significantly associated with gallstone disease. Frequency of H2H2 was significantly higher (P = 0.017) in patients than in controls and it was imposing very high risk (OR 9.416, 95% CI 1.125-78.786) for gallstone disease. When data were stratified in male and female, H2H2 was associated (P = 0.011) with disease in females only. Analysis at allele level revealed no association. APOE HhaI polymorphism and APOE-C1 haplotypes showed no association with gallstone disease. CONCLUSION: APOC1 HpaI polymorphism is associated with gallstone disease and shows gender-specific differences. APOE HhaI polymorphism may not be associated with gallstone disease.

Clinical correlation of gallstone disease in a Chinese population in Taiwan: experience at Cheng Hsin General Hospital.

AIM: To explore the prevalence of gallstone disease (GSD) in Taiwan and condition-associated factors related to it. METHODS: We studied a total of 2386 healthy adults (1235 males and 1151 females) voluntarily admitted to Cheng Hsin General Hospital for a paid physical check-up between January 2002 and December 2002. Blood samples and ultrasound sonography results were collected. RESULTS: The overall prevalence of GSD among this study-population was 5.3%, including 1.7% (n=40) having a single stone, 2.3% (n=55) having multiple stones, and 1.3% (n=31) having cholecystectomy. The prevalence revealed a statistically significant increase with increasing age (P<0.0001). Females exhibited a greater prevalence of multiple stones than did males (3.0% vs 1.7%, P=0.04). Using multiple logistic regression analysis, the following appeared to be significantly related to the prevalence of GSD: older age (40-49 years vs < 40 years, OR=1.63 [95% CI: 0.76-3.48], 50-59 years vs < 40 years, OR=4.93 [95% CI: 2.43-9.99], 60-69 years vs < 40 years, OR=6.82 [95% CI: 3.19-14.60], > or = 70 years vs < 40 years, OR=10.65 [95% CI: 4.78-23.73]), higher BMI (> or = 27 kg/m2 vs < 24 kg/m2, adjusted OR=1.74 [95% CI: 1.04-2.88]), and higher FPG (> or = 126 mg/dL vs < 110 mg/dL, OR=1.71, 95%CI: 1.01-2.96). CONCLUSION: Older age (> or = 50 years), obesity (BMI > or = 27 kg/m2), and type 2 diabetes (FPG > or = 126 mg/dL) are associated with the prevalence of GSD.

Cholelithiasis and cholecystitis: changing prevalence in an African community.

BACKGROUND AND OBJECTIVES: Cholelithiasis and cholecystitis were thought to be rare in Africans. It is now seen more frequently than previously thought. The essence of this study is to determine the prevalence of cholelithiasis and cholecystitis in a Nigerian population, changing pattern and outcome. DESIGN: Descriptive study over a five-year period in an urban teaching hospital in Nigeria. MATERIALS AND METHODS: All cases of inflammatory gallbladder disease seen in the University of Ilorin Teaching Hospital, Ilorin, Nigeria, from January 1997 to December 2001 were studied prospectively. Only those who had a surgical operation and histological confirmation of cholelithiasis and cholecystitis were included in the study. The patients' demographic details, clinical presentation, findings at surgical operation and histological results of gallbladder specimens and outcome were studied. RESULTS: In this study, 46 patients had cholecystectomy for cholelithiasis and cholecystitis in five years. In the first three years, 18 (39.1%) cases were seen, but in the next two years 28 (60.9%) patients had cholecystectomy. The male:female ration was 1:4.8. Only four (8.7%) of these patients were obese. Thirty-two (69.6%) were multiparous. Only four (8.7%) of the patients had pigmented stones, the majority of which were mixed stones. Many of the patients have been on treatment for suspected peptic ulcer disease for a period ranging from four weeks to five years. One of the patients had Mirizzi syndrome type 1. Abdominal ultrasound was found useful in the diagnosis. All patients had open cholecystectomy. Outcome of treatment was satisfactory. CONCLUSION: We are beginning to have an increase in gallbladder disease probably as a result of changing dietary habits (increase in intake of calories and cholesterol/fats) of the population. A high index of suspicion and careful clinical judgment coupled with the use of simple ancillary investigation like ultrasound will make early diagnosis and treatment feasible.

Risk factors for cholelithiasis in pregnancy.

This study was designed to examine the relationships of demographics, anthropometrics, prenatal physical activity, serum cholesterol, and nutrient intakes to symptomatic cholelithiasis (gallstone) occurrence in 128 northern plains pregnant women. Data collected at 14 and 26 weeks of pregnancy and 4 weeks after delivery, indicated 25.8% of the Native American and 8.3% of the Caucasian pregnant women experienced symptoms of cholelithiasis. Body mass indices (BMIs) were significantly higher in the pregnant women who experienced cholelithiasis than in those who did not have cholelithiasis, and prenatal physical activity was significantly lower in those same women. History of gallbladder disease (beta=.73; p=.001), BMI (beta=.33; p=.01), and prenatal physical activity (beta=-.20; p=.04) were predictive of increased occurrence of cholelithiasis during pregnancy.

[Natural history of cholelithiasis and incidence of cholecystectomy in an urban and a Mapuche rural area]. / Historia natural de la colelitiasis. Incidencia de colecistectomía en un área urbana y una rural mapuche, en la última década.

BACKGROUND: Cholelithiasis is the second cause of hospital admissions in Chile. AIM: To study the prevalence of symptomatic gallstone disease and opportunity of cholecystectomy in La Florida, Santiago and among Mapuche Indians in Huapi Island. PATIENTS AND METHODS: In the period 2000-2001, we contacted to 71% (1127 subjects) and to 61% (145 subjects) patients of La Florida and Huapi Island, respectively, that had previously participated in an epidemiological study on cholelithiasis in 1993. We defined symptomatic gallstone patients as those with a history of biliary colic. Each patient was subjected to gallbladder ultrasound. RESULTS: In 1993, 30-35% of gallstone patients were symptomatic (approximately 70% women). During the lapse 1993-2001, only 50% of subjects from La Florida and 25% of patients from Huapi Island were cholecystectomized (p < 0.05). Fifty percent of cholecystectomies were emergency operations. In 38 symptomatic Mapuche Indians from Huapi, cholecystectomy was indicated in 2001. After five months of the indication, only one of these subjects had been operated. Laparoscopic cholecystectomy represented 40% of all cholecystectomies performed in the National Health Service Hospitals. CONCLUSIONS: This study demonstrates an unacceptable high prevalence of symptomatic gallstone patients remaining non-operated in both the urban and rural communities. This reciprocally correlates with the high frequency of emergency cholecystectomies and the high incidence of gallbladder cancer among Chileans. This study contrasts negatively with the situation of Scotland, where 73.5% of cholecystectomies were laparoscopic in 1998-1999. To reach Scotland standards, the Chilean Public Health System should increase the number of cholecystectomies from 27,000 in 2001 to 57,510

Epidemiology of the American Indians' burden and its likely genetic origins.

It was not known until recently whether the endemic of cholesterol gallstones among certain southwestern American Indian tribes was unique among this ethnic group. With use of ultrasonography of the gallbladder and standard diagnostic criteria, gallstones are now found in epidemic proportions in 13 diverse American Indian tribes and communities living in Arizona, Oklahoma, and the Dakotas. We speculate that this predisposition is polygenic involving "thrifty" genes that conferred survival advantages when Paleo-Indians migrated from present-day Siberia to the Americas during the last Great Ice Age approximately 50,000 to 10,000 years ago. A reasonable hypothesis is that functioning of these genes promoted more efficient calorie utilization and storage in the form of adipose tissue. Beneficial results would have been operative during the isolation of Paleo-Indians in the Bering Strait land bridge (Beringia) when thrifty genes would have ensured sufficient fat reserves for survival of prolonged winters, successful pregnancy outcomes, and extended lactation periods. The authors' conjoint work on genetics of experimental cholesterol cholelithiasis in inbred mice promises help in pinpointing orthologous genetic loci (LITH genes) in the human genome. Moreover, the shared environments and homogeneity of American Indian tribes and communities should facilitate discovery of the ensembles of their common and rarer cholesterol gallstone genes. It is anticipated that knowledge of expression, polymorphisms, and functionality of LITH genes will help resolve the molecular mechanisms of this complex heterogeneous trait and thereby provide targets for novel therapies to prevent cholesterol cholelithiasis worldwide.

Pancreatitis in remote Australia: an indigenous perspective.

In Australia, pancreatitis has been associated with gallstones in approximately 35% of cases and alcohol in approximately 25% of cases. The present study was performed to analyse the aetiology of pancreatitis in patients admitted to a remote Australian hospital that has a population base comprising both indigenous and non-indigenous people. A retrospective study was conducted of all cases of pancreatitis admitted to the Alice Springs Hospital from August 1993 to August 1999. One hundred and two patient records were examined, and 77% of these patients were Aboriginal. Alcohol was the most common aetiological factor (64%), with gallstone disease being the next most common. Aboriginal patients with pancreatitis were younger than non-Aboriginal patients ( P = 0.0304) and were also more likely to have alcohol as their cause of pancreatitis ( P = 0.035), especially if they were male. In males, alcohol was implicated in at least 70% of cases. In females, the causes were gallstone disease (41%) and alcohol (49%). Patients with gallstone disease were significantly older than patients with other causes of pancreatitis ( P = 0.000). There was an overall 30% increase in admission rate per year, which was primarily due to an increase in the number of Aboriginal admissions (36% per year) ( P = 0.000). The present study highlights a difference in the aetiology of pancreatitis in Aboriginal and non-Aboriginal people from a remote Australian population.

Gallstone pancreatitis: a community teaching hospital experience.

GOALS: The current study reviews the Bridgeport Hospital experience with gallstone pancreatitis (GP) and examines its incidence by race and gender. STUDY: Consecutive patients admitted with acute pancreatitis between October 1994 and October 1996 were identified using discharge diagnosis codes. Demographics and clinical information were abstracted. Patients were categorized as having definite GP, probable GP, and non-GP using the available information. RESULTS: One hundred twenty-three patients met criteria for acute pancreatitis. Of these, 40 met the criteria for definite GP; 14, probable; and 69, non-GP. The estimated incidence for acute pancreatitis was 45 per 100,000 person-years (95% CI = 41-58 per 100,000 person-years) for definite GP and was 20 per 100,000 person-years (95% CI = 14-25 per 100,000 person-years) for probably GP. Patients with definite or probable GP were predominantly white or Hispanic women and tended to be older. Only 16% of pancreatitis in black patients was associated with gallstones. Elevated alanine aminotransferase (ALT > 120 U/L) was highly specific (97%) in predicting GP, with a positive likelihood ratio of 18.3. Abdominal ultrasound was the most widely used imaging study. Complication rates were low. There was only one intrahospital death. CONCLUSIONS: The incidence of acute pancreatitis requiring hospitalization at our community hospital in 1994-1996 was 45 (95% CI = 41-58) per 100,000 person-years. Forty percent of these cases were associated with gallstones. Gallstone pancreatitis was more common among the elderly women and the white (white, non-Hispanic) population. Elevated ALT was highly specific in the prediction of GP.

[Oriental biliary lithiasis. Retrospective study of 690 patients treated surgically over 8 years at Hospital 108 in Hanoi (Vietnam)]. / Les lithiases biliaires extrême-orientales. Etude rétrospective sur 690 patients opérés en 8 ans d'activité à l'Hôpital 108 de Hanoi (Vietnam).

The purpose of this study was to review the unique features distinguishing Oriental from Western gallbladder disease based on a series of 690 patient who underwent surgical treatment at hospital 108 in Hanoi. Oriental cholangiohepatitis often affects in young patients with no gender predilection. The disease originates mainly in canaliculi and leads to blockage or obstruction of the main bile duct inside and outside the liver. Onset has been related to nutritional, infectious, and parasitic factors. Ascariasis may play a determinant role. Because of these unique features, surgical treatment is usually focused on the main bile duct and depends on the size, number, and effects of gallstones. The authors recall that excision of liver tissue may be unavoidable in some cases due to the severity and consequences of lithiasis.

Gallstones and ethnicity in the Americas.

Information on ethnicity as related to gallstones has been limited by insufficient or inaccurate characterization of ethnicity. Nevertheless, in recent years, ultrasonography has allowed limited examination of ethnic differences in the risk of gallbladder disease, defined by a history of cholecystectomy or ultrasonographic detection of gallstones. Among women, the risk of gallbladder disease is highest among American Indians, followed by Hispanics, non-Hispanic whites, and non-Hispanic blacks. Men differ from women by having lower risk in all ethnic groups and by having a similar prevalence between Hispanics and non-Hispanic whites. It does not appear that the type of stone differs much according to ethnic group in the United States. Well-known risks for gallbladder disease, such as obesity, weight loss, pregnancy, and low alcohol use do not explain differences in ethnic risk. As yet, genetic markers have not been identified that would explain differences in risk among ethnic groups. Higher case fatality rates among non-Hispanic blacks than non-Hispanic whites suggest that blacks may have inadequate access to medical care for gallbladder disease.