Effects of laparoscopic cholecystectomy in normokinetic biliary dyskinesia.

This is the largest single center retrospective study to date looking at response to laparoscopic cholecystectomy in patients with acalculous biliary disease. A chart review was completed on 1116 patients from 2009 to 2014 who had admitting diagnoses related to acalculous cholecystitis and biliary colic. Four hundred and seventy four patients were available for long term follow up (6 months or longer). Multiple factors were studied as related to cholescintigraphy scans with cholecystokinin administration (HIDA with CCK). Hyperkinetic, normokinetic and hypokinetic ejection fractions (EF), as well as reproduction of symptoms with administration of CCK were catagorized. ROME III criteria (Table 1) were used to describe cholecystitis/biliary colic symptoms. (1). It was found that rates of resolution of symptoms after laparoscopic cholecystectomy in normokinetic and hypokinetic were similar. It was also found that reproduction of symptoms after administration of CCK was a better predictor of favorable response to surgery than calculated ejection fraction.

Gallbladder Ejection Fraction Is Unrelated to Gallbladder Pathology in Children and Adolescents.

OBJECTIVES: Biliary dyskinesia is a common diagnosis that frequently results in cholecystectomy. In adults, most clinicians use a cut off value for the gallbladder ejection fraction (GBEF) of <35% to define the disease. This disorder is not well characterized in children. Our aim was to determine the relation between GBEF and gallbladder pathology using a large statewide medical record repository. METHODS: We obtained records from all patients of 21 years and younger who underwent hepatic iminodiacetic acid (HIDA) testing within the Indiana Network for Patient Care from 2004 to 2013. GBEF results were obtained from radiology reports using data mining techniques. Age, sex, race, and insurance status were obtained for each patient. Any gallbladder pathology obtained subsequent to an HIDA scan was also obtained and parsed for mention of cholecystitis, cholelithiasis, or cholesterolosis. We performed mixed effects logistic regression analysis to determine the influence of age, sex, race, insurance status, pathologist, and GBEF on the presence of these histologic findings. RESULTS: Two thousand eight hundred forty-one HIDA scans on 2558 patients were found. Of these, 310 patients had a full-text gallbladder pathology report paired with the HIDA scan. GBEF did not correlate with the presence of gallbladder pathology (cholecystitis, cholelithiasis, or cholesterolosis) when controlling for age, sex, race, insurance status, and pathologist using a mixed effects model. CONCLUSIONS: Hypokinetic gallbladders are no more likely to have gallbladder pathology than normal or hyperkinetic gallbladders in the setting of a patient with both a HIDA scan and a cholecystectomy. Care should be used when interpreting the results of HIDA scans in children and adolescents.

Management of gallbladder dyskinesia: patient outcomes following positive 99mtechnetium (Tc)-labelled hepatic iminodiacetic acid (HIDA) scintigraphy with cholecystokinin (CCK) provocation and laparoscopic cholecystectomy.

AIMS: To evaluate clinical outcomes in patients with typical biliary pain, normal ultrasonic findings, and a positive (99m)technetium (Tc)-labelled hepatic iminodiacetic acid analogue (HIDA) scintigraphy with cholecystokinin (CCK) provocation indicating gallbladder dyskinesia, as per Rome III criteria, undergoing laparoscopic cholecystectomy (LC). METHODS AND MATERIALS: Consecutive patients undergoing LC for gallbladder dyskinesia were identified retrospectively. They were followed up by telephone interview and review of the electronic case records to assess symptom resolution. RESULTS: One hundred consecutive patients (median age 44; 80% female) with abnormal gallbladder ejection fraction (GB-EF <35%) were followed up for a median of 12 months (range 2-80 months). Following LC, 84% reported symptomatic improvement and 52% had no residual pain. Twelve percent had persisting preoperative-type pain of either unchanged or worsening severity. Neither pathological features of chronic cholecystitis (87% of 92 incidences when histology available) nor reproduction of pain on CCK injection were significantly predictive of symptom outcome or pain relief post-LC. CONCLUSION: In one of the largest outcome series of gallbladder dyskinesia patients in the UK with a positive provocation HIDA scintigraphy examination and LC, the present study shows that the test is a useful functional diagnostic tool in the management of patients with typical biliary pain and normal ultrasound, with favourable outcomes following surgery.

[Imbalance of microelements and vitamins in adolescents with diffuse nontoxic goiter and biliary dyskinesia].

The purpose of the present work was to study the level of microelements and vitamins in adolescents with diffuse nontoxic goiter. It has been shown that comorbid biliary dyskinesia leads to significant dysregulation of vitamin and mineral metabolism: the level of essential elements was decreased and the level of toxic elements was increased. Comorbid biliary dyskinesia in adolescents with diffuse nontoxic goiter was accompanied by a disbalance of vitamins. The changes found in micronutrients have sex differences.

Pathogenesis of gallstones.

Cholesterol gallstone formation is a complex process and involves phase separation of cholesterol crystals from supersaturated bile. In most cases, cholesterol hypersecretion is considered the primary event in gallstone formation. The sterol is transported through the hepatocytic canalicular membrane by ABCG5-G8. Expression of this transport protein is regulated by transcription factor Liver X Receptor-alpha, which may be responsible for biliary hypersecretion. Hydrophobic bile salt pool, bile concentration, excess pronucleating mucin, and impaired gallbladder and intestinal motility are secondary phenomena in most cases but nevertheless may contribute to gallstone formation.

[Pathogenetic basis of pharmaceutical hepatitis induced by depakine in children].

42 children with epilepsy receved treatment by depakin drug. We defined the factors of lipid exchange processes of liver and their correlation between itself and with changes in immune status. The results of the studies indicated shaping the medical hepatitis with cholestatic syndrome on background of the long acceptance of depakin. Metabolic desadaptation was conditioned by glicolis activation in the condition of the oxygen deficit in tissue.

[The comparative analysis of the glycemic effect of certain carbohydrate products on diseases of the biliary system]. / Sravnitel'nyi analiz glikemicheskikh éffektov uglevodsoderzhashchikh produktov pri nekotorykh zabolevaniiakh biliarnoi sistemy.

A comparative analysis of glycemia effect of hydrocarbon foods in patients with dyskenisia of belieferous tract (n = 21), cholelithiasis (n = 20) and postcholecystectomy syndrome (n = 21). The food was given on an empty stomach on the basis of 50 g of carbohydrate per portion. The glucose level was defined in blood on an empty stomach and in 30, 60, 90 and 120 min. intervals after each loading. A significantly smaller increase of postfood glucemia after consumption of boiled rice and lentil was registered as well as accordingly low meanings of their glycemia indices in comparison with those of wheat bread and boiled potatoes.

Biliary dyskinesia and biliary crystals: a prospective study.

The management of patients with biliary colic without gallstones has remained controversial in part because a mechanism for "biliary dyskinesia" has not been elucidated. A prospective study was done on patients presenting with biliary colic symptoms but without demonstrable gallstones. Thirty-six patients were evaluated with ultrasound and hepatobiliary/cholecystokinin scintigraphic scanning. Patients with gallbladder ejection fractions of less than 35 per cent and/or symptoms reproducible with cholecystokinin were offered cholecystectomy. At cholecystectomy, bile was aspirated from the gallbladder for crystal analysis. A random sample of 36 patients with gallstones undergoing cholecystectomy were analyzed as a control group. Pathologic evaluation was done; the gallbladder wall was examined using polarized microscopy to determine the presence of crystals within the gallbladder wall. The mean gallbladder ejection fraction in patients without stones was 24.1 per cent and in patients with stones, 34.6 per cent (P = 0.14). 89.7 per cent of patients without stones had crystals in their gallbladder bile. 61.8 per cent of patients without stones and 81.3 per cent of patients with stones (P = 0.22) had crystals within their gallbladder walls. 94.1 per cent of patients without stones and 100 per cent of patients with stones (P = 0.49) had pathologic evidence of chronic cholecystitis. These data suggest that a spectrum of biliary disease exists in which bile saturation and gallbladder dysmotility lead to crystal growth and subsequent gallstone formation and chronic inflammation. Biliary pain may be generated at any point in this spectrum.

[The role of different investigations in diagnosis of functional disorders of the biliary system]. / Rol' razlichnykh metodov issledovaniia v diagnostike funktsional'nykh rasstroistv v zhelchevyvodiashchei sisteme.

The paper presents the results obtained upon examination of inpatients with various types of biliary dyskinesia. The examination included: fraction chromatic duodenal intubation, stepwise manometry, cholecystography, ultrasound investigation of the liver, gall bladder, biochemical tests of the bile. Fraction duodenal intubation discovered gall bladder dysfunction. The manometry was necessary for diagnosis of duodenal hypertension. X-ray revealed primary defects in gall bladder motility. It is concluded that the diagnosis of functional disorders implies combined clinical and instrumental modalities.

[Lipid content of the bile in diseases of the biliary tract in male and female Evenkis]. / Lipidnyi sostav zhelchi pri zabolevaniiakh zhelchevyvodiashchikh putei u evenov i evenkov.

A total of 156 Evens and 162 Evenks were examined in the reindeer-breeding regions of Evenkia and Yakutia in the Extreme North of the country. The Evens suffering from cholecystitis presented with higher saturation of the B and C duodenal bile with cholesterol than patients with dyskinesias. Such regularities were not observed in the Evenks. These findings permit a conclusion that the ethnic and geographic factors influence the lipid composition of the bile in indigenous population of the Extreme North in case of diseases of the biliferous ducts.

[Membrane-destructive processes in lesions of the biliary system in children]. / Membranodestruktivnye protsessy pri porazhenii biliarnoi sistemy u detei.

The authors analyze the data on lipid peroxidation in children with biliary system derangement. Lipid peroxidation was found to be significantly activated in children with exacerbation of chronic cholecystocholangitis and hypokinetic dyskinesia of the biliary tract. The data obtained suggest the development of the cytolysis syndrome in patients with inflammatory and functional diseases of the biliary tract. It is therefore recommended that the complex of treatment measures may include membrano-stabilizing agents.

[The correction of disorders of lipid-mineral composition of the bile as a method for preventing cholelithiasis]. / Korrektsiia narushenii lipidno-mineral'nogo sostava zhelchi kak metod profilaktiki zhelchnokamennoi bolezni.

A study is presented of the lipid and mineral metabolism composition in 60 patients with diseases of the biliary tract (dyskinesias, chronic noncalculous cholecystitis, cholelithiasis) before and after treatment with a hepatoprotective agent silibor, with a dry protein mixture containing amino acids and minerals and a vitamin-mineral agent quadevit. It was established that the patients showed disorders of the mineral and lipid composition of monotypical character but of different degrees of severity in those suffering of dyskinesias, cholecystitis and cholelithiasis. Silibor treatment furthered normalization of the lipid composition of bile, while treatment with dry protein mixture--of the mineral, with quadevit--of the lipid and mineral.

[Activity of acetylation processes and the indicators of the lipid spectrum of blood in children with combined gastro-duodeno-biliary pathology]. / Aktivnost' protsessov atsetilirovaniia i pokazateli lipidnogo spektra krovi u detei s sochetannoi gastroduodenobiliarnoi patologiei.

As many as 110 children with chronic gastroenterological diseases were examined for coenzymic acetylation in the liver and for the blood lipid spectrum. Considerable disorders in the activity of the acetylation processes in the liver and unbalance in the blood lipid spectrum have been revealed. A complex of vitamins exerting a protective action on the system of coenzymic acetylation in the body have been tried.

[Biogenic amines in duodenal contents in various forms of biliary tract dyskinesia]. / Biogennye aminy v duodenal'nom soderzhimom pri raznykh formakh diskinezii zhelchevyvodiashchikh putei.

The concentration and secretion of adrenaline and noradrenaline with different portions of the bile seem to significantly reflect the function of the vegetative innervation apparatus of the biliary tract. A correlation was established between the pattern of motor and tonic disorders and the pattern of catecholamine secretion during multi-stage duodenal exploration. The data obtained make it possible to outline approaches to adequate therapy.