The prevalence of gallstone disease and associated factors in the entire population of subjects aged 15-65 years born and resident in Chianciano Terme (Siena - Tuscany) was examined in the years 1985 and 1986. The investigation included gallbladder ultrasonography, administration of a questionnaire on personal and family history, physical examination and blood chemistry. A total of 1809 subjects (attendance rate 87.7%) participated in the study. Personal history and physical examination showed that Chianciano inhabitants have a low prevalence of obesity (4.3%) and only 4.4% of the female population had more than two pregnancies. Overall prevalence of gallstone disease (cholecystectomy+cholelithiasis) was 5.9% (3.7% for males and 8.4% for females). Age standardized relative risk of gallstone disease for females was 2.25 (95% confidence limits = 1.68-2.68). Prevalence of cholelithiasis was 3.5% (2.7% for males and 4.2% for females). Prevalence of gallstone disease increased with increasing age in both sexes, being extremely low in the age interval of 15-29 years (0.25%). The overall gallstones/cholecystectomy ratio was found to be lower (1:1) in females than in males (2.7:1). Although subjects with gallstones reported more frequently biliary colics and non-specific dyspeptic symptoms, the diagnostic power of all symptoms in identifying cholelithiasis was very poor due to low sensitivity. Only one third of subjects with gallstones was aware of having the disease. Age, obesity and number of pregnancies were positively associated with gallstone disease in univariate analyses. The association with obesity and parity disappeared in multivariate analysis. Blood lipids and glucose were not associated with the disease both in univariate and multivariate analyses.(ABSTRACT TRUNCATED AT 250 WORDS)

To test whether de novo synthesis of cholesterol is a limiting factor for bile acid synthesis, we studied the acute effect of simvastatin, an inhibitor of HMG-coenzyme A reductase (the limiting step of cholesterol synthesis) on bile acid synthesis and biliary lipid secretion in subjects with interrupted enterohepatic circulation. In these conditions bile acid synthesis is derepressed and is assumed to equal biliary bile acid secretion. Five cholecystectomized patients fitted with T-tubes were studied. All subjects were administered simvastatin (80 mg as a single dose) 5 days after surgery. Bile was collected in 3-hr intervals for 15 hr before and 30 hr after the administration of the drug. During the experiment we kept the enterohepatic circulation of bile acid interrupted by inflating an occludable balloon inserted, during cholecystectomy, in the common bile duct. Simvastatin induced significant decreases of plasma total and low density lipoprotein cholesterol concentrations, from 163 +/- 29 mg/dl and 97 +/- 24 mg/dl of the pretreatment value to 144 +/- 30 mg/dl and 82 +/- 22 mg/dl 18 hr after simvastatin administration, respectively. Bile flow tended to increase after simvastatin, and the mean values from the third to the 15th hour after simvastatin administration (22.1 +/- 1.9 ml/hr) were significantly greater than the mean values of the pretreatment period (19.9 +/- 2.8 ml/hr). Concomitantly biliary bile acid, cholesterol and phospholipid concentrations fell from basal values of 15.9 +/- 5.1, 2.3 +/- 0.3 and 5.5 +/- 0.3 mmol/L to mean values, after treatment, of 9.0 +/- 3.5, 1.9 +/- 0.5 and 3.0 +/- 0.9 mmol/L, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

We report a case of multiple myeloma (MM) displaying an unusual course, with metastatic spread in uncommon sites (gastroduodenal and upper respiratory tract, breast, skin and liver) and with a fatal outcome. In our patient this plasma cell neoplasm was associated with a rare condition named crystal-storing histiocytosis (CSH), resulting from the storage in reactive histiocytes of crystalline immunoglobulin inclusions. These crystal-forming paraprotein components are secreted by the neoplastic plasma cells and give rise to the crystalline material of the histiocytes only after their ingestion and degradation by the same histiocytes. In this disorder crystal-storing cells may be present in various tissues (in our case mainly in bone marrow), often with functional alterations of the involved organs. In our opinion the association of this "atypical" MM with CSH is to be considered an uncommon event.

both bile acids, biliary cholesterol is transported in nonThis study aimed to determine the effect in humans micellar aggregates. Finally, in the conditions of our of taurohyodeoxycholic acid, a 6a-hydroxylated bile acid study, taurohyodeoxycholic acid was not hepatotoxic. with hydrophilic properties, on bile lipid secretion. Four (HEPATOLOGY 1997;25:1306-1314.) cholecystectomized patients who had gallstones and an interrupted enterohepatic circulation were intraduodenally infused with taurohyodeoxycholic and tauroursoHyodeoxycholic acid (HDCA) is a 6a-dihydroxylated natudeoxycholic acids on separate occasions at a dose of 0.8 ral bile acid (3a-, 6a-dihydroxy-5b-cholan-24-oic acid) found to 1 g/h for 3 hours. In hourly bile samples collected for in pig and rat bile. [1][2][3] In humans, 6a-hydroxylated bile acids 8 hours after the beginning of the infusion, biliary bile are present in trace amounts in the urine in physiological acid composition (by high-performance liquid chroma-conditions, 4 and in increased amounts in cholestatic liver distography), biliary lipid concentrations (by standard eases, 5,6 suggesting that in humans the 6a-hydroxylation is methods), and distribution of biliary carriers (by gel a metabolic pathway that, repressed in normal conditions, chromatography) were evaluated. Blood liver function can be derepressed in pathological situations. tests were performed before and after the infusions.HDCA, because of the presence of a hydroxyl group in the Taurohyodeoxycholic and tauroursodeoxycholic acids 6a position of the steroid ring, is a highly hydrophilic bile became the predominant biliary bile acids in all patients acid. 7,8 It is known that the enrichment of the endogenous except for one infused with taurohyodeoxycholic acid. bile acid pool with hydrophilic bile acids such as ursodeoxyTaurohyodeoxycholic acid stimulated significantly cholic acid (UDCA) has two main clinical effects: (1) it induces greater (P õ .05) cholesterol and phospholipid secretion the dissolution of cholesterol gallstones 9,10 by a reduction of per unit of secreted bile acid (0.098 and 0.451 mmol/mmol, bile cholesterol saturation 11,12 because of a decrease in biliary respectively) compared with tauroursodeoxycholic acid cholesterol secretion, 13,14 and (2) it improves results of liver (0.061 mmol/mmol for cholesterol and 0.275 mmol/mmol function tests in patients with liver disease, 15-17 possibly refor phospholipids). The secretory ratio between phos-lated to a decreased detergency and cell-damaging potency pholipid and cholesterol was significantly higher after of the physiological bile acid pool. 18,19 infusion of taurohyodeoxycholic acid (3.88 mmol/mmol) HDCA has been reported to prevent gallstone formation in compared with taroursodeoxycholic acid (3.09 mmol/ hamsters fed a fat-free, glucose-enriched diet [20][21][22] and in praimmol) (P õ .05). Biliary enrichment with taurohyodeoxy-rie dogs fed a cholesterol-containing diet. [23][24][25] This effect was cholic acid was positively related with percent concen-n...

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