Investigations on Common Bile Duct Stones

Wosiewitz, U.; Schenk, Jeannette M.; Sabinski, Frauke; Schmack, Bastian

doi:10.1159/000198867

Cited by 54 publications

(18 citation statements)

References 14 publications

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“…Fifty of these patients had undergone cholecystectomy prior to operative treatment for common bile duct stones. The stones presented here resemble stones reported in these materials [3, 14, 15, 16], but we find an even higher proportion of layered brown pigment stones. The minor part of stones with an easily identifiable structure had cholesterol crystals with a radiating structure.…”

Section: Discussionsupporting

confidence: 83%

“…In 1964 Bogren [14]published a thorough description of the composition and structure of gallstones, and in 1983 Wosiewitz et al [15]showed that choledocholithiasis in contrast to cholecystolithiasis is characterized by a higher percentage of calculi with large portions of pigment (Ca-bilirubinate). Similar results were found in 96 patients operated for common duct stones [3], of which 53 had cholesterol stones, 42 had pigment stones and 1 stone was unclassified.…”

Section: Discussionmentioning

confidence: 99%

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Structure and Composition of Common Bile Duct Stones in Relation to Duodenal Diverticula, Gastric Resection, Cholecystectomy and Infection

Sandstad¹,

Osnes²,

Skar³

et al. 2000

Digestion

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Background: Common bile duct stones represent a clinical problem often involving severe infection, cholangitis and cholestasis. Stasis and infection are thought to play a part in the pathogenesis of choledocholithiasis. Investigations on the etiology of common bile duct stones are, however, scarce because of the difficult access to common bile duct stones and bile. In a clinical series of common bile duct stones, we studied the gross appearance of stones extracted endoscopically from the common bile duct and measured the cholesterol and bilirubinate content in order to elucidate factors of importance to etiology. Methods: In 135 patients treated endoscopically for bile duct stones, the stones or parts of the stones were collected. Appearances of the cut surface of the stones were studied and described. Cholesterol and bilirubinate content were analyzed enzymatically and with infrared spectroscopy. The growth in bile of gas-producing bacteria previously shown to be correlated with enterobacteriacea was investigated. Results: Seventy-five percent of the stones were pigment stones, the majority with concentric pigmented layering. There was good agreement between cholesterol measurements. With a cutoff at 50% for the infrared measurements and 25% for the enzymatic assay only 3 stones were discordant between cholesterol measurements and visual inspection. Twenty-one of 23 patients with a previous Billroth-II gastric resection had pigment stones (p < 0.05). Gas-producing bacteria were significantly more prevalent in the bile from patients with layered pigment stones. Conclusion: Pigment stones with concentric layering highly suggestive of a cyclic process of crystallization were recovered from the common bile duct in 70% of the patients in our series.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Structure and Composition of Common Bile Duct Stones in Relation to Duodenal Diverticula, Gastric Resection, Cholecystectomy and Infection

Sandstad¹,

Osnes²,

Skar³

et al. 2000

Digestion

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“…(2), while the extraction of cholesterol only can be carried out with isopropylalcohol (3). The measurement of cholesterol is carried out with non-enzymatic (2, 4-7) or enzymatic (3,8) colorimetric methods or by GLC (9,10). Bilirubin can be analysed colprimetrically according to Michaelson (2) or Weber & Schalm (11).…”

Section: Introductionmentioning

confidence: 99%

Chemical Analysis of Gallstones

Steen¹,

Blijenberg²

1991

Clinical Chemistry and Laboratory Medicine

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Summary:A new promising treatment for patients with symptomatic cholelithiasis is extracorporeal shock wave lithotripsy. In Order to learn how to Interpret the computed tomographic (CT) densities of gallstones measured in vivo, our radiologists asked the clinical chemistry laboratory to analyse cholesterol, bilirubin and calcium in gallstones. No reference methods for the analysis of gallstones have been described. A literature search for manageable quantitative methods for these analyses was not successful. Among the different Xray diffraction, infrared and chemical analyses described, we could find no well documented analyses that have been compared with reference methods or proposed reference methods for serum. This finding prompted us to develop chemical methods for cholesterol, bilirubin and total calcium in gallstones starting from (proposed) reference methods for serum and to investigate the accuracy, imprecision and linearity of these methods.

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“…Ca-bilirubinate and black pigment stones are disaggregated in BA-EDTA. These results were confirmed with six CHS, 12 BBIL and 12 BPS from 5 further patients, incubated in the most eligible solvent for any individual stone type.After cholecystectomy common-bile-duct stones are cholesterol stones in about 35% of cases and brown calcium bilirubinate stones in 60-70% [1,2], Approximately 90% of these concretions can be extracted endoscopically [3,4], Of all gallstone patients 10-30% [5][6][7] have black pigment stones in the gall bladder. From here they can migrate into the…”

mentioning

confidence: 99%

Dissolution of Calcified Cholesterol Stones and of Brown and Black Pigment Stones of the Gallbladder

et al. 1988

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The influence of different solvents on cholesterol and pigment stones was investigated in vitro. Stone analysis was performed chemically, with infrared spectroscopy (IRS), scanning electron microscopy, energy-dispersive X-microanalysis (EDXA) and wave-length-dispersive X-microanalysis (WDXA). Each set of stones came from one source: eight human calcified cholesterol stones (CHS), eight fragments of bovine radiopaque Ca-bilirubinate stones (BBIL), and two complete BBIL. CHS and BBIL fragments were treated with (1) a buffered, alkaline 1% ethylenediamine tetraacetate solution (BA-EDTA; pH 9.5); (2) with BA-EDTA and monooctanoin preparation (GMOC) alternately; (3) with GMOC alone, and (4) with methyl-tert-butyl ether (MTBE). The complete BBIL were treated with BA-EDTA and MTBE. Furthermore, two human black pigment stones (BPS) were incubated in BA-EDTA. Calcified cholesterol stones are not dissolved by GMOC alone, nor by alternating treatment with BA-EDTA. They are dissolved by MTBE. MTBE is unsuitable for complete Ca-bilirubinate stones but MTBE, GMOC and GMOC/BA-EDTA alternately disaggregate stone fragments. This means that stone fragments behave differently from complete Ca-bilirubinate stones, which is important for further in vitro investigations. Ca-bilirubinate and black pigment stones are disaggregated in BA-EDTA. These results were confirmed with six CHS, 12 BBIL and 12 BPS from 5 further patients, incubated in the most eligible solvent for any individual stone type.

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Investigations on Common Bile Duct Stones

Cited by 54 publications

References 14 publications

Structure and Composition of Common Bile Duct Stones in Relation to Duodenal Diverticula, Gastric Resection, Cholecystectomy and Infection

Structure and Composition of Common Bile Duct Stones in Relation to Duodenal Diverticula, Gastric Resection, Cholecystectomy and Infection

Chemical Analysis of Gallstones

Dissolution of Calcified Cholesterol Stones and of Brown and Black Pigment Stones of the Gallbladder

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