OBJECTIVETo explore the ultrastructural changes of hepatocyte fibrogenesis in cholelithiasis in biliary tract.

METHODSl0 liver biopsies were taken from the patients suffered from gallstone and choledocholithiasis during surgical treatment and the ultrastructural changes were observed under electromicroscope.

RESULTSThere were plentiful collagenous microfibrils (CMFs) grown within some hepatocytes. These CMFs distributed locally or diffusely in cytoplasm even extended into nucleus. In 7 cases numerous megamitochondrias appeared in several hepatocytes, the inclusions mimicking fibrils could be frequently seen and grew beyond the envelope. Furthermore, typical CMFs could be seen in the large microbodies, and several vesicular or cystic structures similar as fibroblast were presented in marginal areas of the hepatocytes.

CONCLUSIONSWe deduce that the fibrosed hepatocytes may be remained and take part in the hyperplasia of hepatic fibrous tissue.

Adult ; Cholelithiasis ; pathology ; ultrastructure ; Female ; Hepatocytes ; pathology ; ultrastructure ; Humans ; Liver Cirrhosis ; pathology ; Male ; Middle Aged

OBJECTIVETo evaluate the therapeutic effect of subcutaneous tunnel hepaticoplasty on the treatment of hepatolithiasis.

METHODSThe early complications and clinical effects of 99 hepatolithiasis cases who underwent subcutaneous tunnel hepaticoplasty from January 1993 to August 2006 were analyzed retrospectively. The stones of 28 (28.3%) patients were in the left lobe, 24.2% (24/99) in the right, and 47.5% (47/99) in bilateral lobe. Sixty-six patients (66.7%) had both stones and biliary strictures. During the procedure, a portion of the liver habouring stone was resected if necessary. The hepatic duct and strictures were opened, the stones were removed, and the porta hepatis was repaired by one end of a segment of jejunum. The other end of the jejunum was set subcutaneously. The gall bladders of 27 patients (27.3%) were used as subcutaneous tunnel instead.

RESULTSNinety-five out of ninety-nine cases were followed up with an average of 4.2 years (1 month to 13.5 years). The rates of residual stone, recurrent stone and cholangitis were 23.2% (23/99), 20.0% (19/95) and 14.7% (14/95) respectively. Postoperatively, 34 cases who had residual or recurrent stones were underwent lithotomy by choledochoscope through the subcutaneous blind loop and the achievement ratio was 91.2% (31/34).

CONCLUSIONSSubcutaneous tunnel hepatocholangioplasty decreases the relapsing cholangitis effectively, and makes an easy way to take out residual or recurrent stones.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bile Ducts, Intrahepatic ; pathology ; surgery ; Biliary Tract Surgical Procedures ; methods ; Cholelithiasis ; pathology ; surgery ; Female ; Follow-Up Studies ; Hepatectomy ; methods ; Humans ; Liver Diseases ; pathology ; surgery ; Male ; Middle Aged ; Postoperative Complications ; etiology ; prevention & control ; Recurrence ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the relationship between anatomic abnormalities and malfunction of Oddi sphincter with formation of bile duct pigment gallstone.

METHODSOne hundred and twenty-three patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group by measuring the amounts of radioactivity of (99m)Tc-DTPA in the bile. Among them 53 were selected randomly to undergo choledochoscopic manometry. Basal pressure of Oddi's sphincter (SOBP), amplitude of Oddi's sphincter (SOCA), frequency of contraction (SOF), duration of contraction (SOD), duodenal pressure (DP), common bile duct pressure (CBDP) were scored and analyzed. The level of plasma motilin and serum gastrin of 45 patients and 12 healthy volunteers were measured by radioimmunoassay. The incidence rates of duodenal descending part diverticulum in patients with bile duct pigment stones, patients without alimentary tract diseases, patients with gallbladder polyps, patients with gallbladder stones were studied by means of barium meal examination. The incidence rates of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stones, patients with bile duct stone and gallbladder stones, patients with bile duct stones originating from the gallbladder, patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla, patients with post-cholecystectomy syndrome were detected by duodenoscope.

RESULTSOf the patients, 44 were detected with duodenal-biliary reflux (35.8%). SOBP, SOCA and CBDP in the reflux group were much lower than those in control group (P < 0.001). The level of serum gastrin and plasma motilin of the reflux group were much lower than those of control group (P < 0.01). Positive correlation was found between level of motilin and SOBP while level of gastrin was positively correlated with SOBP and CBDP. The incidence of duodenal diverticulum in patients with bile duct pigment stone was 36.62%, which was higher than that of the other 3 groups. The incidence rate of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stone was higher than that of patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla and patients with bile duct stones originating from the gallbladder.

CONCLUSIONSThe patients with bile duct pigment stone have apparent duodenal-biliary reflux and infection of the bile duct. The state of structure and function of Oddi's sphincter is correlated significantly with bile duct pigment stone. The anatomic abnormalities and malfunction of Oddi's sphincter played an important role in the formation of bile duct pigment stone.

Adult ; Aged ; Aged, 80 and over ; Bile Pigments ; metabolism ; Cholelithiasis ; metabolism ; pathology ; physiopathology ; Female ; Gastrins ; blood ; Humans ; Male ; Middle Aged ; Motilin ; blood ; Pressure ; Radioimmunoassay ; Retrospective Studies ; Sphincter of Oddi ; pathology ; physiopathology

Although laparoscopic surgery has become more popular, its technical difficulties have limited the applications of this technique to liver surgery. We report here on our experience with liver resection with using the laparoscopy-assisted (Lap-Assist) and total laparoscopic (Total-Lap) methods. From April 2001 to June 2003, a total of 20 laparoscopic anatomical resections of the liver were retrospectively reviewed. These were comprised of 10 cases in which the Lap-Assist method was used (these were performed during the early study period), and 10 cases in which the Total-Lap was used (these were done in the later study period). In the Lap-Assist group, the following resections were performed: 7 cases of left lateral sectionectomy, a case of left hemihepatectomy, a case of right hemihepatectomy and a case of open conversion. In the Total-Lap group, 6 cases of left hemihepatectomy and 4 cases of left lateral sectionectomy were performed. The sizes of the incisions were 8.7 cm and 4.6 cm, respectively, (p=0.000). There were no differences in the operation times, the transfusion amounts, the starting days of the patients' diets, the complication rates or the durations of the hospital stay between the two groups. Both the laparoscopy-assisted method and the total laparoscopic method are feasible to use for performing anatomical liver resection.
Adult ; Aged ; Carcinoma, Hepatocellular/surgery ; Cholelithiasis/surgery ; Comparative Study ; Female ; Follow-Up Studies ; Hepatectomy/*methods ; Humans ; Laparoscopy/*methods ; Length of Stay ; Liver/pathology/*surgery ; Liver Neoplasms/surgery ; Male ; Middle Aged ; Treatment Outcome

Bile Duct Neoplasms ; surgery ; Bile Ducts ; pathology ; surgery ; Bile Ducts, Intrahepatic ; pathology ; surgery ; Biliary Tract Diseases ; surgery ; Biliary Tract Surgical Procedures ; methods ; trends ; Cholecystectomy, Laparoscopic ; methods ; trends ; Cholelithiasis ; surgery ; Humans

A 13-year-old Thoroughbred mare, retired from race, was admitted to Equine Hospital, Korea Racing Association with signs of colic. One and a half months following the previous treatment (second time) and 11 days following her previous discharge (third time), the mare repeatedly exhibited signs of colic and finally along with icteric eyes. Routine medical treatment with intravenous fluids, analgesics resulted in resolution of signs of colic in the first and second admission. The condition of the mare did not improve in the third admission despite over one month supportive treatment and she was subject to euthanasia at the request of the owner on the thirtyeighth day of hospitalization (95 days from her first admission). The clinical signs (fever, icterus, mild intermittent colic) in conjunction with clinical laboratory findings (leukocytosis, elevations of serum total bilirubin, direct bilirubin, alkaline phosphatase, aspartate aminotransferase, gamma glutamyl transferase, creatine phosphokinase, lactic dehydrogenase and blood fibrinogen indicative of obstructive biliary disease) in this mare suggested possible chlolelithiasis. However, liver enzymes and bilirubin estimations are often not part of routine screening in emergency colic cases. At necropsy, multiple dark brown choleliths of various sizes obstructing hepatopancreatic ampulla were found in the hepatic duct. The choleliths were found as large as 3-5 cm in diameter, faceted to each other, dark brown in color and showed soap consistency. Histopathologic findings revealed: biliary fibrosis, plugging of the bile canaliculi with bile pigments, cholangiohepatitis and pigmentation of the hepatic lymph node with bile pigment laden macrophages. Although definitive diagnosis of cholelithiasis might be challenging, clinicians should consider this condition in the differential diagnosis of recurrent colic.
Animals ; Cholelithiasis/complications/pathology/*veterinary ; Colic/complications/pathology/therapy/*veterinary ; Fatal Outcome ; Female ; Horse Diseases/*pathology ; Horses

OBJECTIVETo discuss the principles of diagnosis and treatment of the polypoid lesion of gallbladder.

METHODSClinical and pathological features of 342 cases were analysed.

RESULTSTotally 328 patients with benign polypoid lesions (including 234 cholesterol polyps, and 74 adenomas), and 14 patients with malignant polypoid lesions (including 10 adenocarcinomas and 4 adenomas with malignant changes) were included. Two hundred and forty-seven cases (72.2%) had symptoms. Seventy-eight point six percent of patients with malignant polyps were over 50 years of age, and while 29.9 percent of patients with non-malignant polyps were over 50 years. The lesions were more than 1 cm in 91.7% of the malignant polyps and in only 13.2% of the benign polyps. One hundred percent of malignant polyps, and 46 percent of benign polyps were single polyp.

CONCLUSIONSCholesterol polyps, adenomas, and adenocarcinomas are the most common lesions in polypoid lesion of the gallbladder. Cholecystectomy should be done in patients with symptoms. The risk factors for malignancy are the age of the patient (> 50), the size (> 1 cm), and number (single) of the polypoid lesions. In asymptomatic patients, cholecystectomy can be justified after integrated analysis.

Adenocarcinoma ; diagnostic imaging ; surgery ; Adenomatous Polyps ; diagnostic imaging ; pathology ; surgery ; Adult ; Aged ; Aged, 80 and over ; Cholecystectomy, Laparoscopic ; Cholelithiasis ; diagnostic imaging ; surgery ; Diagnosis, Differential ; Female ; Gallbladder Diseases ; diagnostic imaging ; pathology ; surgery ; Gallbladder Neoplasms ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Polyps ; diagnostic imaging ; pathology ; surgery ; Retrospective Studies ; Ultrasonography

BACKGROUND/AIMS: Diagnosis of bile duct strictures as well as detection and localization of hepatolithiasis is important for an effective treatment of hepatolithiasis. For this purpose, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) have been preferred as the diagnostic modalities of choice for hepatolithiasis. At present, magnetic resonance cholangiopancreatography (MRCP) is rapidly replacing ERCP. To determine the usefulness and limitation of MRCP for detecting hepatolithiasis and biliary strictures, we compared the result of MRCP with that of percutaneous transhepatic cholangioscopy (PTCS) as the standard reference. METHODS: Sixty-six patients with primary hepatolithiasis who underwent both MRCP and PTCS were enrolled. All patients underwent PTCS within 2 weeks of MRCP. The results of MRCP were reviewed by radiologists who were unaware of the clinical information about the location of hepatolithiasis and the presence of biliary strictures. RESULTS: The sensitivity and specificity of MRCP for detecting intrahepatic stones were 72.4 and 90%, respectively. The sensitivity of MRCP for depicting intraheptic bile duct strictures was 64%. The overall agreement between MRCP and PTCS for intrahepatic stones showed a good reliability (kappa value=0.64, p<0.05). The agreement of MRCP for hepatolithiasis with intrahepatic bile duct strictures with reference to PTCS showed a moderate reliability (kappa value=0.47, p<0.05). Imaging findings such as pneumobilia and hepatic parenchymal atrophy were related to false positive results in location of hepatolithiasis (p<0.05). CONCLUSIONS: MRCP has a good agreement rate in evaluation of intrahepatic stones and a moderate agreement rate in intrahepatic strictures, compared to PTCS.
Adult ; Aged ; Bile Duct Diseases/*diagnosis ; Bile Ducts/pathology ; *Bile Ducts, Intrahepatic ; Cholangiopancreatography, Endoscopic Retrograde ; Cholelithiasis/*diagnosis ; Female ; Humans ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Sensitivity and Specificity

Over the decades, there has been a great deal progress in the understanding of gallstones owing to the continuous efforts aimed at elucidating their pathogenesis. An optimal classification system is needed because the etiology, pathogenesis, clinical features and treatment can be different according to the classes. Currently, two systems are widely used: one from the National Institutes of Health (NIH) -International Workshop on Pigment Gallstone Disease held in 1981 and the other from Gallstone Research Committee from the Japanese Society of Gastroenterology in 1984. However, some stones cannot be classified into either of these categories. In addition, several terms have been not been clearly defined. In several aspects, both systems need to be reevaluated. This paper reviewed the classification systems and terms that are currently used for gallstones, and raises several points that need to be reconsidered. In the near future, large scaled prospective studies on gallstones need to be carried out on the basis of the external color, chemistry, cutting surface, etc. Only when these studies are completed can an ideal classification system for gallstones be expected.
Cholelithiasis/*classification/history/pathology ; History of Medicine, 19th Cent. ; History of Medicine, 20th Cent. ; Human ; Korea ; *Terminology

PURPOSE: The laparoscopic cholecystectomy has become a common procedure for treating gallbladder disease. The objectives of this study was to evaluate the learning curve by reviewing 145 patients treated with laparoscopic cholecystectomy, between Group A (From January 1991 to December 1995) and Group B (From January 1996 to December 2000). METHODS: We retrospectively analyzed 145 laparoscopic cholecystectomies performed at the Department of General Surgery, National Medical Center, from January 1991 to December 2000. The sex, age, operation time, associated disease, previous operation history, hospital stay, and pathology were reviewed. RESULTS: The ratio of Females to males was 1.9:1, and their age ranged from 18 to 80 years with the majority in their fifties and sixties. Most of the operative indications were cholelithiasis. The mean operative time was 89 minutes, which varied between 40 and 180 minutes, and the average admission time was five days. The operation times of Group A and Group B were statistically significant with respect to learning curve (p value<0.000). A linear regression test of the operation time and operation cases was also significant. The postoperative analgesic injection and hospital stay were improved in Group B, but had no statistical significance. A conversion to open cholecystectomy was done in four cases due to bleeding, severe adhesion, or clip migration of the cystic duct during surgery. CONCLUSION: The laparoscopic cholecystectomy was a safe and effective treatment for gallbladder disease, and wepredict that the operation time will become shorter with more experience.
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Cystic Duct ; Female ; Gallbladder Diseases ; Hemorrhage ; Humans ; Learning Curve ; Length of Stay ; Linear Models ; Male ; Operative Time ; Pathology ; Retrospective Studies