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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The prevalence of gallstone disease in the world is heterogenous, it exist a wide range between different geographic areas, sex and age groups. Its distribution seems to be influenced by various factors such as age, sex, socieconomic class, genetic and ethnic influences and diseases like diabetes mellitus and obesity. Therefore, in this study, we will analyse the importance of each of those factors in the development of cholesterol gallstone disease.
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PMID:[Cholesterol biliary lithiasis (risk factors)]. 182 6

Obesity has been suggested to be a contraindication to laparoscopic cholecystectomy (LC). In our center, in which all patients presenting with symptomatic gallstones are considered to be candidates for LC, 24 of the first 325 LC candidates were retrospectively found to be morbidly obese. In all, 20 were women and 4 were men. The average age was 51 years (range 32 to 83 years); the average height and weight amounted to 72 inches and 298 pounds, respectively, for men; and 63.5 inches and 258 pounds, respectively, for women. One-third of these patients suffered from acute cholecystitis, and more than 50% had undergone prior abdominal surgery. The average duration of LC in these subjects was 114 min., which was 25% longer than that in nonobese patients. The average length of the hospital stay was 1.6 days, with patients returning to normal activities within an average of 6.5 days. There was no major morbidity and no mortality. Since obese patients tolerated LC as easily as did normal patients, we concluded that obesity is an indication rather than a contraindication to LC.
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PMID:Laparoscopic approach to gallstones in the morbidly obese patient. 183 85

In the recent 5 years, several important conceptual changes in the understanding of cholesterol gallstone formation have occurred. This article discusses the molecular basis of the disease, as we understand it today. The discovery of a vesicular carrier of biliary lipids and the metabolic regulation of biliary cholesterol secretion have markedly modified our understanding of the pathogenesis of cholelithiasis, giving more emphasis to molecular and cell biology aspects, rather than to physicochemistry, as occurred in the late seventies (micellar theory). The critical step in gallstone formation is cholesterol crystallization and it occurs after vesicle aggregation and fusion. This process is probably dependent of hepatic glycoproteins secreted into bile, presumably associated to the vesicular carrier of biliary cholesterol. Risk factors such as sex, obesity, sexual hormones, and diet seem to modify either biliary cholesterol secretion, and/or nucleation (crystallization) in the gallbladder, and/or gallbladder motility. It seems most likely that gallstones is a multifactorial disease, dependent of an interactions between environmental and genetic, or ethnic, factors.
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PMID:[Conceptual evolution regarding the pathogenesis of biliary lithiasis due to cholesterol calculi]. 184 27

Data from 4524 patients in a randomized, controlled trial of aspirin were analyzed to determine if aspirin reduced the risk for hospitalization for gallstone disease. Aspirin at a dose of 1000 mg/day did not reduce the risk of hospitalization for gallstones. Hospitalization rates for gallstone disease were consistent with national rates, and the data confirmed previous associations of gallstone disease with age, elevated serum triglycerides, obesity, and female gender.
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PMID:One gram of aspirin per day does not reduce risk of hospitalization for gallstone disease. 186 5

Examined were 27 patients with pancreatic cancer and concomitant diabetes mellitus. It was established that in women, the likelihood of pancreatic cancer development increases with the age. Obesity and cholelithiasis are also the risk factors for development of cancer of the given location. In pancreatic cancer and diabetes mellitus lasting more than 2 years which is an independent disease with a tumor developed against its background, the mutual aggravation syndrome occurs: a severe course of diabetes and increased growth of a neoplasm.
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PMID:[The mutual aggravation syndrome in pancreatic cancer and diabetes mellitus]. 187 8

The authors evaluated the risk of development of cholelithiasis in 6050 patients treated at a single hospital for various childhood cancers with different therapeutic modalities, including chemotherapy, surgery, radiation therapy, and bone marrow transplantation, from 1963 to 1989. Patients with underlying chronic hemolytic anemia or preexisting gallstones were excluded. Nine female and seven male patients with a median age of 12.4 years (range, 1.2 to 22.8 years) at diagnosis of primary cancer had gallstones develop 3 months to 17.3 years (median, 3.1 years) after therapy was initiated. Cumulative risks of 0.42% at 10 years and 1.03% at 18 years after diagnosis substantially exceed those reported for the general population of this age group. Treatment-related factors significantly associated with an increased risk of cholelithiasis were ileal conduit, parenteral nutrition, abdominal surgery, and abdominal radiation therapy (relative risks and 95% confidence intervals = 61.6 [27.9-135.9], 23.0 [9.8-54.1], 15.1 [7.1-32.2], and 7.4 [3.2-17.0], respectively). There was no correlation with the type of cancer, nor was the frequency of conventional predisposing features (e.g., family history, obesity, use of oral contraceptives, and pregnancy) any higher among the affected patients in this study than in the general population. Patients with cancer who have risk factors identified here should be monitored for the development of gallstones.
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PMID:Cholelithiasis after treatment for childhood cancer. 189 56

The relation between symptomatic cholelithiasis in women under 30 years of age and pregnancy, obesity and oral contraceptive use was retrospectively studied. A total of 885 cholecystectomies were carried out in an English district hospital. In the age group under 30 years the female-male ratio was 9.7:1 vs 2.3:I in the total group (p less than 0.01). Gallstones were present in 39 women with a previous pregnancy and in 14 women without pregnancy. Compared to an age and sex matched control group of appendicectomies a relative risk of 1.6 was found for pregnancy related gallstone disease requiring cholecystectomy (p less than 0.05). 455 Cholecystectomies were carried out in a Dutch academic hospital. The female-male ratio in the group younger than 30 years was 7.0:I vs 2.3:I in the total group (p less than 0.01). In the Dutch group more women under 30 years were operated on than in the English group: 23% vs 10% (p less than 0.001). There was no significant association between symptomatic gallstones and previous pregnancies in the Dutch group (p = 0.07). Gallstone disease occurs earlier in women than in men. There appears to be a relationship between early symptomatic cholelithiasis and pregnancy in the English group only. No relationship could be found between cholelithiasis and obesity or oral contraceptive use in either group.
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PMID:Gallstone disease in women younger than 30 years. 192 81

Gallstones are common, affecting about one fourth of women and 10% to 15% of men over the age of 50. They are more prevalent in Amerindians and Mexican-Americans and less common in blacks. Principal risk factors are age, sex, and obesity. Lesser risk factors include childbearing, abstinence from alcohol, and some medications. The rate at which asymptomatic gallstones become symptomatic is low but significant, while patients with mildly symptomatic stones are at even greater risk for future pain and complications.
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PMID:Epidemiology and natural history of gallstone disease. 202 15

American Indians and Alaska Natives (AI/ANs) are experiencing an epidemic of diabetes, increasing rates of coronary artery disease and hypertension, and poor survival rates for breast cancer that are likely partially attributable to the increasing prevalence of obesity over the past generation. Obesity may also contribute to the high rates of gallstones and to adverse outcomes of pregnancy in AI/ANs. Although overall mortality was not associated with obesity in Pima Indians (except in the most obese men), the relationship of obesity to longevity in other AI/AN groups is not known. Further study of the specific health effects of obesity in various groups of AI/ANs are needed. In the meantime, community-based programs to prevent obesity and its sequelae should be implemented in all AI/AN communities.
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PMID:Health implications of obesity in American Indians and Alaska Natives. 203 95

Obesity is a condition associated with an increased frequency of gallstone disease. This study attempted to evaluate the comparative effects of two gallstone-dissolving agents, chenodeoxycholic acid and ursodeoxycholic acid, on bile acid metabolism and biliary lipid secretion in obese subjects in order to identify the bile acid of choice in preventing and treating gallstone disease in obesity. Twenty obese subjects (greater than 120% ideal body wt) were randomly treated with ursodeoxycholic acid (10 mg.kg-1.day-1.1 mo-1) and then with chenodeoxycholic acid (15 mg.kg-1.day-1.1 mo-1) or with chenodeoxycholic acid first and then with ursodeoxycholic acid. Patients 1-10 were studied while eating an unrestricted weight-maintenance diet, whereas patients 11-20 were eating a 1080-kcal/d hypocaloric diet. Biliary lipid composition, cholesterol saturation index, and biliary bile acid pattern were evaluated in all subjects before and after each treatment period; in subjects 6-10 and 16-20, biliary lipid secretion rates and bile acid pool size were also evaluated. Both ursodeoxycholic acid and chenodeoxycholic acid decreased cholesterol outputs and cholesterol saturation index. However, during the weight-maintenance period the decrease induced by chenodeoxycholic acid was not significant. Biliary cholesterol outputs and cholesterol saturation index were always lower during ursodeoxycholic acid administration than during chenodeoxycholic acid therapy. Ursodeoxycholic acid levels during ursodeoxycholic acid administration and chenodeoxycholic acid levels during chenodeoxycholic acid administration increased in bile to 50% and 77%, respectively, of total bile acid levels. Bile acid pool size remained unchanged during chenodeoxycholic acid administration and was significantly reduced by ursodeoxycholic acid administration during the weight-reduction period. In conclusion, ursodeoxycholic acid in obese subjects seems more effective than chenodeoxycholic acid, at least during weight maintenance, in reducing cholesterol saturation of bile. This effect is related to a significant decrease of biliary cholesterol output.
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PMID:Comparative evaluation of chenodeoxycholic and ursodeoxycholic acids in obese patients. Effects on biliary lipid metabolism during weight maintenance and weight reduction. 206 25


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