Simplified Technique of Conventional Cholecystectomy in a Patient with Situs Inversus Totalis: A Case Report from Nepal

Introduction: Situs inversus is a rare autosomal recessive disorder occurring in 1:5,000 to 1:20,000 indiviuals. Cholecystectomy is a standard treatment for symptomatic gallbladder stone. We report a case of cholelithiasis in patient with inversus totalis who underwent cholecystectomy. Case presentation: A 48 years old obese female patient with dextrocardia and hypertention presented with a recurrent left upper abdominal pain for two years. Ultrasound abdomen showed gallbladder stone. Conventional cholecystectomy was done with a small left subcostal incision. The postoperative period was uneventful and the patient was discharged on 3rd post operative day. Conclusion: Cholecystectomy is the treatment of choice in patients with a left sided gallbladder stone, like in normal gallbladder and it is safe.

Arsenic Induced Gallbladder Cancer Risk in Eastern Part of Indo-Gangetic Plains

BackgroundIn recent times Gallbladder cancer (GBC) incidences increased many folds in India. Majority of GBC cases are being reported from arsenic hotspots identified in Bihar. MethodsIn this prospective study volunteers were selected who underwent surgery in our cancer institute. There were 11 control benign gallbladder cases and 28 confirmed gallbladder cancer cases. Their biological samples such as blood, gallbladder tissue, gallbladder stone, bile and hair samples were collected for arsenic estimation. Moreover, n=512 gallbladder cancer patients blood samples were evaluated for the presence of arsenic to understand exposure level in the population. ResultsA significantly high arsenic concentration (p<0.05) was detected in the blood samples, gallbladder tissue, gallstones, bile and hair samples in comparison to the control group. Moreover, n=512 blood samples of GBC patients had significantly very high arsenic concentration. ConclusionsThe study shows very high arsenic concentration observed in the blood, gallbladder tissue, gallbladder stone, bile and hair samples in GBC cases in comparison to the benign control cases indicates the correlation between chronic arsenic exposure and gallbladder cancer incidences in eastern Indo-Gangetic plains region. The study also makes an attempt to establish the likely correlation/association between arsenic exposure and gallbladder cancer disease.

The Discrepancy between Gross Features and Chemical Compositions in Gallbladder Stone: A Descriptive Single Center Study in the United Arab Emirates

Background and Study Aim: Gallbladder stone (GBS) is a common gastrointestinal disease that is the primary indication for cholecystectomy. The present study was conducted to describe the chemical composition of gallstones in a tertiary referral hospital in the United Arab Emirates. Materials and Methods: Patients diagnosed with GBS and who underwent cholecystectomy due to symptomatic GBS and cholecystitis in Sheikh Khalifa Specialty Hospital were enrolled in this study. After cholecystectomy, all stone specimens were classified according to their gross findings into 4 groups, namely black pigmented stones (BLPS), brown pigmented stones (BRPS), mixed cholesterol stones, and cholesterol stones (CLS). Quantitative analysis using Fourier transform infrared spectroscopy was then performed to define the stones’ chemical constituents. They were reclassified into two groups as CLS (cholesterol ≥ 60%) and pigmented stones (PGS, cholesterol ≤ 59%) based on gallstone composition analysis. Results: A total of 237 stones were divided into four groups based on their gross findings; cholesterol stones (32.0%), mixed cholesterol (29.2%), black pigmented (26.4%), and brown pigmented (12.3%). After chemical composition analysis, they were resorted into the two following groups according to their cholesterol proportions: pigmented (28.3%) and cholesterol (71.7%). There were significant statistical mean age differences between the pigmented and cholesterol stone groups (58.5±19.8 vs. 34.4±11.0, p < 0.01). Conclusion: This descriptive study showed the hospital-based clinical incidence of GBS and suggested that there might be a discrepancy in stone classification based on gross findings and chemical compositions. Moreover, pigmented stones are more likely to be present in older patients than cholesterol stones.

Comparison of Outcomes After Primary Laparoscopic Versus Open Approach for T1b/T2 Gallbladder Cancer

ObjectivesThe primary laparoscopic approach (PLA) for T1b/T2 gallbladder cancer (GBC) remains contradicted. We aimed to compare the perioperative and long-term outcomes after PLA versus open approach (OA) for T1b/T2 GBC.MethodsPatients with resected T1b/T2 GBC were selected from our hospital between January 2011 and August 2018. Overall survival (OS), disease-free survival (DFS), and several secondary outcomes were used to evaluate safety and effectiveness. Subgroup analyses were performed to identify significant risk factors for OS/DFS in GBC patients undergoing PLA/OA.ResultsA total of 114 patients who underwent OA (n = 61) or PLA (n = 53) were included in the study. The percent of PLA cases was increased over time from 40.0% in 2011 to 70.0% in 2018 (p &lt; 0.05). There was no significant difference in OS [hazard ratio (HR), 1.572; 95% confidence interval (CI), 0.866–2.855; p = 0.13] and DFS (HR, 1.225; 95% CI, 0.677–2.218; p = 0.49). No significance was found for intraoperative drainage placement (p = 0.253), intraoperative blood loss (p = 0.497), operation time (p = 0.105), postoperative hospitalization (p = 0.797), positive LNs (p = 0.494), total harvested LNs (p = 0.067), and recurrence rates (P = 0.334). Subgroup analyses demonstrated no significance of conversion rates after PLA (all p &gt; 0.05). Patients undergoing PLA with good/poor OS would have similar recurrence rates (p = 0.402). Positive LNs (p = 0.032) and tumor differentiation (p = 0.048) were identified as risk factors for OS after PLA, while positive LNs (p = 0.005) was identified for OS after OA. Moreover, age (p = 0.013), gallbladder stone (p = 0.008), tumor size (p = 0.028), and positive LNs (p = 0.044) were potential risk factors for DFS after OA.ConclusionsPLA for T1b/T2 GBC was comparable to OA in terms of perioperative and long-term outcomes. Less positive LNs and well-differentiated tumors were independent predictors for better OS after PLA, and less positive LNs were also identified for better OS after OA. Additionally, younger age, without gallbladder stone, smaller tumor size, and less positive LNs were potential risk factors for better DFS after OA.

Growth and Spectral Investigation on Pure Calcium Phosphate Doped With (Copper and Magnesium) Crystals

Calcium stones are most commonly occurring form of cholelithiasis or gallbladder stones most one of the oldest and common afflictions of humans. Calcium phosphate is dissolved minerals in causes of renal to gallbladder stone in both human and animals. Of course, the calcium phosphate is one of the components of gallbladder. Calcium phosphate doped with (Cu and Mg) are crystals are grown by sol-gel method. In the present work the growth and characterization of pure and doped with (Cu and Mg) crystals. The grown crystals were characterization by FT-IR, SEM-EDX and TG/DTA analysis.

Duodenal bulbar necrosis with hemorrhage caused by cholecystolithiasis: a case report

Gastrointestinal bleeding and gallbladder stones are common diseases of the digestive system. However, duodenal necrosis and bleeding caused by gallbladder stone compression is relatively rare. The present report describes a patient with repeated hematemesis and melena that relapsed after several symptomatic treatments. The patient and his family elected surgical treatment. Intraoperative examination revealed necrosis of the duodenal bulb with hemorrhage, which was related to compression of the gallbladder neck. Because the imaging manifestations of this disease lack specificity, early diagnosis is difficult.

The cerebral mechanism underlying the acupoints with specific effect for gallbladder stone disease: protocol for a randomized controlled task-fMRI trial

Background As it has been recorded in ancient Chinese classics, Yanglingquan (GB34) and Dannangxue (EX-LE6) are two important acupoints that can regulate the function of the gallbladder. Acupuncture at these two acupoints is considered particularly effective for gallbladder disease treatment, especially for alleviating gallbladder stone disease (GSD) symptoms that can be aggravated after intaking high-fat food. However, the superior effect between the two acupoints still needs to be further explored, as well as the underlying central mechanism has never been investigated to date. Methods and design Ninety participants diagnosed with GSD will be randomly divided into group A (acupuncture at GB34), group B (acupuncture at EX-LE6), and group C (acupuncture at non-acupoint) in a ratio of 1:1:1. All of them will receive a 30-min acupuncture treatment with fatty-food cues being presented before and after acupuncture. During the task, participants will be scanned by MRI and required to rate their desire for high-/low-fat food with an 11-point Likert scale. Additionally, the participants’ pain/discomfort sensation will be evaluated using the Numeric Rating Scale (NRS) at four timepoints, including before the 1st task fMRI scan, before and after acupuncture, and after the 2nd task fMRI scan. For both behavior and fMRI data, the ANOVA analysis will be conducted among three groups to testify the immediate effect of GB34 and EX-LE6. The post hoc t-test will be employed to further explore the superiority between acupuncture with GB34 and EX-LE6. Furthermore, correlation analyses will be conducted to investigate a possible correlation between neural changes and clinical data. Discussion In comparison to the non-acupoint, the results will firstly explore the superior effect between acupuncture with GB34 and EX-LE6 on GSD patients by observing their behavioral and neural response change to fatty-food cue, and then to investigate the underlying central mechanism. Trial registration Chinese Clinical Trial Registry ChiCTR2000034368. Registered on 3 July 2020.

Ceftriaxone-Induced Gallbladder Stones in Children

Gallbladder stones in children is one complication that is mostly seen in diseases such as hemolytic diseases, liver disease, and obesity. It can also be a secondary complication of long-duration use of antibiotics like ceftriaxone. However, gallbladder stone, together with sludge themselves, is unusual within the children's population. We observed three children with gallbladder stones who were on along course of intravenous ceftriaxone. In this study, we present the three cases of children aged between eleven months to seven years who were treated with high doses and for an extended period (more than two weeks) of intravenous ceftriaxone for a complicated systemic bacterial infection. The goal of this study is to raise awareness about the possibility of developing gallbladder stones in pediatric patients who receive a long course of intravenous ceftriaxone.

Analysis of serum lipid profile and apolipoprotein in patients with concurrent gallbladder stone disease and type 2 diabetes mellitus: a population-based study in China

Background Gallbladder stone diseases being common disorder, prior studies have identified an association between gallstones and abnormal lipids, type 2 diabetics have higher rates of significant abnormalities in lipid metabolism, so the prevalence of dyslipidemia may be higher in gallstone disease patients with type 2 diabetes mellitus (T2DM) than in the general population. This study aimed to compare the serum lipid and lipoprotein abnormalities between gallbladder stone patients who have T2DM and controls in China. Methods Retrospective analysis of serum lipid and apolipoprotein levels in patients aged 40 years and older with gallbladder stone combined with T2DM, T2DM, gallbladder stone, and a normal group of 407 individuals in four groups. 135 cases with gallbladder stones combined with T2DM were compared with 102 cases with T2DM, 119 cases with gallbladder stones, and 51 normal individuals respectively among four groups. Triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), very low-density lipoprotein (VLDL), serum apolipoprotein (apo) AI (ApoAI), apolipoprotein (apo) B (ApoB) and their ratio (ApoAI/ApoB) were collected from the four groups and compared. One-way ANOVA and nonparametric tests (Kruskal-Wallis H tests) were used to compare groups. P < 0.05 was considered statistically significant. Results Compared to three control groups, the patients over 40 years old with gallbladder stone combined with T2DM had significant abnormal changes in lipids: the LDL and APoB levels were significantly raised in patients with gallbladder stones combined with T2DM (P < 0.05), and in males LDL levels were significantly higher in gallbladder stones patients with concomitant T2DM (P < 0.05). Conclusions The study showed that LDL and APoB levels were statistically significant in patients over 40 years of age with concurrent gallbladder stone disease and T2DM, with male patients having significantly higher LDL levels but no statistically significant parameters were found in female patients.