Non-operative removal of bile duct stones by duodenoscopic sphincterotomy in the elderly.

Between January 1975 and December 1979, 71 patients over the age of 70 underwent attempted duodenoscopic sphincterotomy for stones in the common bile duct. Fifteen patients still had gall bladders in situ. Sphincterotomy was possible in 69 of the patients and in 65 of these duct clearance was achieved, giving an overall success rate of 92%. Failure to achieve sphincterotomy in two cases was due to substantial peripapillary diverticula. Duct clearance failed in four patients, mostly due to the size of the retained stones. The largest stone extracted was 24 mm diameter. There were no deaths but complications occurred in nine patients (13%); these were haemorrhage in four (requiring surgery in one), cholangitis in four (two of whom required surgical extraction of stones), and pancreatitis in one. The average duration of hospital stay in successful cases was 11 days (range three to 30). Clinical follow-up of 55 patients one to five years after sphincterotomy showed no evidence of stones or of stenosis of the sphincter. Duodenoscopic sphincterotomy is a major advance in the management of elderly patients with stones in the common bile duct.     

Identification of parasite DNA in common bile duct stones by PCR and DNA sequencing

We attempted to identify parasite DNA in the biliary stones of humans via PCR and DNA sequencing. Genomic DNA was isolated from each of 15 common bile duct (CBD) stones and 5 gallbladder (GB) stones. The patients who had the CBD stones suffered from cholangitis, and the patients with GB stones showed acute cholecystitis, respectively. The 28S and 18S rDNA genes were amplified successfully from 3 and/or 1 common bile duct stone samples, and then cloned and sequenced. The 28S and 18S rDNA sequences were highly conserved among isolates. Identity of the obtained 28S D1 rDNA with that of Clonorchis sinensis was higher than 97.6%, and identity of the 18S rDNA with that of other Ascarididae was 97.9%. Almost no intra-specific variations were detected in the 28S and 18S rDNA with the exception of a few nucleotide variations, i.e., substitution and deletion. These findings suggest that C. sinensis and Ascaris lumbricoides may be related with the biliary stone formation and development.     

在职中年人群胆道结石的相关因素分析

目的:探讨在职的40～60岁人群胆囊结石形成的相关因素,为该人群提供降低健康风险、改变不良行为的健康教育信息.方法:随机抽样632个体检人员.采用问卷调查、体重测量、身高测量、胆道B超和空腹血糖、血脂检查.经过统计学处理分析与上述因素的关系,,结果:调查的应答率为88.7%.胆石症患病率为7.55%.在危险因素中性剐、体重指数、血脂和进餐间隔时胆结石的影响较大.结论:胆结石的形成是多因素作用的结果,其中性别、体重指数、血脂和进餐间隔对胆结石形成影响较大.     

Indications for and results following exploration of the common bile duct for stones

Among 100 consecutive patients who had removal or drainage of the gallbladder and exploration of the common bile duct for stones, there were no serious, immediate or late complications and there were no operative deaths. Ninety-six of the 100 patients had stones in the gallbladder, in the common duct, or in both, and 52 of these patients had one or more stones in the common duct. Ten patients died subsequently of unrelated causes. Six patients were lost to followup. Of the 84 patients whose present condition is known, 75 or 89 per cent have had a completely satisfactory result. Six more patients have minor residual symptoms, and for them the result has been classified as good. In three patients, the results were unsatisfactory. Cholangiograms taken before the removal of the T-tube showed residual stones in two patients. In each instance, the stone or stones have been subsequently passed and both patients are in excellent condition.     

Congenital Hypertrophic Pyloric Stenosis

In a large metropolitan general hospital, a high incidence of congenital hypertrophic pyloric stenosis was noted in non-Caucasian groups. Bile-free emesis was consistently reported, and admission was frequently delayed. A prompt diagnosis following admission was not always possible. Unequivocal palpation of a right upper quadrant mass was successful in less than half of the patients in this series, and radiographic studies were helpful in establishing the proper diagnosis in the remainder. Liver fracture can occur with improper abdominal palpation techniques.Despite a surprisingly high complication rate, the ultimate result of operative therapy is uniformly excellent. Three patients not operated upon who were followed for more than two years still have evidence of gastric dysfunction. Postoperative emesis following adequate operation is not unusual, occurring approximately one-third of the time. When postoperative emesis is protracted, incomplete pyloromyotomy should be considered.