Molecular Identification of Members of Campylobacteriaceae Family in Gallstone

Introduction: The role of Bacterial infections as one major cause of occurrence of gallstones has been admitted. Campylobacteraceae family consists of Helicobacter, Campylobacter and Arcobacter genus have been identified as significant bacteria in the appearance of gastric disorders. This study aimed to investigate the frequency of Campylobacteriaceae family bacteria in the gallstones of patients hospitalized in the surgery ward of Shahid Rajaei hospital in Tonekabon. Materials and Methods: Sample of gallbladder stone was collected form 36 patients. After culture in the BHI medium for the primary enrichment, DNA extraction was carried out and then, the presence of the desired bacteria was examined by PCR technique. The obtained data was analyzed by SPSS software (21) and Chi-square (x2) test. Results: Of total 36 samples of the studied gallstone, 3 samples (8.33%) were positive from viewpoint of presence of Helicobacter, 5 samples (13.88%) were positive in terms of presence of Campylobacter and only 1 sample (2.77%) was positive with respect to the presence of Arcobacter. No significant relationship was observed between type of stone and presence of these bacteria. Conclusion: The results achieved from this research show the presence of DNA belonging to the Campylobacteraceae family in the gallbladder stone, using PCR technique. These bacteria have an etiological significance in the formation of the gallstones. Therefore, more studies are required to determine the role of these bacteria in the formation of gallbladder stone

Morphological and Crystal Chemical Characteristics of Gallbladder Biomineralization

Pathological biomineralization can be found in some gallbladder (GB) diseases such as chronic calculous cholecystitis (CCCh), gallbladder cancer (GBC) and porcelain gallbladder (PGB). The aim of the work was to analyze the morphology of pathological biomineralization in GB tissue in CCCh, GBC and PGB. Five cases of PGB, 10 samples of CCCh and 5 cases of GBC with biomineralization were selected for this study. All samples were examined by histology, histochemistry and scanning electron microscopy with X-ray diffraction. The X-ray diffraction of mineral deposits of PGB wall and GB concretions revealed their different mineral composition. All PGB and GBC samples had the presence of hydroxyapatite. Calcium-containing GB concretions were composed of calcium carbonate with the presence of trace amounts of other calcium phosphate phases (vaterite, dolomite). We did not find cancer in all PGB cases. The different crystal phases of biominerals were found in the wall (PGB and GBC) and in the GB cavity (CCCh) during pathology development. The difference between mineral content of biominerals can be caused by various conditions and mechanisms of their formation.This research has been performed with the financial support of grants of the Ministry of Education and Science of Ukraine No. 0117U003937 “The development of tumor diagnosis method of reproductive system organs using cellular adhesion molecules of cancer-embryonic antigen” and No. 0118U003570 “The efficiency of “liquid biopsy” and tissue biopsy in the diagnosis and treatment of malignant tumors”, Erasmus+ Project 2017-1-SE01-KA107- 034386 between Sumy State University (Sumy, Ukraine) and Umeå University (Umea, Sweden)

Surgeon-performed ultrasound and timing of surgery in acute cholecystitis

Introduction: The use of bedside ultrasound has increased, as equipment has become accessible, user friendly, and ultrasound education is expanding in many specialties. The aim of this project was to validate surgeon-performed ultrasound and to optimise the surgical treatment for patients with acute cholecystitis, in particular in planning timing of surgery. Methods: Papers I-III represent prospective clinical studies where patients with gallstones, acute cholecystitis or appendicitis were included. Sensitivity, specificity, accuracy, and predictive values of surgeon-performed ultrasound were calculated for these diagnoses. Radiologist-performed ultrasound was used as reference for the diagnosis of gallstones (Paper I). In acute cholecystitis, internationally accepted criteria for the diagnosis were used as reference, and in appendicitis, operation logs were used to verify the diagnosis (Paper II). In Paper III, patients with diagnosed acute cholecystitis were included and followed with repeated daily ultrasounds, during admission. The study had a descriptive design, where measures of the gallbladder wall, gallbladder volume, and gallbladder wall oedema were followed over time. Paper IV consists of a register-based cohort study with retrospectively analysed data from the National Register for Gallstone surgery. Out-of-hours surgery was considered independent variable and the primary outcome was any complication within 30 days. Secondary outcomes were proportion of open procedures and operative time exceeding two hours. Logistic regression models were used to adjust for confounders. Results: Papers I and II: Sensitivity for surgeon-performed ultrasound was 88.2% in diagnosing gallstones. Specificity was 99.0% and the accuracy was 94.4%. The sensitivity for surgeon-performed ultrasound in diagnosing acute cholecystitis was 60.0%, specificity 98.6%, and accuracy 93.9%. For appendicitis the sensitivity was 53.3%, specificity 89.7%, and accuracy 77.3%. Paper III: The gallbladder volume and gallbladder wall thickness were mostly stable over time, with a slight tendency to decrease among the 37 patients that received repeated examinations. The presence of gallbladder wall oedema did not change over time. Paper IV: Out-of-hours cholecystectomy did not result in a higher proportion of complications 15.6% versus 13.6% (adjusted odds ratio 1.12 (95% CI 0.99-1.28)), but in a higher proportion of open procedures 37.9% versus 28.9% (adjusted odds ratio 1.39 (1.25-1.54)). There was a lower proportion of long procedures out of hours, 40.4% versus 55.8% (adjusted odds ratio 0.63 (0.58-0.69)). Conclusion: Surgeon-performed ultrasound can be used to diagnose gallstones with high accuracy. Diagnosing acute cholecystitis and appendicitis with ultrasound is more challenging, but examinations with a positive test can help to confirm a clinically suspected diagnosis. The use of ultrasonography in preoperative risk scoring for acute cholecystitis needs to be further evaluated. Out-of-hours surgery for acute cholecystitis is not associated with a higher risk of complications, but with a higher proportion of open procedures

Criterios bioquímicos y ultrasonográficos para la indicación de colangiopancreatografía retrograda endoscópica terapéutica en pacientes con diagnóstico presuntivo de coledocolitiasis

El diagnóstico de coledocolitiasis es complejo. La evaluación clínica y la realización de pruebas bioquímicas séricas frecuentemente no son suficientes para realizar un diagnóstico exacto de esta enfermad. La colangiopancreatograf’ía retrógrada endoscópica (CPRE) se considera el abordaje ideal para su diagnóstico y tratamiento, sin embargo el número creciente de pacientes que son sometidos a este procedimiento de forma innecesaria se ha visto aumentado. OBJETIVO: Determinar los valores predictivos de los parámetros bioquímicos y ultrasonográficos en pacientes con sospecha de coledocolitiasis a quienes se les realizó CPRE. METODOLOGÍA: Estudio retrospectivo, transversal y observacional analítico, la población estudiada fueron pacientes a quienes se les practicó CPRE por sospecha de coledocolitiasis entre los meses Enero a Agosto 2015 en los servicios de cirugía de Hospitales Nacional San Rafael, Medico Quirúrgico y Hospital Militar Central. RESULTADOS: Al realizar la regresión logística multivariable se determinaron las que mayor valor predictivo tenían en cuanto a coledocolitiasis: hospital de los cuales el HNS presento mayor predictibilidad de todos (p<.01), diámetro de colédoco ≥6mm (p<.01) y ALT entre 100-199 (p<.008). CONCLUSIONES Ningún parámetro de los estudiados es capaz por sí solo de predecir con total exactitud la presencia de coledocolitiasis, ya que el valor predictivo de las pruebas hepáticas puede verse afectado por otras enfermedades, sin embargo al combinar los patrones ecográficos con los bioquímicos aumenta la probabilidad de identificar que pacientes presentan mayor riesgo de coledocolitiasis. El método de clasificación de ASGE es reproducible, benéfico y con adecuada validez estadística para aplicarla ante la sospecha de coledocolitiasis en los pacientes y de esta manera disminuir riesgos innecesarios, ahorrar en el coste hospitalario y del propio paciente y sobretodo ayudar a seleccionar los pacientes en necesidad terapéutica de CPRE.Tesis presentada para optar al título de Doctorado en Medicin