Relation of Gallbladder Motility to Viscosity and Composition of Gallbladder Bile in Patients with Cholesterol Gallstones

Background/Aims: Increased viscosity and supersaturation of cholesterol in gallbladder bile, as well as an impaired motility of the gallbladder, are considered to be important factors in the pathogenesis of cholesterol gallstones. However, the relation of these parameters has not yet been determined. Material and Methods: Bile viscosity (mPa.s) was measured by rotation viscosimetry and the composition of gallbladder bile was determined using standard methodology. Gallbladder motility was calculated as ejection fraction in percent of total volume 45 min after a test meal using ultrasonography in patients with gallstones prior to elective cholecystectomy. Results: The study included 35 patients with cholesterol gallstones. Viscosity of gallbladder bile ranged between 0.9 and 12.5 mPa.s (median 2.2 mPa.s) and an ejection fraction of the gallbladder of 55.4 +/- 18.3% (mean +/- SD) was determined. No significant correlation (r = 0.19, p < 0.2) between the 2 parameters could be calculated. Analysis of the composition of gallbladder bile revealed a positive correlation of all components to biliary viscosity but not to the motility of the gallbladder, with the exceptions of a negative correlation (r = 0.39, p < 0.02) between mucin concentration and the ejection fraction at 45 min after the test meal. Conclusions: The motility of the gallbladder appears to be unrelated to the viscosity of gallbladder bile or gallbladder bile composition. The negative correlation between the ejection fraction of the gallbladder and mucin concentration of gallbladder bile suggests that chronic inflammation of the gallbladder wall is associated with both an impaired motility of the gallbladder and increased mucin release into gallbladder bile. Copyright (C) 2009 S. Karger AG, Base

Pattern of S100-release in benign and malignant diseases beside malignant melanoma/Freisetzung von S100 bei benignen und malignen Erkrankungen jenseits des malignen Melanoms

Background: The usefulness of S100 as a prognostic marker and aid in follow-up care in patients with malignant melanoma as well as in individuals with various neurological pathologies is well known. The aim of this study was to investigate its release and clinical relevance in benign and malignant disorders beyond these indications to elucidate tumor and organ specificity of S100. Methods: S100 levels were studied in serum samples of 1856 untreated patients, among them 59 healthy individuals, 358 patients with benign disorders, and 1439 patients with malignant tumors. Results: Healthy individuals had low S100 levels reaching a median of 0.041 ng/mL and 95th and 100th percentiles of 0.096 ng/mL and 0.144 ng/mL, respectively. The medians of patient groups with benign diseases ranged from 0.030 to 0.057 ng/mL, patients with malignant diseases from 0.020 to 0.059 ng/mL, and thus were comparable to healthy individuals. Only 2% of patients with benign diseases, mainly suffering from infectious, autoimmune, or benign gastrointestinal diseases and 1% of patients with malignant diseases showed slightly higher values than healthy individuals, in most cases up to 0.5 ng/mL. Conclusions: In contrast to many other oncological biomarkers, S100 is only rarely released in elevated levels from most benign and malignant diseases apart from malignant melanoma and neurological diseases, resulting in superior organ and tumor specificity. As potentially influencing factors, severe infectious diseases have to be considered.Hintergrund: S100 ist als nützlicher Biomarker für die Prognoseaschätzung und die Verlaufsbeobachtung bei Patienten mit malignem Melanom und in Patienten mit verschiedenen neurologischen Erkrankungen anerkannt. Das Ziel dieser Studie war, die Freisetzung und klinische Relevanz von S100 bei anderen benignen and malignen Erkrankungen jenseits dieser Indikationen zu untersuchen, um die Tumor- und Organspezifität von S100 zu bewerten. Methoden: S100-Konzentrationen wurden in Serumproben von 1856 unbehandelten Patienten ermittelt, darunter 59 gesunde Personen, 358 Patienten mit benignen Erkrankungen und 1439 Patienten mit malignen Tumoren. Ergebnisse: Gesunde Personen hatten niedrige S100 Serumwerte, die einen Median von 0.041 ng/mL, eine 95. Perzentile von 0.096 ng/mL und ein Maximum von 0.144 ng/mL erreichten. Die Mediane der Patientengruppen lagen bei benignen Erkrankungen zwischen 0.030 und 0.057 ng/mL, bei Patienten mit malignen Tumoren zwischen 0.020 und 0.059 ng/mL – und waren somit vergleichbar zu gesunden Kontrollpersonen. Lediglich 2% der Patienten mit benignen Erkrankungen, v.a. infektiösen, autoimmunen oder benignen gastrointestinalen Erkrankungen, sowie 1% der Patienten mit malignen Tumoren wiesen im Vergleich zu gesunden Personen leicht erhöhte Werte auf – in den meisten Fällen bis 0.5 ng/mL. Schlussfolgerung: Im Gegensatz zu vielen anderen onkologischen Biomarkern wird S100 nur selten in höheren Konzentrationen von den meisten benignen und malignen Erkrankungen – mit Ausnahme des malignen Melanoms und neurologischer Erkrankungen – freigesetzt, was sich in einer sehr hohen Organ- und Tumorspezifität widerspiegelt. Als möglicher Einflussfaktor sind schwere infektiöse Erkrankungen zu berücksichtigen

Pattern of S100-release in benign and malignant diseases beside malignant melanoma/Freisetzung von S100 bei benignen und malignen Erkrankungen jenseits des malignen Melanoms

Background: The usefulness of S100 as a prognostic marker and aid in follow-up care in patients with malignant melanoma as well as in individuals with various neurological pathologies is well known. The aim of this study was to investigate its release and clinical relevance in benign and malignant disorders beyond these indications to elucidate tumor and organ specificity of S100. Methods: S100 levels were studied in serum samples of 1856 untreated patients, among them 59 healthy individuals, 358 patients with benign disorders, and 1439 patients with malignant tumors. Results: Healthy individuals had low S100 levels reaching a median of 0.041 ng/mL and 95th and 100th percentiles of 0.096 ng/mL and 0.144 ng/mL, respectively. The medians of patient groups with benign diseases ranged from 0.030 to 0.057 ng/mL, patients with malignant diseases from 0.020 to 0.059 ng/mL, and thus were comparable to healthy individuals. Only 2% of patients with benign diseases, mainly suffering from infectious, autoimmune, or benign gastrointestinal diseases and 1% of patients with malignant diseases showed slightly higher values than healthy individuals, in most cases up to 0.5 ng/mL. Conclusions: In contrast to many other oncological biomarkers, S100 is only rarely released in elevated levels from most benign and malignant diseases apart from malignant melanoma and neurological diseases, resulting in superior organ and tumor specificity. As potentially influencing factors, severe infectious diseases have to be considered.Hintergrund: S100 ist als nützlicher Biomarker für die Prognoseaschätzung und die Verlaufsbeobachtung bei Patienten mit malignem Melanom und in Patienten mit verschiedenen neurologischen Erkrankungen anerkannt. Das Ziel dieser Studie war, die Freisetzung und klinische Relevanz von S100 bei anderen benignen and malignen Erkrankungen jenseits dieser Indikationen zu untersuchen, um die Tumor- und Organspezifität von S100 zu bewerten. Methoden: S100-Konzentrationen wurden in Serumproben von 1856 unbehandelten Patienten ermittelt, darunter 59 gesunde Personen, 358 Patienten mit benignen Erkrankungen und 1439 Patienten mit malignen Tumoren. Ergebnisse: Gesunde Personen hatten niedrige S100 Serumwerte, die einen Median von 0.041 ng/mL, eine 95. Perzentile von 0.096 ng/mL und ein Maximum von 0.144 ng/mL erreichten. Die Mediane der Patientengruppen lagen bei benignen Erkrankungen zwischen 0.030 und 0.057 ng/mL, bei Patienten mit malignen Tumoren zwischen 0.020 und 0.059 ng/mL – und waren somit vergleichbar zu gesunden Kontrollpersonen. Lediglich 2% der Patienten mit benignen Erkrankungen, v.a. infektiösen, autoimmunen oder benignen gastrointestinalen Erkrankungen, sowie 1% der Patienten mit malignen Tumoren wiesen im Vergleich zu gesunden Personen leicht erhöhte Werte auf – in den meisten Fällen bis 0.5 ng/mL. Schlussfolgerung: Im Gegensatz zu vielen anderen onkologischen Biomarkern wird S100 nur selten in höheren Konzentrationen von den meisten benignen und malignen Erkrankungen – mit Ausnahme des malignen Melanoms und neurologischer Erkrankungen – freigesetzt, was sich in einer sehr hohen Organ- und Tumorspezifität widerspiegelt. Als möglicher Einflussfaktor sind schwere infektiöse Erkrankungen zu berücksichtigen

Relation of gallbladder function and Helicobacter pylori infection to gastric mucosa inflammation in patients with symptomatic cholecystolithiasis

Background. Inflammatory alterations of the gastric mucosa are commonly caused by Helicobacter pylori (Hp) infection in patients with symptomatic gallstone disease. However, the additional pathogenetic role of an impaired gallbladder function leading to an increased alkaline duodenogastric reflux is controversially discussed. Aim:To investigate the relation of gallbladder function and Hp infection to gastric mucosa inflammation in patients with symptomatic gallstones prior to cholecystectomy. Patients: Seventy-three patients with symptomatic gallstones were studied by endoscopy and Hp testing. Methods: Gastritis classification was performed according to the updated Sydney System and gallbladder function was determined by total lipid concentration of gallbladder bile collected during mainly laparoscopic cholecystectomy. Results: Fifteen patients revealed no, 39 patients mild, and 19 moderate to marked gastritis. No significant differences for bile salts, phospholipids, cholesterol, or total lipids in gallbladder bile were found between these three groups of patients. However, while only 1 out of 54 (< 2%) patients with mild or no gastritis was found histologically positive for Hp, this infection could be detected in 14 (74%) out of 19 patients with moderate to marked gastritis. Conclusion: Moderate to marked gastric mucosa inflammation in gallstone patients is mainly caused by Hp infection, whereas gallbladder function is not related to the degree of gastritis. Thus, an increased alkaline duodenogastric reflux in gallstone patients seems to be of limited pathophysiological relevance. Copyright (c) 2006 S. Karger AG, Basel

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care