Jüngst, Dieter

English

Open Access LMU

The Journal of Lithotripsy & Stone Disease A P R I L 1991 V O L U M E 3 N U M B E R 2 C O N T E N T S 119 FROM THE EDITORS R E V I E W A R T I C L E 128 LAPAROSCOPIC CHOLECYSTECTOMY D E S M O N D H . B I R K E T T , M . D . O R I G I N A L M A N U S C R I P T S 133 BILIARY LITHOTRIPSY VERSUS CHOLECYSTECTOMY: A COST-UTILITY ANALYSIS U L R I C H S T E N G E L E , M . S . , B R U C E R. B A U M G A R T N E R , M . D . , J U D I T H L . C H E Z M A R , M . D . , and D I R K P. S L A K E R , M . D . 141 INITIAL EXPERIENCE USING A NEW TYPE EXTRACORPOREAL LITHOTRIPTER WITH AN ANTI-MISSHOT CONTROL DEVICE M A S A - A K I K U W A H A R A , K O I C H I K A M B E , K A T U T U K I T A G U C H I , T O S H I N O R I S A I T O , S H U I C H I S H I R A I and S E I I C H I O R I K A S A 147 T H E ACOUSTIC FIELDS OF THE WOLF ELECTROHYDRAULIC LITHOTRIPTER D.S. C A M P B E L L , H . G . F L Y N N , D.T . B L A C K S T O C K , C . L I N K E , and E . L . C A R S T E N S E N 157 RESULTS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN YOUNG CHILDREN A H M E D M O S A A D , M . D . and T A R E K E L - S A L A M O U N I , M . D . 162 MAGNETIC RESONANCE IMAGING OF RENAL CALCULI: A N IN VITRO STUDY M A R S H A L L L . S T O L L E R , M . D . , A N D R E A S F L O T H , M . D . , H E D V I G H R I C A K , M . D . , M A R K A N D E R S E N , M . D . , and L A U R E N C E S. B A S K I N , M . D . 165 PATHOLOGICAL-ANATOMICAL ALTERATIONS OF HUMAN KIDNEYS FOLLOWING EXTRACORPOREAL PIEZOELECTRIC SHOCK WAVE LITHOTRIPSY G . S E I T Z , D . N E I S I U S , N . W E R N E R T , and T. G E B H A R D T 171 COMPUTED TOMOGRAPHIC EVALUATION OF GALLSTONE CALCIFICATION FOR BLLIARY LITHOTRIPSY P A M E L A L . C A S L O W I T Z , M . D . , E L L I O T K . F I S H M A N , M . D . , D A V I D R. K A F O N E K , M . D . , K E I T H D . L I L L E M O E , M . D . , S A L L Y M I T C H E L L , M . D . , D A V I D M . W I D L U S , M . D . , and G E O R G E P. S A B A , M . D . 176 TREATMENT IN THE PRONE POSITION OF CALCULI IN THE MIDURETER OVERLYING THE BONY SACRUM WITH EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY L O U I S L . K E E L E R , M . D . , T H O M A S C. M c N A M A R A , M . D . , F R E D O . D O R E Y , M . D . , and R I C H A R D M I L S T E N , M . D . UROLOGICAL CLASSIC ARTICLE 182 COMMENTARY: PERCUTANEOUS NEPHROLITHOTOMY—AN APPROACH TO BRANCHED AND STAGHORN RENAL CALCULI D A V I D M . A L B A L A , M . D . and R A L P H V . C L A Y M A N , M . D . 190 LITERATURE REVIEW 203 CALENDAR OF EVENTS L I T E R A T U R E R E V I E W ing conditions. O n sodium dodccyl sulfate-Polya-crylamide gel electrophoresis, the apparent molec-ular weight of the glycoprotein was 130 k D . In conclusion, gallbladder bile contains nuclcating-promoting activity that binds to concanavalin A . The activity is increased in bile from patients with multiple cholesterol gallstoncs and could therefore play an important role in the pathogenesis of gall-stone disease. I S O L A T I O N O F A P O T E N T C H O L E S -T E R O L N U C L E A T I N G - P R O M O T I N G A C -T I V I T Y F R O M H U M A N G A L L B L A D D E R B I L E : R O L E I N T H E P A T H O G E N E S I S O F G A L L S T O N E D I S E A S E . Groen A K , Noordam CH, Drapers J A G , et al. Hepatology 1 9 9 0 ; 1 1 : 5 2 5 -5 3 3 . Gallbladder bile contains nucleating-promoting activity diat binds to concanavalin A . The activity was found in gallbladder bile from cholesterol gall-stone patients but also in gallbladder bile from pa-tients without stones and patients with pigment stones. Bile from patients with multiple cholesterol gallstoncs contained high concanavalin A-binding nucleation-promoting activity. The activitv was much lower in bile samplcs from pigment stonc pa-tients, patients without stones and patients with a solitary cholesterol stonc. Serum contained vcry lit-tle activity and no concanavalin A-binding nucle-ation-promoting activity could be demonstrated in gallbladder mucosa. This suggests that concanavalin A-binding nucleation promotcr is produced in the liver or bile duct epithelium. The activity was fully resistant to digestion with pronase but was heat labile and could be destroyed by prolonged incu-bation with a mixed glycosidase preparation indi-cating that sugar residues are important for this ac-tivity. O n a Superose 12 gel permeation column, promoting activity eluted in two major peaks at ap-parent molecular weights of 150 ± 30 k D (n = 5) and < 5 k D , rcspectively. The mobility on the column was not influenced by pronase digestion. The factor with the higher molecular weight could be isolated further by Pol-yacrylamide gel electrophoresis under nondenatur-Comment Abnormal rapid nucleation of cholesterol from supersaturated gallbladder bile is of key importance in primary gallstone formation. However, the de-gree of supersaturation in bile is not related to the presence of cholesterol crystals or to the time rc-quired for their nucleation. Therefore, nucleation-promoting factors in lithogenic bile have becn pos-tulatcd. Groen et al. have isolated by concanavaline A -Sepharose chromatography of gallbladder bile a glucosc-/mannose-containing 130-kD glycoprotein with strong cholesterol nucleation-promoting ac-tivity of model biles. The activity was found in the majority of gallbladder biles investigated and high nucleation-promoting activity titers were observed in biles from patients with multiple cholesterol stones. The activity titer in bile was not correlated to total protein content, cholesterol Saturation index and total lipid concentration. Furthcrmorc and more important, aecording to a prior publi-cation of the authors ( C l i n C h i m Acta 1987;165:292-302), no corrclation between the nucleating promoting activity titcr and the choles-terol nucleation time has been observed. The data of Groen et al. are of particular intcrest and the relationship between the 130-kD glycoprotein and the pathogenesis of multiple cholesterol gallstoncs seems to be evident. The low nucleation-promoting activity titer in biles from patients with solitary cholesterol stones, indistinguishable from the titers in biles of patients with pigment stones or no stones, is surprising and difficult to explain. It points to an cxclusive role of the isolated glycoprotein in the pathogenesis of multiple cholesterol gallstoncs. However, the finding of low-activitv titers in biles of patients with solitarv cholesterol gallstoncs 200 Journal of Lithotripsy and Stonc Disease Vol. 3, No. 2, 1991 L I T E R A T U R E R E V I E W and the missing correlation between activity titer and cholesterol nucleation time clearly shows that the 130-kD glycoprotein could not be the sole nu-cleation-promoting factor. This underscores the multifactorial etiology of cholesterol gallstone dis-ease and should stimulate further investigation of the pathophysiology of cholesterol gallstone for-mation. Dieter Jüngst, M . D . Munich, Federal Republic of Germany BILIARY LITERATURE SURVEY Albert M B , Fromm H , Borstelmann R, et al. Successful outp;atient treatment of gallstones with piezoelectric lithottripsy. A n n Intern M e d 1990;113:164-166. Aoki T , Tanimura H , Kawashima H , et al. Cholescin-tigraphic Observation of the sphincter of Oddi motor activity in patients with gallstone. Nippon Geka Hokan 1989;58:289-298. Baillie I , Cairns SR, Putman W S , et al. Endoscopic man-agement of choledocholithiasis during pregnancv. Surg, Gynecol Obstet 1990; 171:1-4. Braver J M , Clarke P D . Cholecystoduodenal fistula with impending gallstone ileus. Invest R a d i o l 1990;25:757-758. Brink JA, Simeone JF, Saini S, et al. Simulation of gall-stone fragments by cavitation bubbles during extra-corporeal shock wave lithotripsy: phvsical basis and in vitro demonstration. Radiology 1990;174:787-791. Buiumsohn A , A l b u E , Gerst P H , et al. Cholelithiasis and teenage mothers. J Adolesc Health Care 1990; 11:339-342. Burch J M , Feliciano D V , Mattox K L , et al. Gallstone pancreatitis. The question of time. Arch Surg 1990;125:853-860. Burnett D A , Greenberger N J . Restraint urged for biliar}' lithotripsy: reply. D i g Dis Sei 1990;35:917. Carr Locke D L . Acute gallstone pancreatitis and endo-scopic therapy. Endoscopy 1990;22:180-183. Chen M F , Jan Y Y . Percutaneous transhepatic cholan-gioscopic lithotripsy. Br J Surg 1990;77:530-532. Clavien P A , Richon J, Burgan S, et al. Gallstone ileus. Br J Surg 1990;77:737-742. Cometta A , Gallot-Lavallee-Villars S, Iten A , et al. In-cidence of gallbladder lithiasis after ceftriaxone treat-ment. J Antimicrob Chemother 1990;25:689-695. Connelly N R , Weinstock A D . Continuous alfentanil In-fusion for extracorporeal shock wave lithotripsv of gall-bladder stones. Anesth Anaig 1990;70:299-302. Cope C, Burke D R , Meranze SG. Percutaneous extrac-tion of gallstones in 20 patients. Radiolog}' 1990;176:19-24. Cucchiaro G , Rossitch JC, Bowie J, et al. Clinical sig-nificance of ultrasonographicallv detected coincidental gallstones. D i g Dis Sei 1990;35:417-421. DeSantis A , Paganelli R , Stefanoni R, et al. Prevalence of gallstones in patients with primary immunoglobulin deficiency. Evidence for lack of association. D i g Dis Sei 1990;35:716-720. Dickerman JL. Gallstone formation associated with weight reduetion. J A m Osteopath Assoc 1990; 90:456-458. Diehl A K , Sugarek N J , Todd K H . Clinical evaluation for gallstone disease: usefulness of svmptoms and signs in diagnosis. A m J M e d 1990;89:29-33. Ditzel H , Schaffalitzky-de-Muckadell O B . Endoscopic sphineterotomy in acute Cholangitis due to choledoch-olithiasis. Hepatogastroenterology 1990;37:204-207. Duane W C . Pathogenesis of gallstones: implications for management. Hosp Pract 1990;25:65-72. Ericsson S, Eriksson M , Angelin B. Biliary lipids in fa-milial combined hvperlipidaemia: effects of aeipimox therapy. Eur J C l i n Invest 1990;20:261-265. Feldman R K , Freeny P C , Kozarek R A . Pancreatic and biliary calculi: percutaneous treatment with tunable dye laser lithotripsy. Radiolog}' 1990;174:793-795. Finch PJ, Haddock J, Grundy A . Duodenal pseudotu-mour: a silent impacted common bile duet calculus. Postgrad M e d J 1989;65:794-796. Flick A L . Restraint urged for biliary lithotripsy. D i g Dis Sei 1990;35:916-918. Floyd JB Jr. Risk factors that would improve the course and outcome of acute gallstone pancreatitis. A m J Surg 1990;159:270. Garcia-Ontiveros A , Cantero-Hinojosa J, Gil-Eextremera B, et al. Differences in gallstone strueture in primary common bile duet lithiasis and gallbladder lithiasis. Kl in Wochenschr 1990;68:496-502. Gibnev EJ. Asvmptomatic gallstones. Br J Surg 1990;77:368-372. Glecson D , Ruppin D C , Saunders A , et al. Final outcome of ursodeoxycholic acid treatment in 126 patients with radiolucent gallstones. Q J M e d 1990;76:711-730. Haapiainen R K , Lindeil O l , Schröder T M . Intraopera-tive removal of pancreatic duet calculus with a rigid ureterorenoscope and ultrasonic lithotripsv. Surgery 1990;107:353-355. Hall RI , Ingoldby CJ , Denver M E . Periampullaty di-verticula predispose to primary rather than secondary stones in the common bile duet. Endoscopv 1990;22:127-128. H o Y D , H o K J . Biliary D-glucaric acid: its quantitation and preventive role in gallstone formation. Scand J Gastroenterol 1990;25:631-640. Höre PJ, Silbert BS, Cook R-J, et al. A double-blind assessment of segmental sensory changes with epidural fentanyl versus epidural saline in patients undergoing extracorporeal shock-wave lithotripsv. Anesthesiology 1990;2:603-606. Ingber S, Jacobson I M . Biliar}' and pancreatic disease in the elderlv. Gastroenterol C l i n N o r t h A m 1990;19:433-457. Josephs L G , Birkett D H . Electrohydraulic lithotripsy Vol. 3, No. 2, 1991 Journal of Lithotripsy and Stonc Disease 201 L I T E R A T U R E R E V I E W ( E H L ) for the treatment of large retained common duet stones. A m Surg 1990;56:232-234. Kelly T R , Elliott D W . Proper timing of surgerv for gall-stone pancreatitis. A m J Surg 1990;159:361-362. Kopecky K K , Hawes R H , Bogan M L , et al. Percuta-neous pulsed-dye laser lithotripsy of gallbladder stones in swine. Invest Radiol 1990;25:627-630. Kowak A , Nowakowska-Dutawa E , Rybicka J. Patencv of the Santorini duet and acute biliar}' pancreatitis. Ä prospective E R C P studv. Endoscopv 1990;22:124-126. Landreneau RJ , McClelland R N . Impaction of the en-doscopic basket. A n important consideration in the trans-sphineteric management of choledocholithiasis. A m Surg 1990;56:388-393. Levin D C , Matteucci T. "Turf battles" over imaging and interventional procedures in Community hospitals: sur-vey results. Radiolog}' 1990;176:321-324. Lorusso D , Misciagna G , Mangini V , et al. Duodeno-gastric reflux of bile acids, gastrin and parietal cells, and gastric acid secretion before and 6 months after cholecystectomy. A m J Surg 1990;159:575-578. L u DS , H o CS, Allen L - C . Gallstone dissolution in methyl tert-butyl ether after mechanical fragmenta-tion: in vitro studv. A m J Roentgenol 1990; 155:67-72. MacFadyen B V Jr, Sandler C M . Percutaneous cholecys-tostomy and lithotripsy of gallstones. A m Surg 1990;56:226-231. Magnuson T H , Lillemoe K D , Scheeres D E , et al. Altered bile composition during cholesterol gallstone forma-tion: cause or effect> J Surg Res 1990;48:584-589. Marteau C , Sastre B, Iconomidis N , et al. p H regulation in human gallbladder bile: study in patients with and without gallstones. Hepatology 1990;11:997-1002. McGrath FP, Lee S H , Gibney R G , et al. liepatic Silb-capsular hematoma: an unusual complication of biliary lithotripsy. A J R 1990;154:1015-1016. Morgentaler A , Kourman C N . Treatment of an impacted fecalith with electrohvdraulic lithotripsv. N Engl J Med 1990;322:855-856. Nowak A , Nowakowska-Dutawa E, Rvbicka J. Patencv of the Santorini duet and acute biliary pancreatitis. Ä prospective E R C P study. Endoscopv 1990;22:124-126. Ohara N , Schaefer J. Clinical significance of biliarv Sludge. J Cl in Gastroenterol 1990;12:291-294. Ransohoff D F , Gracie W A . Management of patients with svmptomatic gallstones: a quantitative analvsis. A m J M e d 1990;88:154-160. Rawat B, Burhenne H J . Extracorporeal shock wave lith-otripsy of calcified gallstones. Work in progress. Ra-diolog}' 1990;175:667-670. Rege R V , Dawes L G , Moore E W . Biliar}' calcium se-cretion in the dog occurs primarily by passive convec-tion and diffusion and is linked to bile flow. J Lab Clin Med 1990;115:593-602. Reihner E , Rudling M , Stahlberg D , et al. Influence of pravastatin, a specific inhibitor of H M G - C o A reduc-tase, on hepatic metabolism of cholesterol. N Engl J Med 1990;323:224-228. Rothschild JG, Holbrook R F , Reinhold R B . Gallstone lithotripsv vs cholecystectomy. A preliminarv cost-benefit analysis. Arch Surg 1990;125:710-714. Sanden H V , Schmitt W , Ottenjann R. Single-step per-cutaneous transhepatic cholecvstoscopv. Endoscopv 1990;22:149-150. Scheeres D E , Magnuson T H , Pitt H A , et al. The effect of calcium on gallbladder absorption. J Surg Res 1990;48:547-551. Senior JR, Johnson M F , DcTurck D M , et al. In vivo kinetics of radiolucent gallstone dissolution by oral dihvdroxv bile acids. Gastroenterology 1990;99:243-251. Smith BF . Effect of laser fragmentation of cholesterol and mixed gallstones on in vitro dissolution in methvl tert-butyl ether. D i g Dis Sei 1990;35:236-241. Soehendra N , Schulz H , Nam V C , et al. E S W L and gall-stone dissolution with M T B E via a naso-vesicular cath-eter. Endoscopv 1990;22:176-179. Tandon R K , Anand A C . Dietary factors in the padio-genesis and management of gallstones. J Assoc Phy-sicians India 1989;37:337-340. Tung G A , Mueller P R , Brink JA, et al. Gallstone frag-mentation with contact electrohvdraulic lithotripsy: in vitro study of phvsical and technical factors. Radiology 1990;174:781-785. Weingarten M A , Eiiat-Zanani Z , Hart J. Frequency of clinical gallstone disease among Yemenite Jews in Is-rael. Isr J Med Sei 1990;26:200-204. Weinstein M C , Coley C M , Richter J M . Medical man-agement of gallstoncs: a cost-effectiveness analysis. J Gen Intern Med 1990;5:277-284. Westlake PJ, Hcrshfield N B , Kelly JK, et al. Chronic right Upper quadrant pain without gallstones: does H I D A scan predict outcome after cholecystectomy? A m J Gastroenterol 1990;85:986-990. Yee A C , H o CS. Percutaneous transhepatic biliary drain-age: a review. Crit Rev Diagn Imaging 1990;30:247-279. Zeman R K , Davros WJ , Garra BS, et al. Relationship between stone motion, targeting, and fragmentation during experimental biliarv lithotripsy. Radiology 1990;176:125-128. 202 Journal of Lithotripsy and Stonc Disease Vol. 3, No. 2, 1991 

Isolation of a potent cholesterol nucleating-promoting activity from human gallbladder bile

Universität München: Elektronischen Publikationen

The Journal of 
Lithotripsy & 
Stone Disease A P R I L 1991 V O L U M E 3 N U M B E R 2 
C O N T E N T S 
119 FROM THE EDITORS 
R E V I E W A R T I C L E 
128 LAPAROSCOPIC CHOLECYSTECTOMY 
D E S M O N D H . B I R K E T T , M . D . 
O R I G I N A L M A N U S C R I P T S 
133 BILIARY LITHOTRIPSY VERSUS CHOLECYSTECTOMY: A COST-UTILITY ANALYSIS 
U L R I C H S T E N G E L E , M . S . , B R U C E R. B A U M G A R T N E R , M . D . , J U D I T H L . C H E Z M A R , M . D . , 
and D I R K P. S L A K E R , M . D . 
141 INITIAL EXPERIENCE USING A NEW TYPE EXTRACORPOREAL LITHOTRIPTER WITH AN ANTI-
MISSHOT CONTROL DEVICE 
M A S A - A K I K U W A H A R A , K O I C H I K A M B E , K A T U T U K I T A G U C H I , T O S H I N O R I S A I T O , 
S H U I C H I S H I R A I and S E I I C H I O R I K A S A 
147 T H E ACOUSTIC FIELDS OF THE WOLF ELECTROHYDRAULIC LITHOTRIPTER 
D.S. C A M P B E L L , H . G . F L Y N N , D.T . B L A C K S T O C K , C . L I N K E , and E . L . C A R S T E N S E N 
157 RESULTS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN YOUNG CHILDREN 
A H M E D M O S A A D , M . D . and T A R E K E L - S A L A M O U N I , M . D . 
162 MAGNETIC RESONANCE IMAGING OF RENAL CALCULI: A N IN VITRO STUDY 
M A R S H A L L L . S T O L L E R , M . D . , A N D R E A S F L O T H , M . D . , H E D V I G H R I C A K , M . D . , 
M A R K A N D E R S E N , M . D . , and L A U R E N C E S. B A S K I N , M . D . 
165 PATHOLOGICAL-ANATOMICAL ALTERATIONS OF HUMAN KIDNEYS FOLLOWING 
EXTRACORPOREAL PIEZOELECTRIC SHOCK WAVE LITHOTRIPSY 
G . S E I T Z , D . N E I S I U S , N . W E R N E R T , and T. G E B H A R D T 
171 COMPUTED TOMOGRAPHIC EVALUATION OF GALLSTONE CALCIFICATION FOR BLLIARY 
LITHOTRIPSY 
P A M E L A L . C A S L O W I T Z , M . D . , E L L I O T K . F I S H M A N , M . D . , D A V I D R. K A F O N E K , M . D . , 
K E I T H D . L I L L E M O E , M . D . , S A L L Y M I T C H E L L , M . D . , D A V I D M . W I D L U S , M . D . , and 
G E O R G E P. S A B A , M . D . 
176 TREATMENT IN THE PRONE POSITION OF CALCULI IN THE MIDURETER OVERLYING THE BONY 
SACRUM WITH EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY 
L O U I S L . K E E L E R , M . D . , T H O M A S C. M c N A M A R A , M . D . , F R E D O . D O R E Y , M . D . , and 
R I C H A R D M I L S T E N , M . D . 
UROLOGICAL CLASSIC ARTICLE 
182 COMMENTARY: PERCUTANEOUS NEPHROLITHOTOMY—AN APPROACH TO BRANCHED AND 
STAGHORN RENAL CALCULI 
D A V I D M . A L B A L A , M . D . and R A L P H V . C L A Y M A N , M . D . 
190 LITERATURE REVIEW 
203 CALENDAR OF EVENTS 
L I T E R A T U R E R E V I E W 
ing conditions. O n sodium dodccyl sulfate-Polya-
crylamide gel electrophoresis, the apparent molec-
ular weight of the glycoprotein was 130 k D . In 
conclusion, gallbladder bile contains nuclcating-
promoting activity that binds to concanavalin A . 
The activity is increased in bile from patients with 
multiple cholesterol gallstoncs and could therefore 
play an important role in the pathogenesis of gall-
stone disease. 
I S O L A T I O N O F A P O T E N T C H O L E S -
T E R O L N U C L E A T I N G - P R O M O T I N G A C -
T I V I T Y F R O M H U M A N G A L L B L A D D E R 
B I L E : R O L E I N T H E P A T H O G E N E S I S O F 
G A L L S T O N E D I S E A S E . Groen A K , Noordam 
CH, Drapers J A G , et al. Hepatology 1 9 9 0 ; 1 1 : 5 2 5 -
5 3 3 . 
Gallbladder bile contains nucleating-promoting 
activity diat binds to concanavalin A . The activity 
was found in gallbladder bile from cholesterol gall-
stone patients but also in gallbladder bile from pa-
tients without stones and patients with pigment 
stones. Bile from patients with multiple cholesterol 
gallstoncs contained high concanavalin A-binding 
nucleation-promoting activity. The activitv was 
much lower in bile samplcs from pigment stonc pa-
tients, patients without stones and patients with a 
solitary cholesterol stonc. Serum contained vcry lit-
tle activity and no concanavalin A-binding nucle-
ation-promoting activity could be demonstrated in 
gallbladder mucosa. This suggests that concanavalin 
A-binding nucleation promotcr is produced in the 
liver or bile duct epithelium. The activity was fully 
resistant to digestion with pronase but was heat 
labile and could be destroyed by prolonged incu-
bation with a mixed glycosidase preparation indi-
cating that sugar residues are important for this ac-
tivity. O n a Superose 12 gel permeation column, 
promoting activity eluted in two major peaks at ap-
parent molecular weights of 150 ± 30 k D (n = 
5) and < 5 k D , rcspectively. 
The mobility on the column was not influenced 
by pronase digestion. The factor with the higher 
molecular weight could be isolated further by Pol-
yacrylamide gel electrophoresis under nondenatur-
Comment 
Abnormal rapid nucleation of cholesterol from 
supersaturated gallbladder bile is of key importance 
in primary gallstone formation. However, the de-
gree of supersaturation in bile is not related to the 
presence of cholesterol crystals or to the time rc-
quired for their nucleation. Therefore, nucleation-
promoting factors in lithogenic bile have becn pos-
tulatcd. 
Groen et al. have isolated by concanavaline A -
Sepharose chromatography of gallbladder bile a 
glucosc-/mannose-containing 130-kD glycoprotein 
with strong cholesterol nucleation-promoting ac-
tivity of model biles. The activity was found in the 
majority of gallbladder biles investigated and high 
nucleation-promoting activity titers were observed 
in biles from patients with multiple cholesterol 
stones. The activity titer in bile was not correlated 
to total protein content, cholesterol Saturation 
index and total lipid concentration. Furthcrmorc 
and more important, aecording to a prior publi-
cation of the authors ( C l i n C h i m Acta 
1987;165:292-302), no corrclation between the 
nucleating promoting activity titcr and the choles-
terol nucleation time has been observed. The data 
of Groen et al. are of particular intcrest and the 
relationship between the 130-kD glycoprotein and 
the pathogenesis of multiple cholesterol gallstoncs 
seems to be evident. 
The low nucleation-promoting activity titer in 
biles from patients with solitary cholesterol stones, 
indistinguishable from the titers in biles of patients 
with pigment stones or no stones, is surprising and 
difficult to explain. It points to an cxclusive role of 
the isolated glycoprotein in the pathogenesis of 
multiple cholesterol gallstoncs. 
However, the finding of low-activitv titers in 
biles of patients with solitarv cholesterol gallstoncs 
200 Journal of Lithotripsy and Stonc Disease Vol. 3, No. 2, 1991 
L I T E R A T U R E R E V I E W 
and the missing correlation between activity titer 
and cholesterol nucleation time clearly shows that 
the 130-kD glycoprotein could not be the sole nu-
cleation-promoting factor. This underscores the 
multifactorial etiology of cholesterol gallstone dis-
ease and should stimulate further investigation of 
the pathophysiology of cholesterol gallstone for-
mation. 
Dieter Jüngst, M . D . 
Munich, Federal Republic of Germany 
BILIARY LITERATURE SURVEY 
Albert M B , Fromm H , Borstelmann R, et al. Successful 
outp;atient treatment of gallstones with piezoelectric 
lithottripsy. A n n Intern M e d 1990;113:164-166. 
Aoki T , Tanimura H , Kawashima H , et al. Cholescin-
tigraphic Observation of the sphincter of Oddi motor 
activity in patients with gallstone. Nippon Geka 
Hokan 1989;58:289-298. 
Baillie I , Cairns SR, Putman W S , et al. Endoscopic man-
agement of choledocholithiasis during pregnancv. 
Surg, Gynecol Obstet 1990; 171:1-4. 
Braver J M , Clarke P D . Cholecystoduodenal fistula with 
impending gallstone ileus. Invest R a d i o l 
1990;25:757-758. 
Brink JA, Simeone JF, Saini S, et al. Simulation of gall-
stone fragments by cavitation bubbles during extra-
corporeal shock wave lithotripsy: phvsical basis and in 
vitro demonstration. Radiology 1990;174:787-791. 
Buiumsohn A , A l b u E , Gerst P H , et al. Cholelithiasis 
and teenage mothers. J Adolesc Health Care 1990; 
11:339-342. 
Burch J M , Feliciano D V , Mattox K L , et al. Gallstone 
pancreatitis. The question of time. Arch Surg 
1990;125:853-860. 
Burnett D A , Greenberger N J . Restraint urged for biliar}' 
lithotripsy: reply. D i g Dis Sei 1990;35:917. 
Carr Locke D L . Acute gallstone pancreatitis and endo-
scopic therapy. Endoscopy 1990;22:180-183. 
Chen M F , Jan Y Y . Percutaneous transhepatic cholan-
gioscopic lithotripsy. Br J Surg 1990;77:530-532. 
Clavien P A , Richon J, Burgan S, et al. Gallstone ileus. 
Br J Surg 1990;77:737-742. 
Cometta A , Gallot-Lavallee-Villars S, Iten A , et al. In-
cidence of gallbladder lithiasis after ceftriaxone treat-
ment. J Antimicrob Chemother 1990;25:689-695. 
Connelly N R , Weinstock A D . Continuous alfentanil In-
fusion for extracorporeal shock wave lithotripsv of gall-
bladder stones. Anesth Anaig 1990;70:299-302. 
Cope C, Burke D R , Meranze SG. Percutaneous extrac-
tion of gallstones in 20 patients. Radiolog}' 
1990;176:19-24. 
Cucchiaro G , Rossitch JC, Bowie J, et al. Clinical sig-
nificance of ultrasonographicallv detected coincidental 
gallstones. D i g Dis Sei 1990;35:417-421. 
DeSantis A , Paganelli R , Stefanoni R, et al. Prevalence 
of gallstones in patients with primary immunoglobulin 
deficiency. Evidence for lack of association. D i g Dis 
Sei 1990;35:716-720. 
Dickerman JL. Gallstone formation associated with 
weight reduetion. J A m Osteopath Assoc 1990; 
90:456-458. 
Diehl A K , Sugarek N J , Todd K H . Clinical evaluation for 
gallstone disease: usefulness of svmptoms and signs in 
diagnosis. A m J M e d 1990;89:29-33. 
Ditzel H , Schaffalitzky-de-Muckadell O B . Endoscopic 
sphineterotomy in acute Cholangitis due to choledoch-
olithiasis. Hepatogastroenterology 1990;37:204-
207. 
Duane W C . Pathogenesis of gallstones: implications for 
management. Hosp Pract 1990;25:65-72. 
Ericsson S, Eriksson M , Angelin B. Biliary lipids in fa-
milial combined hvperlipidaemia: effects of aeipimox 
therapy. Eur J C l i n Invest 1990;20:261-265. 
Feldman R K , Freeny P C , Kozarek R A . Pancreatic and 
biliary calculi: percutaneous treatment with tunable 
dye laser lithotripsy. Radiolog}' 1990;174:793-795. 
Finch PJ, Haddock J, Grundy A . Duodenal pseudotu-
mour: a silent impacted common bile duet calculus. 
Postgrad M e d J 1989;65:794-796. 
Flick A L . Restraint urged for biliary lithotripsy. D i g Dis 
Sei 1990;35:916-918. 
Floyd JB Jr. Risk factors that would improve the course 
and outcome of acute gallstone pancreatitis. A m J Surg 
1990;159:270. 
Garcia-Ontiveros A , Cantero-Hinojosa J, Gil-Eextremera 
B, et al. Differences in gallstone strueture in primary 
common bile duet lithiasis and gallbladder lithiasis. 
Kl in Wochenschr 1990;68:496-502. 
Gibnev EJ. Asvmptomatic gallstones. Br J Surg 
1990;77:368-372. 
Glecson D , Ruppin D C , Saunders A , et al. Final outcome 
of ursodeoxycholic acid treatment in 126 patients with 
radiolucent gallstones. Q J M e d 1990;76:711-730. 
Haapiainen R K , Lindeil O l , Schröder T M . Intraopera-
tive removal of pancreatic duet calculus with a rigid 
ureterorenoscope and ultrasonic lithotripsv. Surgery 
1990;107:353-355. 
Hall RI , Ingoldby CJ , Denver M E . Periampullaty di-
verticula predispose to primary rather than secondary 
stones in the common bile duet. Endoscopv 
1990;22:127-128. 
H o Y D , H o K J . Biliary D-glucaric acid: its quantitation 
and preventive role in gallstone formation. Scand J 
Gastroenterol 1990;25:631-640. 
Höre PJ, Silbert BS, Cook R-J, et al. A double-blind 
assessment of segmental sensory changes with epidural 
fentanyl versus epidural saline in patients undergoing 
extracorporeal shock-wave lithotripsv. Anesthesiology 
1990;2:603-606. 
Ingber S, Jacobson I M . Biliar}' and pancreatic disease in 
the elderlv. Gastroenterol C l i n N o r t h A m 
1990;19:433-457. 
Josephs L G , Birkett D H . Electrohydraulic lithotripsy 
Vol. 3, No. 2, 1991 Journal of Lithotripsy and Stonc Disease 201 
L I T E R A T U R E R E V I E W 
( E H L ) for the treatment of large retained common 
duet stones. A m Surg 1990;56:232-234. 
Kelly T R , Elliott D W . Proper timing of surgerv for gall-
stone pancreatitis. A m J Surg 1990;159:361-362. 
Kopecky K K , Hawes R H , Bogan M L , et al. Percuta-
neous pulsed-dye laser lithotripsy of gallbladder stones 
in swine. Invest Radiol 1990;25:627-630. 
Kowak A , Nowakowska-Dutawa E , Rybicka J. Patencv 
of the Santorini duet and acute biliar}' pancreatitis. Ä 
prospective E R C P studv. Endoscopv 1990;22:124-
126. 
Landreneau RJ , McClelland R N . Impaction of the en-
doscopic basket. A n important consideration in the 
trans-sphineteric management of choledocholithiasis. 
A m Surg 1990;56:388-393. 
Levin D C , Matteucci T. "Turf battles" over imaging and 
interventional procedures in Community hospitals: sur-
vey results. Radiolog}' 1990;176:321-324. 
Lorusso D , Misciagna G , Mangini V , et al. Duodeno-
gastric reflux of bile acids, gastrin and parietal cells, 
and gastric acid secretion before and 6 months after 
cholecystectomy. A m J Surg 1990;159:575-578. 
L u DS , H o CS, Allen L - C . Gallstone dissolution in 
methyl tert-butyl ether after mechanical fragmenta-
tion: in vitro studv. A m J Roentgenol 1990; 155:67-
72. 
MacFadyen B V Jr, Sandler C M . Percutaneous cholecys-
tostomy and lithotripsy of gallstones. A m Surg 
1990;56:226-231. 
Magnuson T H , Lillemoe K D , Scheeres D E , et al. Altered 
bile composition during cholesterol gallstone forma-
tion: cause or effect> J Surg Res 1990;48:584-589. 
Marteau C , Sastre B, Iconomidis N , et al. p H regulation 
in human gallbladder bile: study in patients with and 
without gallstones. Hepatology 1990;11:997-1002. 
McGrath FP, Lee S H , Gibney R G , et al. liepatic Silb-
capsular hematoma: an unusual complication of biliary 
lithotripsy. A J R 1990;154:1015-1016. 
Morgentaler A , Kourman C N . Treatment of an impacted 
fecalith with electrohvdraulic lithotripsv. N Engl J 
Med 1990;322:855-856. 
Nowak A , Nowakowska-Dutawa E, Rvbicka J. Patencv 
of the Santorini duet and acute biliary pancreatitis. Ä 
prospective E R C P study. Endoscopv 1990;22:124-
126. 
Ohara N , Schaefer J. Clinical significance of biliarv 
Sludge. J Cl in Gastroenterol 1990;12:291-294. 
Ransohoff D F , Gracie W A . Management of patients with 
svmptomatic gallstones: a quantitative analvsis. A m J 
M e d 1990;88:154-160. 
Rawat B, Burhenne H J . Extracorporeal shock wave lith-
otripsy of calcified gallstones. Work in progress. Ra-
diolog}' 1990;175:667-670. 
Rege R V , Dawes L G , Moore E W . Biliar}' calcium se-
cretion in the dog occurs primarily by passive convec-
tion and diffusion and is linked to bile flow. J Lab Clin 
Med 1990;115:593-602. 
Reihner E , Rudling M , Stahlberg D , et al. Influence of 
pravastatin, a specific inhibitor of H M G - C o A reduc-
tase, on hepatic metabolism of cholesterol. N Engl J 
Med 1990;323:224-228. 
Rothschild JG, Holbrook R F , Reinhold R B . Gallstone 
lithotripsv vs cholecystectomy. A preliminarv cost-
benefit analysis. Arch Surg 1990;125:710-714. 
Sanden H V , Schmitt W , Ottenjann R. Single-step per-
cutaneous transhepatic cholecvstoscopv. Endoscopv 
1990;22:149-150. 
Scheeres D E , Magnuson T H , Pitt H A , et al. The effect 
of calcium on gallbladder absorption. J Surg Res 
1990;48:547-551. 
Senior JR, Johnson M F , DcTurck D M , et al. In vivo 
kinetics of radiolucent gallstone dissolution by oral 
dihvdroxv bile acids. Gastroenterology 1990;99:243-
251. 
Smith BF . Effect of laser fragmentation of cholesterol and 
mixed gallstones on in vitro dissolution in methvl tert-
butyl ether. D i g Dis Sei 1990;35:236-241. 
Soehendra N , Schulz H , Nam V C , et al. E S W L and gall-
stone dissolution with M T B E via a naso-vesicular cath-
eter. Endoscopv 1990;22:176-179. 
Tandon R K , Anand A C . Dietary factors in the padio-
genesis and management of gallstones. J Assoc Phy-
sicians India 1989;37:337-340. 
Tung G A , Mueller P R , Brink JA, et al. Gallstone frag-
mentation with contact electrohvdraulic lithotripsy: in 
vitro study of phvsical and technical factors. Radiology 
1990;174:781-785. 
Weingarten M A , Eiiat-Zanani Z , Hart J. Frequency of 
clinical gallstone disease among Yemenite Jews in Is-
rael. Isr J Med Sei 1990;26:200-204. 
Weinstein M C , Coley C M , Richter J M . Medical man-
agement of gallstoncs: a cost-effectiveness analysis. J 
Gen Intern Med 1990;5:277-284. 
Westlake PJ, Hcrshfield N B , Kelly JK, et al. Chronic 
right Upper quadrant pain without gallstones: does 
H I D A scan predict outcome after cholecystectomy? 
A m J Gastroenterol 1990;85:986-990. 
Yee A C , H o CS. Percutaneous transhepatic biliary drain-
age: a review. Crit Rev Diagn Imaging 1990;30:247-
279. 
Zeman R K , Davros WJ , Garra BS, et al. Relationship 
between stone motion, targeting, and fragmentation 
during experimental biliarv lithotripsy. Radiology 
1990;176:125-128. 
202 Journal of Lithotripsy and Stonc Disease Vol. 3, No. 2, 1991 


https://epub.ub.uni-muenchen.de/6544/1/6544.pdf

Isolation of a potent cholesterol nucleating-promoting activity from human gallbladder bile

Abstract

Similar works

Full text

Available Versions

Open Access LMU

Universität München: Elektronischen Publikationen