Setoyama M

Gallstones in Western Japan: Factors affecting the prevalence of intrahepatic gallstones

In a study from 40 hospitals in Western Japan between 1975 and 1978, intrahepatic gallstones were identified at the first biliary tract operation in 106 patients (a 3.03% prevalence). These were predominantly bilirubin stones. The occurrence rate for patients with intrahepatic stones was the same as for patients with bilirubin stones solely in the common bile duct suggesting the pathogenetic similarity of these two conditions. The prevalence of intrahepatic stones was 1.5% at urban and 4.97% at rural hospitals (P less than 0.005). Rural patients were significantly older than urban patients (P less than 0.005), but both groups showed an increasing prevalence with age. However, patients with intrahepatic stones were younger than those with bilirubin stones solely in the common bile duct, reflecting the increase likelihood that stones obstructing the biliary tree in this location would cause hepatic damage, pain, and, fever or the possibility that congenital anomalies of the bile ducts migt lead to stone formation at an earlier age. Among the 106 patients, only 12% had stones in the intrahepatic ducts alone. The majority of patients with both bilirubin and cholesterol intrahepatic stones had stones throughout the biliary tree simultaneously. The decreasing prevalence of bilirubin stones in Japan may be related to multiple factors including eradication of parasites and westernization of the diet.

Present features of gallstones in Japan: A collective review of 2,144 cases

A collective review of 2,144 patients operated on for cholelithiasis during the last twenty-two months has shown that younger Japanese adults have predominantly cholesterol stones in their gallbladders and that elderly persons still frequently have bilirubin stones not only in their gallbladders but also in their common bile ducts. Recent westernization of dietary habits in Japan is considered to be the most probable factor causing the increased incidence of cholesterol stones. The decreased incidence of bilirubin stones is considered to be caused by the decreased incidence of biliary infection and increased intake of proteins in food.

Pathogenesis and treatment of pancreatitis due to essential fatty acid deficiency

SummaryPathogenesis of pancreatitis was studied in experimental animals and essential fatty acid deficiency was condemned as an etiological factor, since it caused pathological changes in permeability of cell membrane of the pancreatic acinar cells.Favorable effects of intravenous fat emulsion was clearly demonstrated in treatment for acute and chronic pancreatitis.

Surgical significance of dilatation of the common bile duct--with special reference to choledocholithiasis.

Diameter of the common bile duct was measured in 3,119 patients who underwent primary operation for gallstones, during the period from 1975 to 1978. Although dilatation of the common bile duct was most marked in patients with bilirubin stones in the bile duct alone, dilatation was also observed in patients with cholesterol stones in the gallbladder alone. Drip infusion cholangiograms of 84 healthy patients showed that the common bile duct dilated in parallel with aging. A review of patients with congenital choledochal cysts reported in the literature in Japan revealed that few had gallstones. Thus, it was difficult to determine whether common bile duct dilatation was the cause or result of gallstones, and it was suggested that the socalled drainage operation such as choledochoenterostomy should be done only under strict indications.

Recurrent common duct stones, with special reference to primary common duct stones.

SummaryA series of 1,358 cholelithic patients operated on at 32 affiliated hospitals during the last year and 492 patients operated on at authors’ hospital during the last 21 years were reviewed with special reference to the cases of recurrent common duct stones. Of the former series 15 patients and of the latter series 12 patients respectively were reoperated on for recurrent, but not for residual, common duct stones, and all of them had in the markedly dilated common duct bilirubin stones showing characteristics of stasis stone-primary in common duct. Two representative cases are presented briefly. Congenital hypotonia of the common duct and inflammatory choledochitis are condemned and bilioenterostomy is recommended for preventing stone recurrences.

Etiology of cholesterol gallstones.

SummaryFormation of pure cholesterol stones is initiated by an excessive intake of highly purified carbohydrates, a large intake of animal fats and a restricted intake of vegetable fibers.When the protein content of the lithogenic diet was reduced, mixed or combined stones were formed in golden hamsters. These experimentally, dietarily produced gallstones had compositions and fine structures similar to those of human gallstones.Some mentions were made on black stones which were found in the aged golden hamsters fed with lithogenic diets.