THE 2002 OFFICIAL PATIENT’S SOURCEBOOK
on
ALLSTONES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient’s Sourcebook on Gallstones: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83276-5 1. Gallstones-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of gallstones.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to gallstones. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to gallstones, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Appendicitis
·
The Official Patient's Sourcebook on Autoimmune Hepatitis
·
The Official Patient's Sourcebook on Bacteria and Foorborne Illness
·
The Official Patient's Sourcebook on Barrett's Esophagus
·
The Official Patient's Sourcebook on Celiac Disease
·
The Official Patient's Sourcebook on Cirrhosis of the Liver
·
The Official Patient's Sourcebook on Constipation
·
The Official Patient's Sourcebook on Crohn Disease
·
The Official Patient's Sourcebook on Cyclic Vomiting Syndrome
·
The Official Patient's Sourcebook on Diarrhea
·
The Official Patient's Sourcebook on Diverticular Disease
·
The Official Patient's Sourcebook on Fecal Incontinence
·
The Official Patient's Sourcebook on Gas
·
The Official Patient's Sourcebook on Gastritis
·
The Official Patient's Sourcebook on Gastroparesis
·
The Official Patient's Sourcebook on Hemolytic Uremic Syndrome
·
The Official Patient's Sourcebook on Hemorrhoids
·
The Official Patient's Sourcebook on Hepatitis a
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The Official Patient's Sourcebook on Hepatitis B
·
The Official Patient's Sourcebook on Hepatitis C
·
The Official Patient's Sourcebook on Hiatal Hernia
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The Official Patient's Sourcebook on Hirschsprung
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The Official Patient's Sourcebook on Indigestion
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The Official Patient's Sourcebook on Inguinal Hernia
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The Official Patient's Sourcebook on Intestinal Pseudo-obstruction
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The Official Patient's Sourcebook on Irritable Bowel Syndrome
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The Official Patient's Sourcebook on Lactose Intolerance
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The Official Patient's Sourcebook on Ménétrier
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The Official Patient's Sourcebook on Pancreatitis
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The Official Patient's Sourcebook on Peptic Ulcer
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The Official Patient's Sourcebook on Porphyria
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The Official Patient's Sourcebook on Primary Biliary Cirrhosis
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The Official Patient's Sourcebook on Primary Sclerosing Cholangitis
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The Official Patient's Sourcebook on Proctitis
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The Official Patient's Sourcebook on Rapid Gastric Emptying
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·
The Official Patient's Sourcebook on Short Bowel Syndrome
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The Official Patient's Sourcebook on Ulcerative Colitis
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The Official Patient's Sourcebook on Whipple Disease
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The Official Patient's Sourcebook on Wilson's Disease
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The Official Patient's Sourcebook on Zollinger-ellison Syndrome
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents
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Table of Contents INTRODUCTION ................................................................................................................................. 1 Overview ....................................................................................................................................... 1 Organization ................................................................................................................................. 3 Scope.............................................................................................................................................. 3 Moving Forward............................................................................................................................ 4 PART I: THE ESSENTIALS ............................................................................................................. 7 CHAPTER 1. THE ESSENTIALS ON GALLSTONES: GUIDELINES......................................................... 9 Overview ....................................................................................................................................... 9 What Are Gallstones?.................................................................................................................. 11 What Causes Gallstones? ............................................................................................................ 12 Who Is at Risk for Gallstones? .................................................................................................... 13 What Are the Symptoms? ........................................................................................................... 14 How Are Gallstones Diagnosed?................................................................................................. 15 Surgical Treatment...................................................................................................................... 15 Nonsurgical Treatment ............................................................................................................... 17 Do People Need Their Gallbladders? ........................................................................................... 17 Points to Remember..................................................................................................................... 18 More Guideline Sources .............................................................................................................. 18 Vocabulary Builder...................................................................................................................... 30 CHAPTER 2. SEEKING GUIDANCE ................................................................................................... 37 Overview ..................................................................................................................................... 37 Associations and Gallstones ........................................................................................................ 37 Finding More Associations ......................................................................................................... 39 Finding Doctors........................................................................................................................... 41 Selecting Your Doctor ................................................................................................................. 42 Working with Your Doctor ......................................................................................................... 43 Broader Health-Related Resources .............................................................................................. 44 PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ........................... 45 CHAPTER 3. STUDIES ON GALLSTONES .......................................................................................... 47 Overview ..................................................................................................................................... 47 The Combined Health Information Database .............................................................................. 47 Federally-Funded Research on Gallstones................................................................................... 53 E-Journals: PubMed Central ....................................................................................................... 65 The National Library of Medicine: PubMed................................................................................ 66 Vocabulary Builder...................................................................................................................... 66 CHAPTER 4. PATENTS ON GALLSTONES ......................................................................................... 73 Overview ..................................................................................................................................... 73 Patents on Gallstones .................................................................................................................. 74 Patent Applications on Gallstones .............................................................................................. 81 Keeping Current .......................................................................................................................... 81 Vocabulary Builder...................................................................................................................... 81 CHAPTER 5. BOOKS ON GALLSTONES............................................................................................. 83 Overview ..................................................................................................................................... 83 Book Summaries: Federal Agencies ............................................................................................. 83 Book Summaries: Online Booksellers .......................................................................................... 87 The National Library of Medicine Book Index............................................................................. 90 Chapters on Gallstones ................................................................................................................ 92 General Home References .......................................................................................................... 101 Vocabulary Builder.................................................................................................................... 102
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Contents CHAPTER 6. MULTIMEDIA ON GALLSTONES ................................................................................ 105 Overview ................................................................................................................................... 105 Video Recordings....................................................................................................................... 105 Audio Recordings ...................................................................................................................... 108 Bibliography: Multimedia on Gallstones................................................................................... 109 Vocabulary Builder.................................................................................................................... 112 CHAPTER 7. PERIODICALS AND NEWS ON GALLSTONES ............................................................. 113 Overview ................................................................................................................................... 113 News Services & Press Releases ................................................................................................ 113 Newsletter Articles .................................................................................................................... 118 Academic Periodicals covering Gallstones ................................................................................ 120 Vocabulary Builder.................................................................................................................... 121 CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES .............................................................. 123 Overview ................................................................................................................................... 123 NIH Guidelines ......................................................................................................................... 123 NIH Databases .......................................................................................................................... 124 Other Commercial Databases .................................................................................................... 133 The Genome Project and Gallstones .......................................................................................... 134 Specialized References ............................................................................................................... 138 Vocabulary Builder.................................................................................................................... 139 CHAPTER 9. DISSERTATIONS ON GALLSTONES ............................................................................ 141 Overview ................................................................................................................................... 141 Dissertations on Gallstones ....................................................................................................... 141 Keeping Current ........................................................................................................................ 142
PART III. APPENDICES .............................................................................................................. 143 APPENDIX A. RESEARCHING YOUR MEDICATIONS ..................................................................... 145 Overview ................................................................................................................................... 145 Your Medications: The Basics ................................................................................................... 146 Learning More about Your Medications ................................................................................... 147 Commercial Databases............................................................................................................... 149 Contraindications and Interactions (Hidden Dangers)............................................................. 150 A Final Warning ....................................................................................................................... 151 General References..................................................................................................................... 152 Vocabulary Builder.................................................................................................................... 152 APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ............................................................... 153 Overview ................................................................................................................................... 153 What Is CAM? .......................................................................................................................... 153 What Are the Domains of Alternative Medicine? ..................................................................... 154 Can Alternatives Affect My Treatment?................................................................................... 157 Finding CAM References on Gallstones ................................................................................... 158 Additional Web Resources......................................................................................................... 167 General References..................................................................................................................... 181 Vocabulary Builder.................................................................................................................... 182 APPENDIX C. RESEARCHING NUTRITION..................................................................................... 185 Overview ................................................................................................................................... 185 Food and Nutrition: General Principles .................................................................................... 186 Finding Studies on Gallstones................................................................................................... 190 Federal Resources on Nutrition................................................................................................. 193 Additional Web Resources......................................................................................................... 194 Vocabulary Builder.................................................................................................................... 201 APPENDIX D. FINDING MEDICAL LIBRARIES ............................................................................... 203 Overview ................................................................................................................................... 203 Preparation ................................................................................................................................ 203
Contents
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Finding a Local Medical Library ............................................................................................... 204 Medical Libraries Open to the Public ........................................................................................ 204 APPENDIX E. NIH CONSENSUS STATEMENT ON GALLSTONES AND LAPAROSCOPIC CHOLECYSTECTOMY ..................................................................................................................... 211 Overview ................................................................................................................................... 211 Abstract ..................................................................................................................................... 212 Epidemiology of Gallstones........................................................................................................ 212 What Is Laparoscopic Cholecystectomy?................................................................................... 213 Which Patients with Gallstones Should Be Treated? ................................................................ 214 Patients Who Should Be Treated with Laparoscopic Cholecystectomy ..................................... 216 Alternative Medical and Surgical Treatments of Gallstone Disease ......................................... 218 Laparoscopic Cholecystectomy Compared with Other Treatments ........................................... 221 How Should Bile Duct Stones Be Detected and Treated? ......................................................... 223 Directions for Future Research.................................................................................................. 225 Conclusions ............................................................................................................................... 227 Vocabulary Builder.................................................................................................................... 229 ONLINE GLOSSARIES ............................................................................................................... 231 Online Dictionary Directories................................................................................................... 232 GALLSTONES GLOSSARY........................................................................................................ 233 General Dictionaries and Glossaries ......................................................................................... 250 INDEX.............................................................................................................................................. 252
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Gallstones
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The 2002 Official Patient’s Sourcebook on Gallstones has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to gallstones, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on gallstones. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on gallstones should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching gallstones (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to gallstones. It also gives you sources of information that can help you find a doctor in your local area specializing in treating gallstones. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with gallstones. Part II moves on to advanced research dedicated to gallstones. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on gallstones. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with gallstones or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with gallstones. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with gallstones.
Scope While this sourcebook covers gallstones, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that gallstones is often considered a synonym or a condition closely related to the following: ·
Gallstones
4
Gallstones
In addition to synonyms and related conditions, physicians may refer to gallstones using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for gallstones:4 ·
560.31 gallstone ileus
·
574.0 calculus of the gallbladder with acute cholecystitis
·
574.2 calculus of gallbladder without mention of cholecystitis
·
574.2 calculus of the gallbladder without mention of cholecystitis
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to gallstones. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with gallstones will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
5
are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with gallstones is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of gallstones, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
7
PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on gallstones. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of gallstones to you or even given you a pamphlet or brochure describing gallstones. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
CHAPTER 1. GUIDELINES
THE
ESSENTIALS
ON
9
GALLSTONES:
Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on gallstones. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on gallstones can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on gallstones. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Gallstones
There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with gallstones and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·
Division of Diabetes, Endocrinology, and Metabolic Diseases
·
Division of Digestive Diseases and Nutrition
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Division of Kidney, Urologic, and Hematologic Diseases
The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The Institute supports basic and clinical research through investigator-initiated This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6
Guidelines 11
grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on gallstones.
What Are Gallstones?7 Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. The liquid, called bile, is used to help the body digest fats. Bile is made in the liver, then stored in the gallbladder until the body needs to digest fat. At that time, the gallbladder contracts and pushes the bile into a tube—called a duct—that carries it to the small intestine, where it helps with digestion. Bile contains water, cholesterol, fats, bile salts, and bilirubin. Bile salts break up fat, and bilirubin gives bile and stool a brownish color. If the liquid bile contains too much cholesterol, bile salts, or bilirubin, it can harden into stones. The two types of gallstones are cholesterol stones and pigment stones. Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Pigment stones are small, dark stones made of bilirubin. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination.
Adapted from The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/digest/pubs/gallstns/gallstns.htm. 7
12 Gallstones
The gallbladder and the ducts that carry bile and other digestive enzymes from the liver, gallbladder, and pancreas to the small intestine are called the biliary system. Gallstones can block the normal flow of bile if they lodge in any of the ducts that carry bile from the liver to the small intestine. That includes the hepatic ducts, which carry bile out of the liver; the cystic duct, which takes bile to and from the gallbladder; and the common bile duct, which takes bile from the cystic and hepatic ducts to the small intestine. Bile trapped in these ducts can cause inflammation in the gallbladder, the ducts, or, rarely, the liver. Other ducts open into the common bile duct, including the pancreatic duct, which carries digestive enzymes out of the pancreas. If a gallstone blocks the opening to that duct, digestive enzymes can become trapped in the pancreas and cause an extremely painful inflammation called pancreatitis. If any of these ducts remain blocked for a significant period of time, severe— possibly fatal—damage can occur, affecting the gallbladder, liver, or pancreas. Warning signs of a serious problem are fever, jaundice, and persistent pain.
What Causes Gallstones? Cholesterol Stones Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason. Pigment Stones The cause of pigment stones is uncertain. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anemia.
Other Factors It is believed that the mere presence of gallstones may cause more gallstones to develop. However, other factors that contribute to gallstones have been identified, especially for cholesterol stones.
Guidelines 13
·
Obesity. Obesity is a major risk factor for gallstones, especially in women. A large clinical study showed that being even moderately overweight increases one’s risk for developing gallstones. The most likely reason is that obesity tends to reduce the amount of bile salts in bile, resulting in more cholesterol. Obesity also decreases gallbladder emptying.
·
Estrogen. Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones.
·
Ethnicity. Native Americans have a genetic predisposition to secrete high levels of cholesterol in bile. In fact, they have the highest rates of gallstones in the United States. A majority of Native American men have gallstones by age 60. Among the Pima Indians of Arizona, 70 percent of women have gallstones by age 30. Mexican-American men and women of all ages also have high rates of gallstones.
·
Gender. Women between 20 and 60 years of age are twice as likely to develop gallstones as men.
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Age. People over age 60 are more likely to develop gallstones than younger people.
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Cholesterol-lowering drugs. Drugs that lower cholesterol levels in blood actually increase the amount of cholesterol secreted in bile. This in turn can increase the risk of gallstones.
·
Diabetes. People with diabetes generally have high levels of fatty acids called triglycerides. These fatty acids increase the risk of gallstones.
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Rapid weight loss. As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones.
·
Fasting. Fasting decreases gallbladder movement, causing the bile to become overconcentrated with cholesterol, which can lead to gallstones.
Who Is at Risk for Gallstones? ·
Women
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People over age 60
·
Native Americans
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Mexican-Americans
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Overweight men and women
14 Gallstones
·
People who fast or lose a lot of weight quickly
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Pregnant women, women on hormone therapy, and women who use birth control pills
What Are the Symptoms? Symptoms of gallstones are often called a gallstone “attack” because they occur suddenly. A typical attack can cause ·
Steady, severe pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours.
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Pain in the back between the shoulder blades.
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Pain under the right shoulder.
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Nausea or vomiting.
Gallstone attacks often follow fatty meals, and they may occur during the night. Other gallstone symptoms include ·
Abdominal bloating.
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Recurring intolerance of fatty foods.
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Colic.
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Belching.
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Gas.
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Indigestion.
People who also have the following symptoms should see a doctor right away: ·
Sweating.
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Chills.
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Low-grade fever.
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Yellowish color of the skin or whites of the eyes.
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Clay-colored stools.
Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called “silent stones.” They do not
Guidelines 15
interfere in gallbladder, liver, or pancreas function and do not need treatment.
How Are Gallstones Diagnosed? Many gallstones, especially silent stones, are discovered by accident during tests for other problems. But when gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound exam. Ultrasound uses sound waves to create images of organs. Sound waves are sent toward the gallbladder through a handheld device that a technician glides over the abdomen. The sound waves bounce off the gallbladder, liver, and other organs, and their echoes make electrical impulses that create a picture of the organ on a video monitor. If stones are present, the sound waves will bounce off them, too, showing their location. Other tests used in diagnosis include: ·
Cholecystogram or cholescintigraphy. The patient is injected with a special iodine dye, and x-rays are taken of the gallbladder over a period of time. (Some people swallow iodine pills the night before the x-ray.) The test shows the movement of the gallbladder and any obstruction of the cystic duct.
·
Endoscopic retrograde cholangiopancreatography (ERCP). The patient swallows an endoscope—a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. ERCP is used to locate stones in the ducts.
·
Blood tests. Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice.
Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So accurate diagnosis is important.
Surgical Treatment Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones. (Asymptomatic gallstones usually do not need
16 Gallstones
treatment.) Each year more than 500,000 Americans have gallbladder surgery. The surgery is called cholecystectomy. The standard surgery is called laparoscopic cholecystectomy. For this operation, the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a closeup view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures. Then the cystic duct is cut and the gallbladder removed through one of the small incisions. Because the abdominal muscles are not cut during laparoscopic surgery, patients have less pain and fewer complications than they would have had after surgery using a large incision across the abdomen. Recovery usually involves only one night in the hospital, followed by several days of restricted activity at home. If the surgeon discovers any obstacles to the laparoscopic procedure, such as infection or scarring from other operations, the operating team may have to switch to open surgery. In some cases the obstacles are known before surgery, and an open surgery is planned. It is called “open” surgery because the surgeon has to make a 5- to 8-inch incision in the abdomen to remove the gallbladder. This is a major surgery and may require about a 2- to 7-day stay in the hospital and several more weeks at home to recover. Open surgery is required in about 5 percent of gallbladder operations. The most common complication in gallbladder surgery is injury to the bile ducts. An injured common bile duct can leak bile and cause a painful and potentially dangerous infection. Mild injuries can sometimes be treated nonsurgically. Major injury, however, is more serious and requires additional surgery. If gallstones are in the bile ducts, the surgeon may use ERCP in removing them before or during the gallbladder surgery. Once the endoscope is in the small intestine, the surgeon locates the affected bile duct. An instrument on the endoscope is used to cut the duct, and the stone is captured in a tiny basket and removed with the endoscope. This two-step procedure is called ERCP with endoscopic sphincterotomy. Occasionally, a person who has had a cholecystectomy is diagnosed with a gallstone in the bile ducts weeks, months, or even years after the surgery. The two-step ERCP procedure is usually successful in removing the stone.
Guidelines 17
Nonsurgical Treatment Nonsurgical approaches are used only in special situations—such as when a patient’s condition prevents using an anesthetic—and only for cholesterol stones. Stones recur after nonsurgical treatment about half the time.
Oral Dissolution Therapy Drugs made from bile acid are used to dissolve the stones. The drugs, ursodiol (Actigall) and chenodiol (Chenix), work best for small cholesterol stones. Months or years of treatment may be necessary before all the stones dissolve. Both drugs cause mild diarrhea, and chenodiol may temporarily raise levels of blood cholesterol and the liver enzyme transaminase.
Contact Dissolution Therapy This experimental procedure involves injecting a drug directly into the gallbladder to dissolve stones. The drug—methyl tert butyl—can dissolve some stones in 1 to 3 days, but it must be used very carefully because it is a flammable anesthetic that can be toxic. The procedure is being tested in patients with symptomatic, noncalcified cholesterol stones. Extracorporeal shockwave lithotripsy (ESWL). This treatment uses shock waves to break up stones into tiny pieces that can pass through the bile ducts without causing blockages. Attacks of biliary colic (intense pain) are common after treatment, and ESWL’s success rate is not very high. Remaining stones can sometimes be dissolved with medication.
Do People Need Their Gallbladders? Fortunately, the gallbladder is an organ that people can live without. Losing it won’t even require a change in diet. Once the gallbladder is removed, bile flows out of the liver through the hepatic ducts into the common bile duct and goes directly into the small intestine, instead of being stored in the gallbladder. However, because the bile isn’t stored in the gallbladder, it flows into the small intestine more frequently, causing diarrhea in some people. Also, some studies suggest that removing the gallbladder may cause higher blood cholesterol levels, so occasional cholesterol tests may be necessary.
18 Gallstones
Points to Remember ·
Gallstones form when substances in the bile harden.
·
Gallstones are common among women, Native Americans, MexicanAmericans, and people who are overweight.
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Gallstone attacks often occur after eating a fatty meal.
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Symptoms can mimic those of other problems, including heart attack, so accurate diagnosis is important.
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Gallstones can cause serious problems if they become trapped in the bile ducts.
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Laparoscopic surgery to remove the gallbladder is the most common treatment.
More Guideline Sources The guideline above on gallstones is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to gallstones. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with gallstones. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas.
Guidelines 19
If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on gallstones and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Gallstones: Finding Relief for an Uncomfortable Problem Source: San Bruno, CA: StayWell Company. 1999. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. E-mail:
[email protected]. Website: www.staywell.com. Price: $17.95 for pack of 50; plus shipping and handling. Summary: This patient education brochure describes gallstones and their treatment. Written in nontechnical language, the brochure first lists the populations in which gallstones are more likely: women (especially those who have been pregnant), people of American Indian or Hispanic descent, people who are overweight, people who have lost weight quickly, women who have taken estrogen birth control pills or hormone replacement therapy, and people who eat a high fat diet. Common symptoms of gallstones range from no symptoms to disabling pain and can include mild to severe pain in the upper abdomen; frequent stomach upset, burping, or bloating; fever, nausea, or vomiting; or jaundice (a liver problem that makes the skin yellowish). Gallstones may be found on x rays done for other reasons, or symptoms may lead the physician to suspect gallstones. Diagnosis will include the patient's medical history and some diagnostic tests such as ultrasound, x rays, and endoscopic
20 Gallstones
retrograde cholangiopancreatography (ERCP). Treatments for gallstones include monitoring (watchful waiting), medications to dissolve the stones, ERCP, or surgery (laparoscopic cholecystectomy or open cholecystectomy, both of which remove the gallbladder). One section of the brochure illustrates the gallbladder and surrounding organs and describes how gallstones form. The last page of the brochure summarizes the recommendations for preventing future gallstones, notably by eating a low fat diet. The brochure is illustrated with full color line drawings. 7 figures. ·
Gastro-Esophageal Reflux Disease: A Common and Uncomfortable Problem. [Enfermedad de Reflujo Gastroesofagico: Un Problema Molesto y Comun] Source: San Bruno, CA: StayWell Company. 1999. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. E-mail:
[email protected]. Website: www.staywell.com. Price: $17.95 for pack of 50; plus shipping and handling. Summary: This patient education brochure describes gastroesophageal reflux disease (GERD) and its treatment. Written in nontechnical language, the brochure first defines GERD as reflux (return) of the stomach's gastric acid back up into the esophagus. Common symptoms of GERD include frequent heartburn or heartburn at night; sour tasting fluid in the mouth; frequent need for antacids; frequent burping or belching; symptoms that get worse after eating, bending over, or lying down; and difficult or painful swallowing. Diagnosis will include the patient's medical history and some diagnostic tests such endoscopy and blood tests. Treatments for gallstones include watching one's eating habits (avoiding certain foods), ceasing to use tobacco and alcohol, raising the head of the bed, and working closely with a physician to determine which medications may be used to reduce stomach acid and improve the working of the digestive system. In very rare cases, GERD may not respond to lifestyle changes or medications. Surgery may then be necessary. One section of the brochure illustrates the upper digestive system, including the lower esophageal sphincter (LES) and its role in GERD. The last page of the brochure summarizes additional strategies that may help relieve GERD symptoms. The brochure is illustrated with full color line drawings and is available in English or Spanish. 8 figures.
·
Pancreatitis: Understanding This Painful Condition Source: San Bruno, CA: StayWell Company. 1998. [2 p.].
Guidelines 21
Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $ 17.95 for 50 copies; plus shipping and handling; bulk copies available. Order number 9779. Summary: This brochure describes acute pancreatitis (irritated or inflamed pancreas), a condition most often caused by gallstones. Acute pancreatitis is very painful and emergency medical treatment is usually needed. Symptoms include severe pain in the upper abdomen (that goes through to the back), nausea and vomiting, abdominal swelling and tenderness, fever, rapid pulse, and shallow, fast breathing. Blood tests are used to determine whether the symptoms are due to acute pancreatitis; health history and physical exam can help confirm the diagnosis. Other tests used include ultrasound (to confirm gallstones), CT scan (computed tomography, used to show how much the pancreas is inflamed), and ERCP (endoscopic retrograde cholangiopancreatography, which examines the common bile duct for gallstones). The brochure briefly describes the treatment for acute pancreatitis, which can include resting the pancreas (nutrition and fluids are given through an intravenous line), medications for the pain, and dietary modifications (after leaving the hospital). The brochure emphasizes the importance of avoiding alcohol. One sidebar describes chronic pancreatitis, which is most often due to continued drinking of alcohol. Another section describes the anatomy and function of the pancreas. The brochure is illustrated with full color drawings. 6 figures. ·
Gallstones. [Calculos Biliares] Source: Camp Hill, PA: Chek-Med Systems, Inc. 1996. 2 p. Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011. (800) 451-5797. Fax (717) 761-0216. Price: $22 per pack of 50 pamphlets for order of 3-10 packs; 3 packet minimum. Discounts available for larger quantities and complete kits of gastroenterology pamphlets. Summary: This patient brochure, available in English and Spanish, provides information about the causes, symptoms, diagnosis, and treatment of gallstones. As many as half of all gallstone patients experience one of three principal symptoms: colic pain; gallbladder inflammation; or yellow jaundice. The nature of each of these symptoms is described. Diagnosis is typically made by gallbladder X-ray. It is recommended that patients with colic pain avoid large meals (especially fatty foods, either animal or vegetable), and reduce excess body weight. Effective treatments for gallstones are described. These include watchful
22 Gallstones
waiting, elective surgery, gallstone dissolving, or shockwave therapy (lithotripsy). ·
Gallstones at Time of Diagnosis Source: New York, NY: Patient Education Media, Inc. Time Life Medical. 1996. (videocassette). Contact: Available from Milner-Fenwick, Inc. 2125 Greenspring Drive, Timonium, MD 21093. (800) 432-8433. Fax (410) 252-6316. Website: www.milner-fenwick.com. Summary: This videocassette program provides information for patients newly diagnosed with gallstones. The half-hour, newsmagazine style educational program features four sections or 'reports.' The first report examines what is going on inside the body and how the diagnosis was made; computer animation is used to aid viewer understanding. The second report discusses what happens after the diagnosis and introduces the viewer to practical issues, including the types of health professionals they may encounter and what lifestyle changes may need to occur. The third report explores options for treatment and management of the condition. The final report addresses issues and answers common questions through the use of an in-studio question and answer session. The videotape comes with a personal workbook that includes the program highlights, a glossary, a resource guide, and blank space for readers to record their personal medical journal. (AA-M).
·
Common Gastrointestinal Problems: A Consumer Health Guide. Volume II Source: Arlington, VA: American College of Gastroenterology. 1996. 23 p. Contact: Available from American College of Gastroenterology. 4900B South 31st Street, Arlington, VA 22206. (703) 820-7400. Price: Single copy free. Summary: This brochure provides an overview of common gastrointestinal problems, including constipation, gallstones, hemochromatosis, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), viral liver disease, and alcoholic liver disease. Each topic is addressed by a specialist in the field and the information is provided in a question and answer format. The section on constipation covers normal digestive function, normal bowel habits, a definition of constipation, how to know when to consult a health care provider, diagnostic tests that may be performed, treatment options, and dietary fiber. The section on gallstones describes the gallbladder and its functions, how gallstones are formed, risk factors for developing gallstones, the symptoms of
Guidelines 23
gallstones, diagnostic tests used to confirm gallstones, treatment options, and prevention. The section on hemochromatosis describes the condition and its symptoms, diagnostic tests, treatment options, how hemochromatosis can be confused with other liver diseases, and the indications for screening of family members. The chapter on IBD covers the difference between ulcerative colitis and Crohn's disease, how IBD differs from IBS, the causes of IBD, how stress affects IBD, diagnostic tests, complications of IBD, medication treatments available, complications from medical treatment, diet therapy for patients with IBD, and surgical options for IBD. The section on IBS focuses on recommended treatment strategies, including consulting a health care provider, reducing stress, watching dietary intake, and using medications. The section on viral liver disease describes the liver and its function, a definition of hepatitis and its symptoms, the different viruses and how they are transmitted, prevention issues, treatment options, and the longterm consequences of hepatitis. The final section, on alcoholic liver disease, covers the impact of alcohol consumption on the liver, gender differences in alcoholic liver disease, fatty liver, alcoholic hepatitis, alcohol-induced cirrhosis, differentially diagnosis, complications of alcoholic liver disease, and treatment options. 3 figures. 1 table. (AA-M). ·
Gallstones and Their Treatment: A Guide for Patients Source: San Ramon, CA: HIN, Inc., The Health Information Network. 1995. 25 p. Contact: Available from HIN, Inc. 231 Market Place, Number 331, San Ramon, CA 94583. (800) HIN-1121. Fax (925) 358-4377. Website: www.hinbooks.com. Price: $36.25 plus shipping per set of 25 booklets; quantity discounts available. Order Number 0201. ISBN: 188527421x. Summary: This patient education brochure familiarizes readers with gallstones and their treatment. It is written in non-technical language and includes information about what gallstones are; how they develop; risk factors; complications; symptoms; diagnostic tests; treatment options; preparing for laparoscopic surgery; the operation itself; recovery after surgery; and nonsurgical treatment options. The brochure is illustrated with simple line drawings and figures and includes a glossary.
·
Gallstones: A National Health Problem Source: Cedar Grove, NJ: American Liver Foundation. 4 p. Contact: Available from American Liver Foundation. 1425 Pompton Avenue, Cedar Grove, NJ 07009. (800) 223-0179 or (201) 256-2550. Price:
24 Gallstones
$0.50 each; $6 for 25 copies; $12 for 50 copies (as of 1995); discounts available for larger quantities. Summary: An estimated 20 million Americans, more than 10 percent of the population, have gallstones. Another million develop gallstones each year. Recognition and understanding of the problem is needed to support research to find solutions to the problem. Information is provided on the gallbladder and its function and on gallstones: their causes, symptoms, diagnosis, and treatment. ·
Your Gallstones: Diagnosis and Treatment Source: Washington, DC: Digestive Disease National Coalition. 1991. 4 p. Contact: Available from Digestive Disease National Coalition. 711 Second Street, NE, Suite 2. Washington, DC 20002. (202) 544-7497. Price: Single copy free. Summary: Written in a question and answer format, this brochure reviews the diagnosis and treatment of common gallstones. Topics include the role of the gallbladder, the occurrence of gallstones, how rapid weight loss affects the formation of gallstones, the symptoms of gallstones, how gallstones are diagnosed, how gallstones typically progress, traditional surgical treatment of gallstones, laparoscopic removal of the gallbladder, oral medication used for dissolving cholesterol gallstones, and shock wave lithotripsy used to fragment the stones. The brochure stresses the importance of learning about all the options available to treat gallstones, in order to make an informed decision about treatment. 4 figures.
·
Erythropoietic Protoporphyria (EPP): A Description for Patients and Their Relatives Source: Houston, TX: American Porphyria Foundation. 199x. 2 p. Contact: Available from American Porphyria Foundation. P.O. Box 22712, Houston, TX 77227. (713) 266-9617. Price: Single copy free; $2.50 for 5 pamphlets. Summary: Erythropoietic protoporphyria (EPP) is a disease of porphyrin metabolism characterized by abnormally elevated levels of protoporphyrin IX in erythrocytes, feces and plasma, and by sensitivity to visible light. This brochure, from the American Porphyria Foundation, describes the disease, its diagnosis, clinical features, and treatment. The disease of EPP is often coexistent with cholelithiasis (gallstones) and sometimes can lead to serious liver disease. The brochure discusses the drug therapy used to treat EPP, as well as some suggestions for
Guidelines 25
environmental changes that can be made to improve the quality of life for those with this disease. ·
Cirrhosis of the Liver Source: Bethesda, MD: American Gastroenterological Association. 199x. [4 p.]. Contact: American Gastroenterological Association (AGA). 7910 Woodmont Avenue, Seventh Floor, Bethesda, MD 20814. (800) 668-5237 or (301) 654-2055. Fax (301) 652-3890. Website: www.gastro.org. Price: Single copy free; bulk copies available. Summary: When chronic diseases cause the liver to become permanently injured and scarred, the condition is called cirrhosis. This brochure, from the American Gastroenterological Association (AGA), reviews the problem of cirrhosis. Topics include the major causes of cirrhosis, the symptoms of the condition, diagnostic methods used to confirm cirrhosis, treatment strategies, and treatment options for the complications of cirrhosis. Cirrhosis can result from direct injury to the liver cells (i.e., hepatitis), or from indirect injury via inflammation or obstruction to bile ducts (e.g., primary biliary cirrhosis, primary sclerosing cholangitis), which drain the liver cells of bile. Chronic alcoholism is the most common cause of cirrhosis in the United States. People with cirrhosis often have few symptoms at first. The two major problems that eventually cause symptoms are loss of functioning liver cells and distortion of the liver caused by scarring. Associated problems include fluid accumulation (ascites), jaundice (yellow skin), gallstones, intense itching, loss of appetite, fatigue and weakness, buildup of toxins, slowed drug processing, portal hypertension (high blood pressure in the main veins of the liver), and varices (thin walled, enlarged blood vessels). Diagnosis is confirmed from the patient's symptoms and from diagnostic tests such as CT scan, ultrasound, and biopsy. Treatment of cirrhosis is aimed to stop the development of scar tissue in the liver and prevent complications. Regardless of the cause of cirrhosis, every patient must avoid all substances, habits, and drugs that may further damage the liver, cause complications, or speed the progression to liver failure. Liver failure refers to the end stage of liver disease and cirrhosis when the liver stops working and cannot support life. The brochure includes a list of references and a diagram of the digestive tract, with organs labeled. 3 figures. 6 references.
·
Gallstones Source: Bethesda, MD: American Gastroenterological Association. 199x. [4 p.].
26 Gallstones
Contact: American Gastroenterological Association (AGA). 7910 Woodmont Avenue, Seventh Floor, Bethesda, MD 20814. (800) 668-5237 or (301) 654-2055. Fax (301) 652-3890. Website: www.gastro.org. Price: Single copy free; bulk copies available. Summary: Gallstone disease is a common medical problem in the United States. This brochure from the American Gastroenterological Association (AGA) reviews the problem of gallstones and advances in the diagnosis and treatment of this condition. Topics include a definition of gallstones and how they form, diagnostic tests used to confirm the presence of gallstones, and treatment options. Gallstones form when the components of bile (a digestive juice) precipitate out of solution and form crystals. Pigment (bilirubin) gallstones and cholesterol gallstones are the most common types. The most typical symptom of gallstone disease is severe steady pain in the upper abdomen or right side. If the blockage caused by a gallstone is prolonged, the gallbladder may become inflamed (acute cholecystitis), which usually requires hospitalization for treatment. Abdominal ultrasound and oral cholecystograms are used to diagnose gallstones. Surgical removal of the gallbladder (cholecystectomy) remains the most widely used therapy for gallstones; surgical options include the standard open procedure and a less invasive procedure using laparoscopy ('belly button surgery'). Alternatives to surgery include endoscopic removal of the stone, chemical dissolution, and lithotripsy (in which sound waves are used to disintegrate the stones). Unfortunately, in all nonsurgical approaches, the gallstones tend to recur in about half of patients treated. The brochure includes a diagram of the digestive tract, with organs labeled. 2 figures. ·
Dieting and Gallstones Source: Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 4 p., 1993. Contact: Weight-Control Information Network, 1 Win Way, Bethesda, MD 20892-3665. (301) 570-2178 OR (800) 946-8098. Summary: This patient education brochure provides an overview of the problems associated with low-calorie diets and the development of gallstones. The difference between silent and symptomatic gallstones is explained. Overweight people are at greater risk of developing gallstones than people of average weight. People who are considering embarking on a diet program requiring very low intake of calories each day should be aware that during rapid or substantial weight loss, a person's risk of developing gallstones is increased. The risks and benefits of weight loss
Guidelines 27
are considered, along with a discussion of possible treatment for gallstones and a suggested reading list.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “gallstones” or synonyms. The following was recently posted: ·
AACE/ACE position statement on the prevention, diagnosis and treatment of obesity. Source: American Association of Clinical Endocrinologists/American College of Endocrinology.; 1997 (revised 1998); 35 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0976&sSearch_string=gallstones
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ACR Appropriateness Criteria™ for evaluation of patients with acute right upper quadrant pain. Source: American College of Radiology.; 1996 (revised 1999); 5 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1628&sSearch_string=gallstones
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Cholecystectomy. Source: Optimed Medical Systems Clinical Development Group.; 1989 (revised 2000); The software includes over 19 menus and requires user to spend 2-5 minutes depending on the clinical information. http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1489&sSearch_string=gallstones
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Drug treatment for hyperlipidaemias. Source: Finnish Medical Society Duodecim.; 2001 April 4; Various pagings http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1837&sSearch_string=gallstones
28 Gallstones
·
Early discharge of the term newborn. Source: National Association of Neonatal Nurses.; 1999; 33 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1374&sSearch_string=gallstones
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Effects of menopause and estrogen replacement therapy or hormone replacement therapy in women with diabetes mellitus: consensus opinion of The North American Menopause Society. Source: The North American Menopause Society.; 2000 March; 9 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1792&sSearch_string=gallstones
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Guidelines for the clinical application of laparoscopic biliary tract surgery. Source: Society of American Gastrointestinal Endoscopic Surgeons.; 1990 (updated 1999); 3 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1091&sSearch_string=gallstones
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Hormone replacement therapy: collaborative decision making and management. Source: Institute for Clinical Systems Improvement.; 1999 August (revised 2001 Jul); 64 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2210&sSearch_string=gallstones
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Lipids. Source: National Committee on Cardiac Care (Singapore)/National Medical Research Council (Singapore Ministry of Health)/Singapore Cardiac Society/Singapore Ministry of Health.; 2001 July; 52 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2301&sSearch_string=gallstones
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that
Guidelines 29
contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Dieting and Gallstones Summary: This online document gives consumers basic information on gallstones and the effect of weight loss on this condition. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=1448
·
Gallstones Summary: Gallstones are pieces of solid material that form in the gallbladder. This consumer health information fact sheet contains basic information about this digestive disorder. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2745
·
Gallstones: A National Health Problem Summary: This online document was written for consumers and answers questions about the causes, diagnosis, prognosis and treatment of this disorder. Source: American Liver Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2211 The NIH Search Utility
After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to gallstones. The drawbacks of this approach are that the information is not organized by theme and that the references are often a
30 Gallstones
mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU]
Guidelines 31
Asymptomatic: No symptoms; no clear sign of disease present. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Cardiac: Pertaining to the heart. [EU] Cholangitis: Inflammation of a bile duct. [EU] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [EU] Cholelithiasis: The presence or formation of gallstones. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colitis: Inflammation of the colon. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the
32 Gallstones
Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatitis: Inflammation of the liver. [EU] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [EU] Hyperlipidaemia: A general term for elevated concentrations of any or all of the lipids in the plasma, including hyperlipoproteinaemia, hypercholesterolaemia, etc. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU] Inflammation: A pathological process characterized by injury or destruction
Guidelines 33
of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Intravenous: Within a vein or veins. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Lithotripsy: The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is lithotripsy, laser. [NIH] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neonatal: Pertaining to the first four weeks after birth. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH]
34 Gallstones
Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Reflux: A backward or return flow. [EU] Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transaminase: Aminotransferase (= a subclass of enzymes of the transferase class that catalyse the transfer of an amino group from a donor (generally an amino acid) to an acceptor (generally 2-keto acid). Most of these enzymes are pyridoxal-phosphate-proteins. [EU] Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Veins: The vessels carrying blood toward the heart. [NIH]
Guidelines 35
Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
Seeking Guidance 37
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with gallstones. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with gallstones. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Gallstones As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
38 Gallstones
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Liver Foundation Address: American Liver Foundation 75 Maiden Lane, Suite 603, New York, NY 10038 Telephone: (212) 668-1000 Toll-free: (800) 465-4837 Fax: (973) 256-3214 Email:
[email protected] Web Site: http://www.liverfoundation.or Background: The American Liver Foundation is a national voluntary notfor-profit organization dedicated to the prevention, treatment, and cure of diseases of the liver through programs of research and education. Established in 1976, the Foundation's activities include support groups, patient advocacy, support of medical research, and patient and professional education. Educational materials include brochures on Hepatitis, Cirrhosis, Biliary Atresia, liver transplantation, gallstones, and Hereditary Hemochromatosis. Fact sheets are also available on a variety of liver diseases including Alagille Syndrome, Alpha-1-Antitrypsin Deficiency, Cancer of the Liver, Fatty Liver, Gilbert Syndrome, Primary Biliary Cirrhosis, Porphyria, and others. Videotapes produced by the Foundation include 'A Healthy Liver: A Happier Life,' 'Foundations for Decision Making,' 'Hepatitis B: Patient Information,' 'Hepatitis C: A Guide for Primary Care Physicians,' and 'The Visionaries.' The Foundation also offers liver wellness and substance abuse prevention programs to elementary schools and corporations. Relevant area(s) of interest: Gallstones, Hepatitis C, Porphyria, Wilson's Disease
·
Canadian Liver Foundation Address: Canadian Liver Foundation 365 Bloor Street, Suite 200, Toronto, Ontario, M4W 3L4, Canada
Seeking Guidance 39
Telephone: (416) 964-4935 Toll-free: (800) 563-5483 Fax: (416) 964-0024 Email:
[email protected] Web Site: http://www.liver.c Background: The Canadian Liver Foundation (CLF) is a not-for-profit health organization committed to reducing the incidence and impact of liver disease by providing support for research and education into the causes, diagnosis, prevention and treatment of more than 100 diseases of the liver. Established in 1969, the CLF has established 30 chapters across Canada and provides information in both English and French. Some of the liver diseases discussed in brochures and medical information sheets available from CLF include gallstones, hemochromatosis, primary biliary cirrhosis, several forms of hepatitis, porphyria, fatty liver, and liver cancer. Further information is provided on liver transplantation, the effects of sodium, and management of variceal bleeding. The Foundation also produces a newsletter and maintains World Wide Web site at http://www.liver.ca. Relevant area(s) of interest: Cirrhosis of the Liver, Gallstones, Hepatitis A, Hepatitis B, Hepatitis C, Porphyria
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about gallstones. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
40 Gallstones
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “gallstones” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “gallstones”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “gallstones” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with gallstones. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “gallstones” (or a synonym) in the search box. Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site:
Seeking Guidance 41
http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with gallstones must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
42 Gallstones
http://www.abms.org/newsearch.asp.11 You can also contact the ABMS by phone at 1-866-ASK-ABMS. ·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor12 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about gallstones?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for gallstones?
While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 12 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 11
Seeking Guidance 43
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor13 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
13
44 Gallstones
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:14 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
14
45
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on gallstones. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on gallstones. In Part II, as in Part I, our objective is not to interpret the latest advances on gallstones or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with gallstones is suggested.
Studies 47
CHAPTER 3. STUDIES ON GALLSTONES Overview Every year, academic studies are published on gallstones or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on gallstones. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on gallstones and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and gallstones, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
48 Gallstones
format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “gallstones” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Acupuncture for Gastrointestinal and Hepatobiliary Disorders Source: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice and Policy. 5(1): 27-45. 1999. Summary: This journal article provides an overview of the basic scientific data regarding the effects of acupuncture on gastrointestinal (GI) function, areas of clinical application, and promising directions for future research. Extensive research in both animal models and human subjects supports the effect of acupuncture on the physiology of the GI tract, including acid secretion, motility, neurohormonal changes, and changes in sensory thresholds. Much of the neuroanatomic pathway of these effects has been identified in animal models. A large body of clinical evidence supports the effectiveness of acupuncture for suppressing nausea associated with chemotherapy, postoperative state, and pregnancy. Prospective randomized controlled trials have shown the efficacy of acupuncture for analgesia for endoscopic procedures, including colonoscopy and upper endoscopy. Acupuncture also has been used for a variety of other conditions, including postoperative ileus, achalasia, peptic ulcer disease, functional bowel disease, diarrhea, constipation, inflammatory bowel disease, expulsion of gallstones and biliary ascariasis, and pain associated with pancreatitis. Although there are few randomized clinical trials, the author concludes that the welldocumented effects of acupuncture on the physiology of the GI tract and its extensive history of successful clinical use makes this a promising modality that warrants further study. The article has 3 figures and 117 references. (AA-M).
·
Shock-Wave Lithotripsy in Gallstones and Bile Duct Stones: LongTerm Evaluation of Extracorporeal Shock-Wave Lithotripsy for Cholesterol Gallstones Source: Journal of Gastroenterology and Hepatology. 16(1): 93-99. January 2001.
Studies 49
Contact: Available from Blackwell Science. 54 University Street, Carlton South 3053, Victoria, Australia. +61393470300. Fax +61393475001. E-mail:
[email protected]. Website: www.blackwell-science.com. Summary: Extracorporeal (outside the body) shock wave lithotripsy (ESWL) is a treatment for gallstones that preserves the gallbladder. Problems after ESWL treatment can include stone recurrence and the development of biliary symptoms. This article reports on a study of 262 patients with cholesterol type gallstones (the best indication for ESWL treatment) who underwent ESWL and 42 control patients with cholesterol type gallstones who received no treatment. The authors evaluated the factors associated with recurrence of gallstones after stone clearance and the development of biliary symptoms after ESWL treatment. The 3, 5, and 7 year cumulative probabilities of gallstone recurrent were 20.6, 27.1, and 33.1 percent, respectively, with the recurrence probability significantly lower in patients with good gallbladder contractility. In patients with recurrence, treatment with ursodeoxycholic acid (UDCA, given orally) was effective. In 69 patients with residual gallstones, the 3, 5, and 7 year cumulative risks of biliary symptoms were 17.3, 24.9, and 30.5 percent, respectively. With residual gallstones, the risk of biliary symptoms developing was significantly lower in patients with a smaller than 3 mm fragment size at the end of ESWL treatment and in those treated consistently with UDCA for 6 months or more after treatment with ESWL. The risk of biliary symptoms was significantly lower in ESWL treated patients with residual stones who had a less than 3 mm fragment size after treatment, compared with control patients. The authors conclude that UDCA was effective in clearing stones in patients with gallstone recurrence. In patients with residual stones, the fragmentation of stones to less than 3 mm and UDCA administration effectively reduced the risk of subsequent biliary symptoms. 3 figures. 4 tables. 18 references. ·
Epidemiology of Gallstones: Prevalence of Gallstone Disease in Iran Source: Journal of Gastroenterology and Hepatology. 16(5): 564-567. May 2001. Contact: Available from Blackwell Science. 54 University Street, Carlton South 3053, Victoria, Australia. +61393470300. Fax +61393475001. E-mail:
[email protected]. Website: www.blackwell-science.com. Summary: The prevalence of gallstone disease varies depending on the geographic region involved. Few studies, in Asia but not from Iran, about the frequency of gallstone disease have been published. This article reports on a study of the prevalence of gallstone disease in Iran. The study included 477 nomads from southern Iran, 513 industrial laborers
50 Gallstones
older than 34 years, and 421 laborers from a pharmaceutical company above 30 years of age, and 471 elderly persons from three nursing homes near Tehran underwent abdominal sonography. There was a total of 1,373 men and 509 women. Gallstone disease was present in 89 subjects; 10.1 percent of them had undergone cholecystectomy (removal of the gallbladder). While the prevalence in the men and women in the age group 31 to 40 years was very low (0.3 percent in men and 1.8 percent in women), it increases sharply in men older than 60 years and women older than 50 years to more than 10 fold (12.5 and 24.6 percent in males and females aged 71 to 80 years, respectively). The author concludes that, in Iran, gallstone disease is very uncommon in middle aged people, but increases sharply in older people. However, this does not reach the high prevalence seen in Western countries. The intake of a high fiber containing diet, and low numbers of overweight people, smoking habits, and hyperlipidemia (elevated concentrations of fats in the blood) are probably the cause for this low prevalence. 2 tables. 44 references. ·
Management of Gallstones and Their Complications Source: American Family Physician. 61(6): 1673-1680. March 15, 2000. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This article reviews the management of gallstones (cholelithiasis) and their complications. The accurate differentiation of gallstone induced biliary colic (pain) from other abdominal disease processes is the most crucial step in the successful management of gallstone disease. Despite the availability of many imaging techniques to demonstrate the presence of gallstones, clinical judgement ultimately determines the association of symptoms with cholelithiasis and its complications. The authors contend that adult patients with silent or incidental gallstones should be observed and managed expectantly, with few exceptions. In symptomatic patients, the intervention varies with the type of gallstone induced complication. Diagnostic tests reviewed include laboratory tests, ultrasonography, endoscopic retrograde cholangiopancreatography, bile microscopy, computed tomography (CT) and magnetic resonance imaging (MRI), and hepatobiliary scintigraphy. Ultrasound provides more than 95 percent sensitivity and specificity for the diagnosis of gallstones greater than 2 mm in diameter. Ultrasonography of the gallbladder should follow a fast of at least 8 hours because gallstones are visualized better in a distended, bile filled gallbladder. Nonoperative therapies for symptomatic gallstones include oral bile acid dissolution, contact solvents, and extracorporeal shock
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wave lithotripsy. A patient care algorithm offers management strategy for gallstones. 1 figure. 5 tables. 26 references. ·
Gallstones, from Gallbladder to Gut: Management Options for Diverse Complications Source: Postgraduate Medicine. 108(3): 143-146, 149-153. September 1, 2000. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Summary: Gallstones may be incidental and asymptomatic or painful and accompanied by life threatening obstruction or infection. A thorough knowledge of potential complications is therefore critical, especially because some asymptomatic stones require prompt treatment. In this article, the authors offer guidelines for recognizing and treating the various manifestations of gallstone disease (cholelithiasis). Once the gallstones become symptomatic, surgical removal of the gallbladder (cholecystectomy) is usually recommended. Endoscopic retrograde cholangiopancreatography (ERCO) with sphincterotomy and stone extraction is performed if bile duct stones are evident on imaging studies or suspected on the basis of the clinical picture or liver enzyme abnormalities. In patients with cholangitis (a consequence of bacterial infection superimposed on an obstructed biliary system), the mainstay of therapy is biliary drainage, which should be performed as early as possible, even before determining and treating the cause of obstruction. In selected patients with gallstone pancreatitis, use of early ERCP, sphincterotomy, and stone extraction results in lower morbidity (illness) and mortality (death). Nonsurgical treatment is appropriate for patients with recurrent biliary colic or chronic cholecystitis (gallbladder infection), but not for those with acute cholecystitis. Recurrence rates are high with nonsurgical treatment. 3 figures. 29 references.
·
Gallstones in Elderly Patients: Impact of Laparoscopic Cholecystectomy Source: Canadian Journal of Gastroenterology. 14(11): 929-932. December 2000. Contact: Available from Pulsus Group, Inc. 2902 South Sheridan Way, Oakville, Ontario, Canada L6J 7L6. Fax (905) 829-4799. E-mail:
[email protected]. Summary: The use of laparoscopic cholecystectomy (LC, removal of the gallbladder) in elderly patients may pose problems because of their poor general condition, especially of cardiopulmonary (heart and lung)
52 Gallstones
function. Moreover, these patients present with acute cholecystitis (inflammation of the gallbladder) and associated common bile duct stones more often than their younger counterparts. In this article, the authors report on their experience from 1990 to 1999 when they performed 943 LCs; 31 (3.2 percent) were attempted on elderly patients, 11 (35 percent) of which were on an emergency basis because of acute cholecystitis, cholangitis (bile duct inflammation) or acute biliary pancreatitis. Ten percent of LCs needed to be converted to an open cholecystectomy, most often because of an increase in the partial pressure of carbon dioxide in the blood produced by excessive operative time. A gasless procedure (LC usually uses gas to increase the abdominal cavity for access and visualization purposes) was used in the last three years of the study on eight cases; the overall rate of conversion from LC to open cholecystectomy in this group was 0 percent. Associated gallbladder and common bile duct stones were found in five (16 percent) patients. The success rate was 100 percent, overall morbidity was 29 percent and there was no mortality. The authors conclude that their results show that LC is a feasible and safe procedure for use in elderly patients. Gasless LC should be preferred in patients classified as American Society of Anesthesiologists' class III. 4 figures. 21 references. ·
Obesity: Effects on the Liver and Gastrointestinal System Source: Current Opinion in Gastroenterology. 15(2): 154-158. March 1999. Contact: Available from Lippincott Williams and Wilkins Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Summary: Obesity, determined by a body mass index (BMI) greater than 30, has assumed epidemic proportions in the U.S. More than a cosmetic issue, obesity is associated with many comorbidities that contribute to multiple organ dysfunction, illness, and shortened life span. This review article covers new and emerging information on the relationship between obesity and common and debilitating hepatic and gastrointestinal disorders, including nonalcoholic steatohepatitis, gastroesophageal reflux, gallstones, and colon and esophageal cancer. Because these complications can be prevented or treated by optimizing body weight, it is important that the practicing gastroenterologist include the evaluation and treatment of obesity as part of the general approach to the patient. Calculation of BMI is the most reliable and predictive tool for assessing obesity and effective weight reduction. Multiple, often unsatisfactory, medical strategies exist for weight reduction, each optimally requiring the ancillary services of a professional dietitian. Compelling evidence points to the surgical approach to the severely obese. The author
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concludes that understanding the role of obesity in these disorders should lead to new insights into the pathogenesis of common liver and gastrointestinal diseases and to new treatment strategies for the practicing gastroenterologist. 41 references (21 annotated). ·
Gallstones and Diabetes: A Case-Control Study in a Free-Living Population Sample Source: Hepatology. 25(4): 787-790. April 1997. Summary: This article reports on a case-control study to determine the prevalence of diabetes mellitus in a group of subjects with gallstones or who have undergone cholecystectomy (cases). The authors compared these subjects with a control group of subjects without gallstones, selected during an epidemiological study. The subjects were matched for sex, age, and body mass index; there were 336 cases and 336 controls, aged 30 to 69 years. All subjects with fasting glycemic levels of less than 140 mg per dL and without a documented history of diabetes were submitted to a simplified oral glucose tolerance test (OGTT) and then classified according to the National Diabetes Data Group criteria. The prevalence of diabetes in the subjects affected by gallstone disease was significantly higher than that in controls (11.6 percent versus 4.8 percent). Diabetes was more frequent in subjects with gallstone disease than in the control group, even according to sex (18.3 percent versus 9.9 percent for men; 9.3 percent versus 2.6 percent for women). The authors conclude that an altered glucose metabolism may increase the risk of developing cholelithiasis in certain subjects. 3 tables. 36 references. (AA-M).
Federally-Funded Research on Gallstones The U.S. Government supports a variety of research studies relating to gallstones and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.15 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can 15 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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perform targeted searches by various criteria including geography, date, as well as topics related to gallstones and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore gallstones and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for gallstones: ·
Project Title: Second Messengers, Gallbladder Absorption and Gallstones Principal Investigator & Institution: Abedin, Mohammad Z.; Surgery; Mcp Hahnemann University Broad & Vine Sts Philadelphia, Pa 19102 Timing: Fiscal Year 2000; Project Start 1-AUG-1997; Project End 1-JUL2002 Summary: (Adapted from investigator's abstract) The development of cholesterol gallstones involves alterations in the relationship of the amount of cholesterol, phospholipid and bile salts present in bile resulting in bile becoming supersaturated with cholesterol. Cholesterol crystal formation then occurs and aggregation of crystals results in macro stone formation. During the crystalline and early stages of gallstone formation increased absorption of sodium and water occurs which is believed to contribute to the formation of stones by potentially increasing the concentration of crystals and nucleating factors. The proposed research is directed at determining the mechanisms by which supersaturated bile increase gallbladder absorption. The absorption of water is dependent on the transport of sodium which is dependent on the function of various Na+/H+ exchangers. The activity of the Na/HE is regulated by a number of factors which possibly include cyclic nucleotides and calcium. The proposed research intends to determine if lithogenic bile increases gallbladder absorption and the activity of the second messenger system and if these alterations are necessary for gallstone formation. The research will determine the mechanisms of sodium absorption, if it is regulated by the cyclic AMP/ Ca++ second messenger system and if these alterations accompany cholesterol gallstone formation in the cholesterol fed prairie dog. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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·
Project Title: Alimentary Tract Lipids in Health and Disease Principal Investigator & Institution: Carey, Martin C.; Brigham and Women's Hospital 75 Francis St Boston, Ma 02115 Timing: Fiscal Year 2000; Project Start 1-JUL-1985; Project End 1-MAR2004 Summary: Bile formation and secretion control homeostatic mechanisms for eliminating cholesterol and tetrapyrrole molecules form the organism as well as absorption of dietary fat. Bile dysfunction causes several common diseases, including gallstones and cholestasis. This proposal employs biophysical rationale and physical-chemical methodology to further molecular understanding of the physical biochemistry of bile, its formation, secretion and functions. The PI and colleagues will design and study appropriate model systems and correlate the results with pathophysiological phenomena pertaining to the function and dysfunction of native systems. They will use I)novel flurocholesterol methodology, cryoelectron microscopy and electron energy-loss spectroscopy to elucidate physical-chemical pathways whereby cholesterol molecules are transferred from blood to liver cell and bile, ii) characterize interactions of bile salt molecules with sphingomyelin in micellar solutions and at interfaces related to cholesterol secretion, absorption and apoptosis, iii) determine the physical-chemical origin and pathophysiology of lipoprotein X in bile secretory failure, iv) define how phosphatidylcholine, cholesterol and calcium influence the physicalchemical state of natural conjugated bilrubins in model (bilrubin ditaurate) and native biles employing analytical ultracentrifugation and spectrophotometric techniques, v) measure the metastable and equilibrium solubilities of unconjugated bilirubin in modelbiles utilizing potentiometric titration and dissolution and correlate the information pathophysiologically with pigment-stone biles, vi) discover whether humans with ~black~ pigment gallstones have dysfunctional mutations of the ileal bile acid transporter gene. These objectives are designed to advance our understanding of physical chemistry of bile as ell as normal and abnormal movements of cholesterol and billirubin to and from the liver and alimentary tract. The systematic project should lead to new targets and strategies for prevention of pigment and cholesterol gallstone diseases as well as lipid transport abnormalities sin cholestasis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Bile Salts, Membranes, and Cytotoxicity Principal Investigator & Institution: Heuman, Douglas; Virginia Commonwealth University 901 W Franklin St Richmond, Va 23284
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Timing: Fiscal Year 2000 Summary: Bile salts adsorb to membranes, at high concentrations causing membrane disruption. Adsorption of bile salts to intracellular membranes may determine many of their physiological effects, and bile salt induced membrane injury may be important in pathogenesis of cholestatic liver disease and gallstones. We have studied the adsorption of bile salts to lecithin-cholesterol vesicles and have developed and validated a quantitative model which predicts the distribution of bile salt taurine conjugates in mixed bile salt solutions between lecithincholesterol bilayers and the aqueous phase. In the studies proposed, this model will be generalized to a broad array of bile acids and other organic anions, membrane lipids, and solution conditions. Using large unilamellar vesicles of varying lipid composition, we will examine the relationship between membrane binding of bile salts, mixed micellar dissolution of membrane lipids (observed with quasielastic light scattering) and altered membrane permeability (release of trapped soluble markers assessed by ultrafiltration) to determine if the mixed micellar threshold concentration and the permeation threshold at which membrane leakage begins are predictable consequences of the membrane-bound ionized bile salt/lecithin ratio. Pure protein kinase C isoenzymes (alpha, betaII, delta, epsilon) prepared in a baculovirus system will be employed to test the hypothesis that bile salts activate protein kinase C isoenzymes by binding to membranes and serving as a "bridge" between the enzymes and membrane lipids. The model of bile salt-lecithin interactions will be extended beyond the limits of the two phase (monomer-membrane) region into micellar regions of the phase diagram by combining techniques of gel filtration and ultrafiltration, in order to permit modelling of detergent effects of mixed bile salt solutions. Using synthetic vesicles, isolated canalicular plasma membranes, and living cells (erythrocytes, cultured neoplastic gallbladder epithelia) we will test the hypothesis that lecithin in bile normally protects high cholesterol plasma membranes from bile salt injury by depressing the non-lecithin- associated bile salt concentration to non-toxic levels, and that this protective effect declines predictably as the cholesterol content of biliary vesicles increases. Finally the hepatoprotective role of biliary lipids and biliary bile salt-lipid interactions will be studied in two in vivo models of bile salt-induced liver injury: acute infusion of bile salts in the choline deficient bile fistula rat and chronic feeding of bile salts in hamsters fed lithogenic diets. The ultimate goal of these studies is to provide a conceptual framework for understanding the toxic and protective properties of bile salts and the role of bile salt toxicity in human disease.
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Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Genetics of Gallbladder Disease in Mexican Americans Principal Investigator & Institution: Duggirala, Ravindranath; Medicine; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2000; Project Start 0-SEP-1998; Project End 9-SEP-2003 Summary: (Adapted from investigator's abstract) Gallbladder disease (GBD) is one of the major causes of morbidity and mortality in the United States. In populations such as the Mexican Americans, the prevalence of GBD is high, and it often clusters with diseases such as non-insulin dependent diabetes mellitus (NIDDM) and obesity. The etiology of GBD is unclear, but it is believed to be multifactorial in origin involving abnormalities of the hepatobiliary system such as supersaturation of bile with cholesterol, changes in cholesterol nucleation, and hypomotility of the gallbladder. Despite the epidemiological evidence for its association with risk factors such as age, sex (higher in women), obesity, native American ancestry, NIDDM, and cardiovascular disease risk factors, evidence for genetic determination of GBD is very limited. The purpose of this project is to conduct a genetic epidemiologic investigation involving molecular genetic data, GBD phenotypes, and statistical genetic techniques to examine the genetic basis for variation in GBD phenotypes in a set of 32 low-income Mexican American families that is currently under investigation in relation to the genetic determination of NIDDM (San Antonio Family Diabetes Study: SAFADS). The overall objectives of this study are to measure genetic effects on GBD phenotypes, and to identify and localized GBD susceptibility genes. The specific aims are 1) to define GBD phenotypes such as gallstone disease (presence of gallstones), gallstone number (solitary versus multiple), gallstone diameter, and gallbladder wall thickness using ultrasonography; 2) to perform genetic analysis in order to estimate heritabilities for GBD phenotypes, to detect initial evidence of linkage to GBD susceptibility loci, to refine the initial screening using multipoint linkage analysis, and to detect linkage or association using non-parametric methods. Ultrasound GBD phenotypic data will be collected from 720 individuals distributes across 32 families. The initial genome screening will be based on a subset of SAFADS families involving 444 subjects for whom the 1015 centiMorgan (cM) genome map based on more than 360 markers is already available. After detecting potential signals for linkage, a high resolution 5 cM gene map to be obtained from a full set of SAFADS families(720 individuals) will be used to precisely localize susceptibility loci influencing GBD phenotypes.
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Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Identification of Genes Activated by Bile Acids Principal Investigator & Institution: Edwards, Peter A.; Professor; Medicine; University of California Los Angeles Box 951361, 405 Hilgard Ave Los Angeles, Ca 90095 Timing: Fiscal Year 2001; Project Start 1-SEP-2001; Project End 1-JUL-2005 Summary: (provided by applicant): Chenodeoxycholic acid (CDCA), a primary bile acid, has recently been shown to activate the farnesoid X receptor (FXR), a member of the nuclear hormone receptor superfamily. Recent data suggest that activated FXR controls both bile acid biosynthesis and plasma lipid levels. As such, FXR may affect the development of gallstones and/or atherosclerosis. However at the current time, very little is known about the target genes and metabolic pathways that are affected by activated FXR. In the first specific aim, we propose to use Suppression Subtractive Hybridization and DNA microarrays to identify genes that are regulated by CDCA-activated FXR. These studies will utilize HepG2 and Caco2 cells that stably overexpress high levels of FXR in order to more easily identify FXR-target genes. We will use normal, FXR-/- or VP16-FXR transgenic mice, treated with FXR ligands, to demonstrate (i) that these same genes are induced in vivo and (ii) that activation of FXR results in a decrease in plasma lipids. In the second specific aim, we will identify FXREs and other critical cis elements in the promoters of a few selected genes that have been identified in aim 1, so as to confirm that these genes are direct targets of FXR/CDCA. In the third aim, we will generate mice that overexpress rat VP16-FXR in their livers (see aim 1). Finally, in specific aim 4, we will isolate cell lines derived from HepG2 and Caco2 cells that express either FXR1, FXR2, or FXR3. The induction of target genes, identified in aim 1, by each FXR isoform will be determined in order to test the hypothesis that specific genes/metabolic pathways are activated by each FXR isoforms. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
·
Project Title: Pathogenesis
Mucin
and
Non-Mucin
Proteins
in
Gallstone
Principal Investigator & Institution: Offner, Gwynneth D.; Medicine; Boston University 121 Bay State Rd Boston, Ma 02215 Timing: Fiscal Year 2000; Project Start 1-FEB-1992; Project End 1-MAR2002 Summary: The overall goal of this project is to understand the role of gallbladder mucin in the pathogenesis of cholesterol gallstones. Medical
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or surgical treatment for symptomatic gallstones is a frequent cause for hospitalization in the United States and consumes more than 8 billion dollars in health care costs per year. Gallbladder mucin has been shown to have a central role in gallstone pathogenesis. Mucin hypersecretion occurs prior to stone formation in both experimental animals and man. Mucin also promotes cholesterol crystal nucleation, a critical early step in stone formation, and the mucin gel lining. The gallbladder provides an ideal environment for growth of cholesterol crystals into mature stones. Human gallbladder expresses genes for five different mucins and two of these, MUC5B and MUC3 have been identified as the major human gallbladder mucins. Nothing is known about the structural features of these proteins which interact with biliary lipids and lead to the lithogenic state. In this project, a novel recombinant approach will be used to identify the structural domains of MUC5B and MUC3 which bind biliary lipids. The specific aims of this proposal are to: (l) characterize the major human gallbladder mucins MUC5B and MUC3 by determining the nucleotide and deduced amino acid sequences of the poorly glycosylated amino- and carboxyl-terminal regions, (2) determine the genomic organization of these mucins and (3) to identify functional domains in MUC5B and MUC3. Information obtained in specific aims 1 and 2 will be used to design constructs containing individual mucin domains. Recombinant mucin polypeptides will be expressed in bacteria and examined in lipid binding, cholesterol crystal nucleation and vesicle fusion assays. The results of these studies will provide new information about the relationship between the structure of the major human gallbladder mucins and their function in normal and pathologic gallbladder. This information is necessary for the rational design of therapies for the prevention and treatment of gallstone disease. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Myogenic Disorders of the Gallbladder Principal Investigator & Institution: Behar, Jose; Professor of Medicine; Rhode Island Hospital (Providence, Ri) 593 Eddy St Providence, Ri 02902 Timing: Fiscal Year 2000; Project Start 1-SEP-1980; Project End 0-JUN2005 Summary: Acute cholecystitis (AC) affects 88% of patients with symptomatic gallbladder (GB) stones over a 18 year period and has a significant morbidity and mortality in elderly patients. in spite of its high prevalence, its pathogenesis has yet to be elucidated. Our preliminary studies suggest the hypothesis that human AC develops in a permissive GB environment characterized by GB stasis and impaired muscle cytoprotection that allows biliary aggressive factors to initiate the
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inflammatory process. This proposal therefore will study the myogenic abnormalities responsible for creating this GB environment and examine hydrophobic bile salts and reactive oxygen species (ROS) as possible aggressive factors. Specifically, it will investigate: 1) the role of bile stasis induced by lithogenic bile and excessive cholesterol (Ch) incorporation by muscle cells that seems to worsen during the inflammatory process; 2) the mechanisms of cytoprotection utilized by GB muscle cells. It will focus on the role of PGE2 in the upregulation of scavengers of free radicals and whether its receptors and pathways remain functional after exposure to soluble mediators of inflammation. It will examine the mechanisms of receptor protection and resistance to agonist induced desensitization a well as the detrimental influence of excessive membrane Ch on cytoprotective functions mediated by PGE2 receptors. Defective PGE2 receptors could make these cells more susceptible to damage by lower concentrations o aggressive factors; 3) whether hydrophobic bile salts and ROS initiate the inflammatory process and cause the muscle defects demonstrated in human and experimental AC. It will examine whether bile stasis enhances the diffusion of bile salts through the GB wall. It will also investigate the mechanisms whereby they affect muscle cells by examining whether they are mediated by ROS and whether they induce cytoprotective responses in normal and defective muscle cells; and, 4) whether hydrophobic bile salts prevent the deleterious effects of hydrophobic bile salts in vitro and whether they are effective in the prophylactic treatment of experimental AC in GB's with normal and lithogenic bile. These studies will be conducted in dissociated muscle cells from human GB's with gallstones with or without AC and from experimental AC induced by ligation of the common bile duct in animals with normal and lithogenic bile. The results of these studies may provide evidence and a rationale in support for using hydrophobic bile acids in the prophylactic treatment of this complication. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Novel Erythromycin Analogs for GI Motility Disorders Principal Investigator & Institution: Carreras, Christopher W.; Kosan Biosciences 3832 Bay Center Pl Hayward, Ca 94545 Timing: Fiscal Year 2000; Project Start 1-MAR-2000; Project End 1-AUG2000 Summary: The long-term objective of this proposal is to discover novel prokinetic agents with superior pharmacological and pharmacokinetic properties for the treatment of gastrointestinal motility disorders such as gastroesophogeal reflux disease (GERD), gastroparesis, postoperative ileus, scleroderma, gallstones, and as a quick and effective drug to
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stimulate stomach emptying in patients requiring emergency surgery. We propose to prepare the first member of a new class of acid-stable erythromycin analogs from a novel erythromycin scaffold obtained through genetic engineering of the erythromycin gene cluster. The analog will be tested for acid stability and its ability to serve as an effective prokinetic agent ("motilide"). A lead compound made in this fashion will serve as a scaffold for future preparations of novel acid-stable semisynthetic motilides during Phase II of this program. PROPOSED COMMERCIAL APPLICATIONS: The ideal motilide will be a safe and effective treatment for common heartburn. Motilides are anticipated to have applications for the treatment of diabetic gastroparesis, postoperative ileus and scleroderma. The stimulatory effects of motilides on gallbladder contraction suggest that they may' find application in patients at risk of gallstone formation. Finally, intravenous administration of motilides has been recommended as a quick and safe procedure to empty the stomach before emergency surgery, and in pregnant women undergoing caesarian delivery. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Protein Lipid Interactions in Gallstone Pathogenesis Principal Investigator & Institution: Afdhal, Nezam H.; Chief of Hepatology; Beth Israel Deaconess Medical Center 330 Brookline Ave Boston, Ma 02215 Timing: Fiscal Year 2000; Project Start 5-JUL-1993; Project End 1-MAY2003 Summary: Cholesterol gallstone disease is one of the commonest digestive diseases in the United States and results in 700,000 cholecystectomies annually with a direct health care cost in excess of $3 billion. Gallbladder mucin plays a central role in gallstone formation and this proposal will examine the mechanism by which mucin interacts with biliary lipids to promote gallstones. The specific Aims are to 1) Characterize the interaction of specific sites of the mucin molecule with lipid vesicles to improve our understanding of how mucin promotes crystallization of cholesterol monohydrate; 2) Characterize how mucin effects the morphology and rate of crystal growth in solution and in gels so that growth inhibitors can eventually be developed; 3) Examine the central role of mucin as the matrix protein in the biomineralization of both calcium and cholesterol. These Aim's will be achieved by utilizing multiple biophysical techniques to examine model systems where mucin and its modified structural forms will interact with biliary lipids similar to those seen in gallstone bile. Fluorescent assays, dynamic light scattering and magic angle spinning magnetic resonance will examine
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how mucin promotes vesicle fusion and sub- microscopic nucleation. Light and electron microscopy will examine the way in which mucin can promote both the pattern and rate of crystal growth. These studies may lead to strategies for the prevention and non-surgical therapy of this very common disease. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Role of Gallbladder Ion Transport in Gallstone Formation Principal Investigator & Institution: Moser, a J.; Surgery; University of Pittsburgh at Pittsburgh 4200 5Th Ave Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 5-FEB-2002; Project End 1-JAN2007 Summary: (provided by applicant) The candidate is an academic gastrointestinal surgeon whose career objective is to become an independently funded clinician scientist. After graduating at the top of his class from college and medical school, the candidate trained in surgery at UCLA. He undertook a Research Fellowship during residency that provided preliminary experience in membrane biology and instilled a strong desire to become a clinician scientist and an innovator in the treatment of gallstones. To develop his research career, the candidate needs significantly more time for scientific pursuits as well as the mentorship of an experienced membrane biologist. His career development plan includes both didactic and practical studies of gallbladder ion transport with the supervision of two highly successful and innovative scientists at the University of Pittsburgh. The environment provided by the Laboratory of Epithelial Cell Biology is outstanding and has already trained numerous accomplished clinician scientists. The sponsors have dedicated their laboratory resources, equipment, and time to insure the candidate's success. The research plan focuses on one therapeutically promising aspect of gallstone pathogenesis: increased salt and water absorption by the gallbladder prior to gallstone formation. Increased electrolyte absorption excessively concentrates gallbladder bile and promotes the crystallization of cholesterol. The potential clinical relevance of increased gallbladder salt and water transport is dramatized by data showing that amiloride prevents the formation of gallstones in cholesterol-fed prairie dogs. Contrary to the paradigm for gallbladder transport described in stoneresistant animals, we now demonstrate electrogenic ion transport in human and prairie dog gallbladder. Alterations in electrogenic ion transport precede the formation of gallstones and cause absorption to increase, and the mechanism is unknown. We propose studies with three Specific Aims to test our hypothesis that electrogenic ion transport
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confers susceptibility to the formation of gallstones; Aim 1: Determine the mechanism for electrogenic ion transport in prairie dog gallbladder. Although prairie dogs are used extensively as a model of human disease, the basic mechanism for gallbladder ion transport in normal prairie dogs has not been established. Aim 2: Characterize alterations in gallbladder ion transport prior to the formation of gallstones. Using cholesterol-fed animals, we will test our hypothesis that alterations in channel-mediated ion transport stimulate electrolyte absorption and promote gallstones. Aim 3: Determine the mechanism for human gallbladder ion transport in health and disease. Given the high incidence of gallstones in patients with abnormal gallbladder ion transport, these studies will test our hypothesis that increased gallbladder electrolyte absorption is also a cause of gallstones in man. These studies are ideal for teaching the Principal Investigator critical new skills required for a successful research career as a clinician scientist in an era of increasingly sophisticated membrane biology. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: The Unsuspected Small Stone Study (USSS) Principal Investigator & Institution: Disario, James A.; Associate Professor; Internal Medicine; University of Utah 200 S University St Salt Lake City, Ut 84112 Timing: Fiscal Year 2000; Project Start 5-AUG-2000; Project End 1-JUL2001 Summary: (adapted from the application) Gallstones are the most common and the most costly digestive disease, with an annual estimated expenditure of 5 billion dollars. Fifteen percent of persons with symptomatic gallstones will have concomitant bile duct stones (BDS). Expert opinion varies, but there are several reports of leaving BDS in situ without adverse outcomes. The aim of this proposal is to determine if conservative or expectant management is a safe and effective therapy for patients with unsuspected small BDS found at intraoperative cholangiography (10C) during laparoscopic cholecystectomy (LC), compared to conventional therapy with endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy (ES). This is a randomized, prospective, multicenter study of patient outcomes and treatment costs. The primary endpoint is overall morbidity I year after randomization. Secondary endpoints include rates of severe morbidity, mortality, abdominal pain, jaundice, abnormal serum liver tests, abnormal transcutaneous abdominal ultrasound examinations, quality of life indices, and overall treatment costs. A database will be established for long-term follow up. The duration of the study is aimed to be 2 years
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from the onset of funding. One hundred and eighty two (91 per group) patients will be randomized to have expectant management or to have ERCP with sphincterotomy and stone extraction. Eligibility requirements include no history of jaundice, pancreatitis, or cholangitis, and <3 BDS, < 5 mm in diameter found by intraoperative imaging. Follow up will be by standardized interview at 1, 6, and 12 months. Persons in the both expectant and treatment groups will have serum liver tests at 6 and 12 months, post-LC or post-ERCP respectively. The expectantly managed group will have transabdominal ultrasound at 12 months. Expectantly managed individuals with abnormal results will have ERCP. Statistical power for detecting differences will be emphasized (beta=0.01, alpha=0.05). This proposal will allow the investigators to explore an important clinical question, expand a previously constructed study framework to become an interdisciplinary study group including gastroenterologists and surgeons, and to refine and validate study operational systems. Should there be nonsignificant trends detected in the results with the proposed sample size, we intend to proceed with a larger scale multicenter study proposal. The study group and systems developed in this proposal will be used for future multicenter projects on gallstone disease. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Transferrin, Iron Deficiency, and Gallstone Pathogenesis Principal Investigator & Institution: Pitt, Henry A.; Surgery; Medical College of Wisconsin 8701 Watertown Plank Rd Milwaukee, Wi 53226 Timing: Fiscal Year 2000; Project Start 5-JUL-1992; Project End 1-MAR2001 Summary: Approximately 30,000,000 Americans have gallstones. This laboratory's long-term goal has been the evaluation of pathogenic mechanisms which may lead to new strategies to prevent cholesterol gallstones. The major pathogenic factors include 1) cholesterol supersaturated bile, 2) Diminished gallbladder motility, and 3) nucleation and growth of cholesterol monohydrate crystals. In recent years a number of pronucleating agents have been identified, but none account for the majority of whole bile pronucleating activity. Ongoing studies from this laboratory suggest that an 84 kDa nonmucin glycoprotein, which has recently been identified to be transferrin, may play an important role in e cholesterol crystal nucleation process. These observations along with the knowledge that cholesterol gallstones develop most commonly in women of childbearing age have led us to propose a new Central Hypothesis: Iron deficiency results in increased serum and biliary transferrin. increased biliary cholesterol secretion.
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enhanced cholesterol monohydrate crystal precipitation and cholesterol gallstone formation. Transferrin is a pro-nucleating agent, is concentrated in the vesicular fraction of bile, and is present, as is iron, in higher concentrations in the gallbladder bile of cholesterol gallstone than in control patients. However, the exact type and role of transferrin, and iron, in bile and the possible relationship between iron deficiency and gallstone formation need to be carefully examined. Therefore, we plan to pursue the following aims. The First Specific Aim is to further define the role of transferrin as a pronucleating agent and the relationship between serum and biliary transferrin. The Second Specific Aim is to determine the role of iron in gallstone pathogenesis. The Third Specific Aim is to compare levels of transferrin, iron, transferrin receptors, and hepatic enzymes in controls as well as cholesterol gallstone patient and animals. The Fourth Specific Aim is to determine the presence and site of transferrin and iron in cholesterol gallstones. The Fifth Specific Aim is to define the relationship between iron deficiency, biliary transferrin, an cholesterol gallstone formation. A series of human and prairie dog studies should confirm the proposed link between iron deficiency, biliary transferrin and cholesterol gallstones. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central16 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).17 Access to this growing archive of e-journals is free and unrestricted.18 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “gallstones” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for gallstones in the PubMed Central database: ·
A comparative study of gallstones from children and adults using FTIR spectroscopy and fluorescence microscopy by Oleg Kleiner, Jagannathan
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 17 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 18 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 16
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Ramesh, Mahmoud Huleihel, Beny Cohen, Keren Kantarovich, Chen Levi, Boris Polyak, Robert S. Marks, Jacov Mordehai, Zahavi Cohen, and Shaul Mordechai; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=65695
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.19 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with gallstones, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “gallstones” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “gallstones” (hyperlinks lead to article summaries): ·
The varied uses of gallstones. Author(s): Aronson SM. Source: R I Med J. 1991 December; 74(12): 569-70. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1763274&dopt=Abstract
Vocabulary Builder Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Acidosis: Too much acid in the body. For a person with diabetes, this can lead to diabetic ketoacidosis. [NIH] PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
19
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Adsorption: The attachment of one substance to the surface of another; the concentration of a gas or a substance in solution in a liquid on a surface in contact with the gas or liquid, resulting in a relatively high concentration of the gas or solution at the surface. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Aqueous: Watery; prepared with water. [EU] Ascariasis: Infection by nematodes of the genus ascaris. Ingestion of infective eggs causes diarrhea and pneumonitis. Its distribution is more prevalent in areas of poor sanitation and where human feces are used for fertilizer. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Cadmium: An element with atomic symbol Cd, atomic number 48, and atomic weight 114. It is a metal and ingestion will lead to cadmium poisoning. [NIH] Cardiopulmonary: Pertaining to the heart and lungs. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Cholangiography: Roentgenography of the biliary ducts after administration or injection of a contrast medium, orally, intravenously or percutaneously. [EU] Cholestasis: Impairment of biliary flow at any level from the hepatocyte to Vater's ampulla. [NIH] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Contractility:
Capacity for becoming short in response to a suitable
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stimulus. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytoprotection: The process by which chemical compounds provide protection to cells against harmful agents. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Dietetics: The study and regulation of the diet. [NIH] Diffusion: The process of becoming diffused, or widely spread; the spontaneous movement of molecules or other particles in solution, owing to their random thermal motion, to reach a uniform concentration throughout the solvent, a process requiring no addition of energy to the system. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and
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emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Haplotypes: The genetic constitution of individuals with respect to one member of a pair of allelic genes, or sets of genes that are closely linked and tend to be inherited together such as those of the MAJOR histocompatibility complex. [NIH] Hemolysis: The destruction of erythrocytes by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. [NIH]
Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydration: The condition of being combined with water. [EU]
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Hydrogen: Hydrogen. The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hyperlipidemia: An excess of lipids in the blood. [NIH] Ileus: Obstruction of the intestines. [EU] Incidental: 1. small and relatively unimportant, minor; 2. accompanying, but not a major part of something; 3. (to something) liable to occur because of something or in connection with something (said of risks, responsibilities, ...) [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoenzymes: One of various structurally related forms of an enzyme, each having the same mechanism but with differing chemical, physical, or immunological characteristics. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU]
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Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Motility: The ability to move spontaneously. [EU] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU]
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Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Solvent: 1. dissolving; effecting a solution. 2. a liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Taurine: 2-Aminoethanesulfonic acid. A conditionally essential nutrient, important during mammalian development. It is present in milk but is isolated mostly from ox bile and strongly conjugates bile acids. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vesicular: 1. composed of or relating to small, saclike bodies. 2. pertaining to or made up of vesicles on the skin. [EU]
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CHAPTER 4. PATENTS ON GALLSTONES Overview You can learn about innovations relating to gallstones by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.20 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with gallstones within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with gallstones. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
Adapted from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
20
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Patents on Gallstones By performing a patent search focusing on gallstones, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on gallstones: ·
Method of treating and preventing gallstones Inventor(s): Krstulovic; Veljko J. (609 W. 114th St. Apt. 62, New York, NY 10025) Assignee(s): none reported Patent Number: 5,935,948 Date filed: April 7, 1998 Abstract: The present invention relates to a method of treating and/or preventing gallstones comprising administering a therapeutically effective amount of dehydrocholic acid. It is based, at least in part, on the discovery that consistent usage of dehydrocholic acid resulted in the dissolution of gallstones and prevention, elimination and/or amelioration of biliary colic in four subjects. Excerpt(s): The present invention relates to a method of preventing and/or treating gallstones, as well as elimination, amelioration, and/or prevention of biliary colic and diminishing or eliminating biliary colic comprising administering a therapeutic amount of dehydrocholic acid. ... Some naturally occurring bile acids have been used therapeutically, by virtue of their ability to decrease the cholesterol content of bile, in the dissolution of cholesterol gallstones. Chenodeoxycholic acid at daily doses of 14-16 mg/kg of body weight, ursodeoxycholic acid at daily doses of 8-10 mg/kg of body weight, or a combination of 5-7 mg/kg of body weight per day of each, have been used for this purpose. Such administration may be associated with undesirable side effects, however, such as diarrhea and, in the case of chenodeoxycholic acid, elevated plasma transaminase activity and elevated serum cholesterol in the lowdensity lipoprotein (LDL) fraction. ... At a daily dose of 750 mg of chenodeoxycholic acid (the highest dose tested), there was confirmed complete dissolution of radiolucent gallstones in only 13% of patients
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during 2 years of treatment. The incidence of significant hepatotoxicity was 3% among patients who received 750 mg of chenodeoxycholic acid daily; biochemical abnormalities disappeared spontaneously in all of these patients after cessation of treatment. Diarrhea occurred in 40% of patients, but it was mild and never caused termination of treatment. The mean plasma cholesterol concentration was elevated slightly. Ursodeoxycholic acid may be more effective than chenodeoxycholic acid, and it appears to have much less tendency to cause hepatotoxicity or diarrhea. Studies indicate that gallstones will recur in a relatively high percentage of patients after cessation of treatment with bile acids. Web site: http://www.delphion.com/details?pn=US05935948__ ·
Agents for distributing gallstones Inventor(s): Moyiyasu; Akihito (Sendai, JP) Assignee(s): Senju Pharmaceutical Co., Ltd. (Osaka, JP) Patent Number: 5,441,748 Date filed: November 10, 1993 Abstract: An aqueous agent for disintegrating gallstones containing an alkali metal carbonate such as sodium or potassium hydrogen carbonate and optionally N-acetylcysteine. Excerpt(s): The present invention relates to an agent for disintegrating gallstones, and more particularly to an agent for disintegrating gallstones containing an alkali metal carbonate or a combination of an alkali metal carbonate and N-acetylcysteine as its effective components. ... The statistical study shows that gallstone carriers reach about 9% of the population in Japan. In 1989, the cholecystolithiasis patients were reported to be 270,000, most of whom were subjected to surgical lithectomy. The gallstones are classified into cholesterol gallstones and pigment gallstones (bilirubin calcium and black-pigment stones) based on the component thereof. Studies on an agent for dissolving gallstones have been performed for a long time, resulting in the development of formulations of bile acid such as ursodeoxycholic acid and chenodeoxycholic acid for dissolving choresterol gallstones. Clinical tests have proved that such formulations are effective for gallstone dissolution. However, actual effect for gallstone dissolution given by such formulations depends on the size of the stone and cholecyst function, whereby the patient should be dosed for a long period such as a halfyear to a year or more. A suitable agent for dissolving pigment stones has not yet been developed in spite of various studies. ... The inventor has found out from studies on composition of the gallstones that
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mucopolysaccharides and mucoproteins (hereinafter abbreviated to muco-substances) play an important role as a component for binding the crystalline cholesterol or bilirubin. On the other hand, SH-compounds including N-acetylcysteine have been known to have action for splitting off the S--S bond of muco-substances. In particular, it has been reported that N-acetylcysteine accelerates dissolution of cholesterol gallstones [see Scand. J. Gastroent., 24, 373-380 (1989); Gastroenterology., 98, 454-463 (1990)]. However, this document reports that the dissolution of cholesterol gallstones takes about 10 hours to several weeks, and further that the absolute effect is small. Web site: http://www.delphion.com/details?pn=US05441748__ ·
Apparatus for the non-intrusive fragmentation of renal calculi, gallstones or the like Inventor(s): LaRocca; Aldo (Revigliasco Torinese, IT) Assignee(s): Lara Consultants s.r.l. (IT) Patent Number: 5,209,234 Date filed: January 30, 1992 Abstract: The apparatus for the non-intrusive fragmentation of renal calculi, gallstones or the like according to the invention comprises at least one ultrasonic receiver-transmitter head (12) focused on the renal calculus (11), gallstone or the like to be disintegrated, a head (12) being associated with a low-power variable frequency transmitter (16) and with a receiver (18) to perform a spectral analysis of the characteristic resonance frequencies of the renal calculus (11), gallstone or the like to be disintegrated, and a controller (Tx1, OSC1) to cause a transmitter (16) to emit relatively high-power energy peaks at the characteristic resonance frequencies of the renal calculus (11), gallstone or the like to promote its disintegration. Excerpt(s): This invention relates to an apparatus for the non-intrusive fragmentation of renal calculi, gallstones or the like. ... It is well known that the conventional method of removing renal calculi, gallstones or the like is by surgery. ... In this respect, it is a well known fact of physics that in the case of oscillation (electrical, mechanical), monochromaticity and phase coherence of the oscillation allows accurate focusing and aiming, and thus the concentration of the available energy at a well determined point in space. It is also a well known fact that in the mechanical field (such as disintegration of renal calculi, gallstones or the like) maximum energy transfer between the elastic wave source and a structure to be oscillated is obtained under conditions of resonance on one or more of
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the resonance modes of the structure. In this respect it is known that in mechanical structures subjected to dynamic stresses, steps are taken to prevent oscillation and/or vibrations which could assume destructive amplitude. Web site: http://www.delphion.com/details?pn=US05209234__ ·
Apparatus for removing gallstones and tissue during surgery Inventor(s): Washington, deceased; Charles N. (980 Terry La., late of Lake Charles, LA 70605), Washington, executrix; by Virginia Y. (980 Terry La., Lake Charles, LA 70605) Assignee(s): none reported Patent Number: 5,147,371 Date filed: June 28, 1991 Abstract: A device for the in situ collection of surgically excised material, including whole gall bladder, gallstones, dissected gall bladder and other tissues, for removal from the body, particularly in laproscopic surgical procedures. Excerpt(s): The invention relates to a medical device for the removal of gallstones and/or gallbladder tissue, more particularly to a device particularly for use through an aperture or an opening in the patients abdomen or the like. ... Therapeutic laparoscopy for gallstone disease was reported by Morris in 1988 in which he described the procedure which allowed the laparoscopist to cannulate the gallbladder directly and remove gallstones, leaving the organ in situ. Laparoscopic removal of the gallbladder was initially performed in the U.S. by Saye and McKernan in 1988. Endocholecystectomy has evolved rapidly since 1988, along with the development of laparoscopic instrumentation and advances in video technology, contributing to the improved safety and quick adoption by general surgeons of this new procedure. Because of the tremendous advantages of endocholecystectomy, this procedure may rapidly replace open cholecystectomy as the procedure of choice. ... Surgical procedures may be performed to excise and remove gallstones, rather than removing the entire gallbladder. To effect such removal, the gallbladder is opened, allowing stones to pass out of the gallbladder. The stones must then be removed from the abdomen. It is often difficult to collect stones, particularly when multiple stones are released, and successfully remove them from the abdomen. Web site: http://www.delphion.com/details?pn=US05147371__
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·
Low viscosity solvent mixture for dissolution of cholesterol gallstones Inventor(s): Hofmann; Alan F. (La Jolla, CA) Assignee(s): The Regents of the University of California (Berkeley, CA) Patent Number: 4,910,223 Date filed: February 19, 1988 Abstract: A composition is described for the dissolution of cholesterol gallstones, which composition is a mixture of monooctanoin and diethyl ether and has a viscosity of not more than 7 cp and can be maintained in the body at a temperature below its boiling point. The volumetric ratio of monooctanoin:diethyl ether will usually be in the range of about 10:90 to about 70:30. The composition can be infused by a variety of techniques including high flow low pressure pumps. Excerpt(s): The invention herein relates to medical treatments for the contact dissolution of cholesterol gallstones. More particularly it relates to low viscosity pumpable solvents for such treatments. ... The contact dissolution of cholesterol gallstones in human patients is a well recognized medical procedure and may be favored over surgical procedures to remove the gallstones in patients at increased risk for surgery; see, e.g., U.S. Pat. No. 4,205,086. The dissolution procedures normally involve infusion of the solvent into the biliary tract by means of a T-tube, nasobiliary tube, percutaneous transhepatic catheter or cholecystostomy tube by use of a constant infusion pump or by gravity or by manual repeated instillation and withdrawal using a syringe; see Palmer et al, Gut, 27, 2, 196 (1986). Frequently the stones fragment during the dissolution procedure, which advantageously increases the rate of dissolution. ... One solvent which has shown efficacy for dissolving cholesterol gallstones is monooctanoin, which is an esterified reaction product of glycerol and octanoic acid; see the aforementioned Gut article as well as Thistle et al, Gastroenterology, 78, 1016 (1980). Studies in vitro and in vivo have shown the ability of monooctanoin to significantly reduce and/or eliminate cholesterol gallstones by dissolving them so that the dissolved material can be eliminated or removed from the body. Monooctanoin has been marketed as an orphan drug with the approval of the Food and Drug Administration. Web site: http://www.delphion.com/details?pn=US04910223__
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·
Double balloon nasobiliary occlusion catheter for treating gallstones and method of using the same Inventor(s): Wilcox; Gilbert M. (12 Towne Rd., Boxford, MA 01921) Assignee(s): none reported Patent Number: 4,696,668 Date filed: July 17, 1985 Abstract: Disclosed is a double balloon multiple lumen nasobiliary occlusion catheter including two inflatable balloons positioned about the distal end of the catheter. The catheter comprises several lumens which are used for inflating and deflating the balloons, venting bile, and infusing and aspirating a dissolution solution. When inflated, the balloons occlude the lumen of the bile duct at two points thereby creating a sealed space between the balloons into which a treatment solution may be infused. Since this space is sealed from the remaining biliary tree, the treatment solution will find access to the gallbladder and any stones therein via the cystic duct with the exclusion of bile from the gallbladder fundus, or it will be confined in high concentration around bile duct gallstones located between the inflated balloons. While the treatment solution is applied to the gallstones, bile is excluded from the treatment site. Excerpt(s): This invention relates to the treatment of gallstones and more particularly to a double balloon catheter and method of using a double balloon catheter for the treatment of gallstones. ... In the past, gallstones have been treated with surgery, but this treatment is usually reserved for patients with gallstones producing symptoms. The operative techniques vary and may include cholecystectomy alone, or cholecystectomy combined with common duct exploration. Operative mortality rates vary with age and other comorbid conditions, and when elevated, make surgery an unattractive treatment. ... In the last decade, treatment of gallstones by dissolution with orally administered bile acids such as chenodeoxycholic acid (CDCA) or ursodeoxycholic acid (UDCA) has been sucessfully accomplished. These agents work by inducing cholesterol unsaturation of bile. While dissolution of stones with orally administered bile acids eliminates many of the risks associated with surgery, many other problems are presented. First of all, complete dissolution occurs in only 30 to 40% of the patients (low index of efficacy). In addition, high doses of CDCA are required (15 mg/kg body wt/day resulting in doses of 1000 mg or more daily), and in order to achieve the dissolution, the duration of treatment must be rather long, i.e. on the order of 1 to 2 years. Furthermore, toxic side effects of the medications are encountered such as bile acid diarrhea, increase in serum
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cholesterol possibly leading to elevated cardiac risk, biochemical changes indicating liver abnormalities and changes in liver histology. Web site: http://www.delphion.com/details?pn=US04696668__ ·
Method for the treatment of gallstones Inventor(s): Babayan; Vigen K. (Indianapolis, IN) Assignee(s): Stokeley-Van Camp, Inc. (Indianapolis, IN) Patent Number: 4,205,086 Date filed: December 2, 1977 Abstract: A method for the treatment of gallstones is disclosed herein which comprises perfusing adjacent the gallstones a liquid form of a physiologically-compatible mixture of fatty acids and/or alcohol esters of fatty acids. The mixture preferably comprises octanoic acid and decanoic acid, and the gylcerol esters thereof. Excerpt(s): The present invention relates to a method for the treatment of gallstones, and more particularly to a method involving the perfusion of a solvent adjacent the gallstones. ... Gallstones occur in a significant number of persons, with obesity and pregnancy being among the known predisposing factors. The causes of the formation of gallstones, more particularly known as biliary calculi, are generally obscure, with biliary stasis and disrupted cholesterol metabolism having been suggested as possible causative factors. Gallstones generally are found in the gallbladder, a condition known as cholelithiasis, or in the common duct, a condition known as choledocholithiasis. Gallstones are generally of three types, pure pigment stones of calcium bilirubinate which occur in hemolytic diseases, cholesterol stones, and mixed stones, the latter two types accounting for 80% of stone occurences. ... Patients having gallstones may be completely asymptomatic for long periods. However, gallstones are generally accompanied by biliary colic, frequently with jaundice. Nausea and vomiting may also exist, and frequently the patient experiences regional pain and tenderness, as well as upper abdominal discomfort. Web site: http://www.delphion.com/details?pn=US04205086__
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Patent Applications on Gallstones As of December 2000, U.S. patent applications are open to public viewing.21 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years).
Keeping Current In order to stay informed about patents and patent applications dealing with gallstones, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “gallstones” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on gallstones. You can also use this procedure to view pending patent applications concerning gallstones. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Cholecystostomy: Establishment of an opening into the gallbladder either for drainage or surgical communication with another part of the digestive tract, usually the duodenum or jejunum. [NIH] 21
This has been a common practice outside the United States prior to December 2000.
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Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Mucoproteins: Conjugated proteins in which mucopolysaccharides are combined with proteins. The mucopolysaccharide moiety is the predominant group with the protein making up only a small percentage of the total weight. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perfusion: 1. the act of pouring over or through, especially the passage of a fluid through the vessels of a specific organ. 2. a liquid poured over or through an organ or tissue. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]
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CHAPTER 5. BOOKS ON GALLSTONES Overview This chapter provides bibliographic book references relating to gallstones. You have many options to locate books on gallstones. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on gallstones include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “gallstones” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on gallstones: ·
Clinical Practice of Gastroenterology. Volume Two Source: Philadelphia, PA: Current Medicine. 1999. 861 p.
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Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Website: www.wbsaunders.com. Price: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: This lengthy textbook brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. This second volume includes 113 chapters in five sections: liver, gallbladder and biliary tract, pancreas, pediatric gastroenterology, and special topics. Specific topics include hepatic (liver) structure and function, jaundice, viral hepatitis, alcoholic liver injury, liver tumors, parasitic diseases of the liver, Wilson's disease, hemochromatosis, the pregnancy patient with liver disease, portal hypertension, hepatic encephalopathy, fulminant hepatic failure, liver transplantation, the anatomy of the gallbladder and biliary tract, gallstones, laparoscopic cholecystectomy (gallbladder removal), cholecystitis (gallbladder infection), primary sclerosing cholangitis, biliary obstruction, pancreatic anatomy and physiology, acute pancreatitis, pancreatic fistulas and ascites (fluid accumulation), chronic pancreatitis, cancer of the pancreas, endoscopic retrograde cholangiopancreatography, esophageal atresia, gastroesophageal reflux in infants and children, achalasia and esophageal motility disorders, caustic and foreign body ingestion, vomiting, chronic abdominal pain, gastritis and peptic ulcer disease in children, malabsorption syndromes in children, inflammatory bowel disease in children and adolescents, acute appendicitis, cystic fibrosis, constipation and fecal soiling (incontinence), hepatitis in children, liver transplantation in children, failure to thrive, pediatric AIDS, the gastrointestinal manifestations of AIDS, the evaluation and management of acute upper gastrointestinal bleeding, principles of endoscopy, eating disorders, nutritional assessment, enteral and parenteral nutrition, gastrointestinal diseases in the elderly and in pregnancy, nosocomial infections, and the psychosocial aspects of gastroenterology (doctor patient interactions). The chapters include figures, algorithms, charts, graphs, radiographs, endoscopic pictures, intraoperative photographs, photomicrographs, tables, and extensive references. The volume concludes with a detailed subject index and a section of color plates. ·
Gastrointestinal and Hepatobiliary Pathophysiology Source: Madison, CT: Fence Creek Publishing. 1998. 475 p. Contact: Available from Blackwell Science, Inc. 350 Main Street, Malden, MA 02148. (800) 215-1000 or (781) 388-8250. Fax (781) 388-8270. E-mail:
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[email protected]. Website: www.blackwellscience.com. Price: $27.95 plus shipping and handling. ISBN: 1889325015. Summary: This book on gastrointestinal and hepatobiliary pathophysiology is one from a series designed to meet the second and third year medical students' needs for a concise but comprehensive resource that focuses on organ system pathophysiology. The test covers the pathogenesis, diagnosis, treatment, and management of common diseases, using a format that includes one or more clinical cases integrated throughout the chapters to foster direct application of clinical problem solving skills; extensive use of margin notes that concisely highlight important concepts, define key terms, and pinpoint clinical correlations; questions at the end of each chapter, using the NBME format, that offer a means for accurate self assessment; and wide margins to accommodate note taking by students as they study. Thirty chapters cover an overview of gastrointestinal and hepatobiliary function; regulation of the digestive system; the anatomy, histology, and embryology of the gastrointestinal tract; an overview of gastrointestinal motility; gastrointestinal electrolyte and fluid secretion; digestion and absorption; management of water and electrolytes; liver anatomy and physiology; liver metabolism, physiology of bile formation, and gallstones; normal and disordered swallowing; peptic ulcer disease; small bowel disorders; acute and chronic pancreatitis; functional bowel disorders; the mucosal immune system; inflammatory bowel disease; infectious disorders of the gastrointestinal tract; viral hepatitis; hereditary liver disease; autoimmune liver disease; pathogenesis and consequences of portal hypertension; disorders of cholestasis, bilirubin metabolism, and jaundice; orthotopic liver transplantation; alcohol and the gastrointestinal tract; the pathophysiology of abdominal pain and pain syndromes; gastrointestinal disorders in pregnancy; the molecular biology of gastrointestinal malignancies and overview of neoplasms of the gastrointestinal tract; pharmacology; principles of nutritional support in the gastrointestinal patient; and gastrointestinal bleeding. A subject index concludes the textbook. ·
Gastroenterology and Hepatology: The Comprehensive Visual Reference. Volume 6: Gallbladder and Bile Ducts Source: Philadelphia, PA: Current Medicine. 1997. [200 p.]. Contact: Available from Current Medicine. 400 Market Street, Suite 700, Philadelphia, PA 19106. (800) 427-1796 or (215) 574-2266. Fax (215) 5742270. E-mail:
[email protected]. Website: current-medicine.com. Price: $125.00 plus shipping and handling. ISBN: 0443078580.
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Summary: This atlas is one in an 8-volume collection of images that pictorially displays the gastrointestinal tract, liver, biliary tree, and pancreas in health and disease, both in children and adults. This volume includes 10 chapters on the gallbladder and bile ducts, each written by experts in their respective fields. Topics covered include normal anatomy, biliary tract neoplasms, adult cholangiopathies, laparoscopic cholecystectomy (gallbladder removal), gallbladder motility in health and disease, the pathogenesis of gallstones, the nonsurgical treatment of gallstones (including dissolution), endoscopic approaches to choledocholithiasis (bile duct stones), and biliary tract infections. The format of the atlas is visual images supported by relatively brief text. Tables, charts, diagrams, and photomicrographs are used extensively. A subject index concludes the volume. ·
Indigestion: Living Better with Upper Intestinal Problems from Heartburn to Ulcers and Gallstones Source: New York, NY: Oxford University Press. 1992. 227 p. Contact: Available from Oxford University Press. Order Department, 2001 Evans Road, Cary, NC 27513. (800) 451-7556. Fax (919) 677-1303. Price: $11.95 plus shipping and handling. ISBN: 019508554X. Summary: This book offers advice on how to take care of and avoid a whole complex of disturbances categorized as indigestion. The author begins with an overview of the anatomy and physiology of digestion, including a chapter on terminology and definitions. After an additional chapter on diagnostic testing, the author turns to specific problems, including acid related problems (heartburn, esophagitis, and hiatal hernia), peptic ulcers, nonulcer dyspepsia, chest pain, gallbladder problems and gallstones, pancreatic diseases, jaundice, malabsorption and maldigestion, food intolerance and food allergies, the impact of aging on the upper digestive tract (including the role of medications and drug interactions), and the brain gut connection. The appendices of the book offer coverage of related problems, including belching, nausea and vomiting, dry mouth and bitter taste, difficulty in tasting, lump in the throat, butterflies, difficulties in swallowing, delayed stomach emptying, the effects of diabetes on the upper digestive system, and the controversy over yeast. The author hopes to foster a cooperative dialogue between patients and their physicians as they work together to diagnose and manage upper digestive tract problems. A subject index concludes the book. 8 figures. 6 tables.
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Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to gallstones (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Bile, Bile Acids, Gallstones, and Gallstone Dissolution by Alan F. Hofmann (1983); ISBN: 0852004974; http://www.amazon.com/exec/obidos/ASIN/0852004974/icongroupin terna
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Epidemiology and Prevention of Gallstone Disease by L. Capocaccia, et al (1984); ISBN: 0852008503; http://www.amazon.com/exec/obidos/ASIN/0852008503/icongroupin terna
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Gallstones (Contemporary Issues in Gastroenterology, Vol 4) by Sidney Cohen, Soloway (Editor) (1985); ISBN: 044308369X; http://www.amazon.com/exec/obidos/ASIN/044308369X/icongroupi nterna
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Retained Common Duct Stones: Prevention and Treatment by Roger W. Motson (Editor), Robert W. Motson (Editor) (1985); ISBN: 0808917293; http://www.amazon.com/exec/obidos/ASIN/0808917293/icongroupin terna
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Liver, Nutrition, and Bile Acids (NATO Asi Series. Series A, Life Sciences, Vol 90) by G. Galli, E. Bosisio (Editor) (1986); ISBN: 0306420112; http://www.amazon.com/exec/obidos/ASIN/0306420112/icongroupin terna
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Gallstone Disease and Its Management by Malcolm C. Bateson (1987); ISBN: 0852009798; http://www.amazon.com/exec/obidos/ASIN/0852009798/icongroupin terna
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Assessment and Management of Hepatobiliary Disease by L. Okolicsanyi, et al (1987); ISBN: 0387177604; http://www.amazon.com/exec/obidos/ASIN/0387177604/icongroupin terna
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Assessment and Management of Hepatobiliary Disease (1987); ISBN: 3540177604;
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http://www.amazon.com/exec/obidos/ASIN/3540177604/icongroupin terna ·
Biliary Lithotripsy: Adapted from the Proceedings of the First International Symposium on Biliary Lithotripsy, Boston, Massachusetts, July 11-13, 198 by Mass.) International Symposium on Biliary Lithotripsy 1988 Boston (1988); ISBN: 0815132026; http://www.amazon.com/exec/obidos/ASIN/0815132026/icongroupin terna
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Bile Acids and the Liver: With an Update on Gallstone Disease (Falk Symposium, Vol 42) by G. Paumgartner, et al (1988); ISBN: 0852006756; http://www.amazon.com/exec/obidos/ASIN/0852006756/icongroupin terna
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Principles of Bilary Lithotripsy by Alexander S. Cass, Leroy H. Stahlgren (Editor) (1989); ISBN: 0879933496; http://www.amazon.com/exec/obidos/ASIN/0879933496/icongroupin terna
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Interventional Radiology of the Gallbladder (1990); ISBN: 3540529055; http://www.amazon.com/exec/obidos/ASIN/3540529055/icongroupin terna
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Interventional Radiology of the Gallbladder: Percutaneous Cholecystostomy by J.G. McNulty (1990); ISBN: 0387529055; http://www.amazon.com/exec/obidos/ASIN/0387529055/icongroupin terna
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Gallstone Disease: Pathophysiology and Therapeutic Approaches by W. Swobodnik, et al (1990); ISBN: 0387509658; http://www.amazon.com/exec/obidos/ASIN/0387509658/icongroupin terna
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Strategies for the Treatment of Hepatobiliary Diseases (Falk Symposium, No 53) by G. Paumgartner, et al (1990); ISBN: 0792389034; http://www.amazon.com/exec/obidos/ASIN/0792389034/icongroupin terna
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Lithotripsy and Related Techniques for Gallstone Treatment: Adapted from the Proceedings of the Third International Symposium on Biliary Lithotripsy, by Germany) International Symposium on Biliary Lithotripsy 1990 Munich, et al (1991); ISBN: 0815166249; http://www.amazon.com/exec/obidos/ASIN/0815166249/icongroupin terna
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Recent Advances in the Epidemiology and Prevention of Gallstone Disease: Proceedings of the 2nd International Workshop on Epidemiology and Preventio by International Workshop on the
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Epidemiology and Prevention of gallstone (1991); ISBN: 0792309944; http://www.amazon.com/exec/obidos/ASIN/0792309944/icongroupin terna ·
Lithotripsy and Related Techniques for Gallstone Treatment by H. Joachim Burhenne (1991); ISBN: 0815113757; http://www.amazon.com/exec/obidos/ASIN/0815113757/icongroupin terna
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Liver Disease and Gallstones by Alan G. Johnson (1992); ISBN: 019261505X; http://www.amazon.com/exec/obidos/ASIN/019261505X/icongroupi nterna
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Cholestatic Liver Diseases: New Strategies for Prevention and Treatment of Hepatobiliary and Cholestatic Liver Diseases (Falk Symposium, Vol 75) by G.P. Van Berge Henegouwen, B. Van Hoek (1994); ISBN: 0792388674; http://www.amazon.com/exec/obidos/ASIN/0792388674/icongroupin terna
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Techniques in the Management of Gallstone Disease by Ara Darzi (Editor), et al (1995); ISBN: 0632036753; http://www.amazon.com/exec/obidos/ASIN/0632036753/icongroupin terna
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Gallstones & Their Treatment: A Guide of Patients (Surgical Series) by James Norman, et al (1995); ISBN: 1885274211; http://www.amazon.com/exec/obidos/ASIN/1885274211/icongroupin terna
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Bile Acids, Cholestasis, Gallstones: Advances in Basic and Clinical Bile Acid Research: Proceedings of the Falk Symposium No. 84, Held in Berlin) by Germany)/ Leuschner, U./ Fromm, Hans Falk Symposium 1995 Berlin (1996); ISBN: 0792388933; http://www.amazon.com/exec/obidos/ASIN/0792388933/icongroupin terna
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Surgery of the Biliary Tract by James Toouli (Editor) (1997); ISBN: 0443043612; http://www.amazon.com/exec/obidos/ASIN/0443043612/icongroupin terna
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Bile Ducts and Bile Duct Stones by George Berci (Editor), et al (1997); ISBN: 0721614884; http://www.amazon.com/exec/obidos/ASIN/0721614884/icongroupin terna
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Cholelithiasis: Causes and Treatment by Fumio, Md. Nakayama (1999); ISBN: 0896403343; http://www.amazon.com/exec/obidos/ASIN/0896403343/icongroupin terna
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Coping With Gallstones by Joan Gomez (2000); ISBN: 0859698378; http://www.amazon.com/exec/obidos/ASIN/0859698378/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “gallstones” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:22 ·
Bile acids and lipids. Author: edited by G. Paumgartner, A. Stiehl, W. Gerok; Year: 1981; Lancaster, England: MTP Press, c1981; ISBN: 0852003897 http://www.amazon.com/exec/obidos/ASIN/0852003897/icongroupin terna
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Bile acids, cholestasis, gallstones: advances in basic and clinical bile acid research: proceedings of the Falk Symposium no. 84, held in Berlin, Germany, June 9-10, 1995. Author: edited by H. Fromm, U. Leuschner; Year: 1996; Dordrecht; Boston: Kluwer Academic Publishers, c1996; ISBN: 0792388933 (casebound: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0792388933/icongroupin terna
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Bile, bile acids, gallstones, and gallstone dissolution: a bibliography of revelant articles, abstracts, and editorials. Author: compiled and
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
22
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indexed by Alan F. Hofmann, with assistance of Vicky L. Huebner and Joseph H. Steinbach; Year: 1983; Lancaster; Boston: MTP Press, c1983; ISBN: 0852004974 http://www.amazon.com/exec/obidos/ASIN/0852004974/icongroupin terna ·
Chenodeoxycholic acid therapy of gallstones. Workshop held in Freidburg i. Br., October 1973. Editors: A. F. Hofmann [and] G. Paumgartner. Author: Bile Acid Meeting (6th: 1980: Freiburg im Breisgau, Germany); Year: 1974; Stuttgart, New York, Schattauer, 1974; ISBN: 3794504119
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Clinical practice of ERCP. Author: written by Derrick F. Martin, David Tweedle, Najib Y. Haboubi; Year: 1998; London; New York: Churchill Livingstone, 1998; ISBN: 0443051178 http://www.amazon.com/exec/obidos/ASIN/0443051178/icongroupin terna
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Gallstones: discussions in surgical management. Author: Joseph A. Caprini ... [et al.]; Year: 1979; Garden City, N. Y.: Medical Examination Pub. Co., c1979; ISBN: 0874889537 http://www.amazon.com/exec/obidos/ASIN/0874889537/icongroupin terna
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Gallstones and ghosts [by] Hubert Bagster [pseud.]. Author: Trumper, Hubert Bagster; Year: 1958; New York, Simon and Schuster, 1958
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Gallstones and laparoscopic cholecystectomy: January 1989 through August 1992: 683 citations. Author: prepared by Peggie S. Tillman, Sarah C. Kalser, and Willis R. Foster; Year: 1992; Bethesda, Md.: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Library of Medicine, Reference Section; Washington, D.C.: Sold by the Supt. of Docs., U.S. G.P.O., 1992
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Gallstones. Author: edited by Sidney Cohen and Roger D. Soloway; Year: 1985; New York: Churchill Livingstone, 1985; ISBN: 044308369X http://www.amazon.com/exec/obidos/ASIN/044308369X/icongroupi nterna
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Gallstones. Author: Thomas C. Chalmers, guest editor; Year: 1983; New York, N.Y.: Thieme-Stratton, c1983
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Gallstones. Author: edited by M. M. Fisher ... [et. al.]; Year: 1979; New York: Plenum Press, c1979; ISBN: 0306401797 http://www.amazon.com/exec/obidos/ASIN/0306401797/icongroupin terna
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Gallstones; causes and treatment. Author: Rains, A. J. Harding (Anthony John Harding); Year: 1964; London, Heinemenn [1964]
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Health provider's guide to contraception. International. Author: C.W. Porter, Jr., R.S. Waife, H.R. Holtrop; Year: 1983; Chestnut Hill., Pathfinder Fund, 1983
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Hepatobiliary diseases: cholestasis and gallstones: proceedings of the Falk Workshop held in Cluj-Napoca, Romania, June 9-10, 2000. Author: edited by M. Acalovschi, G. Paumgartner; Year: 2001; Dordrecht; Boston: Kluwer Academic, c2001; ISBN: 0792387708 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0792387708/icongroupin terna
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Indigestion: living better with upper intestinal problems from heartburn to ulcers and gallstones. Author: Henry D. Janowitz; Year: 1992; New York: Oxford University Press, 1992; ISBN: 0195063082 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0195063082/icongroupin terna
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Introduction to the differential diagnosis of the separate forms of gallstone disease , based upon his own experience gained in 433 laparotomies for gallstones, by Professor Hans Kehr ... Authorized translation by William Wotkyns Seymour... with an introd. Author: Kehr, Hans, 1862-1916; Year: 1901; Philadelphia, P. Blakiston's son & co., 1901
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Liver disease and gallstones: the facts. Author: Alan G. Johnson and David R. Triger; Year: 1987; Oxford; New York: Oxford University Press, 1987; ISBN: 019261505X http://www.amazon.com/exec/obidos/ASIN/019261505X/icongroupi nterna
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Studies on the etiology of gallstones; a subtilis-like bacilli-group as an etiologic factor, by Karl Mårtensson ... Author: Mårtensson, Karl; Year: 1941; [Stockholm] Nordisk rotogravyr [1941]
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Surgery of the liver and biliary tract. Author: edited by L.H. Blumgart and Y. Fong; Year: 2000; London; New York: W.B. Saunders, 2000; ISBN: 0702025011 http://www.amazon.com/exec/obidos/ASIN/0702025011/icongroupin terna
Chapters on Gallstones Frequently, gallstones will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with gallstones, an excellent source of abstracts is the Combined Health
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Information Database. You will need to limit your search to book chapters and gallstones using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “gallstones” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on gallstones: ·
Pancreatitis in Inflammatory Bowel Disease Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 329-332. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 5687281. Fax (905) 522-7839. Email:
[email protected]. Website: www.bcdecker.com. Price: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: This chapter on pancreatitis is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and Ulcerative Colitis (UC), together known as inflammatory bowel disease (IBD). There is a higher incidence and prevalence of pancreatitis in patients with inflammatory bowel disease (IBD) than in the general population. The pancreatitis can be acute or chronic, or subclinical or overt, and has many causes. The most common cause is medications used to treat IBD, especially azathioprine and 6 mercaptopurine. Other causes of pancreatitis include duodenal involvement from Crohn's disease (CD), gallstones (cholelithiasis), and primary sclerosing cholangitis (PSC). Pancreatitis also can be caused by high serum concentrations of triglycerides during total parenteral nutritional (TPN) therapy for CD, and may also be a primary extra-intestinal manifestation of IBD. Treatment is different for each cause. For drug-induced pancreatitis, discontinuation of the drug should improvethe pancreatitis. For TPNinduced pancreatitis, oral medium-chain triglycerides should be substituted for the lipid emulsion. For pancreatitis that has developed from gallstones, the usual treatment is laparoscopic cholecystectomy (removal of the gallbladder). Idiopathic (of unknown cause) pancreatitis is often successfully treated by treating the underlying IBD. 1 table. 10 references.
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Diet and Gastrointestinal Problems Source: in Townsend, C.E. and Roth, R.A. Nutrition and Diet Therapy. 7th ed. Albany, NY: Delmar Publishers. 1999. 343-360 p. Contact: Available from Delmar Publishers. 3 Columbia Circle, Albany, NY 12212. (800) 865-5840. E-mail:
[email protected]. Price: $44.95 plus shipping and handling. ISBN: 0766802965. Summary: This chapter on diet and gastrointestinal problems is from an undergraduate textbook on nutrition and diet therapy. The chapter describes the uses of diet therapy in gastrointestinal illness; identifies foods allowed and disallowed in the therapeutic diets covered; and helps readers learn to adapt normal diets to meet the requirements of various illnesses. The authors note that disturbances of the gastrointestinal tract require many different therapeutic diets. Peptic ulcers are treated with drugs, and diet therapy generally involves only avoiding alcohol and caffeine. Diverticulosis may be treated with a high fiber diet, whereas diverticulitis is treated with a gradual progression from a clear liquid to a high fiber diet. Ulcerative colitis may require a low residue diet combined with high protein and high kcal. Cirrhosis (liver scarring) requires a substantial, balanced diet, with occasional restrictions on fat, protein, salt, or fluids. Diet therapy for hepatitis can include a full, well balanced diet, although protein may be restricted, depending on the patient's condition. Patients with cholecystitis (gallbladder infection) and cholelithiasis (gallstones) require a fat restricted diet and, in cases of overweight, a kcal restricted diet as well. Pancreatitis diet therapy ranges from total parenteral nutrition to an individualized diet as tolerated. The chapter includes lists of key terms to learn, recommended discussion topics, and suggested supplemental activities, and a section of review questions so readers can test their comprehension of the material. Two illustrative case studies are appended. 1 figure. 8 tables.
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Acute Pancreatitis Source: in Brandt, L., et al., eds. Clinical Practice of Gastroenterology. Volume Two. Philadelphia, PA: Current Medicine. 1999. p. 1159-1169. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Website: www.wbsaunders.com. Price: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: Acute pancreatitis varies from clinically mild to fulminating disease and has been recorded as a cause of sudden death. This chapter on acute pancreatitis is from a lengthy textbook that brings practitioners
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up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. Advances made in establishing biochemical and clinical criteria for the severity and prognosis of an attack of acute pancreatitis have markedly influenced the therapeutic approach. Early administration of improved antibiotics, the role of cytokine inhibitors, and the judicious use of endoscopic or surgical techniques to establish the etiology and treat the complications of the disease have reduced the mortality rate from acute pancreatitis (to about 5 to 10 percent for the acute attack). The author notes that the inability to reduce this mortality rate further, despite the increased understanding of the pathophysiology, is one of the more disappointing aspects of the disease. Topics include anatomy, anatomic abnormalities, physiology, etiology (alcohol and gallstones, medications, cancer of the pancreas, endoscopic retrograde cholangiopancreatography, idiopathic pancreatitis), mechanism (duct obstruction, direct toxic effect on acinar cells, neurohormonal mechanisms, vascular insufficiency, enzyme cytokine cascade), pathology, outcome, clinical features (differential diagnosis, assessment of severity, and early assessment of etiology), complications, special diagnostic tests, treatment options, and prognosis. 5 figures. 4 tables. 31 references. ·
Cholelithiasis and Cholecystitis Source: in Friedman, L.S. and Keeffe, E.B., eds. Handbook of Liver Disease. Philadelphia, PA: Churchill-Livingstone. 1998. p. 449-463. Contact: Available from W.B. Saunders Company. Book Order Fulfillment Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522. Fax (800) 874-6418. E-mail:
[email protected]. Price: $73.00 plus shipping and handling. ISBN: 0443055203. Summary: This chapter on cholelithiasis (gallstones) and cholecystitis (gallbladder infection) is from a comprehensive handbook in outline format that offers easy access to information on the full range of liver disorders and covers symptoms, signs, differential diagnoses, and treatments. There are two main types of gallstones: cholesterol and pigment. Pigment gallstones are further subdivided into black and brown varieties. The pathogenesis of cholesterol and pigment stones is different, but the clinical syndromes they cause are similar. Most gallbladder stones are asymptomatic. When they become symptomatic, biliary pain is the most common manifestation. Hallmarks of biliary pain are its episodic nature and location in the upper abdomen, usually in the right upper quadrant. Other conditions may coexist with gallstones and account for symptoms attributed initially to the stones. The treatment of choice for symptomatic gallbladder stones is laparoscopic cholecystectomy; when
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this approach is not feasible, open cholecystectomy is the alternative. Acute cholecystitis is the most common complication of gallstones and cholecystectomy is the treatment of choice. Consultation among the internist, gastroenterologist, surgeon, and radiologist is frequently warranted in order to arrive at the most efficient plan for care. Acute acalculous cholecystitis requires a high index of suspicion for diagnosis; patients are usually quite ill, and rapid therapy is necessary. 10 references. ·
Gastrointestinal Problems Including Colon Cancer Source: in Rosenfeld, J.A., ed. Women's Health in Primary Care. Baltimore, MD: Williams and Wilkins. 1997. p. 633-660. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-8555. Fax (800) 4478438. Price: $59.95 (paperback). ISBN: 0683073664. Summary: This chapter, from a book on women's health for primary care providers, reviews gastrointestinal problems in women. The chapter covers diseases of the upper GI tract, including gastroesophageal reflux disease (GERD), peptic ulcer disease, and gastric carcinoma; gallstones; liver diseases, including primary biliary cirrhosis, autoimmune liver disease, drug-induced liver disease, and alcoholic liver disease; and lower GI disease, including irritable bowel syndrome, inflammatory bowel disease, and colon cancer. For each disease, the author discusses incidence, risk factors, clinical symptoms, diagnosis, and treatment options. 1 figure. 8 tables. 90 references.
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Hepatobiliary Complications of Ulcerative Colitis and Crohn's Disease Source: in Snape, W.J., ed. Consultations in Gastroenterology. Philadelphia, PA: W.B. Saunders Company. 1996. p. 741-749. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Price: $125.00. ISBN: 0721646700. Summary: This chapter, from a gastroenterology yearbook, covers the hepatobiliary complications of ulcerative colitis (UC) and Crohn's disease. Although hepatobiliary abnormalities occur frequently in patients with inflammatory bowel disease (IBD), there are only three associated conditions of major clinical importance: primary sclerosing cholangitis (PSC), autoimmune chronic active hepatitis, and cholelithiasis (gallstones). The authors comment briefly on the latter two diseases, but concentrate primarily on PSC. PSC is a chronic, progressive, idiopathic, cholestatic liver disease that principally affects young men and is
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characterized by diffuse inflammation and fibrosis of the entire biliary tree. The natural history of PSC usually is one of slow progression with eventual development of cirrhosis, portal hypertension with its accompanying complications, and death from liver failure unless liver transplantation is performed. The authors discuss the etiology, clinical features, diagnosis, natural history and course, relationship to IBD, differential diagnosis, treatment, and complications of PSC. The authors note that patients with PSC and UC are doubly at risk for malignancies of the colon and biliary system. Medical therapies that may beneficially affect both PSC and UC are being assessed, and liver transplantation is life saving for patients with advanced PSC. 2 figures. 3 tables. 15 references. (AA-M). ·
Gastrointestinal Disease in the Aged Source: in Reichel, W., et al., eds. Care of the Elderly: Clinical Aspects of Aging. 4th ed. Baltimore, MD: Williams and Wilkins. 1995. p. 198-205. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 4478438 or (410) 528-8550. Price: $69.00 (as of 1996). ISBN: 0683072099. Summary: This chapter on gastrointestinal (GI) disease in the aged is from a text on the clinical aspects of aging. This chapter covers problems associated with the esophagus, the stomach, the small bowel and pancreas, and the colon and rectum; liver disease; biliary disease; and pancreatic disease. Specific conditions discussed include appendicitis, heartburn, dysphagia, drug-induced gastritis, gastroparesis, lactose intolerance, inflammatory bowel disease, diverticulosis, colon cancer, constipation, fecal incontinence, irritable bowel syndrome, jaundice, hepatitis, gallstones, pancreatitis, and pancreatic cancer. 1 table. 22 references.
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Gastrointestinal System Source: in Saxon, S.V.; Etten, M.J. Physical Change and Aging: A Guide for the Helping Professions. 3rd ed. New York, NY: Tiresias Press, Inc. 1994. p. 176-201. Contact: Available from Tiresias Press, Inc. 116 Pinehurst Avenue, New York, NY 10033. (212) 568-9570. Price: $24.90. ISBN: 0913292478. Summary: This chapter on the gastrointestinal (GI) system is from a guide for the helping professions on physical change and aging. Topics include components and functions of the GI system, including digestion, the mouth, the pharynx and esophagus, the stomach, the small intestine, liver, gallbladder, pancreas, and the large intestine; age-related changes
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in the mouth, esophagus, stomach, and other areas of the GI tract; and age-related disorders, including xerostomia, dysphagia, dental caries, periodontal disease, oral cancer, cancer of the esophagus, hiatal hernia, gastritis, peptic (gastric) ulcer, pernicious anemia, cancer of the stomach, appendicitis, diarrhea, constipation, diverticulosis, colorectal cancer, hemorrhoids, cirrhosis, and gallstones. The authors conclude that many functional disorders and diseases can very likely be avoided by more careful attention and adherence to healthy diets, regular exercise, stress reduction, and other positive lifestyle regimens. 1 figure. 29 references. ·
Nonsurgical Treatment of Gallstones Source: in Danzi, J.T.; Scopelliti, J.A., eds. Office Management of Digestive Diseases. Malvern, PA: Lea and Febiger. 1992. p. 112-118. Contact: Available from Lea and Febiger. Box 3024, Malvern, PA 193559725. (215) 251-2230. Price: $39.50. ISBN: 0812114361. Summary: This chapter, from a medical textbook about the office management of common gastrointestinal diseases, discusses the nonsurgical treatment of gallstones. Topics include clinical manifestations of gallstones, taking the family history and performing the physical examination, the pathogenesis of cholesterol gallstones and of pigment gallstones, oral dissolution therapy, contact dissolution therapy, and extracorporeal shock wave lithotripsy. 8 references.
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Indigestion and Dyspepsia, or the Stomach and Its Discontents: Getting the Words Right Source: in Janowitz, H.D. Indigestion: Living Better with Upper Intestinal Problems from Heartburn to Ulcers and Gallstones. New York, NY: Oxford University Press. 1992. p. 19-22. Contact: Available from Oxford University Press. Order Department, 2001 Evans Road, Cary, NC 27513. (800) 451-7556. Fax (919) 677-1303. Price: $11.95 plus shipping and handling. ISBN: 019508554X. Summary: This chapter on terminology is from a book that offers advice on how to take care of and avoid the whole complex of disturbances categorized as indigestion. The author reviews the different terms that patients and physicians use, including indigestion, dyspepsia, heartburn, belching (gas), and flatulence. These problems of indigestion (dyspepsia) are important because they are so common; perhaps as many as one quarter of the population will complain of some of these kinds of symptoms over a 6 month period. The author explores the different kinds of indigestion, including those related to organic disease (such as peptic ulcer, gallstones, or pancreatitis) and those that do not have an organic
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basis (functional disorders). In addition, the author emphasizes that functional disorders are very real, even if their diagnosis by classic measures such as x-rays is uncertain. Many functional disorders are due to problems in gastrointestinal motility, or the movement of the contents of the digestive tract. The author encourages readers to keep close track of their symptoms, as different symptoms point to different etiologies (causes) which can in turn be treated. ·
Acid in the Gullet: Heartburn, Esophagitis, and Hiatal Hernia Source: in Janowitz, H.D. Indigestion: Living Better with Upper Intestinal Problems from Heartburn to Ulcers and Gallstones. New York, NY: Oxford University Press. 1992. p. 41-57. Contact: Available from Oxford University Press. Order Department, 2001 Evans Road, Cary, NC 27513. (800) 451-7556. Fax (919) 677-1303. Price: $11.95 plus shipping and handling. ISBN: 019508554X. Summary: This chapter on acid related problems (heartburn, esophagitis, and hiatal hernia) is from a book that offers advice on how to take care of and avoid the whole complex of disturbances categorized as indigestion. The author reviews each of these three problems, covering their causes, symptoms, and the physiology of what is happening. Heartburn arises in the esophagus and results from the presence of the stomach's acid contents in the lower end of the esophagus. The acid has a direct irritating result because tissues there are not normally exposed to or prepared for the acid (compared to the stomach, which has a protective mucosal lining). The most important anatomical device protecting against heartburn is the lower esophageal sphincter (LES, which guards the opening between the esophagus and the stomach). The author explores the problem that can arise with a hiatal hernia, which can impair the LES's ability to prevent reflux of the stomach's contents into the esophagus. The LES pressure is also affected after a meal of fatty foods, by smoking, and by the presence of acid in the stomach (including the role of stomach emptying). The author also discusses diagnostic testing for acid reflux; treatment options, including habits and dietary modifications, and drug therapy; and general measures for relieving heartburn, including the role of exercise. Following is a discussion of the condition of active inflammation of the esophagus (esophagitis), including its diagnosis, medical treatment, surgery, and the problem of Barrett's esophagus. The chapter concludes with a discussion of the treatment options for hiatal hernia, focusing on the decision about surgical treatment for the condition.
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Peptic Ulcers: When the Stomach Digests Itself Source: in Janowitz, H.D. Indigestion: Living Better with Upper Intestinal Problems from Heartburn to Ulcers and Gallstones. New York, NY: Oxford University Press. 1992. p. 58-95. Contact: Available from Oxford University Press. Order Department, 2001 Evans Road, Cary, NC 27513. (800) 451-7556. Fax (919) 677-1303. Price: $11.95 plus shipping and handling. ISBN: 019508554X. Summary: This chapter on peptic ulcer disease (PUD) is from a book that offers advice on how to take care of and avoid the whole complex of disturbances categorized as indigestion. The author briefly reviews the function of gastric acid and pepsin in digesting food in the stomach, noting that at times this process malfunctions and the stomach can and does digest a part of its own lining or the lining of the duodenum. When this happens, the resulting injury is called a peptic ulcer, which is essentially a localized, usually circular, loss of surface lining of the stomach or duodenum, rarely more than an inch in diameter. The author describes how the stomach normally protects itself against damage from acid and pepsin, the risk factors for peptic ulceration (including cigarette smoking, genetic factors, the use of aspirin and other drugs, and the presence of helicobacter pylori bacteria), the symptoms of a peptic ulcer, and the complications of gastric and duodenal ulcer (obstruction, perforation, bleeding). Also discussed are diagnosis of PUD (including the diagnostic tests used), the differences between gastric and duodenal ulcers, the role of diet in therapy for ulcers, the importance of lifestyle changes (no tobacco, caffeine, or alcohol use), drug therapy (including antacids, H2 blockers, anticholinergic drugs, cytoprotective drugs), the Zollinger Ellison syndrome, drugs and substances which can injure the stomach and upper intestine, and the stomach after surgical procedures (long term complications and care). 5 tables.
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Non-Ulcer Dyspepsia: Indigestion Without a Label Source: in Janowitz, H.D. Indigestion: Living Better with Upper Intestinal Problems from Heartburn to Ulcers and Gallstones. New York, NY: Oxford University Press. 1992. p. 96-106. Contact: Available from Oxford University Press. Order Department, 2001 Evans Road, Cary, NC 27513. (800) 451-7556. Fax (919) 677-1303. Price: $11.95 plus shipping and handling. ISBN: 019508554X. Summary: This chapter on nonulcer dyspepsia (indigestion) is from a book that offers advice on how to take care of and avoid the whole complex of disturbances categorized as indigestion. The author reviews the uncomfortable upper abdominal symptoms that are indicative of this
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problem, noting that the discomfort usually occurs after eating and may include a feeling of bloating or distention. The overlap of this form of indigestion with other upper intestinal diseases means that an important part of the diagnostic problem is to eliminate any serious organic possibilities. Also discussed are how the diagnosis is established, including the crucial role of a detailed patient history, and the diagnostic tests that may be utilized. The author then reviews the management of patients with nonulcer dyspepsia (NUD), focusing on the concept of NUD as a motility problem. Topics include drug therapy, chronic intestinal pseudoobstruction, the use of parenteral nutrition to avoid or treat malnutrition, and the importance of a close working relationship between patient and physician. Many individuals are relieved both mentally and physically by the assurance of the nonorganic nature of their complaints, while many others desire and want relief and help. If the NUD fits the acid reflux pattern in the esophagus or resembles ulcerlike symptoms, the patient should be treated to prevent the possible development of these conditions. If the symptoms and studies show a disturbance in the motility process, a trial of prokinetic drugs may be useful.
General Home References In addition to references for gallstones, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Digestive System (21st Century Health and Wellness) by Regina Avraham; Library Binding (February 2000), Chelsea House Publishing (Library); ISBN: 0791055264; http://www.amazon.com/exec/obidos/ASIN/0791055264/icongroupinterna · American College of Physicians Complete Home Medical Guide (with Interactive Human Anatomy CD-ROM) by David R. Goldmann (Editor), American College of Physicians; Hardcover - 1104 pages, Book & CD-Rom edition (1999), DK Publishing; ISBN: 0789444127; http://www.amazon.com/exec/obidos/ASIN/0789444127/icongroupinterna · The American Medical Association Guide to Home Caregiving by the American Medical Association (Editor); Paperback - 256 pages 1 edition (2001), John Wiley & Sons; ISBN: 0471414093; http://www.amazon.com/exec/obidos/ASIN/0471414093/icongroupinterna
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· Anatomica : The Complete Home Medical Reference by Peter Forrestal (Editor); Hardcover (2000), Book Sales; ISBN: 1740480309; http://www.amazon.com/exec/obidos/ASIN/1740480309/icongroupinterna · The HarperCollins Illustrated Medical Dictionary : The Complete Home Medical Dictionary by Ida G. Dox, et al; Paperback - 656 pages 4th edition (2001), Harper Resource; ISBN: 0062736469; http://www.amazon.com/exec/obidos/ASIN/0062736469/icongroupinterna · Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems by Philip Hagen, M.D. (Editor), et al; Paperback - 279 pages, 2nd edition (December 15, 1999), Kensington Publishing Corp.; ISBN: 0962786578; http://www.amazon.com/exec/obidos/ASIN/0962786578/icongroupinterna · The Merck Manual of Medical Information : Home Edition (Merck Manual of Medical Information Home Edition (Trade Paper) by Robert Berkow (Editor), Mark H. Beers, M.D. (Editor); Paperback - 1536 pages (2000), Pocket Books; ISBN: 0671027263; http://www.amazon.com/exec/obidos/ASIN/0671027263/icongroupinterna
Vocabulary Builder Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Butterflies: Slender-bodies diurnal insects having large, broad wings often strikingly colored and patterned. [NIH] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU]
Diverticulitis:
Inflammation of a diverticulum, especially inflammation
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related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Duodenum: The first or proximal portion of the small intestine, extending from the pylorus to the jejunum; so called because it is about 12 fingerbreadths in length. [EU] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Dysphagia: Difficulty in swallowing. [EU] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Encephalopathy: Any degenerative disease of the brain. [EU] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Flatulence: The presence of excessive amounts of air or gases in the stomach or intestine, leading to distention of the organs. [EU] Gastritis: Inflammation of the stomach. [EU] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU]
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Perforation: 1. the act of boring or piercing through a part. 2. a hole made through a part or substance. [EU] Pernicious: Tending to a fatal issue. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU]
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CHAPTER 6. MULTIMEDIA ON GALLSTONES Overview Information on gallstones can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on gallstones. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on gallstones is the Combined Health Information Database. You will need to limit your search to “video recording” and “gallstones” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “gallstones” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on gallstones:
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Coping with Crohn's Disease Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1996. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. Price: $19.95 plus shipping and handling; bulk copies available. Order number 120296B. Summary: Chronic diarrhea and abdominal pain are the most common symptoms of Crohn's disease, an inflammatory bowel disease (IBD) that affects an increasing number of people each year. This videotape is one in a series of health promotion programs called 'Picture of Health,' produced by the University of Wisconsin. In this program, moderated by Mary Lee and featuring gastroenterologist John Wyman, the common symptoms, diagnosis, and management of Crohn's disease are covered. Crohn's disease can affect any area of the gastrointestinal (GI) tract, from the mouth to the anus. It can spread to other parts of the GI tract but is not a malignant disease. It does not spread like cancer. Surgery is often used for treatment, but will not result in cure of the disease. The most common site for Crohn's disease is the ileum, where the small and large intestines join. Dr. Wyman reviews other IBD conditions, including ulcerative colitis and ulcerative proctitis, and notes that these diseases are all treated by reducing inflammation, primarily with prednisone. Dr. Wyman then discusses the possible etiologies of Crohn's disease, including infectious, genetic, and immunologic factors, and describes the epidemiology of IBD, including geographic distribution and patterns in families. Other topics include the symptoms, diagnostic tests used to confirm the disease, health care providers that should be consulted, symptoms in children, drug therapies used for IBD, quality of life issues, and possible complications, including gallstones, malabsorption, renal (kidney) involvement, oral lesions, and arthritis. The program concludes by referring viewers to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
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Goodbye Gallstones Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1995. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. Price:
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$19.95 plus shipping and handling; bulk copies available. Order number 020195A. Summary: More than one million people will discover they have gallstones this year, and most will be women. Not all gallstones cause problems, but when they do, a variety of treatments are available. This videotape is one in a series of health promotion programs called 'Picture of Health,' produced by the University of Wisconsin. In this program, moderated by Mary Lee and featuring Dr. Eberhard Mack, the common symptoms, diagnosis, and management of gallstones are covered. Dr. Mack introduces the function of the gallbladder as a storage bag for bile, which is a 'detergent' produced by the liver that is used for digestion. Dr. Mack shows an illustration of the anatomy of the gastrointestinal tract, including the gallbladder, and describes where gallstones tend to form. Dr. Mack then shows actual gallstones, one a cholesterol stone, one a black pigment stone, and describes how gallstones form and the speed of growth of different types of stones. Risk factors for gallstones include being gender, being over 40, having a fair complexion (genetics), having a familial tendency, losing weight rapidly, and giving birth to many children. Symptoms include sudden onset of pain in the upper right quadrant of the abdomen, sometimes accompanied by nausea or vomiting. The pain is usually one to two hours in duration, as the gallstone passes. Some people have gallstones that are asymptomatic. Diagnostic considerations include patient history, abdominal film (xray), ultrasound, and cardiovascular testing (to rule out cardiovascular disease). Dr. Mack reviews the complications of gallstones, including gallstone pancreatitis, acute cholecystitis (infection of the gallbladder), hydrops, and jaundice. The program concludes by describing the use of open cholecystectomy, using a mini incision technique, and the use of laparoscopic cholecystectomy; Dr. Mack demonstrates the instruments used for the latter technique. The program concludes by referring viewers to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). ·
Laparoscopic Cholecystectomy: Gallbladder Removal by Laparoscopy Source: Camp Hill, PA: Chek-Med Systems, Inc. 1994. (videocassette). Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011. (800) 451-5797 or (717) 761-1170. Fax (717) 761-0216. Price: $120.00 each; $215.00 for two in series of 3; $295.00 for whole series. Summary: This patient education videotape provides a brief overview of the use of laparoscopy for the removal of the gallbladder (laparoscopic cholecystectomy). The videotape features a general introduction to the procedure of laparoscopy, noting that it usually results in less patient
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discomfort, a quicker recovery time, and lower cost. The program shows a series of patients expressing their concerns and the results they obtained with laparoscopy. The program then defines the role of the gallbladder, the development of gallstones, typical symptoms of gallbladder disease, and diagnostic considerations. After mention of the standard 'open' surgery previously used for gallbladder removal, the program covers the advantages, risk factors and patient selection issues for laparoscopic cholecystectomy. The program then uses graphics to show how the actual laparoscopic procedure is conducted. The program concludes by showing one patient's postoperative recovery period. The program features Dr. Paul Kunkel. ·
Laparoscopic Cholecystectomy: A Patient Education Program Source: New York, NY: American Journal Nursing Company. 1991. Contact: Available from AJN Company. Multimedia Products Division, 555 West 57th Street, New York, NY 10019-2961. (800) CALL-AJN. Fax (212) 586-5462. Price: $250 (purchase); $95 (rental). Summary: Laparoscopic cholecystectomy is rapidly supplanting traditional gallbladder removal. This patient education videotape is designed to answer common patient questions about gallstones and the procedure. The program discusses who is at risk for and describes gallstones; the symptoms of gallstones; and the laparoscopic procedure. The videotape includes actual views of the gallbladder through the laparoscope. The program also discusses laparoscopic cholecystectomy's advantages over open cholecystectomy and postoperative guidelines.
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” By making these selections and typing “gallstones” (or synonyms) into the “For these words:” box, you will only receive results on sound recordings (again, most diseases do not have results, so do not expect to find many). The following is a typical result when searching for sound recordings on gallstones:
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[Digestive Disease Week 1992 Sessions Audiocassettes] Source: Timonium, MD: Milner-Fenwick, Inc. 1992. (audiocassettes). Contact: Available from AGA Audiovisual Materials in Gastroenterology and Liver Disease. c/o Milner Fenwick, Inc., 2125 Greenspring Drive, Timonium, MD 21093-3100. Price: $15 per cassette; discount available for series purchase. Summary: These audiocassettes reproduce clinical symposia, research forums, and lectures sponsored by Digestive Disease Week (DDW). Topics available include the pathogenesis, diagnosis, and treatment of gastroesophageal reflux disease (GERD); controversial issues in acute pancreatitis; the epidemiology, pathogenetic mechanisms, and molecular biology of Helicobacter pylori; the physiological and psychological basis for functional gastrointestinal pain; the management of esophageal varices; obesity, weight loss, and gallstones; therapy of inflammatory bowel disease (IBD); and clinical management strategies for anemia, colon polyps, dyspepsia of unknown cause, dysphagia, achalasia, motility disorders, and liver enzyme abnormalities. Topics in lectures include: alcoholic hepatitis; vitamin status and the elderly; erythromycin, macrolides and motilin as prokinetic agents; gallbladder mucosal function; Crohn's disease; and antibiotic selection for gastroenterology practice.
Bibliography: Multimedia on Gallstones The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in gallstones (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on gallstones. For more information, follow the hyperlink indicated: ·
Bile and gallstones. Source: McMaster University, Health Sciences; Year: 1978; Format: Slide; [Hamilton, Ont.]: The University, c1978
·
Bile salts and gallstones. Source: American Gastroenterological Association; Year: 1974; Format: Slide; [Thorofare, N. J.]: The Association; [Baltimore, Md.: for loan and sale by Milner-Fenwick], c1974
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·
Can gallstones be dissolved. Source: Emory University School of Medicine; Year: 1975; Format: Videorecording; Atlanta: Georgia Regional Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library], 1975
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Cholecystectomy and common bile duct exploration with choledoc[h]oscopy. Source: an educational service provided by Glaxo; produced by Ciné-Med; Year: 1988; Format: videorecording; Woodbury, Conn.: Ciné-Med, c1988
·
Cholesterol gallstone formation. Source: American Gastroenterological Association; Year: 1974; Format: Slide; [Thorofare, N. J.]: The Association, 1974
·
Chronic viral fatigue syndrome : a real disease? Source: with Anthony Komaroff; Year: 1989; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c1989
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Clinical aspects of cholelithiasis. Source: American Gastroenterological Association; Year: 1974; Format: Slide; [Thorofare, N. J.]: The Association, 1974
·
CT scan of the abdomen, common abnormalities. Source: with Marvin J. Weingarten; Year: 1985; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1985
·
Diseases of the gall bladder : a photographic supplement for clinics or conferences. Source: produced and distributed through the courtesy of American Cyanamid Company, Surgical Products Division; by Hilger Perry Jenkins, Rudolph Janda, Douglas; Year: 1966; Format: Motion picture; United States: The Division, [1966]
·
Extracorporeal shockwave lithotripsy for gallstones. Source: author, Bruce D. Schirmer; co-author, R. Scott Jones; produced by DG, Davis & Geck, Medical Device Division; Year: 1990; Format: Videorecording; [Wayne, N.J.]: American Cyanamid Co., c1990
·
Focus, stomach pains. Source: a public service of the American College of Physicians, in association with MEDECommunications; a production of Silvermine Films, Inc; Year: 1985; Format: Videorecording; [Philadelphia, Pa.]: The College, c1985
·
Gall stones can be dissolved. Source: Dept. of Medicine, Emory University, School of Medicine; Year: 1978; Format: Videorecording; Atlanta: Georgia Regional Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library], 1978
·
Gallbladder: a study of structure and function; The formation of gallstones. Source: Trainex Corporation; Year: 1977; Format: Filmstrip; Garden Grove, Calif.: Trainex, c1977
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Gallbladder, a study of structure and function : the formation of gallstones. Source: Trainex Corporation; Year: 1977; Format: Videorecording; Garden Grove, Calif.: Trainex, c1977
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Gallstones : surgery or drugs. Source: presented by the Ohio Medical Education Network; Year: 1987; Format: Slide; [Columbus, Ohio]: The Network, [1987]
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Gallstones. Source: Time Life Medical; produced in association with Sonalysts Studios; Year: 1996; Format: Videorecording; New York, NY: Patient Education Media, c1996
·
Gastroenterology. Source: Robert M. Craig, Douglas R. Gracey; Year: 1977; Format: Sound recording; [Park Ridge, Ill.]: ASCME, p1977
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Interventional radiology in the biliary tree and biliary lithotripsy. Source: Radiological Society of North America; Year: 1990; Format: Videorecording; Oak Brook, Ill.: RSNA, c1990
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Moving X-rays. Source: produced by Nicholas Kaufmann; Year: 1938; Format: Motion picture; [Babelsburg, Germany]: UFA Films, Inc., c1938
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Nonsurgical treatment of gallstones. Source: with Susan Gordon and Ian Grimm; Year: 1989; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c1989
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Oral cholecystography. Source: American Gastroenterological Association; Year: 1974; Format: Slide; [Thorofare, N. J.]: The Association, 1974
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Pediatric gastroenterology. Source: Stephen F. Wang, Eddy D. Palmer; Year: 1974; Format: Slide; New York: Medcom, c1974
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Plain film radiographic diagnosis of gallstones and their complications. Source: Robert N. Berk; Year: 1978; Format: Slide; Westport, Conn.: Medical Education Programs, c1978
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Problems related to diagnosis of gallstones. Source: American Institute of Ultrasound in Medicine; Year: 1980; Format: Slide; [Bethesda, Md.]: The Institute, [1980]
·
Treatment of electric injury. Source: Brooke Army Medical Center; Year: 1972; Format: Videorecording; Fort Sam Houston, Tex.: The Center: [for loan by Academy of Health Sciences, Health Sciences Media Division, 1972]
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Treatment of gallstones. Source: produced in the facilities of Instructional Media Services Television; Year: 1988; Format: Videorecording; [Seattle, Wash.]: University of Washington, c1988
·
X-ray films for nursing instructors. Source: I. F. Hummon; Year: 1969; Format: Slide; Chicago: Hummon: [for sale by Micro X-ray Recorder, inc. Medical Film Slide Division, 1969?]
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·
X-ray findings associated with acquired hemolytic anemia. Source: M. I. Goldstein; produced by Ohio State University, Medical Audiovisual and Television Center; Year: 1972; Format: Videorecording; [Columbus, Ohio]: The Center, c1972
Vocabulary Builder Anus: The distal or terminal orifice of the alimentary canal. [EU] Cholecystography: Radiography of the gallbladder after ingestion of a contrast medium. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Macrolides: A group of organic compounds that contain a macrocyclic lactone ring linked glycosidically to one or more sugar moieties. [NIH] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Proctitis: Inflammation of the rectum. [EU]
Periodicals and News 113
CHAPTER 7. PERIODICALS AND NEWS ON GALLSTONES Overview Keeping up on the news relating to gallstones can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on gallstones. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover gallstones beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on gallstones is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “gallstones” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased.
Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to gallstones. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “gallstones” (or synonyms). The following was recently listed in this archive for gallstones: ·
Got gallstones? It may be in your genes: report Source: Reuters Health eLine Date: June 26, 2002 http://www.reuters.gov/archive/2002/06/26/eline/links/20020626elin 012.html
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Postmenopausal HRT a risk factor for gallstones Source: Reuters Industry Breifing Date: May 23, 2002 http://www.reuters.gov/archive/2002/05/23/business/links/20020523 clin026.html
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Cisapride may prevent gallstones in patients taking octreotide Source: Reuters Industry Breifing Date: December 18, 2001 http://www.reuters.gov/archive/2001/12/18/business/links/20011218 clin005.html
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Crohn's disease, multiple bowel resections increase risk of gallstones Source: Reuters Medical News Date: October 08, 2001 http://www.reuters.gov/archive/2001/10/08/professional/links/20011 008epid003.html
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·
Playing sports lowers risk of gallstones in obese Source: Reuters Health eLine Date: July 18, 2001 http://www.reuters.gov/archive/2001/07/18/eline/links/20010718elin 012.html
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ACAT2-deficient mice resist diet-induced hypercholesterolemia and gallstones Source: Reuters Medical News Date: December 01, 2000 http://www.reuters.gov/archive/2000/12/01/professional/links/20001 201scie003.html
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FDA approves Medstone's lithotripter for gallstones Source: Reuters Industry Breifing Date: September 08, 2000 http://www.reuters.gov/archive/2000/09/08/business/links/20000908 rglt008.html
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Vitamin C may help women steer clear of gallstones Source: Reuters Health eLine Date: April 10, 2000 http://www.reuters.gov/archive/2000/04/10/eline/links/20000410elin 016.html
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Researchers trace microscopic development of gallstones Source: Reuters Health eLine Date: January 26, 2000 http://www.reuters.gov/archive/2000/01/26/eline/links/20000126elin 003.html
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History of gallstones, smoking linked to gall bladder carcinoma Source: Reuters Medical News Date: September 23, 1999 http://www.reuters.gov/archive/1999/09/23/professional/links/19990 923epid004.html
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Cirrhosis markedly increases risk of gallstones Source: Reuters Medical News Date: January 14, 1999 http://www.reuters.gov/archive/1999/01/14/professional/links/19990 114clin006.html
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Regular Exercise Prevents Gallstones Source: Reuters Health eLine Date: March 16, 1998 http://www.reuters.gov/archive/1998/03/16/eline/links/19980316elin 003.html
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Vitamin C And Alcohol Fight Gallstones Source: Reuters Health eLine Date: March 03, 1998 http://www.reuters.gov/archive/1998/03/03/eline/links/19980303elin 005.html
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Small Gallstones Linked To Pancreatitis, Watchful Waiting 'Unwarranted' Source: Reuters Medical News Date: August 11, 1997 http://www.reuters.gov/archive/1997/08/11/professional/links/19970 811clin001.html
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Endoscopic Balloon Dilation A "Viable" Option For Treatment Of Gallstones Source: Reuters Medical News Date: April 21, 1997 http://www.reuters.gov/archive/1997/04/21/professional/links/19970 421clin004.html
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Isoform Of Apolipoprotein E: Risk Factor For Gallstones Source: Reuters Medical News Date: December 09, 1996 http://www.reuters.gov/archive/1996/12/09/professional/links/19961 209clin005.html
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Reduced Gallbladder Emptying May Lead To More Gallstones Source: Reuters Medical News Date: September 13, 1996 http://www.reuters.gov/archive/1996/09/13/professional/links/19960 913clin002.html
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date
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at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine. The following was recently indexed as relating to gallstones: ·
Got Gallstones? It May Be in Your Genes: Report http://www.nlm.nih.gov/medlineplus/news/fullstory_8264.html
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name. Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “gallstones” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “gallstones” (or synonyms). If you know the name of a company that is relevant to gallstones, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “gallstones” (or synonyms).
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Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “gallstones” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on gallstones: ·
Gallstones: A Common, Sometimes Serious Condition Source: Mayo Clinic Health Letter. 17(3): 7. March 1999. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: Most of the time, gallstones cause no symptoms and require no treatment. However, gallstones can sometimes be serious, even fatal, if left untreated. This brief report from the Mayo Clinic health newsletter offers information about gallstones. Most gallstones form when the patient's bile becomes chemically imbalanced and some of the cholesterol in the bile forms crystals. About 80 percent of gallstones produce no symptoms and require no treatment. Symptoms of gallstones can include episodes of intense, building pain in the upper abdomen; continuous (not intermittent) pain lasting 30 minutes to several hours; pain that may spread to the right shoulder blade or back; and nausea (sometimes with vomiting). Gallstones sometimes escape the gallbladder and enter nearby ducts. These migrating stones can cause serious complications and can be fatal if left untreated. The article outlines the risk factors for gallstones, including being female, being overweight, certain diet and dieting factors, age, and ethnicity. Gallstones that cause symptoms are usually treated by removing the gallbladder, a nonessential organ. Occasionally, conventional open abdominal surgery is the method of choice, but most often laparoscopic techniques are used. 1 figure.
·
Gallbladder Disease: What to Do About Troublesome Stones Source: Mayo Clinic Women's Healthsource. 3(9): 6. September 1999.
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Contact: Available from Mayo Foundation for Medical Education and Research. 200 First Street SW, Rochester, MN 55905. Summary: This health newsletter article offers guidelines to identifying and managing a gallstone attack. The author notes the risk factors for gallstones, including female gender, family history, being moderately overweight, losing weight rapidly, and taking estrogen pills. The author then briefly reviews the placement and function of the gallbladder, notably as the storage facility for liver bile (which helps the small intestine digest fat). Gallstones can be tiny or big and about 80 percent of the time, stones cause no problems. However, gallstones can block the exit from the gallbladder which is when the pain (biliary colic) begins. Gallbladder attacks are infrequent, occurring weeks, months, even years apart, and last from 30 minutes to several hours. Pain is the main symptom of gallstone disease. If the pain is severe and continuous in the upper abdomen and lasts for at least half an hour, the health care provider may recommend an ultrasound to confirm the presence of stones or other signs of gallbladder disease. The treatment for gallstones is usually cholecystectomy (gallbladder removal). Most often, the surgery is performed laparoscopically, which requires only three small incisions. Readers are reassured that gallstone attacks are usually infrequent, but if surgery is required, the cholecystectomy is a safe, common procedure. 2 figures. ·
Gallbladder Surgery: A Second Look at a First-Line Treatment Source: Harvard Health Letter. 22(1): 6-8. November 1996. Contact: Available from Harvard Health Letter. P.O. Box 420300, Palm Coast, FL 32142-0300. (800) 829-9045. Summary: This newsletter article reviews the differences between laparoscopy and open surgery for treating gallbladder disease. Unlike open gallbladder surgery, in which the surgeon makes an incision in the abdomen, the laparoscopic method requires only several tiny punctures in the belly to allow for the insertion of a small video camera and surgical instruments. The author reports results of a recent British study of 200 patients that showed that laparoscopic cholecystectomy (gallbladder removal) takes longer to do than mini-incision open surgery and offers no added benefit in recovery time, length of hospital stay, and time back to work. These results were in contrast to earlier evidence showing that people who undergo laparoscopy recover more quickly and with less pain and scarring than those treated with conventional open surgery. The author discusses the incidence of gallstones, the indications for cholecystectomy, rising rates of gallbladder removal, malpractice claims for bile duct injuries from laparoscopic cholecystectomy, and the
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differential diagnosis of gallbladder disease. The author stresses that the decision to have surgery is an individual one. People with infrequent gallstone attacks may be able to live with the prospect of having another down the road, while those whose episodes are more common or severe may find that laparoscopic cholecystectomy greatly improves the quality of their lives. 1 figure.
Academic Periodicals covering Gallstones Academic periodicals can be a highly technical yet valuable source of information on gallstones. We have compiled the following list of periodicals known to publish articles relating to gallstones and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on gallstones published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on gallstones: ·
American Journal of Surgery. (Am J Surg) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=A merican+Journal+of+Surgery&dispmax=20&dispstart=0
·
Hepatology (Baltimore, Md. . (Hepatology) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=He patology+(Baltimore,+Md.+&dispmax=20&dispstart=0
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·
Investigative Radiology. (Invest Radiol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=In vestigative+Radiology&dispmax=20&dispstart=0
·
Journal of Gastroenterology and Hepatology. (J Gastroenterol Hepatol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Gastroenterology+and+Hepatology&dispmax=20&dispstart=0
·
Journal of Pediatric Surgery. (J Pediatr Surg) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Pediatric+Surgery&dispmax=20&dispstart=0
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Medical Hypotheses. (Med Hypotheses) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=M edical+Hypotheses&dispmax=20&dispstart=0
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The American Journal of Gastroenterology. (Am J Gastroenterol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+American+Journal+of+Gastroenterology&dispmax=20&dispstart=0
·
The British Journal of Surgery. (Br J Surg) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+British+Journal+of+Surgery&dispmax=20&dispstart=0
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The Journal of Clinical Investigation. (J Clin Invest) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Clinical+Investigation&dispmax=20&dispstart=0
·
World Review of Nutrition and Dietetics. (World Rev Nutr Diet) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=W orld+Review+of+Nutrition+and+Dietetics&dispmax=20&dispstart=0
·
Zeitschrift Fur Ernahrungswissenschaft. (Z Ernahrungswiss) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ze itschrift+Fur+Ernahrungswissenschaft&dispmax=20&dispstart=0
Vocabulary Builder Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol,
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particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH]
Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Punctures: Incision of tissues for injection of medication or for other diagnostic or therapeutic procedures. Punctures of the skin, for example may be used for diagnostic drainage; of blood vessels for diagnostic imaging procedures. [NIH]
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CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.23 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:24 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
·
HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
·
NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
·
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
·
Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 24 See http://www.nlm.nih.gov/databases/databases.html. 23
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·
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat gallstones, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and gallstones using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “gallstones” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with gallstones. The following is a sample result:
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·
Digestive Diseases in the United States: Epidemiology and Impact Source: Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 1994. 799 p. Contact: Available from National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. (800) 8915389 or (301) 654-3810. E-mail:
[email protected]. Price: $15.00. Summary: This monograph is a compendium of descriptive statistics about the scope and impact of digestive diseases in the United States. Each chapter provides national and population data based on the prevalence, incidence, medical care, disability, mortality, and research needs. Twenty chapters cover the following conditions: infectious diarrheas, viral hepatitis, esophageal cancer, gastric cancer, colorectal cancer, liver cancer, pancreatic cancer, hemorrhoids, esophageal diseases, peptic ulcer, gastritis and nonulcer dyspepsia, acute appendicitis, abdominal wall hernia, inflammatory bowel diseases, diverticular disease of the colon, constipation, irritable bowel syndrome, chronic liver disease and cirrhosis, gallstones, and pancreatitis. These chapters compare the impact and costs of the disease to other diseases. The book also includes an overview chapter, a chapter about the cost of digestive diseases in the United States, and a listing of all digestive diseases diagnostic codes for the ninth and tenth editions of the International Classification of Diseases. Extensive figures are used throughout the volume. 3 appendices.
·
Health Risks of Weight Loss. Third Edition Source: Hettinger, ND: Healthy Living Institute, 160p., 1995. Contact: Healthy Weight Journal, Healthy Living Institute, 402 South 14th Street, Hettinger, ND 58639. (701) 567-2646. Summary: This report brings together scientific evidence on the health risks of weight loss interventions, including dieting, weight loss surgery, diet pills, semi-starvation, purging, rapid weight loss, eating disorders, and weight cutting in sports. It establishes many current weight loss treatment methods as health risks, with a wide range of adverse physical and mental effects: from gallstones to bone fractures to death. This is the third edition of the book, and it includes 15 chapters.
·
ERCP: Locating and Treating Common Bile Duct Blockages Source: San Bruno, CA: StayWell Company. 1999. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-
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4512. E-mail:
[email protected]. Website: www.staywell.com. Price: $17.95 for pack of 50; plus shipping and handling. Summary: This patient education brochure describes endoscopic retrograde cholangiopancreatography (ERCP), a procedure used to view the common bile duct. ERCP is used to help located and treat blockages in the duct. Written in nontechnical language, the brochure describes how to prepare for the ERCP, what the patient can expect during the test itself, and when the patient will get the results. ERCP is most often done in a radiology or endoscopy suite. After the patient is sedated, the endoscope is placed into the throat and guided through the digestive tract. The scope lets the doctor see all the way through the esophagus, stomach, and duodenum to the opening of the common bile duct. The doctor can also insert instruments. As blockages are located and removed, x rays are taken. The most common blockages are gallstones, which can often be removed during ERCP. Stents (tubes) may also be placed in narrow places to allow bile to flow out. The day after the test, the patient can go back to a normal routine and diet. One section of the brochure illustrates the common bile duct and surrounding organs and describes how problems can occur. The brochure is illustrated with full color line drawings. 9 figures. ·
Laparoscopic Gallbladder Surgery. [Cirugia de la Vesicula Biliar por Laparoscopia] Source: San Bruno, CA: StayWell Company. 1998. 11 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $1.25 per copy; plus shipping and handling. Summary: Gallbladder problems can cause severe stomach pain and other distressing symptoms. To relieve this pain, patients may need to have their gallbladder removed. This patient education brochure describes laparoscopic cholescystectomy, a procedure used to remove the gallbladder. Written in nontechnical language, the brochure describes laparoscopic cholecystectomy as a technique that uses several small incisions instead of one large one (open surgery). The laparoscope (a thin tube with a camera and light in the end) allows the doctor to view the gallbladder on a monitor; the gallbladder is then removed through another small incision. The benefits of laparoscopy over open surgery include less discomfort after surgery, a shorter hospital stay, a faster recovery (days instead of weeks), and tiny scars instead of a long scar. The brochure reviews gallbladder anatomy and how gallstones (cholelithiasis) form. Diagnosis of gallstones includes medical history and physical exam, and diagnostic tests including ultrasound, blood tests,
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and computed tomography (CT scan). Risks and complications from gallbladder surgery can include excessive bleeding, infection, injury to surrounding organs, injury to the common duct, blood clots, and injury to the lower digestive tract (rare). The brochure outlines the details of each step of laparoscopic cholecystectomy, then includes a section on postoperative recovery. The brochure is illustrated with full color line drawings and is available in English or Spanish. 26 figures. ·
Gallbladder Surgery Book: Understanding Gallbladder Symptoms, Their Most Common Cause, and Your Treatment Options. Source: San Bruno, CA: Krames Communications. 1996. 11 p. Contact: Available from Krames Communications Order Department. 1100 Grundy Lane, San Bruno, CA 94066. (800) 333-3032. Fax (415) 2444512. Price: $1.60; bulk discounts available. Summary: This booklet provides patients with a readable guide to gallbladder surgery. No one knows for sure what causes gallbladder problems, but those at risk include women, often in their forties; women who have been pregnant; people who are overweight; people who eat large amounts of dairy products, animal fats, and fried foods; and people with a family history of gallbladder problems. This pamphlet uses fullcolor illustrations to discuss the symptoms of gallstones; prevention; the anatomy of the gallbladder; the types of gallstones; and evaluation and diagnosis. The booklet also reviews treatment options, including open cholecystectomy (removing the gallbladder through an incision in the abdomen), laparoscopic cholecystectomy, medications, and ERCP (endoscopic retrograde cholangiopancreatography). Other topics include preparation for surgery, what happens during surgery, and recovery in the hospital and at home. The booklet reassures readers that after surgery they should be able to live full and healthy lives.
·
Gallbladder Disease Source: Emeryville, CA: Parlay International. 1995. [4 p.]. Contact: Available from Parlay International. Box 8817, Emeryville, CA 94662-0817. (800) 457-2752. Website: www.parlay.com. Price: $20.00 per package of 50. Order number: 7033. Summary: Gallstones are one of the most common medical problems in the United States. This brochure offers basic information about gallstones, noting that their presence may indicate a diet too rich in saturated fats. Most gallstones are composed of cholesterol. As a general rule, bile acids keep cholesterol from becoming concentrated enough to form a stone. But if the amount of cholesterol in the bile is more than bile
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acids can handle, the cholesterol crystallizes and can form a stone. For many people, gallstones produce no symptoms. However, pain and inflammation occur when a gallstone obstructs the cystic duct (leading from the gallbladder to the bile duct) or the bile duct itself. The brochure lists the symptoms for which patients should consult their health care provider: sudden, intense pain in the upper-right side of the abdomen that moves to the right shoulder blade, fever, nausea or vomiting, loss of appetite, or jaundice. The brochure discusses how gallstones are diagnosed, treatment options, postoperative care and recovery. Treatment options covered include dissolution, gallstone lithotripsy (ultrasound), laparoscopic surgery, and open surgery. The brochure emphasizes that making dietary changes and adding an exercise program are two important components in staying healthy and avoiding recurrence. The brochure is illustrated with full-color photographs and a simple line drawing of the gallbladder and adjacent organs. ·
Your Liver Lets You Live Source: Cedar Grove, NJ: American Liver Foundation. 4 p. Contact: Available from American Liver Foundation. 1425 Pompton Avenue, Cedar Grove, NJ 07009. (800) 223-0179 or (201) 256-2550. Price: $0.25 each; $10 for 100 copies; $90 for 1000 copies; plus $2 per 100 copies for postage and handling. Summary: The normal functioning of the liver and symptoms and signs of liver disease are discussed. The liver diseases described are gallstones, viral hepatitis, fatty liver, alcoholic hepatitis, cirrhosis, and cancer. A few of the more common liver disorders in children are briefly described, including biliary atresia, chronic active hepatitis, galactosemia, Wilson's disease, Reyes syndromes, and cirrhosis.
·
Gallstones and Laparoscopic Cholecystectomy Source: JAMA. Journal of the American Medical Association. 269(8): 1018-1024. February 1993. Contact: Also available in booklet form (Volume 10, Number 3, September 14-16 1992) from the Office of Medical Applications of Research, National Institutes of Health, Federal Building, Room 618, Bethesda, MD 20892. Summary: This article presents the NIH consensus statement on Gallstones and Laparoscopic Cholecystectomy, as developed at the NIH Consensus Development Conference held in September 1992. The specific problems and patient issues that must be evaluated in dealing with this disease were addressed by surgeons, endoscopists, hepatologists,
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gastroenterologists, radiologists, epidemiologists, and representatives of the general public. After 2 days of presentations by medical experts and discussion by the audience, the consensus panel addressed six topics: which patients with gallstones should be treated, which patients should be treated with laparoscopic cholecystectomy, the alternative medical and surgical treatments of gallstone disease, the comparative results of laparoscopic cholecystectomy with open cholecystectomy and other available treatments, how bile duct stones should be detected and treated, and future directions for research in the prevention and management of gallstone disease and in laparoscopic surgery. The article concludes with a listing of the names and affiliations of the panel members, the speakers, and the planning committee. ·
All About Gall-Stones Source: London, England: British Digestive Foundation. 1993. 3 p. Contact: Available from British Digestive Foundation. 7 Chandos Street, London W1A 2LN England. Price: Single copy free. Summary: This patient education brochure provides basic information about gallstones. Written in a question-and-answer format, it addresses the role of bile in digestion and excretion of wastes; the prevalence of gallstones; what gallstones are made of; complications, including pain, jaundice, and shivering attacks; diagnostic tests used to determine if a patient has gallstones; treatment including; dissolution therapy and surgery; and the need for continuing research in this area. The brochure includes an insert summarizing guidelines for the early diagnosis of digestive disorders. This insert, entitled 'When Should I See My Doctor' lists symptoms that suggest a health care provider should be consulted. The brochure concludes with a brief description of the activities of the British Digestive Foundation.
·
Gallbladder Removal by Laparoscopy. [Extirpacion de la Vesicula Biliar por Laparoscopia] Source: Camp Hill, PA: Chek-Med Systems, Inc. 199x. 2 p. Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011. (800) 451-5797. Fax (717) 761-0216. Price: $22 per packet of 50 pamphlets for order of 3 to 10 packets; minimum order 3 packets. Discounts available for larger quantities and complete kits of gastroenterology pamphlets. Summary: This patient education brochure, available in English and Spanish, provides basic information about gallbladder removal by laparoscopy. Topics include the formation of gallstones; laparoscopy;
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laparoscopic cholecystectomy and the equipment used; the benefits of laparoscopic cholecystectomy; the complications associated with the procedure; other treatment options; and patient selection considerations. The brochure includes a blank space for the physician to provide individualized patient instructions. Simple line drawings illustrate some concepts. 2 figures.
The NLM Gateway25 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.26 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.27 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “gallstones” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category.
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 27 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 25 26
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Results Summary Category Items Found Journal Articles 343187 Books / Periodicals / Audio Visual 2561 Consumer Health 292 Meeting Abstracts 3093 Other Collections 100 Total 349233
HSTAT28 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.29 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.30 Simply search by “gallstones” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Coffee Break: Tutorials for Biologists31 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 30 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 31 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 28 29
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recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.32 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.33 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see http://www.lexical.com/Metaphrase.html.
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 33 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 32
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The Genome Project and Gallstones With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to gallstones. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).34 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “gallstones” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for gallstones: ·
Anemia, Dyserythropoietic Congenital, Type Ii Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?224100
·
Cholecystokinin a Receptor Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?118444
Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
34
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·
Cholelithiasis Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?600803
·
Cholestasis with Gallstone, Ataxia, and Visual Disturbance Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?214980
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Cholesterol Crystallization Inhibitor; Cci Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?118457
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Cytochrome P450, Subfamily Viia, Polypeptide 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?118455
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Erythrocyte Membrane Protein Band 4.1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?130500
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Glucose-6-phosphate Isomerase Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?172400
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Glycogen Storage Disease Vii Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?232800
·
Hemoglobin--beta Locus Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?141900
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever,
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immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html ·
Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html
·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html Entrez
Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
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·
Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
·
OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
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Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “gallstones” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database35 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html.
35
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The Genome Database36 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “gallstones” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in gallstones (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Blackwell’s Primary Care Essentials: Gastointestinal Disease by David W. Hay; Paperback, 1st edition (December 15, 2001), Blackwell Science Inc; ISBN: 0632045035; http://www.amazon.com/exec/obidos/ASIN/0632045035/icongroupinterna · Gastrointestinal Problems by Martin S. Lipsky, M.D. (Editor), Richard Sadovsky, M.D. (Editor); Paperback - 194 pages, 1st edition (August 15, Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission.
36
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2000), Lippincott, Williams & Wilkins Publishers; ISBN: 0781720540; http://www.amazon.com/exec/obidos/ASIN/0781720540/icongroupinterna · Rome II: The Functional Gastrointestinal Disorders by Douglas A. Drossman (Editor); Paperback - 800 pages, 2nd edition (March 1, 2000), Degnon Associates Inc.; ISBN: 0965683729; http://www.amazon.com/exec/obidos/ASIN/0965683729/icongroupinterna
Vocabulary Builder Ataxia: Failure of muscular coordination; irregularity of muscular action. [EU]
Shivering: Involuntary contraction or twitching of the muscles. It is a physiologic method of heat production in man and other mammals. [NIH] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [NIH]
Dissertations 141
CHAPTER 9. DISSERTATIONS ON GALLSTONES Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to gallstones. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Gallstones ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to gallstones. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with gallstones:
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·
An Investigation of the Relationship between Obesity and Demographic, Eating Habit, Nutrient Intake, and Health Status Factors among Adults by Boasi, Claire Bernadette, Edd from Temple University, 1986, 172 pages http://wwwlib.umi.com/dissertations/fullcit/8611814
·
Characterization of Non-insulin-dependent Diabetes Mellitus in an Amerindian Population: the New World Syndrome among the Mvskoke (non Insulin Dependent) by Valdez, Rodolfo Antonio, Phd from The Pennsylvania State University, 1991, 215 pages http://wwwlib.umi.com/dissertations/fullcit/9127439
·
Risk Factors for Gallbladder Disease by Ruhl, Constance E.; Phd from The Johns Hopkins University, 2001, 171 pages http://wwwlib.umi.com/dissertations/fullcit/3006336
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to gallstones is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
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PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with gallstones and related conditions.
Researching Your Medications 145
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with gallstones. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for gallstones. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of gallstones. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
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Your Medications: The Basics37 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of gallstones. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with gallstones take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for gallstones. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
37
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 147
·
About any terms or directions you do not understand.
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What to do if you miss a dose.
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If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for gallstones). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
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Reason taken
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Dosage
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Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
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Diet pills
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Vitamins
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Cold medicine
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Aspirin or other pain, headache, or fever medicine
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Cough medicine
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Allergy relief medicine
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Antacids
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Sleeping pills
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Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for gallstones. One such source
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is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.38 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of gallstones. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to gallstones: Monoctanoin ·
Local - U.S. Brands: Moctanin http://www.nlm.nih.gov/medlineplus/druginfo/monoctanoinloc al202380.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
38
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Ursodiol ·
Systemic - U.S. Brands: Actigall http://www.nlm.nih.gov/medlineplus/druginfo/ursodiolsystemi c202587.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with gallstones (including those with contraindications):39 ·
Fenofibrate http://www.reutershealth.com/atoz/html/Fenofibrate.htm
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Monoctanoin http://www.reutershealth.com/atoz/html/Monoctanoin.htm
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Sibutramine Hydrochloride http://www.reutershealth.com/atoz/html/Sibutramine_Hydrochloride. htm
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information in Mosby’s GenRx database can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
39
Adapted from A to Z Drug Facts by Facts and Comparisons.
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Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with gallstones--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat gallstones or potentially create deleterious side effects in patients with gallstones. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense.
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Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with gallstones. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with gallstones. The FDA warns patients to watch out for40: ·
Secret formulas (real scientists share what they know)
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Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
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Quick, painless, or guaranteed cures
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If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
40
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Drug Development: Molecular Targets for Gi Diseases by Timothy S. Gaginella (Editor), Antonio Guglietta (Editor); Hardcover - 288 pages (December 1999), Humana Press; ISBN: 0896035891; http://www.amazon.com/exec/obidos/ASIN/0896035891/icongroupinterna · Drug Therapy for Gastrointestinal and Liver Diseases by Michael J.G. Farthing, M.D. (Editor), Anne B. Ballinger (Editor); Hardcover - 346 pages, 1st edition (August 15, 2001), Martin Dunitz Ltd.; ISBN: 1853177334; http://www.amazon.com/exec/obidos/ASIN/1853177334/icongroupinterna · Immunopharmacology of the Gastrointestinal System (Handbook of Immunopharmacology) by John L. Wallace (Editor); Hardcover (October 1997), Academic Press; ISBN: 0127328602; http://www.amazon.com/exec/obidos/ASIN/0127328602/icongroupinterna · A Pharmacologic Approach to Gastrointestinal Disorders by James H. Lewis, M.D. (Editor); Hardcover – (February 1994), Lippincott, Williams & Wilkins; ISBN: 0683049704; http://www.amazon.com/exec/obidos/ASIN/0683049704/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Systemic: Pertaining to or affecting the body as a whole. [EU]
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to gallstones. Finally, at the conclusion of this chapter, we will provide a list of readings on gallstones from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?41 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 41
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?42 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
42
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.43
43
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Gallstones Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for gallstones. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required. The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “gallstones” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
Fiber Supplements: New Thoughts, New Choices Source: Alternative and Complementary Therapies. 4(4): 267-275. August 1998.
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Summary: This journal article summarizes research into the therapeutic uses of specific fiber supplements. The first part provides background information about dietary fiber, its basic actions, and the amount of fiber needed for optimum health. The second part discusses the two general categories of fiber, water soluble and water insoluble, and their mechanisms of action in the human body. The third section summarizes evidence of the actions of specific fiber supplements (psyllium, pectin, guar gum, flaxseeds, oat bran, and wheat bran) in such conditions as colitis, colon and breast cancer, constipation, diarrhea, dysbiosis, hypercholesterolemia, diabetes, and gallstones The fourth section discusses two concerns about fiber supplementation: (1) the need for increased water intake to prevent excessive gas production and constipation, and (2) the possibility of fiber-induced mineral deficiencies, particularly in the elderly. The final section offers recommendations regarding the preferred fiber supplements for the treatment or prevention of specific conditions. The article has 1 table and 112 references. ·
Serum Ascorbic Acid and Other Correlates of Gallbladder Disease Among US Adults Source: American Journal of Public Health. 88(8): 1208-1212. August 1998. Summary: This journal article describes a study of the association between serum ascorbic acid levels and risk of gallbladder disease in humans. Data from 9,110 participants, aged 20 to 74 years, were available from the second National Health and Nutrition Examination Survey, conducted between 1976 and 1980. A total of 384 women (8 percent) and 107 men (3 percent) reported a history of gallstone disease, and 347 women (7 percent) and 81 men (2 percent) reported that their gallbladder had been surgically removed. In women, increasing age, body mass index, number of children, white race, low levels of leisure time physical activity, smoking, and diabetes were associated with an increased prevalence of gallstones. Women with higher intakes of dietary fat had a slightly lower prevalence of gallstones. In men, increasing age and use of diuretic and cholesterol-lowering medications were associated with increased prevalence of gallstones. A U-shaped relationship between serum ascorbic acid levels and clinical gallbladder disease was found among women but not men. In women, higher serum ascorbic acid levels were independently associated with a 50 percent lower prevalence of gallbladder disease, and lower serum ascorbic acid levels were associated with a 30 percent lower prevalence. The authors discuss possible explanations for the findings. The article has 2 figures, 3 tables, and 31 references.
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·
Relation of Physical Activity to Risk for Symptomatic Gallstone Disease in Men Source: Annals of Internal Medicine. 128(6): 417-425. March 15, 1998. Summary: This journal article describes a study of the relationship between physical activity and risk for symptomatic gallstone disease in men. The sample consisted of 45,813 male health professionals, aged 40 to 75 years, who were followed from 1986 to 1994. Every 2 years, participants completed questionnaires asking about physical activity patterns, professionally diagnosed gallstone disease and other medical conditions, age, body weight, dietary intake, alcohol consumption, smoking habits, and medication use. During 324,263 person-years of followup, 828 men reported having newly symptomatic gallstones (diagnosed by ultrasonography or radiography) or having undergone cholecystectomy for recent symptoms. After adjusting for multiple confounders, increased physical activity was inversely related to risk for symptomatic gallstone disease. When the extremes were compared, this association was stronger in men younger than 65 years of age than in men age 65 years or older. Sedentary behavior was positively related to risk for symptomatic gallstone disease. Men who watched television more than 40 hours per week had a significantly higher risk for symptomatic gallstones than did men who watched less than 6 hours per week. The authors conclude that physical activity may play an important role in the prevention of symptomatic gallstone disease in men. The article has 5 tables and 62 references.
·
Prevention's Healing With Vitamins: The Most Effective Vitamin and Mineral Treatments for Everyday Health Problems and Serious Disease Source: Emmaus, PA: Rodale Press, Inc. 1996. 593 p. Contact: Rodale Press, Inc. 33 East Minor Street, Emmaus, PA 18098. 800527-8200. Price: $31.95 (hardback), $17.95 (paperback). ISBN: 0875962920 (hardback), 157954018X (paperback). Summary: This book provides information on vitamins and minerals that are thought to have some effect on health. Part 1 describes some of the most popular vitamins and minerals, and includes a list of foods that contain these substances, suggests the amount needed per day, and provides instructions on safe usage. The vitamins and minerals discussed include beta-carotene, biotin, folic acid, iron, magnesium, niacin, phosphorus, selenium, sodium, sulfur, zinc, trace minerals, and vitamins A, B6, B12, C, D, E, and K. Part 2 lists 91 diseases and conditions that could benefit from vitamin supplementation, including allergies, Alzheimer's disease, bedsores, bladder infections, cancer,
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cardiomyopathy, cold sores, diabetes, diarrhea, fatigue, gallstones, genital herpes, hair loss, leg cramps, migraines, psoriasis, scleroderma, sunburn, tinnitus, wrinkles, and yeast infections. This book contains an index.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to gallstones and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “gallstones” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to gallstones: ·
Adjuvant herbal treatment for gallstones. Author(s): Hoffmann J, Raahave D. Source: The British Journal of Surgery. 1993 July; 80(7): 945. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8369949&dopt=Abstract
·
Adjuvant herbal treatment for gallstones. Author(s): Johnston PW. Source: The British Journal of Surgery. 1992 August; 79(8): 845. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1393494&dopt=Abstract
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Adjuvant herbal treatment for gallstones. Author(s): Everson NW. Source: The British Journal of Surgery. 1992 July; 79(7): 713-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1643497&dopt=Abstract
·
Adjuvant herbal treatment for gallstones. Author(s): Savage AP, O'Brien T, Lamont PM.
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Source: The British Journal of Surgery. 1992 February; 79(2): 168. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1555068&dopt=Abstract ·
Advances in the treatment of cholelithiasis by expulsion of the gallstones. Author(s): He RL. Source: J Tradit Chin Med. 1986 June; 6(2): 135-40. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3534469&dopt=Abstract
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Alimentary production of gallstones in hamsters. 23. Influence of hydrogenated palm oil and hydrogenated palm oil in mixture with sunflower seed oil, on the ratio between lipid-soluble phosphorus and cholesterol in the bladder bile. Author(s): Prange I, Dam H. Source: Zeitschrift Fur Ernahrungswissenschaft. 1971 December; 10(4): 303-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5161169&dopt=Abstract
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Alimentary production of gallstones in hamsters. 27. Influence of supplementation of the gallstone producing diet with squalene, cholesterol, certain other sterols, fish oil fatty acid ethyl esters, and modification of the basal diet on gallstone production and levels of cholesterol in serum and liver. Author(s): Dam H, Prange I, Sondergaard E. Source: Zeitschrift Fur Ernahrungswissenschaft. 1974 December; 13(4): 208-36. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4615449&dopt=Abstract
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APF/CBP, the small, amphipathic, anionic protein(s) in bile and gallstones, consists of lipid-binding and calcium-binding forms. Author(s): Lafont H, Domingo N, Groen A, Kaler EW, Lee SP, Koehler R, Ostrow JD, Veis A. Source: Hepatology (Baltimore, Md.). 1997 May; 25(5): 1054-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9141417&dopt=Abstract
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Apple juice and the chemical-contact softening of gallstones. Author(s): Dekkers R. Source: Lancet. 1999 December 18-25; 354(9196): 2171. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10609857&dopt=Abstract
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Ascorbic acid and cholesterol gallstones. Author(s): Simon JA. Source: Medical Hypotheses. 1993 February; 40(2): 81-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8455479&dopt=Abstract
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Basic studies on N''-ursodeoxycholyldiethylenetriamine-N,N,N'triacetic acid for the dissolution of calcified gallstones. Author(s): Takahashi M, Konishi T, Maeda Y, Fukuzawa M, Nishida T, Ohya T, Katayama K, Kakehi N, Sakakura H, Takagi A, Maeda M, Ohama H. Source: Biol Pharm Bull. 1998 June; 21(6): 551-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9657036&dopt=Abstract
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Chemical dissolution of gallstones in Taiwan: an in vitro study. Author(s): Lin XZ, Chou TC, Lin PW, Chou YL, Li CC, Chen SK. Source: Journal of Gastroenterology and Hepatology. 1994 March-April; 9(2): 143-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8003647&dopt=Abstract
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Current treatment modalities for symptomatic gallstones. Author(s): Plaisier PW, van der Hul RL, Terpstra OT, Bruining HA. Source: The American Journal of Gastroenterology. 1993 May; 88(5): 6339. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8480723&dopt=Abstract
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Diet and gallstones in Italy: the cross-sectional MICOL results. Author(s): Attili AF, Scafato E, Marchioli R, Marfisi RM, Festi D. Source: Hepatology (Baltimore, Md.). 1998 June; 27(6): 1492-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9620318&dopt=Abstract
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Disappearing gallstones. Author(s): Thorley K. Source: Lancet. 1984 June 2; 1(8388): 1247-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6144968&dopt=Abstract
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Dissolution of calcified gallstones. Part II. Evaluation of edetic acid preparations for dissolution of residue after in vitro methyl tert-butyl ether treatment. Author(s): Kammer B, Brink JA, Knoefel WT, Mueller PR, Prien EL, Ferrucci JT. Source: Investigative Radiology. 1994 April; 29(4): 454-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8034452&dopt=Abstract
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Dissolution of calcium bilirubinate and calcium carbonate debris remaining after methyl tert-butyl ether dissolution of cholesterol gallstones. Author(s): Nelson PE, Moyer TP, Thistle JL. Source: Gastroenterology. 1990 May; 98(5 Pt 1): 1345-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2323524&dopt=Abstract
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Dissolution of gallstones. Author(s): Plaisier PW, Vergunst H, Terpstra OT. Source: Digestive Diseases (Basel, Switzerland). 1993; 11(3): 181-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8370143&dopt=Abstract
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Does spinal manipulation really cure gallstones? Alternative medicine and the general surgeon. Author(s): Zannis VJ. Source: American Journal of Surgery. 2000 December; 180(6): 389-95. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11182384&dopt=Abstract
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Etiology, pathogenesis and therapy of pigment gallstones. Author(s): Leuschner U, Guldutuna S, Hellstern A.
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Source: Digestive Diseases (Basel, Switzerland). 1991; 9(5): 282-93. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1752067&dopt=Abstract ·
Evaluation of garlic oil as a contact dissolution agent for gallstones: comparison with monooctanoin. Author(s): Nijhawan S, Agarwal V, Sharma D, Rai RR. Source: Trop Gastroenterol. 2000 October-December; 21(4): 177-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11194578&dopt=Abstract
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In vitro dissolution of cholesterol and brown pigmented gallstones: a comparison of MTBE, DMSO and BA-EDTA. Author(s): Cheng JS, Lai KH, Lo GH, Ng WW, Tam TN, Huang SM. Source: Zhonghua Yi Xue Za Zhi (Taipei). 2000 September; 63(9): 667-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11037641&dopt=Abstract
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Is vegetarianism a precipitating factor for gallstones in cirrhotics? Author(s): Jayanthi V, Malathi S, Ramathilakam B, Mathew S, Prasanthi R, Srinivasan V. Source: Trop Gastroenterol. 1998 January-March; 19(1): 21-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9641029&dopt=Abstract
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Isolation of an acidic protein from cholesterol gallstones, which inhibits the precipitation of calcium carbonate in vitro. Author(s): Shimizu S, Sabsay B, Veis A, Ostrow JD, Rege RV, Dawes LG. Source: The Journal of Clinical Investigation. 1989 December; 84(6): 19906. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2592569&dopt=Abstract
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Monoconjugated bilirubin is a major component of hemolysis-induced gallstones in mice. Author(s): Trotman BW, Nair CR, Bernstein SE. Source: Hepatology (Baltimore, Md.). 1988 July-August; 8(4): 919-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3391522&dopt=Abstract
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Mucin glycoprotein content of human pigment gallstones. Author(s): LaMont JT, Ventola AS, Trotman BW, Soloway RD. Source: Hepatology (Baltimore, Md.). 1983 May-June; 3(3): 377-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6840683&dopt=Abstract
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Nonsurgical removal of gallstones in China: a blend of Chinese and western medicine. Author(s): Pollak OJ. Source: Del Med J. 1981 October; 53(10): 531-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7338284&dopt=Abstract
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Nutritional aspects of gallstone formation with particular reference to alimentary production of gallstones in laboratory animals. Author(s): Dam H. Source: World Review of Nutrition and Dietetics. 1969; 11: 199-239. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4904292&dopt=Abstract
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Polymer networks in pigment and cholesterol gallstones assessed by equilibrium swelling and infrared spectroscopy. Author(s): Ohkubo H, Ostrow JD, Carr SH, Rege RV. Source: Gastroenterology. 1984 October; 87(4): 805-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6468871&dopt=Abstract
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Pure calcium carbonate gallstones in a two year old in association with prenatal calcium supplementation. Author(s): Powell RW. Source: Journal of Pediatric Surgery. 1985 April; 20(2): 143-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4009360&dopt=Abstract
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Sunbathing and gallstones. Author(s): Pavel S. Source: Lancet. 1992 January 25; 339(8787): 241-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1346190&dopt=Abstract
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The etiology of pigment gallstones. Author(s): Ostrow JD. Source: Hepatology (Baltimore, Md.). 1984 September-October; 4(5 Suppl): 215S-222S. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6434394&dopt=Abstract
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The varied uses of gallstones. Author(s): Aronson SM. Source: R I Med J. 1991 December; 74(12): 569-70. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1763274&dopt=Abstract
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Treatment with bovine gallstones exacerbates liver damage, but enhances hepatoprotection by bear gall powder in carbon tetrachlorideintoxicated rats. Author(s): Nakashima T, Matsumoto N, Kashima K. Source: Jpn J Pharmacol. 1998 March; 76(3): 271-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9593220&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to gallstones; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Gallstones Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Gallstones Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000277.html
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Alternative Therapy Iridology Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,709, 00.html Reflexology Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,730, 00.html
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Homeopathy Berberis vulgaris Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Berberis_vu lgaris.htm Calcarea carbonica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Calcarea_ca rbonica.htm Chelidonium majus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Chelidoniu m_majus.htm Colocynthis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Colocynthis. htm Dioscorea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Dioscorea.h tm Lycopodium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Lycopodiu m.htm Podophyllum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Podophyllu m.htm ·
Herbs and Supplements Ampicillin
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Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Antibiotics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Antioxidants Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Antioxidants Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Azathioprine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Azathioprine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Beta-Blockers Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Boldo Alternative names: Peumus boldus
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Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Boldo.htm Boldo Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000277.html Boswellia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Celandine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000277.html Chamomile Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Corticosteroids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Corticosteroids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Culver's Root Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsa-c.htm Curcuma longa Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Turmericch. html Dandelion Alternative names: Taraxacum officinale Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Dandelion.htm Dandelion Alternative names: Taraxacum officinale Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Dandelionc h.html Dandelion Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000143.html Dandelion Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 21,00.html Devil’s Claw Alternative names: Harpagophytum procumbens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Devils_Claw.htm Devil's Claw Alternative names: Harpagophytum procumbens, Harpagophytum zeyheri Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DevilsClaw ch.html Devil's claw Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,970, 00.html Diuretics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Ginger Alternative names: Zingiber officinale Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ginger.htm Ginger Alternative names: Zingiber officinale Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Gingerch.ht ml Ginger Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,787, 00.html Ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Glucosamine Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Greater Celandine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000277.html Harpagophytum procumbens Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DevilsClaw ch.html Harpagophytum zeyheri Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DevilsClaw ch.html Herbal Medicine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Insulin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Lecithin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Linden Alternative names: Tilia spp. Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Linden.htm Lipotropic combination Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,861, 00.html Loperamide Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Lysine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Lysine.htm Lysine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000194.html Mentha x piperita Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Peppermint ch.html Mesalamine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Milk Thistle Alternative names: Silybum marianum, Carduus marianus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Milk_Thistle.htm Milk Thistle Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000277.html Milk Thistle Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000209.html
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Milk Thistle Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 44,00.html N-Acetyl Glucosamine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Oral Contraceptives Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Peppermint Alternative names: Mentha piperita Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Peppermint.htm Peppermint Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Peppermint Alternative names: Mentha x piperita Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Peppermint ch.html Peppermint Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000220.html Peppermint Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000277.html
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Peppermint Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,812, 00.html Plantago psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Probiotics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Psyllium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Psyllium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,814, 00.html Senna Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Skullcap Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Sulfasalazine Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Sulfonamides Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Taraxacum officinale Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Dandelionc h.html Taurine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 59,00.html Thiazide Diuretics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Turmeric Alternative names: Curcuma longa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Turmeric.htm Turmeric Alternative names: Curcuma longa Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Turmericch. html Turmeric Source: Prima Communications, Inc.
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Hyperlink: http://www.personalhealthzone.com/pg000243.html Turmeric Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 62,00.html Zingiber officinale Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Gingerch.ht ml ·
Related Conditions Cholesterol, High Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html Gallbladder Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gallbla dderDiseasecc.html Herpes Alternative names: Genital Herpes, Cold Sores Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000281.html High Cholesterol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html Hypercholesterolemia Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html Inflammatory Bowel Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Malabsorption Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Malabsorption.htm Obesity Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obesit ycc.html Pancreas, Inflammation of Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Pancreatic Insufficiency Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Pancreatic_Insufficie ncy.htm Pancreatitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Ulcerative Colitis Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Weight Loss and Obesity Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Weight_Loss.htm
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Gastrointestinal Disorders and Nutrition by Tonia Reinhard; Paperback 192 pages (January 24, 2002), McGraw-Hill Professional Publishing; ISBN: 0737303611; http://www.amazon.com/exec/obidos/ASIN/0737303611/icongroupinterna · Healthy Digestion the Natural Way: Preventing and Healing Heartburn, Constipation, Gas, Diarrhea, Inflammatory Bowel and Gallbladder Diseases, Ulcers, Irritable Bowel Syndrome, and More by D. Lindsey Berkson, et al; Paperback - 256 pages, 1st edition (February 2000), John Wiley & Sons; ISBN: 0471349623; http://www.amazon.com/exec/obidos/ASIN/0471349623/icongroupinterna · No More Heartburn: Stop the Pain in 30 Days--Naturally!: The Safe, Effective Way to Prevent and Heal Chronic Gastrointestinal Disorders by Sherry A. Rogers, M.D.; Paperback - 320 pages (February 2000), Kensington Publishing Corp.; ISBN: 1575665107; http://www.amazon.com/exec/obidos/ASIN/1575665107/icongroupinterna
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For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH]
Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Radiography: The making of film records (radiographs) of internal structures of the body by passage of x-rays or gamma rays through the body to act on specially sensitized film. [EU] Sedentary: 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular
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structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU]
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with gallstones. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with gallstones may be given different recommendations. Some recommendations may be directly related to gallstones, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of gallstones. We will then show you how to find studies dedicated specifically to nutrition and gallstones.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
·
Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
·
Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
·
Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
·
Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:44 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
·
DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
44
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?45
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”46 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.47 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 46 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 47 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 45
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the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected]
Finding Studies on Gallstones The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.48 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
48
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periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “gallstones” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following information is typical of that found when using the “Full IBIDS Database” when searching using “gallstones” (or a synonym): ·
A case-control study of gallstones: a major risk factor for biliary tract cancer. Author(s): Division of Epidemiology, Aichi Cancer Center Research Institute, Kanokoden, Nagoya. Source: Kato, I Kato, K Akai, S Tominaga, S Jpn-J-Cancer-Res. 1990 JunJuly; 81(6-7): 578-83 0910-5050
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A useful cholesterol solvent for medical dissolution of gallstones. Author(s): Shionogi Research Laboratories, Shionogi & Co., Ltd., Osaka, Japan. Source: Igimi, H Watanabe, D Yamamoto, F Asakawa, S Toraishi, K Shimura, H Gastroenterol-Jpn. 1992 August; 27(4): 536-45 0435-1339
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Administration of a terpene mixture inhibits cholesterol nucleation in bile from patients with cholesterol gallstones. Source: von Bergmann, K Beck, A Engel, C Leiss, O Klin-Wochenschr. 1987 May 15; 65(10): 458-62 0023-2173
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Altered cholesterol metabolism in patients with cholesterol gallstones: responses to reduced dietary cholesterol. Source: Kern, F Trans-Am-Clin-Climatol-Assoc. 1992; 104235-40 00657778
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Ascorbic acid and cholesterol gallstones. Author(s): General Internal Medicine Section (111A1), San Francisco VA Medical Center, CA 94121. Source: Simon, J A Med-Hypotheses. 1993 February; 40(2): 81-4 0306-9877
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Basic studies on N''-ursodeoxycholyldiethylenetriamine-N,N,N'triacetic acid for the dissolution of calcified gallstones. Author(s): Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan. Source: Takahashi, M Konishi, T Maeda, Y Fukuzawa, M Nishida, T Ohya, T Katayama, K Kakehi, N Sakakura, H Takagi, A Maeda, M Ohama, H Biol-Pharm-Bull. 1998 June; 21(6): 551-7 0918-6158
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Comparative morphology of the gallbladder and biliary tract in vertebrates: variation in structure, homology in function and gallstones. Author(s): Department of Biological Sciences, Kent State University, Ohio 44242, USA. Source: Oldham Ott, C K Gilloteaux, J Microsc-Res-Tech. 1997 September 15; 38(6): 571-97 1059-910X
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Comparative studies on iodine levels in gallstones and bile of Japanese and Thais (Chiang Mai and Bangkok). Author(s): Center for Digestive Diseases, Second Hospital, Nippon Medical School, Kawasaki, Japan. Source: Naito, E Pausawasdi, A Miki, M Tanaka, M J-Med-Assoc-Thai. 1999 April; 82(4): 374-82 0125-2208
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Diet and gallstones in Italy: the cross-sectional MICOL results. Author(s): Cattedra di Gastroenterologia, Dipartimento di Medicina Clinica, Universita di Roma La Sapienza, Rome, Italy. Source: Attili, A F Scafato, E Marchioli, R Marfisi, R M Festi, D Hepatology. 1998 June; 27(6): 1492-8 0270-9139
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Diet and gallstones in women of a rural town of Sicily. Source: Montalto, G. Carroccio, A. Soresi, M. Cartabellotta, A. Lorello, D. Cavera, G. Averna, M.R. Barbagallo, C.M. Anastasi, G. Bascone, F. J-nutrenviron-med. Abingdon, U.K. : Carfax Publishing Company. June 1997. volume 7 (2) page 101-106. 1359-0847
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Diet, physical activity, and gallstones--a population-based, case-control study in southern Italy. Author(s): Laboratorio di Epidemiologia e Biostatistica, Istituto di Ricovero e Cura a Carattere Scientifico S De Bellis, Ospedale Specializzato in Gastroenterologia, Castellana, Bari, Italy. Source: Misciagna, G Centonze, S Leoci, C Guerra, V Cisternino, A M Ceo, R Trevisan, M Am-J-Clin-Nutr. 1999 January; 69(1): 120-6 0002-9165
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Dietary fibre and gallstones. Source: Judd, P.A. Dietary fibre perspectives : reviews and bibliography 1 / edited by Anthony R. Leeds ; bibliographical editor Alison Avenell ; foreword by D.P. Burkitt. London : John Libbey, 1985. page 40-46. ISBN: 0861960521
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Dissolution of cholesterol gallstones in mice by the oral administration of a fatty acid bile acid conjugate. Author(s): Minerva Center for Cholesterol Gallstones and Lipid Metabolism in the Liver, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
[email protected]
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Source: Gilat, Tuvia Leikin Frenkel, Alicia Goldiner, Ilana Halpern, Zamir Konikoff, Fred M Hepatology. 2002 March; 35(3): 597-600 0270-9139 ·
Evaluation of garlic oil as a contact dissolution agent for gallstones: comparison with monooctanoin. Author(s): Department of Gastroenterology, SMS Medical College, Jaipur, India. Source: Nijhawan, S Agarwal, V Sharma, D Rai, R R Trop-Gastroenterol. 2000 Oct-December; 21(4): 177-9 0250-636X
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Gallstones and diet in Tel Aviv and Gaza. Source: Gilat, T. Horwitz, C. Halpern, Z. Bar Itzhak, A. Feldman, C. AmJ-Clin-Nutr. Bethesda, Md. : American Society for Clinical Nutrition. February 1985. volume 41 (2) page 336-342. ill., charts. 0002-9165
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Gallstones and risk of colonic cancer: a matched case-control study. Source: Gafa, M Sarli, L Sansebastiano, G Lupi, M Longinotti, E Rigamonti, P P Peracchia, A Int-Surg. 1987 Jan-March; 72(1): 20-4 00208868
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Gallstones in acromegalic patients undergoing different treatment regimens. Author(s): KVB-Klinik, Konigstein. Source: Schmidt, K Leuschner, M Harris, A G Althoff, P H Jacobi, V Jungmann, E Schumm Draeger, P M Rau, H Braulke, C Usadel, K H ClinInvestig. 1992 July; 70(7): 556-9 0941-0198
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Gallstones. An epidemiological investigation. Source: Jorgensen, T Dan-Med-Bull. 1990 August; 37(4): 336-46 0907-8916
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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·
The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to gallstones; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation:
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·
Vitamins Ascorbic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_C.htm Vitamin C Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,904, 00.html
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Minerals Betaine Hydrochloride Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Betaine_HCl.htm Betaine Hydrochloride Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000106.html Folate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Lecithin and choline Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 40,00.html Lecithin/Phosphatidylcholine/Choline Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Supp/Lecithin.htm Magnesium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Selenium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html ·
Food and Diet Artichoke Alternative names: Cynara scolymus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Artichoke.htm Artichoke Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000277.html Beets Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Beverages Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Chocolate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html
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Coffee Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Coffee Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Coffee.htm Coffee Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Diabetes Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Eggs Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Fats Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Fats Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Fish Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html
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Fruit Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html High Cholesterol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Juices Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Low-Fat Diet Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Low-Fat Diet Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Meat Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Meat Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Milk Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Milk Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Milk Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000277.html Obesity Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Omega-3 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Rhubarb Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Seeds Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Soybeans Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html
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Spinach Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Sugar Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Sugar Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Vegetables Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Vegetarian Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Weight Loss Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Weight Loss Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulcerat iveColitiscc.html Weight Loss Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Wheat Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
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APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.49
49
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):50 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
50
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 205
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
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Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 209
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
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South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Gallstones and Laparoscopic Cholecystectomy 211
APPENDIX
E.
NIH CONSENSUS STATEMENT ON GALLSTONES AND LAPAROSCOPIC CHOLECYSTECTOMY
Overview NIH Consensus Development Conferences are convened to evaluate available scientific information and resolve safety and efficacy issues related to biomedical technology. The resultant NIH Consensus Statements are intended to advance understanding of the technology or issue in question and to be useful to health professionals and the public.51 Each NIH consensus statement is the product of an independent, non-Federal panel of experts and is based on the panel’s assessment of medical knowledge available at the time the statement was written. Therefore, a consensus statement provides a “snapshot in time” of the state of knowledge of the conference topic. The NIH makes the following caveat: “When reading or downloading NIH consensus statements, keep in mind that new knowledge is inevitably accumulating through medical research. Nevertheless, each NIH consensus statement is retained on this website in its original form as a record of the NIH Consensus Development Program.”52 The following concensus statement was posted on the NIH site and not indicated as “out of date” in March 2002. It was originally published, however, in September 1992.53
51 This paragraph is adapted from the NIH: http://odp.od.nih.gov/consensus/cons/cons.htm. 52 Adapted from the NIH: http://odp.od.nih.gov/consensus/cons/consdate.htm. 53 Gallstones and Laparoscopic Cholecystectomy, NIH Consens Statement Online 1992 Sep 14-16 [cited 2002 February 19];10(3):1-20. http://consensus.nih.gov/cons/090/090_statement.htm.
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Abstract The National Institutes of Health Consensus Development Conference on Gallstones and Laparoscopic Cholecystectomy brought together surgeons, endoscopists, hepatologists, gastroenterologists, radiologists, and epidemiologists as well as other health care professionals and the public to address (1) the circumstances under which patients with gallstones should be treated; (2) the role of laparoscopic cholecystectomy in treating patients with gallstones; (3) the role of alternative medical and surgical treatments for gallstones; (4) the comparative results of laparoscopic cholecystectomy with open cholecystectomy and other available treatments; (5) techniques for detecting and treating bile duct stones with or without laparoscopic cholecystectomy; and (6) future directions for research in prevention and management of gallstone disease and in laparoscopic cholecystectomy. Following 2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) most patients who experience symptoms of gallstones should be treated; (2) in comparison with open cholecystectomy, laparoscopic cholecystectomy provides a safe and effective treatment for most patients with symptomatic gallstones and has become the treatment of choice for many patients; (3) patients who are not good candidates for laparoscopic cholecystectomy include those with generalized peritonitis, septic shock from cholangitis, severe acute pancreatitis, endstage cirrhosis of the liver, and gallbladder cancer; (4) laparoscopic cholecystectomy decreases pain and disability without increasing mortality and morbidity and can be performed at an equal or lower cost than open cholecystectomy; and (5) every effort should be made to ensure that surgeons performing laparoscopic cholecystectomy are properly trained and credentialed.
Epidemiology of Gallstones Approximately 10-15 percent of the adult population or more than 20 million people in the United States have gallstones. It is estimated that there are about 1 million newly diagnosed patients annually. The prevalence is higher in women, in association with multiple pregnancies, obesity, and rapid weight loss, as well as in older patients and in certain ethnic groups. In 1991 approximately 600,000 patients underwent cholecystectomy. As a cause of
Gallstones and Laparoscopic Cholecystectomy 213
hospitalization, gallstones are the most common and most costly digestive disease, with an annual estimated overall cost of more than $5 billion. In humans, gallstones are composed principally of cholesterol, with pigment stones occurring less commonly. The formation of cholesterol stones is believed to result from the occurrence of cholesterol supersaturation, accelerated cholesterol crystal nucleation, and impaired gallbladder motility. Stones tend to grow for the first 2-3 years, at which point growth tends to stabilize; 85 percent of all gallstones are less than 2 cm in diameter. Most patients with gallstones remain asymptomatic for many years and may, in fact, never develop symptoms. However, the consequences of gallstones may be severe, ranging from brief episodes of biliary pain (misnamed “colic”) to potentially life-threatening complications, such as acute cholecystitis and pancreatitis, or rarely gallbladder cancer. Until 2 years ago, the prevailing treatment of symptomatic gallstones was an open operation through an abdominal incision to remove the gallbladder. The usual course of recovery from this procedure was a 5-day hospital stay and a 3- to 6-week period of convalescence. Although the mortality of the operation was relatively low (about 0.05 percent, except in older or high-risk individuals), a variety of nonsurgical approaches were developed and utilized in selected patient populations. These alternative approaches include oral bile acid dissolution therapy, contact solvent dissolution or mechanical extraction through a catheter placed into the gallbladder (either percutaneously or endoscopically), and fragmentation by shock-wave lithotripsy combined with bile acid dissolution therapy. All such alternative approaches leave the gallbladder intact, and thus eventual stone recurrence in a significant number of cases is a potential drawback.
What Is Laparoscopic Cholecystectomy? Laparoscopic cholecystectomy is a new operation that was first performed in France in 1987 and in the United States in 1988. It is performed using laparoscopic visualization of the gallbladder and surrounding vital structures. After distention of the abdominal cavity with carbon dioxide gas, the laparoscopic imaging and surgical instruments are introduced through multiple (about half-inch) incisions for visualization, manipulation, and dissection. The operation is viewed on a videoscreen with magnification. The operative steps, which include identification, isolation, and division of the cystic duct and artery, with subsequent removal of the gallbladder from its attachment to the liver, require meticulous surgical technique. Once free, the
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gallbladder is pulled through one of the small incisions to the exterior, the laparoscope and instruments are removed, and the incisions are closed with sutures and covered with small bandages. The operation usually requires general anesthesia and is subject to the same risks and complications as open cholecystectomy. However, patients have little pain after the operation, and hospital stays (1-2 days) and convalescence (1-2 weeks) are usually shorter than after open cholecystectomy. It is estimated that more than 15,000 surgeons have received some training in the technique of laparoscopic cholecystectomy, and demand for this form of surgery has escalated to the point where probably about 80 percent of cholecystectomies are being performed in this manner. Ongoing attempts are being made to evaluate the safety and efficacy of this procedure, but it is doubtful that a large randomized trial to compare it with open cholecystectomy will be performed. Based on currently available data, it is apparent that complications of laparoscopic cholecystectomy occur infrequently, although evidence indicates that the incidence of bile duct injuries is increased compared with the incidence from open cholecystectomy. To evaluate the available data on laparoscopic cholecystectomy, including evolving techniques, patient selection, and data on traditional surgical and medical treatments for gallstone disease, the Office of Medical Applications of Research and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health convened a consensus development conference on September 14-16, 1992. The specific problems and patient issues that must be evaluated in dealing with this disease were addressed by surgeons, endoscopists, hepatologists, gastroenterologists, radiologists, epidemiologists, and representatives of the general public. After 2 days of presentations by medical experts and discussion from the audience, an independent consensus panel weighed the available scientific evidence and formulated this consensus statement that addressed the questions that follow.
Which Patients with Gallstones Should Be Treated? Gallbladder stones present in one of three clinical stages: (1) asymptomatic, (2) symptomatic, and (3) with complications. Gallstone complications, which include acute cholecystitis, common bile duct stones with or without cholangitis or pancreatitis, gallstone ileus, and gallbladder cancer, are all potentially life-threatening and almost always merit prompt treatment. The issue is which asymptomatic individuals and which patients with symptoms, but without complications, should be treated.
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Asymptomatic Gallstones The majority of gallstones remain silent throughout life. Only 1-4 percent per year of asymptomatic patients will develop symptoms or a complication of gallstone disease. Existing data indicate that 10 percent of patients will develop symptoms in the first 5 years after diagnosis and approximately 20 percent by 20 years. Almost all patients will experience symptoms for a period of time before they develop a complication. Therefore, with few exceptions prophylactic treatment of asymptomatic patients cannot be justified. This also applies to diabetic patients with asymptomatic gallstones. However, because of higher morbidity and mortality rates after emergency operations in diabetic patients, they should be treated promptly when symptoms first appear. It remains controversial whether incidental cholecystectomy during nonbiliary abdominal surgery in asymptomatic individuals is beneficial. It is clear, however, that incidental cholecystectomy should not be done in certain patients at high risk for complications, such as those with cirrhosis and portal hypertension. Insufficient data are present to determine whether prophylactic treatment is indicated in certain other groups with asymptomatic gallstones, such as patients with sickle cell disease and children, both of whom may present diagnostic dilemmas, pretransplantation and/or immunosuppressed patients who may have markedly increased morbidity and mortality from gallstone complications, and those who are isolated from medical care for long intervals. Although oral bile acid therapy has been shown to be effective in the prevention of gallstone formation in certain highly susceptible individuals (e.g., those undergoing rapid weight reduction) the advisability of such treatment has not been established. The risk of gallbladder cancer in patients with gallstones is so low (1 per 1,000 patients per year) that it is not a reasonable justification for prophylactic treatment. One clear exception is the rare entity of the calcified (porcelain) gallbladder, which even in the absence of stones should be removed because of its frequent (about 25 percent) association with gallbladder cancer. Less clear exceptions are some North and South American Indians, individuals with solitary gallbladder polyps greater than 1 centimeter in diameter, individuals with anomalous pancreatic-biliary ductal junctions, and individuals with gallstones greater than 3 cm in diameter. The risk of gallbladder cancer in all of these groups has been reported to be substantially higher than in other patients with gallstones.
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Symptomatic Gallstones Once gallstone symptoms appear, they recur in the majority of patients. Furthermore, patients with symptoms secondary to gallstones are more likely (25 percent within 10-20 years) than asymptomatic patients to develop complications. Thus, most symptomatic patients should be treated. The challenge to the clinician is ascertaining which symptoms are and which are not due to gallstones. The best definition of biliary pain is that which is relatively severe, episodic, epigastric or right upper quadrant in location, lasting 1 to 5 hours, and often waking the patient at night. These are the symptoms that warrant therapy. Although biliary pain also may occur postprandially, this is not a discriminating symptom from other common abdominal conditions (e.g., irritable bowel syndrome). Nearly 90 percent of patients with typical biliary pain are rendered symptom free after successful treatment of their gallstones. Those who are too ill to undergo general anesthesia should be managed with nonoperative therapies. The results of treatment of patients with gallstones are less successful in individuals with atypical pain patterns or painless dyspepsia (fatty food intolerance, bloating, and belching). Such patients should undergo further diagnostic testing to determine whether other diseases, such as irritable bowel syndrome, peptic ulcer disease, or gastroesophageal reflux may be the cause of these symptoms. There is a small group of patients without gallstones and no other identifiable abnormality of the gallbladder who have typical biliary pain. Although pain may be relieved after removal of the gallbladder in some of these patients, it is not in others. Thus, the efficacy of operative therapy in this setting has not been established.
Patients Who Should Cholecystectomy
Be
Treated
with
Laparoscopic
Most patients with symptomatic gallstones are candidates for laparoscopic cholecystectomy, if they are able to tolerate general anesthesia and have no serious cardiopulmonary diseases or other comorbid conditions that preclude operation. In fact, the indications for laparoscopic cholecystectomy, in general, are similar to those for open cholecystectomy. Indeed, the availability of laparoscopic cholecystectomy should not expand the indications for gallbladder removal.
Gallstones and Laparoscopic Cholecystectomy 217
Patients who are usually not candidates for laparoscopic cholecystectomy include those with generalized peritonitis, septic shock from cholangitis, severe acute pancreatitis, end-stage cirrhosis of the liver with portal hypertension, severe coagulopathy unresponsive to treatment, known cancer of the gallbladder, and cholecysto-enteric fistulas. In addition, patients in the third trimester of pregnancy should not usually undergo laparoscopic cholecystectomy, because of risk of damage to the uterus during the procedure. Patients with acute cholecystitis, acute gallstone pancreatitis that has subsided, prior surgery in the upper abdomen, and symptomatic gallstones in the second trimester of pregnancy may be candidates for laparoscopic cholecystectomy, providing the operating surgeon is experienced in treating patients with complex laparoscopic cholecystectomy problems. The use of laparoscopic cholecystectomy in patients in the first trimester of pregnancy is controversial because of the unknown effects of carbon dioxide pneumoperitoneum on the developing fetus. Obese candidates can undergo the procedure, unless the abdominal wall is so thick that the laparoscopic instruments will not reach the area of dissection. Patients with choledocholithiasis with or without jaundice can often be treated by laparoscopic cholecystectomy, but they may well require adjunctive therapy prior to, during, or after the cholecystectomy for diagnosis and treatment of the bile duct stones. Patients with chronic obstructive pulmonary disease can usually tolerate laparoscopic cholecystectomy, but the carbon dioxide used to insufflate the abdominal cavity during the operation may cause hypercarbia and acidosis. An experienced operating team should be able to manage successfully the above groups of patients who have relative contraindications to the operation. During the course of laparoscopic cholecystectomy, patients in whom the surgeon cannot clearly identify the anatomy of the gallbladder and portal region, in whom bleeding obscures the operative field, or in whom other problems develop during the operation that render laparoscopic cholecystectomy unsafe, should have the procedure converted to an open cholecystectomy. Such a conversion is not a complication of laparoscopic cholecystectomy and should be done promptly to protect the patient from serious operative injury. This decision to convert to open cholecystectomy should be considered sound surgical judgment. It is implicit that only surgeons capable of performing open cholecystectomy and biliary surgery should perform laparoscopic cholecystectomy.
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Alternative Medical and Surgical Treatments of Gallstone Disease In the past 20 years, a variety of treatment options for gallstone disease have been developed. Dissolution of gallstones by both mechanical and biochemical means is available. These alternative methods of treating gallstones must be compared to the standard surgical modalities. Open cholecystectomy has become one of our safer surgical procedures as improved methods of surgical technique, better anesthesia, and management of comorbid conditions have evolved. The current issue in the modern treatment of gallstone disease has focused on the role of the new surgical procedure, laparoscopic cholecystectomy.
Oral Dissolution Therapy Bile acid therapy with chenodeoxycholic acid (chenodiol) was introduced in the early 1970’s. However, because of concerns regarding side effects, chenodiol has been largely supplanted by ursodeoxycholic acid (ursodiol). The most effective use of bile acids in gallstone dissolution is in the symptomatic patient with small (less than 5 mm) floating cholesterol stones within a functioning gallbladder. This represents approximately 15 percent of patients. Six to 12 months of therapy are required in many patients and monitoring is necessary until dissolution is achieved. It is estimated that gallstones in such patients have a 60 percent (less than 10 mm stones) to 90 percent (less than 5 mm stones) dissolution rate, but in about one-half of these patients, gallstones recur within 5 years. It is unknown what percentage of recurrent stones will give rise to symptoms. Currently, data are insufficient to support the use of maintenance bile acid therapy after stone dissolution. The chance of complete dissolution is poor in patients with larger and predominantly noncholesterol stones. It is not known whether the addition of hydroxymethylglu-taryl CoA (HMG CoA) reductase inhibitors to bile acid therapy will contribute to the dissolution rate or if the use of nonsteroidal anti-inflammatory drugs (NSAID’s) will reduce recurrence rates. Dissolution rates are higher and recurrence rates are lower in patients with single stones, nonobese individuals, and in young patients. It is not known if the natural history of recurrent stones is similar to that of the original stones. Presently, the indications for bile acid therapy are limited to patients with a comorbid condition that precludes a safe operation and to patients who choose to avoid operation.
Gallstones and Laparoscopic Cholecystectomy 219
Extracorporeal Shock Wave Lithotripsy (ESWL) ESWL was introduced in the mid-1980’s. Various methods of producing shock waves (spark gap and piezo-electric) have been developed, and efficacy depends upon the amount of energy delivered to the stone. At present, none of the ESWL machines have been approved by the Food and Drug Administration for routine clinical use in the United States. The group in Munich and others have demonstrated stone clearance in up to 95 percent of symptomatic patients with solitary noncalcified gallstones less than 20mm in diameter in a functioning gallbladder. Patients with 20-mm to 30-mm gallstones and those with up to three stones in a functioning gallbladder have stone clearance rates of about 60 percent. It is estimated that 16 percent of all patients with symptomatic gallstones would fall into one of the above categories. Effective ESWL requires adjuvant ursodeoxycholic acid therapy. Recurrence is infrequent following therapy with ESWL for a single small stone but is more common in patients with multiple stones. The natural history of recurrent stones is unknown in terms of predicting recurrence of symptoms. Complications of ESWL are minor and include transient elevations of liver enzymes, pancreatitis, and hematuria. Effective ESWL depends on fragmentation of stones into much smaller pieces that can be dissolved or readily passed into the gut. The incidence of transient biliary pain has been reported to be as high as 45 percent after successful stone fragmentation.
Contact Dissolution Therapy Considerably less experience is recorded in the use of contact dissolution agents. The most commonly used agents are methyl tert-butyl ether (MTBE), which is experimental, and to a much lesser degree, monooctanoin, which is approved for the dissolution of bile duct stones. MTBE is usually introduced via a percutaneous transhepatic catheter into the gallbladder. Effective delivery and removal of solvent is facilitated by the use of an automatic peristaltic pump. Stones composed predominately of cholesterol can be cleared in hours to days. This technique is most often used in patients who are high surgical risks. Little information is available regarding recurrence rates. Monooctanoin has been used primarily for dissolution of bile duct stones retained following surgery. Catheters are placed within the bile duct, either transhepatically or through an endoscope, and monooctanoin is perfused for a period of days via the indwelling catheter or an existing T-tube. Methods have been described for the instillation of both contact agents into the gallbladder by endoscopic means.
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The use of contact dissolution agents has limited application in patients with gallstone disease.
Open Cholecystectomy This operation has been employed for over 100 years and is a safe and effective method for treating symptomatic gallstones. At laparotomy, direct visualization and palpation of the gallbladder, bile duct, cystic duct, and blood vessels allow safe and accurate dissection and removal of the gallbladder. Intra-operative cholangiography has been variably used as an adjunct to this operation. The rate of common bile duct exploration for choledocholithiasis varies from 3 percent in series of patients having elective operation to 21 percent in series that included all patients. Major complications of open cholecystectomy are infrequent and include common duct injury, bleeding, biloma, and infections. Open cholecystectomy is the standard against which other treatments must be compared and remains a safe surgical alternative.
Mini-Laparotomy Cholecystectomy This modification of the open operation removes the gallbladder through a substantially smaller incision with the objective of reduced postoperative pain. Published data are limited to fewer than 200 patients highly selected for ease of surgical access. This small number precludes meaningful evaluation of this technique. Cholecystostomy Drainage of the gallbladder, combined with stone removal, may be achieved percutaneously or operatively under local anesthesia. Indications are limited to poor risk or debilitated patients with an obstructed gallbladder, in whom open operation or laparoscopic interventions are considered high risk. Occasionally cholecystostomy is the appropriate operative procedure, if open cholecystectomy becomes unsafe. Mortality rates of 10-12 percent are primarily related to comorbid disease states.
Gallstones and Laparoscopic Cholecystectomy 221
Laparoscopic Treatments
Cholecystectomy
Compared
with
Other
The evaluation and comparison of outcomes of the various available therapeutic modalities are hampered by inherent limitations and by the type and quality of the available data. The rapidly evolving technology for the treatment of gallstones, especially laparoscopic cholecystectomy, presents a swiftly moving target for analysis. This not only complicates the comparison of studies conducted only a few years apart, but necessarily limits analysis to a “snapshot” in time. Moreover, there is strong consensus that there is a rapid acquisition of appropriate technical skills associated with laparoscopic cholecystectomy, which is reflected in widely differing reported rates of morbidity. The following analysis therefore provides a general framework for the evaluation of outcomes, which should facilitate subsequent reanalysis in the face of anticipated further rapid progress. Laparoscopic cholecystectomy owes much of its rapid growth to market forces generated, not inappropriately, by patient demand. Hence, it is important to evaluate outcome from the point of view of the patients themselves, as well as by traditional medical criteria. There are substantial limitations in the quality and the quantity of the data available: ·
Well-controlled studies are unavailable, and there is little prospect that such studies will be done. This is due largely to the unwillingness of patients to forgo treatment with the most “advanced” modality available.
·
Bias toward the reporting of more favorable results is well recognized. While this bias is relevant to each of the treatment modalities, there is a strong probability that it is greater for laparoscopic cholecystectomy, associated with extraordinary competitive pressure in a rapidly evolving field that includes the most common operation performed by the general surgeon. This is suggested by the fact that many major medical centers that are reporting relatively low rates of bile duct injury from laparoscopic cholecystectomy are simultaneously seeing an increased number of patients referred from outside hospitals for the treatment of such injuries. Thus, the reported data most likely underestimate the complication rates for laparoscopic cholecystectomy more than for open cholecystectomy.
·
There is patient selection bias. While the early experience with laparoscopic cholecystectomy undoubtedly included a disproportionate number of relatively low-risk patients, more recent series are expanding
222 Gallstones
the criteria for patient selection. Nevertheless, it seems likely that open cholecystectomy is performed in higher risk patients with more longstanding, more advanced biliary tract disease. ·
There is a paucity of long-term followup data even for traditional procedures, and an absence of such data for laparoscopic cholecystectomy, which was introduced to this country just 3 years ago. This is particularly important for bile duct strictures, of which a substantial proportion present months or years following surgery.
Summary of Outcomes Laparoscopic cholecystectomy is a relatively new operation that provides a safe and effective alternative treatment for patients with symptomatic gallstones. It offers the substantial advantage over open cholecystectomy of markedly decreased pain and disability, without apparent increased mortality or overall morbidity. Although the rate of common bile duct injury is increased, this rate appears to be sufficiently low to justify the patient’s selecting (with the counsel of a physician) this procedure for the treatment of symptomatic gallstones. Laparoscopic cholecystectomy can be performed at a medical treatment cost equal to or slightly less than that of open cholecystectomy, and with substantial cost savings to the patient and society due to markedly reduced disability (see Table). However, the results of laparoscopic cholecystectomy are greatly influenced by the skill and experience of the surgeon performing the procedure and reflect a rapid acquisition of appropriate technical skills. Because the conversion of laparoscopic to open cholecystectomy usually reflects sound surgical judgment, it should not be considered a complication of the procedure. Open cholecystectomy remains a safe and effective procedure for the treatment of patients with symptomatic gallstones. Applicable to almost all such patients, the extensive experience with this time-honored operation makes it the standard with which all other procedures must be compared. Oral bile acid therapy for dissolution of gallstones, with or without extracorporeal shock wave lithotripsy, provides a useful and safe, but ultimately less effective, alternative therapy for selected patients, especially those whose medical condition and/or personal preference precludes operative cholecystectomy.
Gallstones and Laparoscopic Cholecystectomy 223
How Should Bile Duct Stones Be Detected and Treated? It is estimated that 8 to 15 percent of patients under age 60 and 15 to 60 percent of patients over 60 undergoing cholecystectomy have common duct stones. These stones can be a major source of morbidity, and optimal care requires their detection and removal either prior to a planned laparoscopic cholecystectomy, during cholecystectomy, or postoperatively.
Preoperative Evaluation The decision to evaluate the common duct for possible stones prior to planned laparoscopic cholecystectomy may be prompted by clinical suspicion alone or evidence of jaundice, recent pancreatitis, or a dilated common duct on imaging studies. If endoscopic retrograde cholangiography (ERCP) demonstrates a duct free of stones or containing a stone that can be removed endoscopically, subsequent laparoscopic cholecystectomy can be performed without the need for common duct evaluation and with detailed knowledge of the biliary anatomy. The success rate of endoscopic common duct stone extraction approaches 90 to 95 percent in expert hands. In situations where the surgeon or endoscopist is less experienced, percutaneous transhepatic cholangiography (PTHC) or ERCP should be considered prior to the operation to optimize all therapeutic options. In most instances, laparoscopic cholecystectomy can be performed within a few days after successful endoscopic sphincterotomy and stone removal. If there is failure to visualize the bile duct or inability to remove the stone at ERCP or PTHC, the surgeon may elect to perform an open cholecystectomy with cholangiography and common duct exploration.
Intraoperative Evaluation While opinion is divided about the necessity of intraoperative cholangiography, all experienced surgeons stress the necessity of clear identification of ductal anatomy prior to excision of the gallbladder. Highquality cholangiography should be available in all centers, and experience in laparoscopic cannulation of the cystic duct should be part of the training of all surgeons performing laparoscopic cholecystectomy. Options for management of common duct stones found at laparoscopic cholecystectomy include the following:
224 Gallstones
·
Conversion to open cholecystectomy and exploration of the common bile duct,
·
Laparoscopic exploration of the common duct (with options for mechanical stone extraction),
·
Postcholecystectomy ERCP (with sphincterotomy and/or mechanical stone extraction), and
·
Close monitoring of carefully selected patients for possible spontaneous stone passage.
Experience and training in these different therapeutic modalities is evolving rapidly, and the best management decision will often be based on the availability of local expertise.
Postoperative Evaluation A similar, wide assortment of treatment modalities used to remove common bile duct stones before laparoscopic cholecystectomy is available to remove these stones detected after surgery. ERCP with endoscopic sphincterotomy and stone extraction with balloon catheter, basket, or mechanical lithotripters will be successful in the great majority of patients (about 90 percent). For large common bile duct stones that defy conventional extraction methods, extracorporeal shock wave lithotripsy or contact laser techniques may be successful in fragmenting the stone prior to subsequent removal. In some instances, prolonged common bile duct infusion of solvents has been helpful in reducing stone size or enhancing mechanical extraction. In situations where patient anatomy or operator inexperience preclude successful endoscopic stone extraction, interventional radiologic therapy may be considered. The percutaneous transhepatic route enables the radiologist to use many of the stone extraction techniques used by the endoscopist or surgeon. In most circumstances, reoperation and open exploration of the common duct is necessary only if more conservative methods of common duct stone removal fail. In that small group of patients with common duct stones and an intact gallbladder who are judged too ill or too frail to undergo cholecystectomy, endoscopic or radiologic techniques for removal of ductal stones offer a less invasive but effective therapeutic option.
Gallstones and Laparoscopic Cholecystectomy 225
Directions for Future Research Current strategies are not aimed at the primary prevention of gallstones. This approach is based on data that indicate gallstone formation leads to clinically important sequelae in a minority of individuals who can be identified because of pain syndromes. Current management strategies begin after gallstones have already occurred and are targeted to the subset of patients with symptomatic gallstones. Such treatment aims both to rid the individual of existing gallstones and to prevent the formation of further stones. To date, no single therapeutic approach has been identified to accomplish both goals in the entire range of patients with gallstones. Success has been limited by variability in patients’ general state of health; gallstone composition, size, number, and location; and treatment-related morbidity and mortality. Fortunately, safe and effective treatment is already available for most patients with symptomatic gallstones. In patients at low risk for complications from general anesthesia, cholecystectomy achieves both goals of gallstone therapy. Emerging evidence suggests that, when performed by experienced surgeons, laparoscopic cholecystectomy is generally as safe and effective as open cholecystectomy, at least in the short term. However, at present it remains uncertain whether this preliminary impression, which is based on data reported by a select subset of expert surgeons, validly reflects the community experience with laparoscopic cholecystectomy. Accurate centralized registration of laparoscopic cholecystectomy and its associated morbidity and mortality by all operators is necessary in order to clarify this issue. Moreover, few data are available to assess differences in delayed adverse outcomes between the two approaches. Hence, prospective monitoring of long-term complications in patients treated with laparoscopic cholecystectomy is mandatory. Despite these limitations with the early data, the laparoscopic approach has already won patient acceptance and is being widely implemented. Thus, future research should attempt to identify strategies that minimize procedure-associated morbidity and optimize the cost-effectiveness of laparoscopic cholecystectomy. More data must be obtained to clarify the following issues, upon which there is no present consensus:
What Modifications of Current Laparoscopic Techniques Will Minimize Patient Morbidity? Future research should focus on developing improved technology to maximize the safety of entering the peritoneal cavity, to enhance
226 Gallstones
visualization of intra-abdominal anatomy, and to minimize dissectionrelated injuries.
What Is the Best Approach to Identify and Treat Associated Choledocholithiasis? Future studies should address the following areas of controversy: Which patients should be screened for common bile duct stones? Should these patients be screened pre-, intra-, or postoperatively, and, if so, by which technique? If common bile duct stones are found, should they be managed by operative common bile duct exploration, therapeutic endoscopy, lithotripsy, contact dissolution, or other approaches? What are the potential adverse immediate and long-term outcomes of various management options? How do the risks and cost-effectiveness of these treatments compare with those of leaving small, common duct stones untreated in this patient population?
What Strategies Will Maximize Laparoscopic Cholecystectomy?
the
Cost-Effectiveness
of
Future studies should evaluate the costs and benefits of various dissection equipment, disposable versus reusable instruments, and inpatient versus outpatient surgery. The single most important variable that determines the safety and efficacy of laparoscopic cholecystectomy is the skill and laparoscopic surgical experience of the surgeon performing the procedure. Consequently, it is imperative that detailed guidelines be established for surgeon training, determination of competence, certification, and continuous monitoring of quality. The development of such detailed guidelines will require the involvement of various professional societies, certification boards, the credentialing bodies of health care organizations, and educational oversight groups. The rapid dissemination of laparoscopic cholecystectomy outside the customary scientific and academic process of validation and review emphasizes the need for guidelines to be introduced and implemented promptly to deal with other novel surgical procedures. It is likely that some patients will remain who elect nonsurgical treatment of their gallstones or who are not candidates for cholecystectomy. Optimal treatment of gallstones also must be defined in this subset. Ablation of existing stones is the most pressing need in many patients who are too ill to
Gallstones and Laparoscopic Cholecystectomy 227
tolerate definitive cholecystectomy. Treatment options in such patients include oral bile acid therapy, mechanical obliteration or dissolution of stones by percutaneously or endoscopically positioned catheters or extracorporeal shock wave lithotripsy, and techniques that facilitate stone egress, such as endoscopic sphincterotomy or percutaneously/endoscopically placed biliary stents and cholecystostomy. Future studies should define which approaches provide maximal efficacy and safety in this group of patients. Efforts should continue to develop a single, noninvasive approach, which will both eliminate existing stones and prevent recurrent stones. If such a treatment is developed, its safety and efficacy should be compared with that of cholecystectomy. If superior, the “new,” noninvasive approach may ultimately render cholecystectomy obsolete. At that point, it may be appropriate to address whether this new treatment should be extended to asymptomatic patients with gallstones and gallstone-free subjects at risk for stone formation. Future research should identify which subsets of these high-risk populations should be targeted for prophylactic treatment and systematically evaluate the cost-effectiveness of strategies to prevent the development of symptomatic stones. The cost-effectiveness of all new, prophylactic therapies must be weighed against that of currently available, inexpensive, and safe strategies such as weight control and diet modification, which may have prophylactic efficacy.
Conclusions ·
Most patients with gallstones remain asymptomatic. Asymptomatic patients usually develop symptoms before they develop complications. Therefore, with few exceptions, patients with asymptomatic gallstones should not be treated.
·
Once gallstone symptoms appear, they tend to recur, and such patients are more prone to develop complications. Thus, most patients with typical biliary symptoms and gallstones should be treated.
·
Because gallstones are so prevalent, they are often present incidentally in patients with other diseases. Patients with gallstones and atypical pain or dyspepsia need further investigation to determine the cause of their symptoms.
·
Laparoscopic cholecystectomy provides a safe and effective treatment for most patients with symptomatic gallstones. Indeed, it appears to have become the treatment of choice for many of these patients.
228 Gallstones
·
Laparoscopic cholecystectomy provides distinct advantages over open cholecystectomy. It decreases pain and disability, without increasing mortality or overall morbidity. Although the rate of common bile duct injury appears to be increased, this rate is still sufficiently small to justify the use of laparoscopic cholecystectomy in the treatment of symptomatic gallstones.
·
Laparoscopic cholecystectomy can be performed at a treatment cost that is equal to or slightly less than that of open cholecystectomy, and with substantial cost savings to the patient and society due to reduced loss of time from work.
·
The outcome of laparoscopic cholecystectomy is influenced greatly by the training, experience, skill, and judgment of the surgeon performing the procedure.
·
During laparoscopic cholecystectomy, when the anatomy is obscured, excessive bleeding occurs, or other problems arise, the operation should be converted promptly to open cholecystectomy. Conversion under these circumstances reflects sound surgical judgment and should not be considered a complication of laparoscopic cholecystectomy.
·
Open cholecystectomy is a safe and effective operation for symptomatic gallstone disease. Because of its wide applicability and low mortality and morbidity, open cholecystectomy remains a standard against which new treatments should be judged.
·
Oral bile acid therapy, with or without extracorporeal shock-wave lithotripsy, provides a useful and safe, but ultimately less effective, alternative therapy for selected patients. This modality may be indicated for patients whose medical condition and/or personal preference precludes operative cholecystectomy.
·
Contact dissolution of gallstones by solvents currently has limited clinical applicability.
·
Depending on the availability of technical expertise in endoscopic and laparoscopic exploration of the common duct, valid treatment options for common bile duct stones include preoperative, intraoperative, or postoperative identification and removal of stones.
·
Surgeons performing laparoscopic cholecystectomy should possess the skills necessary to perform intraoperative cholangiography. Training in laparoscopic common bile duct exploration is encouraged.
·
Future research should focus on refining the technique of laparoscopic cholecystectomy, to maximize safety and cost-effectiveness of the procedure.
Gallstones and Laparoscopic Cholecystectomy 229
·
Strict guidelines for training in laparoscopic surgery, determination of competence, and monitoring of quality should be developed and implemented promptly. The formulation of such guidelines will require the involvement and cooperation of various professional societies, credentialing committees, certification boards, and educational oversight groups.
·
Safe, noninvasive, cost-effective strategies to prevent gallstones should be actively sought.
Vocabulary Builder Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Artery: A large blood vessel that carries blood from the heart to other parts of the body. Arteries are thicker and have walls that are stronger and more elastic than the walls of veins. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Bandages: Material used for wrapping or binding any part of the body. [NIH] Convalescence: The stage of recovery following an attack of disease, a surgical operation, or an injury. [EU] Credentialing: The recognition of professional or technical competence through registration, certification, licensure, admission to association membership, the award of a diploma or degree, etc. [NIH] Epigastric: Pertaining to the epigastrium. [EU] Hematuria: Presence of blood in the urine. [NIH] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH] Septic:
Produced by or due to decomposition by microorganisms;
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putrefactive. [EU] Uterus: The hollow muscular organ in female mammals in which the fertilized ovum normally becomes embedded and in which the developing embryo and fetus is nourished. In the nongravid human, it is a pear-shaped structure; about 3 inches in length, consisting of a body, fundus, isthmus, and cervix. Its cavity opens into the vagina below, and into the uterine tube on either side at the cornu. It is supported by direct attachment to the vagina and by indirect attachment to various other nearby pelvic structures. Called also metra. [EU]
Online Glossaries 231
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to gallstones and keep them on file.
232 Gallstones
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 233
GALLSTONES GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Acidosis: Too much acid in the body. For a person with diabetes, this can lead to diabetic ketoacidosis. [NIH] Adsorption: The attachment of one substance to the surface of another; the concentration of a gas or a substance in solution in a liquid on a surface in contact with the gas or liquid, resulting in a relatively high concentration of the gas or solution at the surface. [EU] Adverse: Harmful. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Anions: Negatively charged atoms, radicals or groups of atoms which travel
234 Gallstones
to the anode or positive pole during electrolysis. [NIH] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anus: The distal or terminal orifice of the alimentary canal. [EU] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Aqueous: Watery; prepared with water. [EU] Artery: A large blood vessel that carries blood from the heart to other parts of the body. Arteries are thicker and have walls that are stronger and more elastic than the walls of veins. [NIH] Ascariasis: Infection by nematodes of the genus ascaris. Ingestion of infective eggs causes diarrhea and pneumonitis. Its distribution is more prevalent in areas of poor sanitation and where human feces are used for fertilizer. [NIH] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: No symptoms; no clear sign of disease present. [NIH] Ataxia: Failure of muscular coordination; irregularity of muscular action. [EU]
Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Bandages: Material used for wrapping or binding any part of the body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU]
Glossary 235
Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Butterflies: Slender-bodies diurnal insects having large, broad wings often strikingly colored and patterned. [NIH] Cadmium: An element with atomic symbol Cd, atomic number 48, and atomic weight 114. It is a metal and ingestion will lead to cadmium poisoning. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cardiac: Pertaining to the heart. [EU] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiopulmonary: Pertaining to the heart and lungs. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH]
Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Cholangiography: Roentgenography of the biliary ducts after administration or injection of a contrast medium, orally, intravenously or percutaneously. [EU]
236 Gallstones
Cholangitis: Inflammation of a bile duct. [EU] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [EU] Cholecystography: Radiography of the gallbladder after ingestion of a contrast medium. [NIH] Cholecystostomy: Establishment of an opening into the gallbladder either for drainage or surgical communication with another part of the digestive tract, usually the duodenum or jejunum. [NIH] Cholelithiasis: The presence or formation of gallstones. [EU] Cholestasis: Impairment of biliary flow at any level from the hepatocyte to Vater's ampulla. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colitis: Inflammation of the colon. [EU] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Contraception: The prevention of conception or impregnation. [EU] Contractility: stimulus. [EU]
Capacity for becoming short in response to a suitable
Credentialing: The recognition of professional or technical competence through registration, certification, licensure, admission to association membership, the award of a diploma or degree, etc. [NIH] Crystallization: The formation of crystals; conversion to a crystalline form. [EU]
Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU]
Glossary 237
Cytoprotection: The process by which chemical compounds provide protection to cells against harmful agents. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dietetics: The study and regulation of the diet. [NIH] Diffusion: The process of becoming diffused, or widely spread; the spontaneous movement of molecules or other particles in solution, owing to their random thermal motion, to reach a uniform concentration throughout the solvent, a process requiring no addition of energy to the system. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU]
Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Duodenum: The first or proximal portion of the small intestine, extending from the pylorus to the jejunum; so called because it is about 12 fingerbreadths in length. [EU] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Dysphagia: Difficulty in swallowing. [EU] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU]
Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Encephalopathy: Any degenerative disease of the brain. [EU] Endocrinology:
A subspecialty of internal medicine concerned with the
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metabolism, physiology, and disorders of the endocrine system. [NIH] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epigastric: Pertaining to the epigastrium. [EU] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Extraction: The process or act of pulling or drawing out. [EU] Fatal: Causing death, deadly; mortal; lethal. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They
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also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Flatulence: The presence of excessive amounts of air or gases in the stomach or intestine, leading to distention of the organs. [EU] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Haplotypes: The genetic constitution of individuals with respect to one
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member of a pair of allelic genes, or sets of genes that are closely linked and tend to be inherited together such as those of the major histocompatibility complex. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hemolysis: The destruction of erythrocytes by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. [NIH]
Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatitis: Inflammation of the liver. [EU] Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid.
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Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydration: The condition of being combined with water. [EU] Hydrogen: Hydrogen. The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH]
Hyperlipidaemia: A general term for elevated concentrations of any or all of the lipids in the plasma, including hyperlipoproteinaemia, hypercholesterolaemia, etc. [EU] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Ileus: Obstruction of the intestines. [EU] Incidental: 1. small and relatively unimportant, minor; 2. accompanying, but not a major part of something; 3. (to something) liable to occur because of something or in connection with something (said of risks, responsibilities, ...) [EU] Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: 1. the formation of an infarct. 2. an infarct. [EU]
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Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Instillation: . [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoenzymes: One of various structurally related forms of an enzyme, each having the same mechanism but with differing chemical, physical, or immunological characteristics. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lipoprotein:
Any of the lipid-protein complexes in which lipids are
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transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lithotripsy: The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is lithotripsy, laser. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Macrolides: A group of organic compounds that contain a macrocyclic lactone ring linked glycosidically to one or more sugar moieties. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Motility: The ability to move spontaneously. [EU] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucoproteins: Conjugated proteins in which mucopolysaccharides are combined with proteins. The mucopolysaccharide moiety is the predominant
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group with the protein making up only a small percentage of the total weight. [NIH] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make
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the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. the act of boring or piercing through a part. 2. a hole made through a part or substance. [EU] Perfusion: 1. the act of pouring over or through, especially the passage of a fluid through the vessels of a specific organ. 2. a liquid poured over or through an organ or tissue. [EU] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Pernicious: Tending to a fatal issue. [EU] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Postoperative: Occurring after a surgical operation. [EU] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume
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and maintenance of the water-electrolyte balance. [NIH] Precipitation: The act or process of precipitating. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Proctitis: Inflammation of the rectum. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Punctures: Incision of tissues for injection of medication or for other diagnostic or therapeutic procedures. Punctures of the skin, for example may be used for diagnostic drainage; of blood vessels for diagnostic imaging procedures. [NIH] Radiography: The making of film records (radiographs) of internal structures of the body by passage of x-rays or gamma rays through the body to act on specially sensitized film. [EU] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Reflux: A backward or return flow. [EU] Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH] Resection: Excision of a portion or all of an organ or other structure. [EU] Retrograde: 1. moving backward or against the usual direction of flow. 2.
Glossary 247
degenerating, deteriorating, or catabolic. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Sedentary: 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Shivering: Involuntary contraction or twitching of the muscles. It is a physiologic method of heat production in man and other mammals. [NIH] Solvent: 1. dissolving; effecting a solution. 2. a liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [NIH] Steroid:
A group name for lipids that contain a hydrogenated
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cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Substrate: A substance upon which an enzyme acts. [EU] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Systemic: Pertaining to or affecting the body as a whole. [EU] Taurine: 2-Aminoethanesulfonic acid. A conditionally essential nutrient, important during mammalian development. It is present in milk but is isolated mostly from ox bile and strongly conjugates bile acids. [NIH] Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transaminase: Aminotransferase (= a subclass of enzymes of the transferase class that catalyse the transfer of an amino group from a donor (generally an amino acid) to an acceptor (generally 2-keto acid). Most of these enzymes are pyridoxal-phosphate-proteins. [EU] Transplantation: The grafting of tissues taken from the patient's own body
Glossary 249
or from another. [EU] Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Uterus: The hollow muscular organ in female mammals in which the fertilized ovum normally becomes embedded and in which the developing embryo and fetus is nourished. In the nongravid human, it is a pear-shaped structure; about 3 inches in length, consisting of a body, fundus, isthmus, and cervix. Its cavity opens into the vagina below, and into the uterine tube on either side at the cornu. It is supported by direct attachment to the vagina and by indirect attachment to various other nearby pelvic structures. Called also metra. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vegetarianism: Dietary practice of consuming only vegetables, grains, and nuts. [NIH] Veins: The vessels carrying blood toward the heart. [NIH] Vesicular: 1. composed of or relating to small, saclike bodies. 2. pertaining to or made up of vesicles on the skin. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or
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reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC Press-
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Parthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna ·
Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
252 Gallstones
INDEX A Abdomen ....14, 15, 16, 19, 21, 26, 33, 34, 77, 95, 107, 110, 118, 119, 128, 129, 217, 242, 244, 248 Abdominal...16, 21, 30, 31, 50, 52, 63, 80, 84, 85, 100, 106, 107, 118, 126, 213, 215, 216, 217, 226, 229, 234, 236, 245 Abscess .......................................103, 237 Acetylcysteine........................................75 Acidosis ...............................................217 Adsorption .............................................56 Adverse .........................63, 126, 225, 226 Agonist...................................................60 Algorithms..............................................84 Alimentary...... 55, 71, 112, 166, 234, 242, 245 Anatomical.............................................99 Anemia ....................12, 98, 109, 112, 136 Anesthesia...........214, 216, 218, 220, 225 Anionic .................................................162 Anions....................................................56 Antibiotic ..................34, 68, 109, 238, 247 Anticholinergic .....................................100 Anus ....................................................106 Appendicitis .15, 84, 97, 98, 103, 126, 237 Aqueous ..........................................56, 75 Artery ...................................................213 Ascariasis ..............................................48 Ascites .............................................25, 84 Asymptomatic .....14, 51, 80, 95, 107, 213, 214, 215, 216, 227 Atypical ........................................216, 227 B Bandages ............................................214 Bilirubin ............11, 12, 26, 55, 75, 85, 165 Biochemical .......................75, 80, 95, 218 Biopsy......................................25, 82, 245 Biosynthesis ..........................................58 Butterflies...............................................86 C Calculi ..............................................76, 80 Capsules..............................................189 Carcinoma .....................................96, 115 Cardiac ....................................72, 80, 248 Cardiomyopathy ..................................161 Cardiopulmonary ...........................51, 216 Cardiovascular...............................57, 107 Carotene..............................................160 Catheter .....33, 78, 79, 213, 219, 224, 243 Caustic...................................................84 Chemotherapy .......................................48
Cholangiography........... 63, 220, 223, 228 Cholangitis ...... 25, 51, 52, 64, 84, 93, 96, 212, 214, 217 Cholecystitis..... 4, 26, 51, 52, 59, 84, 94, 95, 107, 213, 214, 217 Cholecystography ............................... 111 Cholecystostomy .................. 78, 220, 227 Cholelithiasis.... 24, 50, 51, 53, 80, 93, 94, 95, 96, 110, 127, 162 Cholestasis ......................... 55, 85, 90, 92 Chronic..... 21, 25, 31, 51, 56, 84, 85, 93, 96, 101, 103, 126, 129, 182, 217, 236, 238, 246 Cirrhosis... 12, 23, 25, 39, 96, 97, 98, 126, 129, 212, 215, 217 Colic ........ 17, 21, 50, 51, 74, 80, 119, 213 Colitis ........................ 23, 94, 96, 106, 159 Colonoscopy ......................................... 48 Colorectal...................................... 98, 126 Concomitant.......................................... 63 Conjugated............................................ 55 Constipation ...... 22, 48, 84, 97, 98, 126, 159, 229, 245 Contraception ....................................... 92 Contractility ........................................... 49 Convalescence ........................... 213, 214 Credentialing............................... 226, 229 Crystallization ................................. 61, 62 Cyclic .................................................... 54 Cytoprotection....................................... 59 D Degenerative ...................... 103, 187, 237 Desensitization ..................................... 60 Diarrhea . 17, 48, 67, 74, 79, 98, 106, 159, 161, 186, 234 Diffusion ................................................ 60 Digestion .. 11, 34, 67, 71, 85, 86, 97, 103, 107, 130, 233, 237, 245, 248 Distal ..................................... 79, 112, 234 Distention .................... 101, 103, 213, 239 Diverticulitis........................................... 94 Duodenum ...... 31, 81, 100, 127, 234, 236 Dyspepsia ..... 86, 98, 100, 109, 126, 216, 227 Dysphagia ............................... 97, 98, 109 E Elective ......................................... 22, 220 Electrolyte ......................... 62, 82, 85, 245 Embryology ........................................... 85 Encephalopathy .................................... 84 Endoscopy ................ 20, 48, 84, 127, 226
Index 253
Enzyme....... 17, 32, 51, 70, 95, 109, 238, 242, 248 Epidemic................................................52 Epidemiological .......................53, 57, 193 Epigastric .............................103, 216, 237 Erythrocytes.........24, 30, 32, 56, 233, 238 Erythromycin..................................61, 109 Esophagitis ......................................86, 99 Extracorporeal ...... 50, 98, 222, 224, 227, 228 Extraction.................51, 64, 213, 223, 224 F Fatal...............................12, 104, 118, 245 Fatigue...................................25, 110, 161 Fats.....11, 31, 32, 50, 128, 186, 234, 236, 239 Feces .......................................24, 67, 234 Fibrosis ..............................31, 84, 97, 236 Fistula ......................................32, 56, 239 Flatulence ..............................................98 Fluorescence ...........................65, 69, 239 G Gastritis .............................84, 97, 98, 126 Gastrointestinal..... 22, 32, 48, 52, 60, 62, 68, 84, 85, 86, 94, 96, 97, 98, 99, 106, 107, 109, 238, 239 Gels .........................................61, 69, 239 Glucose .......33, 53, 69, 70, 239, 242, 244 Glycerol .................................................78 H Heartburn...........20, 61, 86, 92, 97, 98, 99 Helicobacter.........................................100 Hematology ...........................................10 Hematuria ............................................219 Hemolysis ............................................165 Hemorrhoids ..................................98, 126 Hepatic ..........................12, 17, 52, 65, 84 Hepatitis .....15, 23, 25, 39, 84, 85, 94, 96, 97, 109, 126, 129 Hepatobiliary........................50, 57, 85, 96 Hernia ..........................15, 86, 98, 99, 126 Herpes .................................161, 182, 240 Hormones ........................71, 72, 246, 248 Hydrogen .................70, 75, 122, 235, 241 Hydrophobic ....................60, 70, 241, 243 Hypercholesterolemia..................115, 159 Hyperlipidemia.......................................50 Hypersecretion ......................................59 Hypertension .......25, 84, 85, 97, 215, 217 I Idiopathic ...........................32, 95, 96, 241 Ileus .....................................4, 48, 60, 214 Incidental .................................50, 51, 215 Incision ...16, 33, 107, 119, 127, 128, 213, 220, 242 Incontinence ....................................84, 97
Indicative......... 71, 72, 100, 244, 245, 249 Induction ............................................... 58 Inflammation .... 12, 21, 25, 30, 31, 52, 60, 97, 99, 102, 106, 129, 234, 236, 237 Infusion ................................... 56, 78, 224 Ingestion ......... 67, 84, 112, 189, 235, 236 Instillation ...................................... 78, 219 Insulin.. 33, 57, 69, 70, 142, 239, 242, 244 Intestines................. 32, 70, 106, 239, 241 Intravenous ....................... 21, 61, 71, 245 Invasive......................................... 26, 224 Iodine ............................................ 15, 192 Isoenzymes........................................... 56 J Jaundice..... 12, 15, 19, 21, 25, 63, 80, 84, 85, 86, 97, 107, 129, 130, 217, 223 L Laparoscopy ... 26, 77, 107, 119, 127, 130 Ligation ................................................. 60 Lipoprotein ........................ 55, 70, 74, 243 Lithotripsy....... 17, 22, 24, 26, 49, 51, 98, 110, 111, 129, 213, 222, 224, 226, 227, 228 Lumen ................................................... 79 M Macrolides........................................... 109 Malabsorption ................. 84, 86, 106, 136 Malignant ............................ 102, 106, 235 Membrane................................. 56, 60, 62 Menopause ........................................... 28 Microscopy.......................... 50, 55, 62, 65 Molecular ...... 10, 34, 55, 57, 71, 85, 109, 124, 133, 134, 246, 248 Motility...... 48, 60, 64, 84, 85, 86, 99, 101, 109, 213 Mucins................................................... 59 Mucoproteins ........................................ 76 N Nausea........ 19, 21, 48, 86, 107, 118, 129 Neoplasms ...................... 85, 86, 103, 244 Neoplastic ............................................. 56 Neural ................................................. 187 Niacin .......................................... 160, 187 Nosocomial ........................... 84, 103, 244 O Oral .. 24, 26, 33, 50, 53, 93, 98, 106, 192, 201, 213, 215, 227, 235, 244 Overdose ............................................ 187 P Palpation ............................. 220, 229, 244 Pancreas.... 12, 15, 21, 33, 34, 70, 84, 86, 95, 97, 242, 244 Parasitic ................................................ 84 Parenteral ......................... 84, 93, 94, 101 Pathologic ............................. 59, 182, 246
254 Gallstones
Peptic......48, 84, 85, 86, 96, 98, 100, 126, 216 Percutaneous ..33, 78, 219, 223, 224, 243 Perforation ...........................100, 103, 237 Perfusion ...............................................80 Peritonitis .....................................212, 217 Pernicious ..............................................98 Pharmacist...................................146, 151 Phenotype .....................................71, 245 Polypeptide....................................69, 241 Postoperative..48, 60, 108, 128, 129, 220, 228 Potassium......................................75, 188 Precipitation...................................65, 165 Predisposition ........................................13 Prednisone ..........................................106 Prenatal ...............................................166 Preoperative ........................................228 Prevalence....49, 53, 57, 59, 93, 126, 130, 159, 212 Proctitis ................................................106 Proteins ....... 34, 59, 68, 69, 82, 186, 188, 238, 241, 243, 248 Psoriasis ..............................161, 182, 246 Punctures ............................................119 R Radiography ........................................160 Radiology.....................................111, 127 Receptor ..........................................58, 60 Recombinant .........................................59 Recurrence ...49, 129, 213, 218, 219, 229, 246 Reflux .....20, 52, 60, 84, 96, 99, 101, 109, 216 Reoperation .........................224, 229, 246 Retrograde..15, 20, 21, 50, 51, 63, 84, 95, 127, 128, 223 Riboflavin.............................................186 S Secretion .48, 55, 64, 71, 72, 85, 243, 247 Septic...........................................212, 217
Serum .... 63, 64, 72, 74, 79, 93, 159, 162, 229, 245, 247 Shivering ............................................. 130 Solvent ...... 68, 78, 80, 82, 191, 213, 219, 237, 238, 239 Species ................................... 60, 72, 247 Spectrum............................................... 10 Stents.................................................. 227 Steroid........................................... 71, 246 Stomach..... 15, 19, 20, 32, 33, 61, 86, 97, 99, 100, 103, 110, 127, 239, 244 Subclinical............................................. 93 Sulfur................................................... 160 T Taurine.................................................. 56 Thermoregulation................................ 186 Thyroxine ............................................ 188 Tinnitus ............................................... 161 Tomography............................ 21, 50, 128 Toxicology..................................... 10, 125 Transaminase ................................. 17, 74 Transcutaneous .................................... 63 Transplantation ..... 38, 39, 84, 85, 97, 215 U Ulcer..... 48, 84, 85, 96, 98, 100, 104, 126, 216, 249 Ulceration............................................ 100 Ultrasonography ..................... 50, 57, 160 Urinary ............ 31, 34, 103, 235, 241, 249 Urology.................................................. 10 Uterus ................................................. 217 V Vascular ................................................ 95 Vegetarianism ..................................... 165 Veins ............................... 25, 33, 229, 234 Vesicular ............................................... 65 Viral..... 22, 81, 84, 85, 110, 126, 129, 233 Viruses .................................................. 23 W Withdrawal ............................................ 78 X Xerostomia............................................ 98
Index 255
256 Gallstones
