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Structure and composition of primary intrahepatic stones in Korean patients

  • Pancreatic and Biliary Disorders
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Abstract

We have analyzed the chemical composition of primary intrahepatic stones from 72 Korean patients. Two types of concretions have been identified: brown pigment (calcium bilirubinate) stones and black-colored mixed stones. Brown pigment stones were found in 68% of all cases and the remainder (32%) consisted of mixed stones. Intrahepatic mixed stones had mean cholesterol and bilirubin contents of 46.6% and 25.9%, respectively, whereas calcium bilirubinate stones had mean cholesterol and bilirubin contents of 14.1% and 43.6%, respectively. Intrahepatic mixed stones had a smooth black-colored surface and on cross section, exhibited a distinct outer shell surrounding an inner yellow, cholesterol-rich body. The finding of intrahepatic mixed stones with high cholesterol content suggests that primary hepatolithiasis may result from at least two different conditions or disorders and points to different approaches to their treatment.

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References

  1. Nakayama F, Furusawa T, Nakama T: Hepatolithiasis in Japan; present status, Am J Surg 139:216–220, 1980

    Google Scholar 

  2. Choi TK: Intrahepatic stones. Br J Surg 76:213–214, 1989

    Google Scholar 

  3. Pridgen JE, Aust JB, McInnis WD: Primary intrahepatic gallstones. Arch Surg 112:1037–1043, 1977

    Google Scholar 

  4. Nakayama F: Classification of intrahepatic stone disease. Jpn J Clin Med 45:150–153, 1987

    Google Scholar 

  5. Saunders KD, Cates JA, Roslyn JJ: Pathogenesis of gallstones. Surg Clin North Am 70:1197–1216, 1990

    Google Scholar 

  6. Nakayama F, Koga A: Hepatolithiasis: Present status. World J Surg 8:9–14, 1984

    Google Scholar 

  7. Pitt HA, Venbrux AC, Coleman J, Prescott CA, Johnson MS, Osterman FA, Cameron JL: Intrahepatic stones—the transhepatic team approach. Ann Surg 219:527–537, 1994

    Google Scholar 

  8. Adson MA, Nagorney DM: Hepatic resection for intrahepatic ductal stones. Arch Surg 117:611–616, 1982

    Google Scholar 

  9. Ker CG, Huang TJ: Intrahepatic stones; Etiological study. J Formosan Med 80:698–711, 1981

    Google Scholar 

  10. Min PC, Cho MH, Im HM, Kim JH, Chin BH, Hahn SS: Biliary tract diseases among Koreans. Analysis of 100 consecutive cases. J Korean Surg Soc 8:1–7, 1966

    Google Scholar 

  11. Trotman BW, Soloway RD: Pigment gallstone disease; summary of the National Institutes of Health international workshop. Hepatology 2:879–884, 1982

    Google Scholar 

  12. Mukaihara S: Chemical analysis of gallstones. Classification and composition of human gallstones. Arch Jpn Chir 50:476–500, 1981

    Google Scholar 

  13. Trotman BW, Morris TA, Sanchez HM, Soloway RD, Ostrow JD: Pigment versus cholesterol cholelithiasis: Identification and quantification by infrared spectroscopy. Gastroenterology 72:495–498, 1977

    Google Scholar 

  14. Takagi I, Toda G: Definition, classification and clinical symptoms of cholelithiasis. Jpn J Clin Med 51:7–12, 1993

    Google Scholar 

  15. Suzuki N, Sato T: A new classification of gallstone. J Biliary Tract Pancreas 7:1467–1470, 1986

    Google Scholar 

  16. Suzuki N, Takahashi W, Sato T: Types and chemical composition of intrahepatic stones.In Intrahepatic Calcli. K Okuda, F Nakayama, J Wong (eds). New York, Alan R Liss, 1984, pp 71–80

    Google Scholar 

  17. Yamashita N, Yanagisawa J, Nakayama F: Composition of intrahepatic calculi: Etiological significance. Dig Dis Sci 33:449–453, 1988

    Google Scholar 

  18. Kim YH, Kim YT, Yoon YB, Choi KW, Kim CY: Identification and quantification of intrahepatic calculi by infrared absorption spectroscopy. Korean J Gastroenterol 25:168–175, 1993

    Google Scholar 

  19. Shoda J, Tanaka N, He B-F, Matsuzaki Y, Osuga T, Miyazaki H: Alterations of bile acid composition in gallstones, bile and liver of patients with hepatolithiasis, and their etiological significance. Dig Dis Sci 38:2130–2141, 1993

    Google Scholar 

  20. Tanimura H, Kobayashi N, Yoshida K, Ozawa K: Chemical composition of intrahepatic stones in Japan. Jpn J Clin Med 45:154–162, 1987

    Google Scholar 

  21. Kondo T, Nimura Y, Hayakawa S: Cholangiographic and endoscopic finding in primary intrahepatic cholesterol stones Jpn J Gastroenterol 86:2779–2786, 1989

    Google Scholar 

  22. Shimada N, Nihmoto S, Matsuba A, Nakagawara G, Kobayashi M, Tsuchiya S: Primary cholesterol hepatolithiasis. Gastroenterol Jpn 24:170–176, 1989

    Google Scholar 

  23. Saito K, Nakanuma Y, Ohta T, Ueda N, Higashino Y, Yamamichi N, Kidani F: Morphological study of cholesterol hepatolithiasis. J Clin Gastroenterol 12:585–590, 1990

    Google Scholar 

  24. Kim SW, Park YH, Choi JW: Clinical and epidemiologic analysis of 10-year experienced 1,719 gallstones patients. Korean J Gastroenterol 25:159–167, 1993

    Google Scholar 

  25. Suh KS, Park YH: Quantitative analysis of composition of gallstones at different location using autoanalyzer. Korean J Gastroenterol 22:641–650, 1990

    Google Scholar 

  26. Nakayama F, Miyaki H: Changing state of gallstone disease in Japan. Am J Surg 120:794–799, 1970

    Google Scholar 

  27. Hikasa Y, Nagase M, Tanimura H, Shioda r, Setoyama M, Kobayashi N, Mukaihara S, Kamata T, Maruyama K, Kato H, Mori K, Soloway RD: Epidemiology and etiology of gallstones. Arch Jpn Chir 49:555–571, 1980

    Google Scholar 

  28. Sasaki M, Endoh M, Yoshihara s, Kohn M: Treatment of intrahepatic gallstone. Jpn J Clin Med 51:153–156, 1993

    Google Scholar 

  29. Yokote M, Takikawa H, Yamanaka M: Diseases with high incidence of gallstone complication. Jpn J Clin Med 51:46–52. 1993

    Google Scholar 

  30. Jessen C: Gallstones restricted to the biliary ducts; A review of 24 Korean cases. Acta Chir Scand 283:242–246, 1961

    Google Scholar 

  31. Sato T, Suzuki N: Changing pattern of gallstones. Jpn J Clin Med 45:5–12, 1987

    Google Scholar 

  32. Maki T, Sato T, Matsushiro T: A reappraisal of surgical treatment for intrahepatic gallstones. Ann Surg 175:155–165, 1972

    Google Scholar 

  33. Su CH, Lui WY, Peng FK: Relative prevalence of gallstone disease in Taiwan, Dig Dis Sci 37:764–768, 1992

    Google Scholar 

  34. Chang TM, Passaro E: Intrahepatic stones; The Taiwan experience. Am J Surg 146:241–244, 1983

    Google Scholar 

  35. Malet PF, Takabayashi A, Trotman BW, Soloway RD, Weston NE. Black and brown pigment gallstones differ in microstructure and microcomposition. Hepatology 4:227–234, 1984

    Google Scholar 

  36. Wosiewitz U: Scanning electron microscopy in gallstone research. Scanning Electron Microsc 1:419–430, 1983

    Google Scholar 

  37. Suzuki N: On bilirubin-metal complex compounds in relation to black pigments of gallstones. Tohoku J Exp Med 90:195–205, 1966

    Google Scholar 

  38. Suzuki N, Nakamura Y, Kobayashi N, Sato T: On metal elements in pure pigment gallstones. Tohoku J Exp Med 116:233–240, 1975

    Google Scholar 

  39. Been JM, Bills PM, Lewis D: Electron probe microanalysis in the study of gallstones. Gut 18:836–842, 1977

    Google Scholar 

  40. Tsuchiya R, Eto T, Tsunoda T, Yamamoto K, Harada N, Koga M, Amano R: Bilateral intrahepatic lithiasis without extrahepatic bile duct stones. Gastroenterol Jpn 25:122–129, 1990

    Google Scholar 

  41. Shoda J, Tanaka N, Natsuzaki Y, Honda A, Osuga T, Shigematsu N, Miyazaki H: Microanalysis of bile acid composition in intrahepatic calculi and its etiological significance. Gastroenterology 101:821–830, 1991

    Google Scholar 

  42. Shoda J, He BF, Tanaka N, Matsuzaki Y, Yamamori S, Osuga T: Primary dual defect of cholesterol and bile acid metabolism in liver of patients with intrahepatic calculi. Gastroenterology 108:1534–1546, 1995

    Google Scholar 

  43. Ohta T, Nagekawa T, Takeda T, Fonseca L, Kanno M, Mori K. Kayahara M. Veno K. Miyazaki I, Terada T: Histological evaluation of the intrahepatic biliary tree in intrahepatic cholesterol gallstones, including immunohistochemical staining against apoprotein A-1. Hepatology 17:531–537, 1993

    Google Scholar 

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Kim, M.H., Sekijima, J., Park, H.Z. et al. Structure and composition of primary intrahepatic stones in Korean patients. Digest Dis Sci 40, 2143–2151 (1995). https://doi.org/10.1007/BF02208998

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