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Introduction: The ketogenic diet is a treatment modality used for patients with refractory epilepsy. Development of cholelithiasis while on the ketogenic diet is a potential side effect that has been described in the literature. There however have not been any reports on the outcomes of continuing the diet after cholecystectomy., Patient: We present a 5-year-old boy with history of pharmacologically intractable epilepsy that was well controlled on the ketogenic diet. He underwent laparoscopic cholecystectomy for the development of symptomatic cholelithiasis 12 months after the initiation of ketogenic diet for seizure control., Results: Patient tolerated the surgery well and was able to continue the ketogenic diet postoperatively., Discussion: There have been no reports describing the continuation of ketogenic diet after cholecystectomy. This child demonstrates the safety of the procedure and the ability to continue the ketogenic diet without further biliary or surgical complications., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Early rehabilitation after open cholecystectomy or cholecystectomy from a mini-approach was performed in 101 patients with cholelithiasis treated surgically at Ust-Kachka health resort. Changes in clinico-laboratory indices reflecting the condition of hepatopancreatobiliary system and central hemodynamics before and after rehabilitation were studied depending on the variant of cholecystectomy. Advantages of early rehabilitation of patients after different variants of cholecystectomy at Ust-Kachka health resort in normalization of general condition of the patients and in prevention of functional disorders progression early after operation are demonstrated.

Cholesterol gallstones affect approximately 10-15% of the adult population in North America. Phosphatidylcholine (PC) is considered to be the main cholesterol solubilizer in bile. This study examined the effect of a PC-enriched diet on gallstone incidence in mice susceptible to cholelithiasis. The result obtained showed that the feeding of a lithogenic (LG) diet for 4 weeks or 8 weeks resulted in cholesterol gallstone incidences of 47% and 89%, respectively. These gallstone incidences were either reduced or prevented when the LG diet was enriched with 2% or 6% PC, respectively. The cholesterol saturation index (CSI) was reduced only in mice fed with LG + 6% PC diet as compared with mice fed the LG diet alone. However, in all groups, the CSI was significantly higher than in mice fed Purina chow diet. The biliary anionic polypeptide fraction (APF) was significantly increased in mice fed the LG + 2% PC diet and was reduced in those fed with LG + 6% PC diet. In conclusion, prevention or delay of gallstone formation was not due to a consistent effect on biliary lipid composition, suggesting a direct effect of PC on cholesterol solubilization and/or the effect of an additional nonlipid biliary component such as APF.

Background/purpose: An increasing number of children are diagnosed with gallstones today. The best management of nonpigmented gallstones in children without hematologic disorders is not known., Methods: The authors prospectively studied 74 children with cholelithiasis diagnosed with ultrasonography. Clinical presentation, natural history, complications, and indications for cholecystectomy were examined. The follow-up (mean, 21 months) consisted of routine clinic visits, chart reviews, and telephone questionnaires with the children or their parents., Results: Of the 74 children, 33 required cholecystectomies, and 41 were followed. The average age was similar in the 2 groups (11.7 v 11.0 years). Children with risk factors for cholelithiasis required earlier surgical treatment (P < .001). In the operative group, 8 presented acutely and 25 electively. There were 2 complications, a wound infection and a retained common duct stone. In the group that underwent follow-up, 34 of 41 children remained asymptomatic or had symptoms improve with dietary manipulation. No complications developed during the follow-up period., Conclusions: Children with gallstones and typical symptoms of right upper quadrant or epigastric pain with food intolerance should undergo cholecystectomy. Eighty-two percent of children with cholelithiasis and atypical symptoms had improvement with dietary manipulation. Pediatric patients with gallstones that are asymptomatic or associated with atypical symptoms can be safely followed without complications.

In 45 patients with biliary calculous disease the relieving-dietetic therapy course was performed. The fragmentation or lysis of echopermeable echononsolid, echononpermeable echononsolid, echopermeable echosolid calculi was established. There was not noted fragmentation of echononpermeable echosolid calculi.

Total parenteral nutrition (TPN) is associated with cholestasis and gallstones. Gallbladder stasis may be important in the development of gallstones, and cholecystokinin (CCK) to stimulate gallbladder contraction has been proposed as a treatment to prevent this complication. We studied in vivo bile acid synthesis and bile acid output in miniswine on TPN to test whether daily CCK improves bile acid output and normalizes bile acid profiles with TPN. Nine miniswine were nutritionally maintained with TPN for 4 weeks; four pigs received CCK (0.1 mg/kg) iv daily. In vivo bile acid synthesis was measured with injection of 7 alpha-tritiated cholesterol. An increase in tritiated water reflects the activity of 7 alpha-hydroxylation, the rate-limiting step in bile acid synthesis. At the end of 4 weeks, bile was collected and bile acid output and bile salt profiles were determined. One of five animals on TPN developed gallstones while two of four receiving daily CCK developed stones. In vivo bile acid synthesis decreased with TPN (controls, 63 +/- 9 mg/24 hr versus TPN, 13 +/- 4 mg/24 hr) and increased in TPN animals with CCK treatment (TPN-CCK, 105 +/- 35 mg/24 hr). Bile acid profiles are changed with TPN with more secondary bile acids, this was not improved with CCK. CCK improved bile acid synthesis and bile acid output but failed to prevent gallstone formation or normalize bile salt profiles. In addition to promoting gallbladder contraction, CCK may have a stimulatory effect on bile acid synthesis. CCK alone did not prevent gallstone formation.

Surgical cholecystectomy used to be the only definitive method of gallstone treatment. Recently, however, there have been greatly advancing in the therapies for gallstones, which comprise oral or topical litholysis, lithotripsies with shock wave or endoscopical techniques, and laparoscopical cholecystectomy. Some factors must be considered in selecting the method for the treatment of gallstones, such as; well-understanding of the physiology and the pathophysiology of gallbladder (stones), precise US tomography, the effects of diet, and especially the patient's performance status, patient's profile and informed consent.

Thirty females aged 21-57 with cholelithiasis in the physicochemical stage were put on a diet including soya bran. Bile acids were assayed in the duodenal portion B by gas-liquid chromatography. A pre- and posttreatment bile spectrum analysis indicated that before the dietetics chenodeoxycholic acid concentration and mean total of bile acids were markedly lower than control values. The diet enriched with food fibers promoted normalization of the above parameters.

We tested two hypotheses, i) whether the type and the amount of fat in the diet will affect the formation of cholesterol gallstones in the hamsters, and ii) whether palmitic acid, a major fatty acid component of butterfat, can act as a potentiator of cholesterol cholelithiasis in the hamster. Young, male golden Syrian hamsters (Sasco) were fed a semipurified diet containing casein, corn starch, cellulose and cholesterol (0.3%) to which various types and amounts of fat (butterfat, olive oil, menhaden oil, corn oil) were added. All diets contained 2% corn oil to supply essential fatty acids to the growing hamsters. No deaths or illness occurred during the experiment. Animals fed the semipurified diet plus 4% butterfat (group 1) had a gallstone incidence of 63%. Replacement of butterfat with either olive oil, corn oil or menhaden oil prevented the formation of cholesterol gallstones entirely (groups 2-4). When total butterfat was increased from 4% to 8% (group 8), the incidence of cholesterol gallstones increased to 80%. Substitution of 4% olive oil (group 5), corn oil (group 6), or menhaden oil (group 7) for the additional 4% butterfat significantly reduced gallstones to 35%, 45% and 30%, respectively. The replacement of 4% butterfat with 1.2% palmitic acid gave the highest incidence of cholesterol gallstones (95%). These results suggest that butterfat (and one of its components, palmitic acid) intensifies gallstone formation in this model whereas mono- and polyunsaturated fats act as inhibitors of cholesterol cholelithiasis. A fatty acid, possibly palmitic acid, appears to act as lithogen in our model.

In experiments on rabbits that had undergone partial constriction of the choledochus, the development of calculous hepatocholecystitis was observed in a half of the operated on animals. No biliary calculi were detected in the animals that received the ration enriched with food vegetable fibres, beta-sitosterol and linoleic polyunsaturated fatty acids after similar operations.

Gallstone disease has been recognized to be linked to others metabolic disorders such as obesity, atherosclerosis, hyperlipidemia and diabetes. Previous studies demonstrated a close relationship between abnormal eating habits and gallstone disease. The total caloric intake should be calculated on each individual energy requirement and should be restricted in over-weight patients. The diet should contain approximately 15-20% of the daily calories from proteins, 30-35% from fat (mainly vegetable fat for the higher content in polyunsaturated fat) and 40-55% from carbohydrate (especially complex carbohydrate). In addition the nutritional plan should consist of adequate amount of minerals and vitamins and the fiber consumption should be increased to 30-40 g/day. Finally, at last the Authors recommends (6279-8372 Kj- a regular subdivision of the meals (small and frequent) dressed in the very natural wag.

In patients with sustained cholecystectomy the content of the basic bile components (cholesterol, cholic acid, total phosphorus) was measured. The cholate-cholesterol coefficient, enabling it to a certain degree to evaluate the lithogeneity of the bile, was calculated. The cholesterol concentration in the serum and bile was contrasted. A total of 104 patients were examined at different post-operative periodss and it was found that in 70 per cent of them the bile was not oversaturated with cholesterol. Two variants of the No. 5 diet were used--the sparing and fatty, differing in the amount of fat and carbohydrates. Under the effect of the No. 5 sparing diet a reduced serum cholesterol concentration was noted along with a noticeable rise of the cholic acid content in the bile with a not too brusque rise of the cholesterol level therein, which led to an increase of the cholate-cholesterol coefficient. Against the background of the treatment with a No. 5 fat diet in evidence was a diminution of the serum cholesterol content, a clearcut fall in the cholesteroland cholic acid concentration in the bile with a continuing fairly high cholate-chole sterol coefficient.

Effects of specific dietary alterations in patients with radiolucent gallstones treated with ursodeoxycholic acid (UDCA, 750 mg at bedtime) were investigated. Patients were allocated randomly to one of four diets: standard (500 mg cholesterol/day), low-cholesterol (250 mg/day), added-bran (30 g/day), or substituted medium-chain triglycerides (MCT) oil (20% of fat). Dietary intake and good compliance were verified by computerized analysis of dietary diaries. Bile-acid kinetics (26 patients) or secretion of biliary lipids (23 other patients) were determined at enrollment and at 6 and 9 mo, respectively, during treatment. Although MCT further decreased the UDCA-induced decrease in the synthesis of chenodeoxycholic acid, it did not lessen desaturation of bile. Otherwise, compared to the standard diet, no experimental diet significantly altered the UDCA-induced increase of the pools of total bile acids and UDCA or the UDCA-induced decrease in synthesis of bile acids and in biliary secretion or saturation of cholesterol. If these dietary manipulations facilitate dissolution of gallstones by UDCA, they do so by other mechanisms.

Male Syrian hamsters were fed a lithogenic diet containing 7% cellulose or 4.2% pectin. After 50 days, pectin was 76% and cellulose 64% less lithogenic than the control diet. Hamsters fed the control diet for 50 days were maintained on that diet for another 50 days or fed diets containing cellulose or pectin. There was a 52% increase in gallstone incidence in hamsters continued on the control diet and a 9% increase in those on cellulose. Pectin promoted regression of gallstones (by 52%).

Sixteen subjects received between 50 g to 121 g of wheat bran in their diet for between 6 to 26 weeks. Five were normal subjects, 5 had gallstones, and 6 young men had suffered a previous myocardial infarction. The serum cholesterol did not show any consistent change in the normal subjects, but there was a fall in cholesterol at 20 weeks in patients with gallstones; patients with previous myocardial infarction had a rise in cholesterol which returned to normal at 20 weeks. There was no significant change in the serum triglyceride.

We have studied the dissolution rate of radiolucent gallstones from validated measurements of gallstone area derived from standardized oral cholecystography in 48 patients receiving chenodeoxycholic (chenic) acid, 15 mg/kg/day. Patients were matched in pairs according to gallstone size and randomly allocated to one of two treatment groups. Group A was given chenic acid in three divided doses at mealtimes with an unrestricted diet (the conventional regimen), and group B was given bedtime chenic acid with a low cholesterol diet. In the 24 matched pairs, the mean reduction in gallstone area at 6 months on regimen A was 36% and on B 60%. Median reductions in area were 20% and 57%, respectively (P less than 0.02). Of these matched pairs, 20 were followed at 6 month intervals for 42 months. There was a significant correlation between percentage reduction in gallstone area at 6 months and length of treatment necessary for complete dissolution (P less than 0.001). Fifty percent achieved complete dissolution by 30 months on regimen A, and by 12 months on regimen B (NS). We conclude that gallstone dissolution rate during chenic acid treatment is approximately doubled by bedtime administration plus a low cholesterol diet, thus reducing the duration and cost of treatment.

The detection of cholesterol crystals in duodenal bile is of clinical value in the diagnosis of cholesterol gallstone disease; however, not all patients with cholesterol gallstones have crystals detected in their duodenal bile, thus limiting the value of examination of duodenal bile. The aims of this study were to (i) determine whether the lack of crystals in some patients with cholesterol gallstones was due to (a) the intermittent presence of crystals, (b) spontaneous crystal dissolution, or (c) changes in dietary cholesterol intake; (ii) determine whether incubation of duodenal bile for 24 h would result in crystal formation. Sixteen patients with radiolucent gallstones each underwent three duodenal biliary drainages. Thirty-one percent of patients had crystals in all three bile specimens, 12% in two specimens, 25% in one specimen, and 32% in no specimen. One of 31 specimens with small numbers of crystals initially had no crystals at 24 h, and five specimens initially devoid of crystals developed crystals by 24 h. Despite a significant increase in biliary cholesterol saturation index with increasing cholesterol intake, the prevalence of crystals in bile did not increase in gallstone patients. No crystals were identified in 18 specimens from normal subjects examined initially or in the 15 specimens that were examined after 24 h. We conclude that the intermittent presence of cholesterol crystals in duodenal bile is probably not due to dissolution of crystals or varying dietary cholesterol intake and that the frequency with which crystals are found increases with incubation. Determination of the diagnostic value of multiple duodenal biliary drainages or incubation of bile in patients with normal oral cholecystograms or gallbladder ultrasonograms, however, will require examinations of large numbers of patients.

Dietary fiber is plant-derived material that is resistant to digestion by human alimentary enzymes. Fiber may be divided into two broad chemical classes: 1) non-alpha-glucan polysaccharides (cellulose, hemicelluloses, and pectins) and 2) lignins. Dietary fiber behaves within the gastrointestinal tract as a polymer matrix with variable physicochemical properties including susceptibility to bacterial fermentation, water-holding capacity, cation-exchange, and adsorptive functions. These properties determine physiological actions of fiber and are dependent on the physical and chemical composition of the fiber. Fiber undergoes compositional changes as a consequence of bacterial enzymatic action in the colon. Dietary fiber is of clinical significance in certain disorders of colonic function and in glucose and lipid metabolism. Dietary fiber increases stool bulk by acting as a vehicle for fecal water and by increasing fecal bacterial volume. Use of fiber in the treatment of constipation and uncomplicated diverticular disease is well established. By increasing stool bulk, fiber also reduces the fecal concentration of bile acids and other substances. Certain types of fiber decrease the rate of glucose absorption and attenuate postprandial rises in blood glucose and insulin. Plasma cholesterol levels are reduced by mucilaginous forms of fiber. This effect appears to be mediated in part by an increase in fecal acidic sterol excretion.

Fasting state, 1 and 3 hours postprandial biliary lipid periods are studied in 19 cholecystectomized gallstone patients. Methodological items togeher with the characteristics of the kind of diet: normocaloric; lipids, 15% (50% of which are obtained from animals); proteins, 25%; and carbohydrates, 60% are established. It is concluded that biliary lipids are not quantitatively modified in the subjects on established diet respect fasting, 1 and 3 hours postprandial periods, particularly pointing out that the biliary cholesterol saturation rate remains unchanged--supersaturated--for fasting state, as well as for postprandial periods. We believe that the lack of observable changes may be in relation with the characteristics of the employed diet, which is usually suggested to people suffering from cholecystopathies in Argentina.