A Study on Bacterial Etiology of Cholecystitis due to Gallstones and their Antimicrobial Susceptibility Pattern in A Tertiary Care Hospital

Cholelithiasis is a very common condition affecting the Gallbladder. Gallstones are present in 10 -15 % of the adult population. Females are three times more likely to develop Gallstones than male. Gall stones are classified into cholesterol and pigment stone. About 80% of them are cholesterol stone and 15-20% pigment stone. Obstruction and infections are the common complications of Cholelithiasis. Approximately 1-2% of the patients become symptomatic and warrants cholecystectomy (1). With this background we conducted a cross sectional study in the Institute of Microbiology, MMC & RGGGH, for 72 consecutive patients who underwent cholecystectomy. The most common age group affected 41-60 yrs. The most common symptoms are abdominal pain, dyspepsia and Jaundice. In this study Gallstones are collected after surgery, processed and Antibiogram pattern also studied as per standard guidelines. Out of 72 samples studied 35 (48.6%) are culture positive. Escherichia coli is the predominant organism isolated followed by Klebsiella pneumonia(52). Most of the isolates were sensitive to commonly used antibiotics for Gram Negative bacilli.

Study of histopathological spectrum of gallbladder in cholecystectomy specimens

Background: Cholecystitis is one of the most common indications for abdominal surgery. Routine examination of gallbladder grossly and microscopically shows lot of interesting findings. This study aims to quantify the various outcomes of routine gallbladder examination following cholecystectomy procedure.Methods: All clinical details and data from case sheet and patient history are collected and analysed for all the patients who underwent cholecystectomy surgery in the Department of General Surgery, Govt. Omandurar Medical College, Chennai, from August 2017 to August 2018. The Study period of this study was from August 2017 to August 2018. Three sections each from neck, body and fundus taken. Tissues were processed in automated tissue processor and paraffin blocks made. Statistical analysis of the data was done.Results: Total number of specimens received were 36. And among the cases the number of females were 33 and the number of males were 3. The number of cases of calculous cholecystitis were 31 and the number of cases with pigment stones were 26, number of cases with cholesterol stone were 2 and the number of cases with mixed stones were 3. The number of cases of acalculous cholecystitis were 5. The number of cases of cholecystectomy by laproscopy were 30 whereas the number of cases of cholecystectomy by open procedure were 6. Chronic cholecystitis was seen in 34 cases and chronic cholecystitis with stones was seen in 29 cases and chronic cholecystitis without stones was seen in 5 cases and Acute on chronic cholecystitis with pigment stone was seen in 1 case and xanthogranulomatous cholecystitis with pigment stone was seen in 1 case.Conclusions: The risk factors for developing chronic cholecystitis was seen in female gender. The predominant histomorphological pattern seen in this study group is chronic calculous cholecystitis. And the predominant type of stone found in this study is pigment stone compared to mixed and cholesterol stone.

PIXE ANALYSIS OF GALLSTONES

Particle Induced X-ray Emission (PIXE) technique has been used to determine the trace elements present in fourteen representative human gallstone samples collected from eastern region (Orissa) and thirteen representative samples collected from southern region (Chennai) of India. PIXE irradiation of the samples has been carried out by using the 3 MV tandem type horizontal pelletron accelerator facility at Institute of Physics, Bhubaneswar with proton beam of energy 3 MeV. In the present investigation, twenty one trace elements like S , Cl , K , Ca , Ti , V , Cr , Mn , Fe , Ni , Cu , Zn , As , Se , Br , Rb , Sr , Y , Zr , Mo and Pb have been estimated in all the three types of gallstones viz. cholesterol stone, mixed stone and pigment stone. While sulphur in cholesterol stones in the eastern region was less than that of the southern region, sulphur was present as a minor element in the pigment stones of both the regions. Less concentration of copper in the gallstones from eastern region is another interesting observation. The lower values of copper in the patients of eastern region may be due to different types of food habits. The concentrations of all the elements in the southern region pigment stones have higher values than that of the eastern region. Moreover, the concentrations of Fe and Mo in cholesterol stone and pigment stone samples in southern region have also higher values than in eastern region. The current PIXE study is of its first kind in this eastern region of India.

CCK receptor dysfunction in muscle membranes from human gallbladders with cholesterol stones

Human gallbladders with cholesterol stones exhibit impaired muscle contraction induced by agonists that act on transmembrane receptors, increased membrane cholesterol content, and abnormal cholesterol-to-phospholipid ratio compared with those with pigment stones. The present study was designed to investigate the functions of the CCK receptor of gallbladder muscle membranes by radioreceptor assay and cross-linking.125I-labeled CCK-8 binding was time-dependent, competitive, and specific. Scatchard analysis showed that the maximum specific binding (Bmax) was significantly decreased in cholesterol compared with pigment stone gallbladders (0.18 ± 0.07 vs. 0.38 ± 0.05 pmol/mg protein, P < 0.05). In contrast, the affinity for CCK was higher in cholesterol than pigment stone gallbladders (0.18 ± 0.06 vs. 1.2 ± 0.23 nM). Similar results were observed in binding studies with the CCK-A receptor antagonist [3H]L-364,718. Cross-linking and saturation binding studies also showed significantly less CCK binding in gallbladders with cholesterol stones. These abnormalities were reversible after incubation with cholesterol-free liposomes. The Bmax increased ( P < 0.01) and the dissociation constant decreased ( P < 0.001) after incubation with cholesterol-free liposomes. In conclusion, human gallbladders with cholesterol stones have impaired CCK receptor binding compared with those with pigment stones. These changes are reversed by removal of the excess membrane cholesterol. These receptor alterations may contribute to the defective contractility of the gallbladder muscle in patients with cholesterol stones.