Re: Spirit, You da man!! (np)

> "I passed a smaller calcified stone in september and had bleeding for a week from the bowels."

farscape66,

Yes, in your case it sure can be important to dissolve stones ... use fresh radish juice every day ... it is known to dissolve and round larger or unregular stones ... also fresh apple juice ... actually most vegetable juices are great ... use them every day!

What was the color of blood from your bowels?
Was it outside feces or inside?

Do you know what part of your bowel was injured?


But, be aware that you are one out of 100 or 200 people who actually have calcified stones ... so for you rules and laws may be different then the rules for other 99 or 199 people.

Only 5-10% of patients with symptomatic Gallstones have sufficient
calcium in their stones to be visible on plain xray.
And only 1 -2% have hard calcified stones, stone that could injure bile ducts or intestines.


Excerpt:
"In 1992 it was estimated that 10 to 15% of the adult population
in the United States had gallstones (which amounted
to more than 20 million people) (NIH Consensus
Statement, 1992). About one million patients are newly
diagnosed annually and approximately 600 000 patients
underwent cholecystectomy in 1991. Gallstones are the
most common digestive disease leading to hospitalization
with an estimated annual cost of $5 billion (NIH Consensus
Statement, 1992).

Gallstones have been described long before the era of modern
abdominal surgery. Numerous calculi were found in the
gallbladder of the mummy of a priestess of Amenen of the
21st Egyptian Dynasty (1500 BC) (Schwartz 1981). The
Greek physician, Alexander Trallianus, described calculi
within the hepatic radicles of a human liver (Glenn & Grafe
1966). By the 16th century, both Vesalius and Fallopius
described gallstones found in the gallbladders of dissected
human bodies (Schwartz 1981). These observations indicate
a clear recognition of the phenomenon of cholelithiasis,
however, pathogenesis and clinical significance of gallstones
are seldom referred to. It was Langenbuch in the late 19th
century (Langenbuch 1882) who widened the understanding
of gallstone pathology and performed the first cholecystectomy.

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PREVALENCE
The population of certain parts of Italy has been studied
extensively as to the prevalence of gallstones.

The Rome Group for the Epidemiology and Prevention
of Cholelithiasis (GREPCO) found gallstones in 8% of
Roman male civil servants between the age of 20 and 69
years. Less than 8% had a history of symptoms compatible
with biliary colic (GREPCO 1988). The same group found
a prevalence of as high as 25% in female civil servants in the
60–64 year age group. One-third reported at least one
episode of biliary pain over a period of 5 years (GREPCO
1984).
As part of the Multicenter Italian Study on Cholelithiasis
(MICOL) 29 739 study participants were examined by
ultrasound and questionnaire with respect to the presence
of gallstones and related symptoms (Attili et al 1995b). The
prevalence of gallstones for women was 10.5% and 6.5% for
men. This increased to 18.9 and 9.5% respectively when
subjects who had already undergone cholecystectomy were
added. A linear increase in prevalence was noted with age in
both sexes. The vast majority of subjects with gallstones
were asymptomatic (84.9% of women and 87.0% of men).
This study confirms the high prevalence of gallstone disease
and also shows that most patients are unaware of it. Similar
numbers were found in a Scandinavian study (Muhrbeck &
Ahlberg 1995).

The overall prevalence of gallstone disease in industrialized
countries appears to be between 10 to 20% (Table
32.1) with an increase for female sex and age. The incidence
is close to ten per 1000 subjects per year (Misciagna et al
1996, Angelico et al 1997).

NATURAL HISTORY OF GALLSTONES

The analysis of the natural history of gallstones started with
a landmark study by Gracie and Ransohoff. They followed
123 Michigan University faculty members (110 men and 13
women) who had been found to have gallstones through
routine screening for 15 years. At 5, 10 and 15 years of
follow-up 10, 15 and 18% had become symptomatic. None
of them had developed complications. The approximate rate
at which the subjects developed biliary pain was 2% per year
for the first 5 years with a subsequent decrease over time.

Three patients in this study developed biliary complications,
all of which were preceded by biliary pain. They concluded
based on the results that prophylactic cholecystectomy for
asymptomatic gallstones could not be recommended
(Gracie and Ransohoff 1982).

Attili and colleagues also followed 151 subjects identi-
fied to have gallstones during the GREPCO study
(GREPCO 1984) over a period of 10 years (Attili et al
1995a). Thirty-three subjects had symptoms while 118
were asymptomatic at the beginning of the study. The
cumulative probability of developing biliary colic was 12%
at 2 years, 17% at 4 years, and 26% at 10 years. The cumulative
probability of developing complications after 10
years was 3% in the initially asymptomatic group and 7% in
the symptomatic group. The authors conclude that the
natural history of gallstone disease might not be as benign
as previously thought.

In a Japanese study Wada and colleagues found one-third
of 1850 patients with cholelithiasis to be symptomatic.
Twenty percent of the remaining 680 asymptomatic turned
symptomatic over a median follow up of 13 years. Patients
over the age of 70 were more likely to become symptomatic
than patients under 70 (Wada and Imamura, 1993).

McSherry followed 135 asymptomatic men and women
with gallstones subscribers to the Health Insurance Plan of
Greater New York. Ten percent developed symptoms and
7% required cholecystectomy over a median follow-up of 46
months (McSherry et al 1985).

A placebo group of 193 asymptomatic patients who were
part of a chemical dissolution trial were followed for 24
months (Thistle et al 1984). Thirty-one percent of them
developed biliary pain. This number is quite high but could
be explained by intense surveillance. Also, the patients had
to be asymptomatic for the 12 months preceding the trial
and some patients might have been symptomatic prior to
that. Similarly, Cucchiaro et al (1990) followed 125 asymptomatic
patients for a period of 5 years. Fifteen patients
developed symptoms during that time and two patients had
to undergo emergency surgery for gallstone complications.
Fifty-four patients died during that period because of malignancies, cardiovascular disease or renal insufficiency. None
of the deaths was gallstone related.

Friedman et al (1989) followed 123 asymptomatic patients for up to 20 years. Six percent of the patients developed severe symptoms related to their gallstones during the first 5 years after diagnosis.

Death as the ultimate complication from gallstones is rare
(Godrey et al 1984, Cucchiaro et al 1989). It usually occurs
in the elderly as a consequence of biliary or postoperative
complications.

Different study designs and outcome measures make it
difficult to deduct a uniform natural history for gallstones.
Most studies support that between 1 and 4% of patients
with asymptomatic gallstones will develop biliary symptoms
per year (Table 32.2). One can extrapolate that after 20
years two-thirds of patients will remain symptom free
(Friedman 1993).


Over 70% of patients developing gallbladder carcinoma
have gallstones (Piehler & Crichlow 1978) (Ch. 53). The risk of developing carcinoma is estimated to be 1% of calculous gallbladders 20 years after the initial diagnosis of gallstones,
with the risk increased mainly in men (Maringhini et al 1987).


REFERENCES

American College of Physicians 1993 Guidelines for the treatment of gallstones. Annals of Internal Medicine 119: 620–622
Angelico F, Del Ben M, Barbato A, Conti R, Urbinati G 1997 Ten-year incidence and natural history of gallstone disease in a rural
population of women in central Italy. The Rome Group for the

Epidemiology and Prevention of Cholelithiasis (GREPCO). Italian
Journal of Gastroenterology and Hepatology 29: 249–254

Ashur H, Siegal B, Oland Y, Adam Y G 1978 Calcified gallbladder
( Porcelain Gallbladder ). Archives of Surgery 113: 594–596

Attili A F, De Santis A, Capri R, Repice A M, Maselli S. 1995a The
natural history of gallstones: the GREPCO experience. The
GREPCO Group. Hepatology 21: 655–660

Attili A F, Carulli N, Roda E, Barbara B, Capocaccia L, Menotti A,
Okoliksanyi L, Ricci G, Capocaccia R, Festi D et al 1995b

Epidemiology of gallstone disease in Italy: prevalence data of the
Multicenter Italian Study on Cholelithiasis (M.I.COL.). American
Journal of Epidemiology 141: 158–165


The natural history of gallstones
and asymptomatic gallstones
J.N. VAUTHEY AND P.F. SALDINGER
32



Porcelain Gallbladder

Background: Extensive calcium encrustation of the gallbladder wall variably has been termed calcified gallbladder, calcifying cholecystitis, or cholecystopathia chronica calcarea. The term porcelain gallbladder has been used to emphasize the blue discoloration and brittle consistency of the gallbladder wall at surgery. Some authorities amalgamate the terms and call all calcified gallbladders porcelain gallbladders. The true incidence of porcelain gallbladder is unknown, but it is reported to be 0.6-0.8%, with a male-to-female ratio of 1:5. Most porcelain gallbladders (90%) are associated with gallstones.
Patients are usually asymptomatic, and porcelain gallbladder is found incidentally on plain abdominal radiographs, sonograms, or CT images. Surgical treatment of porcelain gallbladder is based on results from studies performed in 1931 and 1962, which revealed an association between porcelain gallbladder and gallbladder carcinoma. Porcelain gallbladder is uncommon, and recognizing the clinical and imaging characteristics of the disease is important because of the high frequency (22%) of adenocarcinoma in porcelain gallbladder. Surgery should not be delayed, even if the patient is asymptomatic, because the occurrence of carcinoma in porcelain gallbladder is remarkably high.

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