Many environmental risk factors for hepatobiliary cancers are known but whether they are associated with specific cancer types is unclear. We present here a novel approach of assessing standardized incidence ratios (SIRs) of previously diagnosed comorbidities for hepatocellular carcinoma (HCC), gallbladder cancer (GBC), cholangiocarcinoma (CCA) and ampullary cancer. The 13 comorbidities included alcohol and nonalcohol related liver disease, chronic obstructive pulmonary disease, gallstone disease, viral and other kinds of hepatitis, infection of bile ducts, hepatic and other autoimmune diseases, obesity and diabetes. Patients were identified from the Swedish Inpatient Register from 1987 to 2018, and their cancers were followed from 1997 onwards. SIRs for HCC were 80 to 100 in men and women diagnosed with hepatitis C virus and they were also >10 in patients diagnosed with hepatitis B virus, other kind of hepatitis, hepatic autoimmune disease and nonalcohol related liver disease. Many of these risks, as well as alcohol related liver disease, were either specific to HCC or were shared with intrahepatic CCA. For GBC, CCA and ampullary cancer infection of bile ducts was the main risk factor. Gallstone disease, nonhepatic autoimmune diseases and diabetes were associated with all hepatobiliary cancers. The limitations of the study include inability to cover some rare risk factors and limited follow-up time. Many of the considered comorbidities are characterized by chronic inflammation and/or overt immune disturbance in autoimmune diseases. The results suggest that local chronic inflammation and a related immune disturbance is the carcinogenic trigger for all these cancers.
- MeSH
- ampulla Vateri * patologie MeSH
- autoimunitní nemoci * MeSH
- cholangiokarcinom * epidemiologie etiologie diagnóza MeSH
- cholelitiáza * komplikace patologie MeSH
- hepatocelulární karcinom * patologie MeSH
- lidé MeSH
- nádory ductus choledochus * komplikace patologie MeSH
- nádory jater * epidemiologie etiologie patologie MeSH
- nádory žlučníku * etiologie komplikace MeSH
- nádory žlučových cest * epidemiologie etiologie patologie MeSH
- zánět patologie MeSH
- žlučové cesty intrahepatální patologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Jako Bouveretův syndrom je označována obstrukce v oblasti duodena impaktovaným žlučovým kamenem, který vycestuje cholecystoduodenální či cholecystogastrickou píštělí. Onemocnění je vzácné, vyskytuje se zejména u starších žen s četnými komorbiditami a vysokým operačním rizikem. K diagnóze se zpravidla dospěje endoskopicky nebo pomocí zobrazovacích metod. Pokud stav nelze řešit endoskopicky, je indikováno operační řešení. Autoři prezentují případ Bouveretova syndromu u 79leté pacientky, u níž se zdařilo zdokumentovat všechny fáze vyšetřovacího a léčebného procesu. Součástí sdělení je přehled literatury týkající se diagnostiky a terapie tohoto vzácného syndromu.
Bouveret syndrome is a gastric outlet obstruction caused by impaction of a gallstone that passes through a cholecystoduodenal or cholecystogastric fistula. It is a rare disease, most common in elderly women with multiple comorbidities and high surgical risk. The diagnosis can be made either radiologically or endoscopically. Endoscopic extraction is the preferred therapeutic option. Surgical intervention is indicated when endoscopic methods fail. We describe a case of Bouveret syndrome in a 79 years old woman. The report is followed by a review of literature on the diagnostics and treatment of this rare syndrome.
- Klíčová slova
- biliodigestivní píštěl, biliární ileus,
- MeSH
- bolesti břicha MeSH
- chirurgie trávicího traktu metody MeSH
- cholelitiáza * diagnóza chirurgie komplikace MeSH
- endoskopie trávicího systému MeSH
- ileus * etiologie chirurgie MeSH
- lidé MeSH
- obstrukce duodena * diagnóza etiologie chirurgie MeSH
- senioři MeSH
- střevní píštěle komplikace MeSH
- syndrom MeSH
- zvracení MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
- MeSH
- cholecystolitiáza etiologie terapie MeSH
- cholelitiáza * diagnóza epidemiologie etiologie farmakoterapie chirurgie komplikace terapie MeSH
- kolika diagnóza farmakoterapie terapie MeSH
- lékaři primární péče MeSH
- lidé MeSH
- praktické lékařství metody MeSH
- rizikové faktory MeSH
- vztahy mezi lékařem a pacientem MeSH
- žlučové kameny diagnóza epidemiologie etiologie farmakoterapie chirurgie klasifikace komplikace terapie MeSH
- Check Tag
- lidé MeSH
Acute cholecystitis (AC) appears as the basic complication of cholelithiasis. However, the leading place in the mortality structure belongs to choledocholithiasis, cholangitis obstructive, jaundice, and especially to infected biliary pancreatic necrosis. Retrospective analysis of the results of investigations and surgical treatment of 1023 patients with complicated forms of cholelithiasis included 314 men and 709 women at the age between 15 and 91 years. Such complications of cholelithiasis as AC, choledocholithiasis, cholangitis and stricture of papilla major are not the contra-indication to laparoscopic cholecystectomy. The treating possibilities of laparoscopic and endoscopic technique in 96.2% cases allowed successfully performing cholecystectomy and the correction of bile outflow without doing the wide laparotomy. Offered technical improvements of laparoscopic cholecystectomy promoted lowering of conversions number (from 8.8% to 3.8%) and the quantity of intra- and post-operative complications contained in the changes of trocat inserting points, using modified instruments for tissue dissection, mobilizing of gall-bladder and hemostasis.
- MeSH
- cholecystektomie laparoskopická MeSH
- cholecystostomie MeSH
- cholelitiáza * chirurgie komplikace patofyziologie MeSH
- dospělí MeSH
- endoskopie metody využití MeSH
- laparoskopie metody využití MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- sfinkterotomie endoskopická metody využití MeSH
- video-asistovaná chirurgie MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- žlučové cesty chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
Gallstone ileus is a relatively rare but life threatening entity. We report the case of laser lithotripsy in the sigmoid colon in an 86-year-old female patient with cholecysto-colonic fistula. A tissue recognition system ensured the safety of the procedure. Three treatment sessions were required to obtain complete gallstone evacuation. No complications were observed. One-year follow-up colonoscopy showed nearly healed cholecystocolonic fistula. We conclude that laser lithotripsy with a tissue recognition system is safe and effective in such cases and could be considered in gallstone impaction at the level of large bowel.
- MeSH
- biliární píštěl komplikace terapie MeSH
- cholelitiáza diagnóza komplikace terapie MeSH
- ileus etiologie terapie MeSH
- kolonoskopie využití MeSH
- laserová litotripse metody využití MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- sigmoidoskopie využití MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- akutní cholecystitida diagnóza etiologie komplikace terapie MeSH
- cholecystitida diagnóza etiologie klasifikace komplikace terapie MeSH
- cholecystolitiáza diagnóza etiologie komplikace patologie terapie MeSH
- choledocholitiáza diagnóza etiologie klasifikace terapie MeSH
- cholelitiáza * diagnóza epidemiologie etiologie chirurgie klasifikace komplikace patologie terapie MeSH
- laparoskopie využití MeSH
- laserová litotripse trendy využití MeSH
- lidé MeSH
- litotripse metody MeSH
- žluč fyziologie chemie sekrece MeSH
- žlučové kameny chemie klasifikace MeSH
- Check Tag
- lidé MeSH
OBJECTIVE The clinical picture of primary hyperparathyroidism (PHPT) has changed during the past 50 years. It is currently unknown whether or not PHPT is associated with an increased risk of cholelithiasis. PATIENTS: To determine the frequency of cholelithiasis in PHPT we analyzed 645 consecutive patients seen at Prague University Hospital from 1992 through 2002 and compared them with a of normocalcaemic control group. METHODS: We investigated 645 patients with proven PHPT (518 female and 127 males aged 20-80 years) during a period of 10 years. To determine the frequency of cholelithiasis in normal population we analyzed 2,015 patients receiving periodic health examination at an outpatient ward from January 1998 to December 1998 (1505 females and 510 males aged 24-85 years). A detailed history, physical examination, biochemical measurements and abdominal ultrasonography were done. RESULTS: Cholelithiasis was proven in 157 of 518 women (30.3%) and in 11 of 127 men (8.66%) with PHPT. Their mean age was 59.67+/-12 years in women and 56.0+/-10 years in men. In the control group 260 of 1505 women (17.27%) and 54 of the 510 men (10.58%) had cholelithiasis. The mean age was 64.55+/-13.8 years in women and 61.2+/-12.4 in men. Only in the case of women, the difference was highly statistically significant (p<0.001). There were no significant differences between the mean values for the serum calcium level, bone alkaline phosphatase, total cholesterol, urinary hydroxyproline and body mass index in hyperparathyroid patients with and without cholelithiasis. However the hyperparathyroid women with cholelithiasis had an increased concentration of parathyroid hormone (236.1+/-56 pg/ml) compared with hyperparathyroid women without cholelithiasis (179.0+/-45 pg/ml), p<0.01. CONCLUSION: The mechanism of PTH associated gallstone formation may involve inhibition of gallblader emptying, hepatic bile secretion and sphincter Oddi motility as well as modification of bile composition. While it might be difficult to prove it seems likely that the association of cholelithiasis with primary hyperparathyroidism in women with a high concentration of parathyroid hormone is more than merely coincidental and from our study it is obvious that a significant association exists.
- MeSH
- cholelitiáza epidemiologie etiologie komplikace MeSH
- dospělí MeSH
- financování organizované MeSH
- lidé středního věku MeSH
- lidé MeSH
- parathormon krev MeSH
- pohlavní dimorfismus MeSH
- primární hyperparatyreóza komplikace krev MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
