Several studies have shown that fibrates can raise the biliary cholesterol saturation index (1–3), which is critical for gallstone formation (4). The Coronary Drug Project, which studied men with prior myocardial inf...
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Several studies have shown that fibrates can raise the biliary cholesterol saturation index (1–3), which is critical for gallstone formation (4). The Coronary Drug Project, which studied men with prior myocardial infarction, found that treatment with clofibrate increased the risk of cholecystectomy and gastrointestinal complications (5). A cross-sectional survey of the prevalence of gallstone disease in Spain found that fibrate use was the strongest independent risk factor for gallstones, albeit without delineating the effect of specific fibrate drugs (6). Other studies have implied that newer fibrate drugs, such as bezafibrate, fenofibrate, and gemfibrozil, may be less lithogenic than clofibrate (7–10). The Helsinki Heart Study did not find a statistically significant association between gemfibrozil use and cholecystectomy among dyslipidemic, middle-aged men, although the incidence was higher in the gemfibrozil group compared with the placebo group (11,12). Conversely, some (13,14), but not all (15), studies have suggested that statins reduce biliary cholesterol saturation and could protect against gallstones.
Twenty-seven children aged 18 years and under with homozygous sickle-cell disease had open cholecystectomy for symptomatic gallstones over the 12-year period 1985-1997. Emergency procedures (done during period of acut...
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Twenty-seven children aged 18 years and under with homozygous sickle-cell disease had open cholecystectomy for symptomatic gallstones over the 12-year period 1985-1997. Emergency procedures (done during period of acute exacerbation of symptoms) were performed on 16 patients. Four with haemoglobin levels greater than 1 g/dl below their steady state received a simple blood transfusion preoperatively designed to raise haemoglobin levels to 10 g/dl. All had acute or acute on chronic cholecystitis based on histological examination of gallbladder specimens. Twelve had common bile duct stones. In two patients calculi were missed intraoperatively but these subsequently passed into the duodenum after a period saline irrigation via an in-situ t-tube. Six developed the acute chest syndrome (aetiology not determined) and this progressed to multi system failure and death in one. This high level of postoperative mobility and mortality may in part be due to the high proportion of emergency procedures.
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