Limits...
Tiny cystine stones in the gallbladder of a patient with cholecystolithiasis complicating acute cholecystitis: a case report.

Qiao T, Ma RH, Luo XB, Feng YY, Wang XQ, Zheng PM, Luo ZL - Eur. J. Med. Res. (2012)

Bottom Line: Cystine stones, the main component of which is cystine, are very common urinary calculi, but are rare in the gall bladder.In animals, there has been only one report of cystine gallstones in tree shrews, and to our knowledge, this is the first report of cystine gallstones in humans.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Gallbladder Disease of Panyu, Guangzhou 511470, People's Republic of China. fqj1958@163.com

ABSTRACT
Cystine stones, the main component of which is cystine, are very common urinary calculi, but are rare in the gall bladder. In animals, there has been only one report of cystine gallstones in tree shrews, and to our knowledge, this is the first report of cystine gallstones in humans.

Show MeSH

Related in: MedlinePlus

Endoscopic and gross appearance of the stones. (A,B) Small stones and purulent bile and (C,D) large stones and purulent bile under endoscopy. (E-H) Appearance of (E,F) small stones and (G,H) large stones with a radial, layered arrangement in profile.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3369205&req=5

Figure 1: Endoscopic and gross appearance of the stones. (A,B) Small stones and purulent bile and (C,D) large stones and purulent bile under endoscopy. (E-H) Appearance of (E,F) small stones and (G,H) large stones with a radial, layered arrangement in profile.

Mentions: Consequently, after approval by the medical ethics committee and provision of informed consent by the patient, the gallbladder was laparoscopically isolated and transected at the bottom (< 6 mm) under general anesthesia. First, the bile was drained with a sterile ventricular drainage tube to a sterile injector, and transferred to sterile tubes. Next, the gallbladder was explored with a three-channeled cholecystoscope (CHiAO; Chinese national patent number: ZL200810026985.X HAWK, China [10]), and the stones were collected with a stone extractor. We found only mild congestion in the gallbladder mucosa, which indicated only slight inflammation of gallbladder. Using endoscopy, we found many small, semitransparent stones (< 1 mm) adhered to the gallbladder wall (Figure 1A, B). These stones were removed with an endoscopic attachment (CHiAO absorbing box; Chinese national patent number: ZL 201110167069.X) designed to remove sludge-like gallstones combined with seven types of manipulation (pushing, squeezing, pressuring, tearing, bracing, flushing, and sucking) [5], while several large stones (> 5 mm) were removed with a stone extractor (Figure 1C, D). The small stones were yellowish and semitransparent, and the large stones were polyhedron or globular in shape, and had a radial, layered arrangement in profile (Figure 1E-H). The bile was yellowish, opaque, turbid, and very viscous. After centrifugation at 1,450 g for 10 min, the bile supernatant was transferred to a clean tube, and about 0.5 mL of sediment was kept. The bile sediment was smeared onto labeled slides and viewed under a system microscope (BX51; Olympus, Tokyo, Japan). Colorless hexagonal plate crystals with high refractivity and limpid edges were seen, which were judged to be cystine crystals based on their morphology. Meanwhile, colorless, transparent crystals (in the shape of rectangles with missing corners or squares with missing corners, or glass flakes) were seen, which were judged to be cholesterol crystals from their morphology (Figure 2).


Tiny cystine stones in the gallbladder of a patient with cholecystolithiasis complicating acute cholecystitis: a case report.

Qiao T, Ma RH, Luo XB, Feng YY, Wang XQ, Zheng PM, Luo ZL - Eur. J. Med. Res. (2012)

Endoscopic and gross appearance of the stones. (A,B) Small stones and purulent bile and (C,D) large stones and purulent bile under endoscopy. (E-H) Appearance of (E,F) small stones and (G,H) large stones with a radial, layered arrangement in profile.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369205&req=5

Figure 1: Endoscopic and gross appearance of the stones. (A,B) Small stones and purulent bile and (C,D) large stones and purulent bile under endoscopy. (E-H) Appearance of (E,F) small stones and (G,H) large stones with a radial, layered arrangement in profile.
Mentions: Consequently, after approval by the medical ethics committee and provision of informed consent by the patient, the gallbladder was laparoscopically isolated and transected at the bottom (< 6 mm) under general anesthesia. First, the bile was drained with a sterile ventricular drainage tube to a sterile injector, and transferred to sterile tubes. Next, the gallbladder was explored with a three-channeled cholecystoscope (CHiAO; Chinese national patent number: ZL200810026985.X HAWK, China [10]), and the stones were collected with a stone extractor. We found only mild congestion in the gallbladder mucosa, which indicated only slight inflammation of gallbladder. Using endoscopy, we found many small, semitransparent stones (< 1 mm) adhered to the gallbladder wall (Figure 1A, B). These stones were removed with an endoscopic attachment (CHiAO absorbing box; Chinese national patent number: ZL 201110167069.X) designed to remove sludge-like gallstones combined with seven types of manipulation (pushing, squeezing, pressuring, tearing, bracing, flushing, and sucking) [5], while several large stones (> 5 mm) were removed with a stone extractor (Figure 1C, D). The small stones were yellowish and semitransparent, and the large stones were polyhedron or globular in shape, and had a radial, layered arrangement in profile (Figure 1E-H). The bile was yellowish, opaque, turbid, and very viscous. After centrifugation at 1,450 g for 10 min, the bile supernatant was transferred to a clean tube, and about 0.5 mL of sediment was kept. The bile sediment was smeared onto labeled slides and viewed under a system microscope (BX51; Olympus, Tokyo, Japan). Colorless hexagonal plate crystals with high refractivity and limpid edges were seen, which were judged to be cystine crystals based on their morphology. Meanwhile, colorless, transparent crystals (in the shape of rectangles with missing corners or squares with missing corners, or glass flakes) were seen, which were judged to be cholesterol crystals from their morphology (Figure 2).

Bottom Line: Cystine stones, the main component of which is cystine, are very common urinary calculi, but are rare in the gall bladder.In animals, there has been only one report of cystine gallstones in tree shrews, and to our knowledge, this is the first report of cystine gallstones in humans.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Gallbladder Disease of Panyu, Guangzhou 511470, People's Republic of China. fqj1958@163.com

ABSTRACT
Cystine stones, the main component of which is cystine, are very common urinary calculi, but are rare in the gall bladder. In animals, there has been only one report of cystine gallstones in tree shrews, and to our knowledge, this is the first report of cystine gallstones in humans.

Show MeSH
Related in: MedlinePlus