COIWARISON OF CHOLE,,~kOL NUCLEATlON TIME IN OALLBLAODER BILE OF PATlENTS WlTH SOL,v,RY OR MULTIPLE CHOLESTEROLGPLLSTONES T. Lang.
lJn1ws1ty
0.
angst
OzxiiEh.
Department of Lnternal Medicine II, Klinikum Grossiiadern, F.R.G.
Cholesterol gallstone ~ecurrewe, Ilke primary gallsto”P formatran. probably iWOlves a triple defect with rupersaturat~on a.~d abnormal rapid nucleation of ChoLesterol as well as altered gallbladwr motor funct~an. Patients who initially have multiple vimary gallstones seem to be at greater risk Of recurrence than those Who originally had solitary stone* perhaps because oi differences I” nucieatian. To PPOW thLS hypotneris we StUdlEd besides the cho:esterol saturation index lC51) tr? time required for nucleation of cholesterol monohydrate crystals in ultracentrlfuged bile in 54 patients with solitary and 32 patients with multiple cnole*terol gallstones. SIX patient* with solitary and 10 patients with multiple mixed or pigment stones served as controls. The median 651 in the bile of patients with solitary (1.4) or multiple (1.4) cholesterol stones was ldentlcal but significantly higher CORpared to the median CSI L” the bile of patients with solitary (0.9) or m”Ltiple (l.1) plgnent or mixed stones. The median cholesterol nucleation time (NT) was higher in the bile of patlents with mixed or pigment stones (21.0 days) as compared to the median NT in the bile fron patzents wltn so,itwy (1.8 days, or mu,t,p,e (1.0 days) cholesterol Sto”e5. Although the difference betree” the median NT in the bile of pdtle”ts with solitary vs. multiple Cholesterol stones IS not promnent, To from 52 pdtxnts wtb soi~tary but only from 28 *atxnts With multiple cbolelterol stones Slmw?d a normai NT (> 4 days). Our flndlngs demonstrate no differences in the 51 of blles from patxntz with solitary VPmultiple cholestertll ~allstanes but a wmal NT in the bile of about 20 % of patients with s”,it.Wy ~h0l~~tWD~ Q1115tOWS. This might contribute to the cbserved lower recurrence rates in the*0 patients after zuccessful disso1utio” therapy.