Abstract The mechanism of the precipitation of cholesterol from bile to form gallstones has received increasing attention in recent years. Since the solubility of cholesterol in bile is dependent, to a great extent, on the presence of bile salts, considerable investigation has been directed toward the bile salt-cholesterol ratio in gallbladder bile. Experimental work on dogs clearly demonstrated that the wall of the inflamed gallbladder absorbs the bile salts of the contents rapidly, leaving an increased concentration of cholesterol.1 A large number of studies of bile removed from the gallbladder either at operation1 or at autopsy2 in cases of disease of the bladder indicated that with the increasing inflammation of the organ the bile salt—cholesterol ratio was progressively lowered. This lowered ratio was obviously due to the decreased concentration of bile salts. The methods employed by these various investigators for the determination of bile salts were either the Gregory-Pascoe References 1. (a) Rosenthal, F., and Licht, H.: Die Resorption der Gallensäuren in der normalen und entzündeten Gallenblase , Klin. Wchnschr. 7:1952, 1928.Crossref 2. (b) Andrews, E.; Schoenheimer, R., and Hrdina, L.: Chemical Factors and the Role of the Gall Bladder: Etiology of Gall Stones , Arch. Surg. 25:796 ( (Oct.) ) 1932.Crossref 3. (c) Johnston, C. G.; Ravdin, I. S.; Riegel, C., and Allison, C. L.: Studies on Gall Bladder Function: IX. The Anion-Cation Content of Bile from the Normal and Infected Gall Bladder , J. Clin. Investigation 12:67, 1933.Crossref 4. (d) Riegel, C.; Ravdin, I. S.; Johnston, C. G., and Morrison, P. J.: Studies of Gall Bladder Function: XIII. The Composition of Gall Bladder and Calculi in Gall Bladder Disease , Surg., Gynec. & Obst. 62:933-936. 5. (e) Reinhold, J. G.; Ferguson, L. K., and Hunsberger, A., Jr.: The Composition of Human Gall Bladder Bile and Its Relationship to Cholelithiasis , J. Clin. Investigation 16:367, 1937. 6. Newman, C. E.: Beitrag zum Studium der Gallenniederschlags-und Gallensteinbildung , Beitr. z. path. Anat. u. z. allg. Path. 86:187, 1931. 7. Wieland, H., and Revery, G.: Untersuchungen über die Gallensäuren: XXI. Zur Kenntnis der menschlichen Galle , Ztschr. f. physiol. Chem. 140:186, 1924. 8. (a) Colp, R., and Doubilet, H.: Differential Analysis of Bile Acids in Human Gallbladder Bile , Arch. Surg. 33:913 ( (Dec.) ) 1936. 9. (b) Doubilet, H., and Colp, R.: Differential Analysis of Bile Acids in Human Bile from Fistulas , Arch. Surg. 34:149 ( (Jan.) ) 1937. 10. Spanner, G. O., and Bauman, L.: The Behaviour of Cholesterol and Other Bile Constituents in Solutions of Bile Salts , J. Biol. Chem. 98:181, 1932. 11. Wieland, H., and Sorge, H.: Untersuchungen über die Gallensäuren , Ztschr. f. physiol. Chem. 97:1, 1916. 12. Doubilet, H.: Differential Quantitative Bile Acid Analysis in Bile and in Duodenal Drainage , J. Biol. Chem. 114:289, 1936. 13. Elman, R., and Taussig, J. B.: The Quantitative Determination of Cholesterol in Bile , J. Lab. & Clin. Med. 17:274, 1931. 14. Hammarsten, O.: A Text-Book of Physiological Chemistry , New York, J. Wiley & Sons, 1906, p. 275. 15. (a) Wright, A., and Whipple, G. H.: Bile Cholesterol: Fluctuations Due to Diet Factors, Bile Salt, Liver Injury, and Hemolysis , J. Exper. Med. 59:407, 1934. 16. (b) McMaster, P. D.: Studies on Total Bile , J. Exper. Med. 40:25, 1924. 17. (c) Dostal, L. E., and Andrews, E.: Etiology of Gall Stones: III. Effect of Diet on the Bile Salt-Cholesterol Ratio , Arch. Surg. 26:258 ( (Feb.) ) 1933. 18. (d) Bac- meister: Untersuchungen über Cholesteril Ausscheidung in menschlichen Gallen , Biochem. Ztschr. 26:223, 1910. 19. (e) Fox, F. W.: The Composition of Human Bile and Its Bearing upon Sterol Metabolsim , Quart. J. Med. 21:107, 1927. 20. Dragstedt, Z. R.; Van Poohaska, J., and Harms, H. P.: Observations on a Substance in Pancreas (Fat Metabolizing Hormone) Which Permits Survival and Prevents Liver Changes in Depancreatized Dogs , Am. J. Physiol. 117:175, 1936. 21. Doubilet, H.: Hepatic Excretion in Man of the Various Bile Acids Following Their Oral Administrations , Proc. Soc. Exper. Biol. & Med. 36:50, 1937.
Archives of Surgery – American Medical Association
Published: Jun 1, 1938
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