Diagnosis and clinical characteristics of acute gallbladder sludge in a patient with acute myocarditis and acute cholecystitis, as compared with common chronic gallstones
Affiliations: Department of Nursing, National Tainan Institute of Nursing, Tainan, Taiwan | Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan | Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan | Department of Biotechnology and Pharmaceutical Technology, Yuanpei University, Hsin Chu, Taiwan
Note: [] Corresponding authors (equal contribution): Dr. Hsiao-Huang Chang, MD, Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. E-mail: shchang@vghtpe.gov.tw. Prof. Shan-Yang Lin, PhD, Department of Biotechnology and Pharmaceutical Technology, Yuanpei University of Medical Technology, Hsin Chu, Taiwan. E-mail: sylin@mail.ypu.edu.tw
Abstract: An acute sludge was unexpectedly produced in the gallbladder of a woman with acute myocarditis, liver dysfunction and acute cholecystitis. This study aimed to determine whether the morphological features and chemical composition of this acute gallbladder sludge were different from common chronic gallstones. This acute gallbladder sludge and 12 patients' chronic gallstones were analyzed using histopathological examination, SEM, FTIR spectroscopy and X-ray fluorescence analysis. The chronic gallstones from the 12 patients were classified into calcium bilirubinate (CaBR), cholesterol (Chol) and CaBR–Chol mixed stones. The acute gallbladder sludge was not consistent with chronic gallstones but had developed within the prior 3 months of medical care, which only comprised CaBR and protein/biomaterials. Moreover, none of the long-term transition elements including Pb, Hg, Au, Sn, Sr, Rb, Br, Se and Cr had accumulated in the acute gallbladder sludge but they had found in chronic CaBR gallstone, however, the elements Hf, Co and Ti were present in the acute gallbladder sludge. The levels of Zn, Cu, Mn and Ca were lower in acute gallbladder sludge than in chronic gallstones. Our results indicate that this acute gallbladder sludge comprised large amounts of protein/biomaterials with fewer CaBR aggregates and had different element contents as compared with common chronic gallstones.
Keywords: Acute gallbladder sludge, chronic gallstone, SEM, FTIR, EDXRF, trace element
