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THE COMPOSITION OF GALL STONES AND THEIR SOLUBILITY IN DOG BILE

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THE COMPOSITION OF GALL STONES AND THEIR SOLUBILITY IN DOG BILE Powered By Docstoc
					  THE    COMPOSITION     OF GALL STONES                    AND    THEIR
                SOLUBILITY   IN DOG BILE
        BY   M. PICKENS,     G. 0. SPANNER,        AND  L. BAUMAN
                     of
 (From the Departments b’urgery and Medicine,        Presbyterian Hospital,
                     Columbia   University,   New York)

               (Received for publication,     January 11, 1932)

   Gall stones are usually classified into three groups. Of these




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the solitary cholesterol and pigment stones are rather rare while
the mixed or combination stone is by far the most common.
Throughout the literature a fairly sharp distinction is made
between the solitary cholesterol and the mixed stone, the former
consists of almost pure cholesterol while the latter is said to
contain varying quantities of other material, notably the calcium
salt of bilirubin.
   We have made numerous analyses of mixed stones, selecting
samples of different color, shape, and size. At times we worked
with several hundred gm. that had accumulated in the path-
ological laboratories and at times with individual samplesobtained
from gallbladders, at operation. Recently a series of twenty-six
such individual specimens were analyzed. Of these seventeen
contained 96 per cent or more of cholesterol. The average
cholesterol content of all these stones was 94 per cent (Table I).
The solitary stone contains between 98 and 99 per cent of
cholesterol.
   Cholesterol therefore plays the important role from a quantita-
tive view-point.    Disregarding morphology one might suppose
that the inclusion of substancesother than cholesterol was purely
accidental. As is well known, uric acid, a constituent of kidney
stones, though colorlesswhen pure, appears in urine in characteris-
tic brown whet stone formations. Obviously there is an inclusion
of urinary pigment.
   The residue after extraction of cholesterol consists largely of
calcium carbonate and the calcium salts of bilirubin and other
                                      505
                                                   TABLE      I
         Average     Composition            of “Mixed       or Combination”             Gall Stones
                                                                                                           per cent
Cholesterol .......................................................                                         94
Calcium ..........................................................                                           1.09
Magnesium .......................................................                                            0.13
Sodium and potassium ............................................                                            0.05
Carbonic acid anhydride ..........................................                                           1.06
Phosphoric acid anhydride ........................................                                           0.40
Pigment (by difference) ...........................................                                          3.26
Fatty acids   .......................................................                                      Trace

                                                   TABLE     II




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                               Analytical      Data     of Gallbladder         Bile




                                               Human bile
                     per cent          mg. per cent         per cent           mg. per cent        mg. per cent
     608                4.95             112                  2.26                    133             21
     612             15.0                364                  2.42                    408             44
     613             18.0                610                  3.38                    800            190
     614*             4.75                86                  1.85                    103             17
     102              4.4                 90                  2.05                    110             20
     103             12.9                125                  0.97                    160             35
     104             10.7                330                  3.08                    370             40
     105             13.5                300                  2.22                    350             50
     106              1.85                50                  2.70                     65             15
                                  _-
  Average............                    229                                          278             48
                                  -
                                                   Dog bile
                                                                                              -
      63
      64
                     24.79
                     25.02
                                          70
                                         130
                                                             0.28
                                                             0.52
                                                                                      180
                                                                                      320
                                                                                               I     110
                                                                                                     190
      56             22.0                  8                 0.03                     134            126
      57             15.0                  8                 0.05                      96             88
      58             22.8                  2                 0.01                     288            286
      59             16.7                  2                 0.01                     428            426
      73             21.28                 2                 0.01                     415            413
      73             18.92                20                 0.10                      70             50
      75             23.8                 82                 0.34                     208            126
      84             16.47                44                 0.27                     138             94
                                                        -                 __
 Average      . . . . . . . . . .I          36.8        1                             228            190.9
                                                                          -
  * Mixture        of thirty bile specimens obtained                     at autopsy.
  t Mixture        of two specimens.
                                           506
                   Pickens, Spanner, and Bauman                            507
bile pigments.        No bile salts and only traces of fatty         acids were
found.

                    Xolubility   of Gall Stones in Dog Bile
   The interesting   observation     that human gall stones dissolve
in the gallbladder bile of the dog was first described by Naunyn (1)
and amply confirmed by Harley and Barratt (2), Hansemann (3),
and most recently by Walsh and Ivy (4). The reason for this
phenomenon has never been determined.




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   In the experiments      embodied in Table II, the cholesterol
content of the gallbladder bile of the human and dog was deter-
mined by the gravimetric        method of Windaus before and after
saturation    with cholesterol.     Saturation  was accomplished   by
prolonged shaking with the finely powdered substance.
   It is seen that while cholesterol of dog bile is low, both abso-
lutely and in proportion to solid matter, yet this bile dissolves 4
times as much cholesterol as human bile. This we believe is the
chief cause of the solution of human stones in the gallbladder bile
of the dog. In confirmation        of this theory, it was found that
stones were insoluble in dog bile that had been saturated with
cholesterol.

                                    SUMMARY

   1. The average cholesterol content of a large series of the
common mixed or combination gall stones was 94 per cent.
   2. The solubility of human gall stones in dog bile is due to the
low initial cholesterol content of the dog bile. This is the reason
for its relatively high solubility coefficient for this substance.
                                 BIBLIOGRAPHY

1.   Naunyn, B., Klinik der Cholelithiasis,    Leipsic (1892).
2.   Harley, V., and Barratt, W., J. Physiol.,   29, 341 (1903).
3.   Hansemann, Virchows     Arch. path. Amt.,    212, 139 (1913).
4.   Walsh, E. L., and Ivy, A. C., Ann. Znt. Med., 4,134 (1930).

				
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