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Bakthavatchalam M, Venkataraman J, Ramana RJ, Jain M, Singh B, Thanigai AK, Velyoudam V, Manickam Neethirajan S, Tiwari MK, Agarwal AK, Kalkura NS. Morphological and elemental mapping of gallstones using synchrotron microtomography and synchrotron X-ray fluorescence spectroscopy. JGH Open 2019; 3:381-387. [PMID: 31633042 PMCID: PMC6788379 DOI: 10.1002/jgh3.12171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIM Regional differences in gallstone (GS) composition are well documented in the Indian subcontinent. The reasons for the same are unknown. Etiopathogenesis of GS remains elusive despite advances in instrumentation. This was an in-depth analysis of the chemical, structural, and elemental composition of GS with special reference to synchroton studies. METHODS We used high-end sensitive analytical complementary microscopic and spectroscopic methods techniques, such as X-ray diffraction, scanning electron microscopy, Fourier transform infrared, synchrotron X-ray fluorescence spectroscopy (SR-XRF), and 2D and 3D synchrotron microtomography (SR-μCT), to study the ultra structure and trace element composition of three major types of GS (cholesterol, mixed, and pigment). SR-XRF quantified the trace elements in GS. RESULTS The cholesterol GS (monohydrate and anhydrate) were crystalline, with high calcium content. The pigment GS were amorphous, featureless, black, and fragile, with high calcium bilirubinate and carbonate salts. They had the highest concentration of iron (average 31.50 ppm) and copper (average 92.73 ppm), with bacterial inclusion. The mixed stones had features of both cholesterol and pigment GS with intermediate levels of copper (average 20.8 ppm) and iron (average 17.78 ppm). CONCLUSION SR-μCT has, for the first time, provided cross-sectional computed imaging delineating the framework of GS and mineral distribution. It provided excellent mapping of cholesterol GS. SR-XRF confirmed that pigment GS had high concentrations of copper and iron with bacterial inclusions, the latter possibly serving as a nidus to the formation of these stones.
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Affiliation(s)
| | | | | | - Mayank Jain
- Institute of GI Sciences, Gleneagles Global Hospitals and Health CityChennaiIndia
| | - Balwant Singh
- Indus 2Raja Ramanna Centre for Advance TechnologyIndoreIndia
| | - Arul K Thanigai
- Department of Physics, Energy and Biophotonics LabAMETChennaiIndia
| | | | | | - Manoj K Tiwari
- Indus 2Raja Ramanna Centre for Advance TechnologyIndoreIndia
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Jayanthi V, Sarika S, Varghese J, Vaithiswaran V, Sharma M, Reddy MS, Srinivasan V, Reddy GMM, Rela M, Kalkura S. Composition of gallbladder bile in healthy individuals and patients with gallstone disease from north and South India. Indian J Gastroenterol 2016; 35:347-353. [PMID: 27633032 DOI: 10.1007/s12664-016-0685-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/08/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gallstones (GS) in south India (SI) are predominantly pure pigment or mixed, while in North India (NI), these are either pure cholesterol or mixed. While cholesterol rich gallbladder (GB) bile predicts cholesterol GS, constituent of bile in primary pigment GS is not known. We compared the composition of GB bile from healthy liver donors and patients with GS from north and south India. METHODS Gallbladder bile from healthy liver donors from north (10) and south India (8) served as controls. Cases were patients from north (21) and south India (17) who underwent cholecystectomy for GS disease. Gallbladder bile from both cases and controls was analyzed for cholesterol, lecithin (phospholipid), and bile salts. Gallstones were classified as cholesterol, mixed, and pigment based on morphology and biochemical analysis. RESULTS The median cholesterol concentration in control bile from north was significantly high compared to south (p<0.001) with no difference in lecithin and bile salts (p NS). Except for one sample each from north and south, the cholesterol solubility of controls was within the critical micellar zone. Mixed GS were most frequent in north India (61.9 %) while pigment GS dominated in south (61.9 %). The median cholesterol concentration in bile samples of cholecystectomy patients from north India was significantly high GS (p < 0.00001) with significant lowering of bile salts and lecithin (p < 0.00001). In south India, patients with mixed GS had high cholesterol content in bile compared to controls and patients with pigment GS; bile in latter had significantly higher concentration of bile salt compared to controls and mixed GS. The ternary plot confirmed the composition of GB bile from north and south India. CONCLUSIONS Gallbladder bile in controls and patients with GS from north India had significantly high cholesterol concentration. In south India, patients with mixed GS had cholesterol rich bile while pigment GS had higher concentrations of bile salts.
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Affiliation(s)
- V Jayanthi
- Gastroenterology and Hepatology, Institute of Gastrosciences, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India.
| | - S Sarika
- Crystal Growth Center, AC Technology, University of Madras, Chepauk, Chennai, 600 005, India
| | - Joy Varghese
- Institute of Liver Disease and Liver Transplant, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| | - V Vaithiswaran
- Gastroenterology and Hepatology, Institute of Gastrosciences, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| | - Malay Sharma
- Jaswant Rai Specialty Hospital, Mawana Road, Meerut, 250 001, India
| | - Mettu Srinivas Reddy
- Institute of Liver Disease and Liver Transplant, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| | - Vijaya Srinivasan
- Gastroenterology and Hepatology, Institute of Gastrosciences, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| | - G M M Reddy
- Chettinad Hospital and Research Institute, Rajiv Gandhi Salai, OMR Chennai, Kelambakkam, Chennai, 603 103, India
| | - Mohamed Rela
- Institute of Liver Disease and Liver Transplant, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| | - S Kalkura
- Crystal Growth Center, AC Technology, University of Madras, Chepauk, Chennai, 600 005, India
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