European Journal of Molecular & Clinical Medicine

Mirizzi’s syndrome is characterized by external compression of extra hepatic biliary system by impacted gall stone in cystic duct or infundibulum of gall bladder leading to obstructive jaundice and development of cholecystobiliary fistula in advanced cases. Csendes has described 4 types of the syndrome. In spite of modern investigations like MRCP/CTS available, preoperative diagnosis is not always obtained and it may present as surprise during cholecystectomy. We have done a retrospective study of 7 cases of Mirizzi’s syndrome, in which preoperative diagnosis was obtained only in 3 cases. Cholecystectomy was performed in 2 cases, while 3 cases needed choledochoplasty in addition.  Hepaticojejunostomy was needed in addition to cholecystectomy in 2 cases of TypeIII /IV respectively. Utmost care must be exerted during difficult cholecystectomy cases keeping possibility of Mirizzi’s syndrome as culprit and appropriate surgical procedure performed for the treatment

Aim: To assess the gallbladder volume in T2DM patients and in healthy controls by using Ultrasonography.
Methodology: This cases control study was conducted among 55 diabetic patients enrolled from the diabetes clinic of the RVM Institute of Medical Sciences & Research Centre, Laxmakkapally, Telangana, India and 55 healthy patients (control group). 30-60 year patients of type 2 diabetes mellitus diagnosed since 5 year or more and functioning gall bladder with well controlled blood sugar levels. The diagnosis of diabetes in these patients was in accordance with WHO criteria i.e., fasting plasma glucose level ≥126 mg/dl, and ≥200 mg/dl plasma glucose level after 2hr of ingestion of standardised 75 gm glucose. An informed consent was taken from all the subjects in the study and control groups. All the patients were randomly selected for the study among patients regularly attending diabetic clinic of this hospital and following our criteria’s of selection.
Results: Mean age of diabetic Patient was 48.5 years in study group and 53 years in control group. 45.5% of diabetics were males and remaining 54.5% were females, whereas in control group male to female ratio was equal, means 49% males and 50% females. 85.5% cases in control group had no gall bladder disease, while only 63.6% cases in group with diabetes had no gall bladder disease. In group with DM type 2, 20% had cholelithiasis, 9.1% had cholecystitis, and 7.3% had sludge: while in control group, 5.5% had cholelithiasis, 3.6% had cholecystitis, and 5.5% had sludge. The percentage of contraction of gall bladder had reduced markedly in chronic diabetics (45.6 + 9.57) as compared to controls (65.2 + 7.34) (p value- 0.001). The fasting gall bladder volume in chronic diabetics was higher (43.47 + 5.35) than that of controls (28.45 + 4.26) and the difference of values was found to be highly significant (p value 0.001).
Conclusion: In patients of diabetes mellitus type 2, higher fasting gall bladder volume and decreased percentage of contraction are observed. Therefore, all T2DM patients should be evaluated using ultrasonography for the presence of increased fasting gallbladder volumes to assess the risk of progression to gall stone disease.

Background: Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. As it gained worldwide popularity, it has become one of the most common operations performed in general surgical practice. In this study we aimed to investigate to determine changes in liver function tests after laparoscopic cholecystectomy.
Material & Methods: A prospective observational study done on 100 patients who underwent elective laparoscopic cholecystectomy were taken up for the study in the department of General surgery at JLN medical college and hospital, Ajmer, Rajasthan, India during period between January 2020 to December 2021. All patients who gave consent for the study underwent a standard clinical and laboratory evaluation including USG. Pre-operative investigations included liver function tests i.e. prothrombin time, bilirubin (total and direct), alanine transaminase, aspartate transaminase, alkaline phosphatase, total proteins, serum albumin, GGT, and LDH. The subjects under inclusion criteria have taken up for the study. The liver function tests have repeated 24 hours, 3^rd day, 7^th days, 10^th days after the operation and compared.
Result: The mean age of the study population was 43.3 years with a standard deviation of 13.35 yrs. A negative t-STAT shows that the value of serum total protein, serum albumin was falling after the laparoscopic procedure. A statistically significant increase in the bilirubin(total and direct), SGOT, SGPT, GGT, LDH, and serum alkaline phosphatase levels were noted after laparoscopic cholecystectomy and no statistical significance in prothrombin time.
Conclusion: We concluded that statistically significant increase in the bilirubin (total and direct), SGOT, SGPT, GGT, LDH, and serum alkaline phosphatase levels after Laparoscopic cholecystectomy. There was a decrease in total protein and albumin and no change for prothrombin time. However, further studies with larger sample sizes and multi-center trials would yield more definite results, along with meta-analyses. We strongly suggest the consideration of confounding factors such ascomorbidities, duration of surgery, CO2 pressure, utilized anesthetic agents, and also longer period follow-ups. 

Aim: To assess the gallbladder volume in T2DM patients and in healthy controls by using
Ultrasonography.
Methodology: This cases control study was conducted among 50 diabetic patients enrolled
from the diabetes clinic of the Medicine Department of Maharishi Markandeshwar medical
college and hospital Kumarhatti, Solan, Himachal Pradesh and 50 healthy patients (control
group). 30-60 year patients of type 2 diabetes mellitus diagnosed since 5 year or more and
functioning gall bladder with well controlled blood sugar levels. The diagnosis of diabetes in
these patients was in accordance with WHO criteria i.e., fasting plasma glucose level ≥126
mg/dl, and ≥200 mg/dl plasma glucose level after 2hr of ingestion of standardised 75gm
glucose. An informed consent was taken from all the subjects in the study and control groups.
All the patients were randomly selected for the study among patients regularly attending
diabetic clinic of this hospital and following our criteria’s of selection.
Results: Mean age of diabetic Patient was 48.5 years in study group and 53 years in
control group. 46% of diabetics were males and remaining 54% were females, whereas in
control group male to female ratio was equal, means 50% males and 50% females. 90% cases
in control group had no gall bladder disease, while only 66% cases in group with diabetes
had no gall bladder disease. In group with DM type 2, 10% had cholelithiasis, 8% had
cholecystitis and 3% had sludge: while in control group, 4% had cholelithiasis, 2% had
cholecystitis and 4% had sludge. The percentage of contraction of gall bladder had reduced
markedly in chronic diabetics (45.6 + 9.57) as compared to controls (65.2 + 7.34) (p value-
0.001). The fasting gall bladder volume in chronic diabetics was higher (43.47 + 5.35) than
that of controls (28.45 + 4.26) and the difference of values was found to be highly
significant (p value 0.001).
Conclusion: In patients of diabetes mellitus type 2, higher fasting gall bladder volume and
decreased percentage of contraction are observed. Therefore, all T2DM patients should
be evaluated using ultrasonography for the presence of increased fasting gallbladder
volumes to assess the risk of progression to gall stone disease.