The chemical composition of gallstones removed operatvely from 120 patients with cholelithiasis at the Surgery Department of Chiang Mai and Siriraj University Hospitals, Thailand, was analyzed by use of the infra-red absorption spectra for three parts of the calculus: core, intermediate layer and outer layer. The results were compared with the similar data obtained in 115 cases at the first Department of Surgery of Nippon Medical School.
1) The number of stones having an identical chief component throughout the three parts were 63 (52.5%). Of those 51.7% contained only a single component. In the Chiang Mai samples, the pure cholesterol stones accounted for 14.3% of total and the pure calcium bilirubinate stones 8.6%, while they accounted for 8.2% and 20%, respectively, in the Siriraj samples. Thus, the pure cholesterol stones overwhelmed the pure bilirubin stones in the Chiang Mai samples, but if the mixed stones were also taken into consideration, the frequency of cholesterol stones and bilirubin stones equalled in the two groups of samples.
2) The gallstones with the identical chief component and different auxiliary components in the three parts occurred in 24.2%. Of these stones, 90% had cholesterol as the chief component, and 36.4% included calcium carbonate in the outer layer.
3) The stones having an entirely different composition in each one of the three parts occurred in 23.3%. Of these, 43.5% had cholesterol as the chief component of the core, and 46.4% contained calcium carbonate as the chief component of the outer layer. The latter was found in the Siriraj samples at a particularly high frequency.
4) Taking only the chief component into consideration, the ratio of cholesterol stones to bilirubin stones stood at 1.5 for the Chirng Mai samples and 1.4 for the Siriraj samples. On the other hand, the ratio for the Nippon Medical School samples was 9.2, with the cholesterol stones accounting for 81.8% and the stones containing calcium carbonate accounting for a very small percentage.
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