To evaluate the role of acidic mucin in gallbladder bile in gallstone formation, human gallbladder bile was analyzed in 40 cases (36: cholecystolithiasis,4: control).
Furthermore, gallstones and mucin in whole gallbladde r were studied histochemically in 15lithogenic diet-fed mice (experimental group) and 5 pair-fed mice.
Total hexosamine content in aseptic gallbladder biles was lower in cases with black stone, combination stone and calcium bilirubinate stone than in control. Mean acidic mucin fraction in aseptic gallbladder bile in cases of cholecystolithiasis was 72∼82%, which was 1.5∼2.0 times higher than control. Total amount of acidic mucin calculated by hexosamine contents and acidic mucin fraction was higher in cases of cholecystolithiasis.
By histochemical staining, acidic muc in was observed along both gallbladder wall and gallstones as well as inside of gallstones only in experimental group.
These results suggest that high amount of acidic mucin in gallbladder may play a role in formation of gallstone in the gallbladder.

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Perfussion manometry and choledocho-cineradiography were used, during fasting, to study the physiological anatomy of the sphincter of Oddi in dog for biliary excretion, as well as its morphological characteristics and affective factors. The results are as follows:
1. The physiological anatomy of the sphincter of Oddi consists of high pr essure distal segment and functional ampulla proximal segment.
2. A functional ampulla of the s phincter of Oddi is the primary kinetic source, which surmounts the resistance of biliary excretion produced from the high pressure zone of the sphincter of Oddi, promotes the excretion of bile.
3. In the excretion of bile, high pressure, zone of the sphincter of Oddi is not merely a passive conducting tube, by its own intrinsic activity, contributes secondary dynamics in the excreting procedure.
4. The physiologically filled gallbladder, undergoing the neuro-body fluid accommodation mechanism, upholds the coordination and unification of the function between the functional ampulla and the high pressure zone of the sphincter of Oddi. It is the important assurement of the smooth excretion of bile.

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Wo have evaluated the measurement of gallbladder volume by ultrasonography, in which the method must be non-invasive, simple and accurate. Four different types of experimental gallbladder, using rubber balloon, were prepared: type A, ellipsoid; type B, gourd-shaped; type C, curved; type D, bended and double chambered. Each volume of the gallbladder filled with different amount of water was measured using three ultrasonic methods: Ellipsoid (EL), Single plane (SP), and Biplane method (BP). An appropriate application of these three methods was: EL, SP, BP for type A; SP for type B; BP for type C; and SP, BP for type D. In conclusion, SP or BP is applicable to measuring the volume of various types of the gallbladder easily and accurately.

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One hundred and twenty-four patients were had been performed laparoscopic cholecystectomy (LC) from June 1992 to December 1993. Results of patients who had had LC was compared with that of 134 patients with conventional open cholecystectomy (OC). A questionnaire was sent to patients with LC after surgery and results of LC was evaluated. Two cases with LC (1.6%) were converted to OC during surgery and there were no major complications in patients with LC. The days of hospitalization after LC was 5.5 in average, but 13.3 days were required in the patients with OC (p<0.01). Through questionnaire, it was found that 51.1% of patients undergoing LC had had information (p<0.01). Average hospital charge of LC and OC were 453,013 yen and 648,722 yen respectively (p<0.01). Through questionnaire, it was found that 51.1 % of patients undergoing LC had had informa of LC before hospitalization. As to postoperative pain,91.7% of patients answered that it was better than that they expected. No pain along abdominal wounds extend over a long time was noted in 79.2% of patients and 92.7% of those felt well for wounds in cosmetic view.87.5% of patients were contented for quicker recovery and earlier return to work. LC was considered to be useful operating method for medical staff side also patient side.

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Variations of extrahepatic bile ducts were investigated with regard to gallbladder position, patterns of union in the porta hepatis, and patterns of the cystic duct, in order. In 1,090 patients, anomalous positions of the gallbladder were found on intraoperative inspection in 0.4%,1. e.,0.3%showed left-sided gallbladder and 0.1% showed agenesis of the gallbladder. In 213 patients who underwent direct cholangiography, a bifurcating pattern of union in the porta hepatis was demonstrated in 70 % but this pattern was absent in 30 %. Among those 213 patients, anomalous cystic ducts were found in 6 (3%) i. e.,1 with the cystic duct draining into the right hepatic duct,2draining into the lower portion of the common bile duct,3 draining into the left side of the common bile duct after running in front of the common bile duct (one of those 3 showed combination drainage into the lower portion of the common bile duct). One patient demonstrated a double cystic duct. Therefore, such patterns should receive attention during hepatobiliary surgery.

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Histopathological examinations of the gallbladder resected by laparoscopic cholecystectomy often reveals a massive defect of the mucosa. To elucidate the mechanism of this phenomenon, 50 patients who had undergone laparoscopic cholecystectomy were reviewed to clarify the relationship between the histological findings of the mucosa of the resected gallbladder and the following two factors; duration between ligation and transection of the cystic duct and artery, and fixation of the specimen; the maneuver for destruction of stones in the gallbladder on removing the resected gallbladder from the abdominal cavity. The result proved that the maneuver for destruction of the stones in the gallbladder and the duration between ligation and transection of the cystic duct and artery, and fixation of the specimen had a close relationship with the defect of the mucosa.

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The patient was a 65-year-old woman with a complaint of right hypochondralgia. She developed right hypochondralgia during hospitalization in a hospital due to traffic accident. Because surgical intervention for cholelithiasis and cholecystitis was recommended at other hospital, she presented at our hospital. No subjective or objective symptom associated with the binary disease was detected at our hospital. Abdominal echography and ERCP revealed an impacted gall stone at the neck of the gallbladder and choledocholithiasis. Cholecystectomy and cholelithotripsy were performed. Histopathological examinations of the removed gallbladder revealed squamous cell carcinoma, which was mostly confined within the mucosa but partly invaded into the muscular layer. Squamous cell metaplasia of surrounding epithelium was not observed. The gallbladder cancers are commonly adenocarinomas or adenosquamous cell carcinomas, and thus the report of pure squam ous cell carcinoma is rare. The presented case seemed to be suggestive to know the mechanism of occurrence of pure squamous cell carcinoma as well as diagnosis, prognosis and treatment.

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This paper describes a case of traumatic choledochal stenosis successfully treated with percutaneous transhepatic biliary dilation. The patient was a 23-year-old woman with the chief complaint of jaundice. She was rushed to our hospital because of a trauma sustained by hitting her abdomen against the steering wheel of a car. Twelve days after the accident she developed obstructive jaundice and underwent percutaneous transhepatic biliary drainage (PTCD). The common bile duct was completely obstructed just below the confluence of the cystic duct on cholangiography. Abdominal CT revealed the swollen head of the pancreas showing radiolucy. Judging from her age and clinical course, she was suspected of having traumatic choledochal stenosis. Since the stenosis did not resolve in one month, percutaneous transhepatic biliary dilation was performed via a 12 Fr. tube and she was followed up at the outpatient clinic. Cholangiography performed three months after fistulization approved an improvement of the choledochal stenosis, so that the PTCD tube was removed. No abnormal data suggesting restenosis of the common bile duct was noted in blood chemistry. Since traumatic choledochal stenosis is a benign reversible condition, the authors believe that the technique of percutaneous transhepatic biliary dilation is a useful therapeutic modality for the patients with benign stricture of the common bile duct.

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A 58-year-old Japanese woman, who received cholecystectomy and choledochotomy in 1978, suffered from right upper abdominal pain and nausea from two years after the primary operation and dilatation of CBD was demonstrated by US. In 1991 ERCP showed severe dilatation of CBD (25mm in diameter) but there was no abnormality in papilla Vateri and distal CBD. In 1993, ERCP examination demonstrated that the dilatation of CBD was advanced (35 mm in diameter) and delayed emptying of CBD was observed. All laboratory data including tumor markers were normal throughout the course. She was diagnosed as sphincter Oddi dysfunction and endoscopic sphincterotomy was performed in 1993. After the therapy abdominal pain and naused were dramatically distinguished and DIC examination and US showed the amelioration of dilatation of CBD (15 mm in diameter). We reported a quite rare case of sphincter Oddi dysfunction.

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