Atherosclerosis,
22 (1975) 313-315 cc? Elsevier Scientific Publishing Company, Amsterdam - Printed in The Netherlands
313
Short Communication
THE EFFECT
OF EXTERNAL
DRAINAGE
OF BILE ON
CHOLESTEROLEMIA
J. HANKlEWlCZ
AND
E. RUDZKA
Fit% Clinic c:f’Internal Diseases, Silesiar~ Academy of Medicine. ul. Reymonta 8, PL-40-029 (Polund)
Kato~‘iw
(Received September 27th, 1974) (Revised received March 13th, 1975) (Accepted March 13th, 1975)
SUMMARY
The cholesterolopenic
phenomenon
sterol and up to 23 “/, for esterified external
drainage
-
cholesterol
of bile from the common
Key words : Cholesterolemia
decrease
- External
-
biliary
drainage
of up to 30 % for total choles-
has been obtained
as an effect of
duct.
of bile
_ INTRODUCTION
Hypercholesterolemia is regarded, among other things, as a biochemical manifestation of atherosclerosis. One of the methods that are used to combat this disease is the administration of cholesterolopenic drugs. The report presented here describes an examination of the effect of bile secretion on the cholesterol concentration in serum. MATERIAL
AND
METHODS
In a group of 50 patients who had undergone surgical treatment of the biliary duct, with maintenance of full hepatic efficiency, a study of blood and bile cholesterol concentration was carried out at the time of bile drainage from the common biliary
314
SHORT COMMUNICATION
duct by means
of Kehr’s
drain.
In an emergency
the patients
received
drugs, antibiotics and intravenous infusions of physiological solution chloride and 5 % of glucose. In the first post-operative period the patients
analgesic of sodium were given
a liquid diet and later on a type of hepatic diet. The study did not include a control group. According to other authors1*2 the cholesterol concentration in serum of patients after cholecystectomia without drainage of the bile duct shows no appreciable In the samples cholesterol
of serum
were determined
change.
and bile the concentrations by Watson’s
method
of total
in Richterich’s
and esterified modifications.
RESULTS
In the patients with common biliary duct drainage, the daily amount of drained bile averaged 339 f 201 ml for 5 successive post-operative days. In the period from the 5th to 15th post-operative day the drainage averaged 342 & 175 ml per day. The total cholesterol concentration in the bile up to the 15th and from the 5th to 15th day averaged ca. 240 mg/lOO ml (with extreme values from 30 to 705 mg/lOO ml), and its esterified fraction ca. 175 mg/lOO ml (= 68 %). The excretion of cholesterol in the bile in both post-operative periods averaged 725 * 733 and 881 & 850 mg per day. The total cholesterol concentration in serum taken from patients on the day of operation varied from 153 to 500 mg/ml. The results with external bile drainage show a significant decrease of cholesterolemia - to about 30% (Table 1). On the 5th post-operative day there proved to be a direct relation between the decrease of the cholesterol concentration in the serum and the amount of cholesterol excreted in the bile (for total cholesterol: r = + 0.250, P < 0.05; for esterified cholesterol: r = + 0.265,
P < 0.05). The decrease of the cholesterol
concentration
in the blood
TABLE1 CHOLESTEROL EXTERNAL
CONCENTRATION
DRAINAGE
IN BLOOD
SERUM (2
&
SD)
ON THE DAY
OF OPERATION
AND
DURING
OF BILE
N
Total cholesterol (mg,/lOO ml)
50
on the day of operation
5th drainage day
(al
(b)
274 + 86
215 + 83
t and P for a-b
15th drainage t and P drainage for a-c fc)
3.46
192 i 66
P < 0.05
Decrease Esterified cholesterol (mg/lOO ml)
21.5% 50
159 + 71
131 * 77
30%
1.24
122 * 59
P > 0.05
Decrease (% of total cholesterol)
50
58&21
18% 6Oi21
5.1 I P < 0.01
0.37 P > 0.05
2.61 P < 0.05
23% 62 i 21
1.12 P > 0.05
315
SHORT COMMUNICATION TABLE2 RELATIONSHIP
IN
BILE
BETWEEN
OBTAINED
FROM
THE CONCENTRATION EXTERNAL
N
OF CHOLESTEROL
IN BLOOD SERUM
For 5th droinuge da),
For 15th draitzage dav
r
P
r
P
~: 0.1169
,’ 0.05 (p)
3 0.05 (&)
( 4)
Total cholesterol
50
+ 0.4122
-: 0.01
Esterified cholesterol for mg/lOO ml
50
+ 0.3957
~: 0.01 (+)
+ 0. I567
50
$ 0.2924
~ o.os(+)
-t 0.4728
for percentage
relation
AND ITS CONCENTRATION
DRAINAGE
0.01( ! )
was due to the elimination of this component with bile. The finding for the 5th portoperative day showed a direct relation between the concentration of total and esteritied cholesterol
in serum and the concentration
of these components
in bile (Table 2).
DISCUSSION
The first studies of patients with external draining of the common bile duct were carried out in 1966 by De Palma et al.’ in 8 patients. After 4 days drainage a 40% decrease of the total cholesterol concentration in the serum was observed. Other investigators4 have reported similar findings. In the case of 10 patients with an analogous drain, Jankau2 obtained a 22 ‘A decrease of total cholesterol concentration. We observed in 50 analogous patients a 21 “/ decrease of total cholesterol concentration after 5 drainage
days and a 30% decrease
after 15 drainage
days. In the reports
in Refs.1*2, the decrease of cholesterolemia produced by external draining of bile is explained as a result of a break in feedback of bile acid metabolism. The interruption of cholesterol reabsorption decreases the cholesterol concentration in the blood. By external
drain
considerable
per day. As the drainage was not noted. Therefore, probably
compensated
amounts
of cholesterol
are lost, on an average
725 mg
continued, a further decrease of concentration in the bile this suggests that the loss of cholesterol with the bile was
by an increase
of its synthesis.
As shown above, the increase of cholerese caused by means of bile drainage proved to be a successful method for decreasing cholesterolemia. The effect of the cholesterolopenic action increased as the drainage continued, with the proportion of esters in the amount of total cholesterol remaining the same. REFERENCES 1 DE PALMA, R. G., HLJBAY, C. A. AND INSULL, W., The effect of T-tube
drainage on cholesterol and bile acids metabolism in man, Gyt7ecol. Obstrt., 123 (1966) 269-273. 2 JANKAU, O., Wybiorcze obniienie poziomu cholesterolu w surowicy krwi pod wplywem drenaiu zewnetrznego i&i, Przegl. Lek., 29 (1972) 615-620. 3 RICHTERICH, R., Chemia Kliniczna. Panstwowy Zaklad Wydawnictw Lekarskich, Warsaw, 1971, p. 269. 4 WALMSLEY, M. AND SCHOFIELD, P., Serial serum cholesterol estimation after biliary tract surgery, Brit. J. Swg.. 57 (1970) 829-833.
22 (1975) 313-315 cc? Elsevier Scientific Publishing Company, Amsterdam - Printed in The Netherlands
313
Short Communication
THE EFFECT
OF EXTERNAL
DRAINAGE
OF BILE ON
CHOLESTEROLEMIA
J. HANKlEWlCZ
AND
E. RUDZKA
Fit% Clinic c:f’Internal Diseases, Silesiar~ Academy of Medicine. ul. Reymonta 8, PL-40-029 (Polund)
Kato~‘iw
(Received September 27th, 1974) (Revised received March 13th, 1975) (Accepted March 13th, 1975)
SUMMARY
The cholesterolopenic
phenomenon
sterol and up to 23 “/, for esterified external
drainage
-
cholesterol
of bile from the common
Key words : Cholesterolemia
decrease
- External
-
biliary
drainage
of up to 30 % for total choles-
has been obtained
as an effect of
duct.
of bile
_ INTRODUCTION
Hypercholesterolemia is regarded, among other things, as a biochemical manifestation of atherosclerosis. One of the methods that are used to combat this disease is the administration of cholesterolopenic drugs. The report presented here describes an examination of the effect of bile secretion on the cholesterol concentration in serum. MATERIAL
AND
METHODS
In a group of 50 patients who had undergone surgical treatment of the biliary duct, with maintenance of full hepatic efficiency, a study of blood and bile cholesterol concentration was carried out at the time of bile drainage from the common biliary
314
SHORT COMMUNICATION
duct by means
of Kehr’s
drain.
In an emergency
the patients
received
drugs, antibiotics and intravenous infusions of physiological solution chloride and 5 % of glucose. In the first post-operative period the patients
analgesic of sodium were given
a liquid diet and later on a type of hepatic diet. The study did not include a control group. According to other authors1*2 the cholesterol concentration in serum of patients after cholecystectomia without drainage of the bile duct shows no appreciable In the samples cholesterol
of serum
were determined
change.
and bile the concentrations by Watson’s
method
of total
in Richterich’s
and esterified modifications.
RESULTS
In the patients with common biliary duct drainage, the daily amount of drained bile averaged 339 f 201 ml for 5 successive post-operative days. In the period from the 5th to 15th post-operative day the drainage averaged 342 & 175 ml per day. The total cholesterol concentration in the bile up to the 15th and from the 5th to 15th day averaged ca. 240 mg/lOO ml (with extreme values from 30 to 705 mg/lOO ml), and its esterified fraction ca. 175 mg/lOO ml (= 68 %). The excretion of cholesterol in the bile in both post-operative periods averaged 725 * 733 and 881 & 850 mg per day. The total cholesterol concentration in serum taken from patients on the day of operation varied from 153 to 500 mg/ml. The results with external bile drainage show a significant decrease of cholesterolemia - to about 30% (Table 1). On the 5th post-operative day there proved to be a direct relation between the decrease of the cholesterol concentration in the serum and the amount of cholesterol excreted in the bile (for total cholesterol: r = + 0.250, P < 0.05; for esterified cholesterol: r = + 0.265,
P < 0.05). The decrease of the cholesterol
concentration
in the blood
TABLE1 CHOLESTEROL EXTERNAL
CONCENTRATION
DRAINAGE
IN BLOOD
SERUM (2
&
SD)
ON THE DAY
OF OPERATION
AND
DURING
OF BILE
N
Total cholesterol (mg,/lOO ml)
50
on the day of operation
5th drainage day
(al
(b)
274 + 86
215 + 83
t and P for a-b
15th drainage t and P drainage for a-c fc)
3.46
192 i 66
P < 0.05
Decrease Esterified cholesterol (mg/lOO ml)
21.5% 50
159 + 71
131 * 77
30%
1.24
122 * 59
P > 0.05
Decrease (% of total cholesterol)
50
58&21
18% 6Oi21
5.1 I P < 0.01
0.37 P > 0.05
2.61 P < 0.05
23% 62 i 21
1.12 P > 0.05
315
SHORT COMMUNICATION TABLE2 RELATIONSHIP
IN
BILE
BETWEEN
OBTAINED
FROM
THE CONCENTRATION EXTERNAL
N
OF CHOLESTEROL
IN BLOOD SERUM
For 5th droinuge da),
For 15th draitzage dav
r
P
r
P
~: 0.1169
,’ 0.05 (p)
3 0.05 (&)
( 4)
Total cholesterol
50
+ 0.4122
-: 0.01
Esterified cholesterol for mg/lOO ml
50
+ 0.3957
~: 0.01 (+)
+ 0. I567
50
$ 0.2924
~ o.os(+)
-t 0.4728
for percentage
relation
AND ITS CONCENTRATION
DRAINAGE
0.01( ! )
was due to the elimination of this component with bile. The finding for the 5th portoperative day showed a direct relation between the concentration of total and esteritied cholesterol
in serum and the concentration
of these components
in bile (Table 2).
DISCUSSION
The first studies of patients with external draining of the common bile duct were carried out in 1966 by De Palma et al.’ in 8 patients. After 4 days drainage a 40% decrease of the total cholesterol concentration in the serum was observed. Other investigators4 have reported similar findings. In the case of 10 patients with an analogous drain, Jankau2 obtained a 22 ‘A decrease of total cholesterol concentration. We observed in 50 analogous patients a 21 “/ decrease of total cholesterol concentration after 5 drainage
days and a 30% decrease
after 15 drainage
days. In the reports
in Refs.1*2, the decrease of cholesterolemia produced by external draining of bile is explained as a result of a break in feedback of bile acid metabolism. The interruption of cholesterol reabsorption decreases the cholesterol concentration in the blood. By external
drain
considerable
per day. As the drainage was not noted. Therefore, probably
compensated
amounts
of cholesterol
are lost, on an average
725 mg
continued, a further decrease of concentration in the bile this suggests that the loss of cholesterol with the bile was
by an increase
of its synthesis.
As shown above, the increase of cholerese caused by means of bile drainage proved to be a successful method for decreasing cholesterolemia. The effect of the cholesterolopenic action increased as the drainage continued, with the proportion of esters in the amount of total cholesterol remaining the same. REFERENCES 1 DE PALMA, R. G., HLJBAY, C. A. AND INSULL, W., The effect of T-tube
drainage on cholesterol and bile acids metabolism in man, Gyt7ecol. Obstrt., 123 (1966) 269-273. 2 JANKAU, O., Wybiorcze obniienie poziomu cholesterolu w surowicy krwi pod wplywem drenaiu zewnetrznego i&i, Przegl. Lek., 29 (1972) 615-620. 3 RICHTERICH, R., Chemia Kliniczna. Panstwowy Zaklad Wydawnictw Lekarskich, Warsaw, 1971, p. 269. 4 WALMSLEY, M. AND SCHOFIELD, P., Serial serum cholesterol estimation after biliary tract surgery, Brit. J. Swg.. 57 (1970) 829-833.
