Study on dissolution and disintegration of calcium bilirubinate stone.

When a slice of calcium bilirubinate stone was incubated in a solution of tetrasodium salt of ethylendiamine-tetraacetic acid (EDTA.4Na), a potent chelating agent, the solution exhibited a yellow brown tint, which was spectroscopically characteristic of bilirubin. Microscopic examination of the slice revealed dissolution of granules of calcium bilirubinate, leaving behind a reticular matrix of PAS-positive substance. The effect of EDTA.4Na was influenced by pH, being fully effective only at pH 10 or more, and by temperature and concentration as well. Simultaneous application of bile salt enhanced the activity of EDTA.4Na, hydrophilizing the gallstone surface to facilitate chelating reaction and also dissolving minor fatty components of the stone. Heparin at proper concentrations also promoted disintegration of the stone, changing surface potential of its constituent particles to the dispersion-prone charge. The effect of composite EDTA.4Na-bile salt-heparin was thus significantly greater than that of single EDTA.4Na. This mixture is promising for clinical application as a means of direct dissolution of residual gallstones.