The clinical behavior of the normal and the diseased gall bladder

Background—Endoscopic sphincterotomy has been shown to inhibit stone formation in the gall bladder of experimental animals.Aims—To investigate the alterations in bile composition and gall bladder motility after endoscopic sphincterotomy.Patients—A study was performed of gall bladder bile composition and gall bladder motility in patients with gallstone disease ((n = 20; age 40–60 years, median age 55 years: seven men), with gall bladder calculi (n = 12) and with diseased gall bladder (chronic inflammation) without gall bladder calculi (n = 8)), who had received endoscopic sphincterotomy for common bile duct stones. Age and sex matched disease controls comprised 20 patients with gallstone disease but without stones and an intact sphincter of Oddi (with gall bladder calculi (n = 10) and diseased gall bladder without gall bladder calculi (n = 10)).Methods—Gall bladder motility was assessed by ultrasound. Duodenal bile collected by nasoduodenal tube after stimulation of gall bladder by intravenous ceruletid infusion was analysed for cholesterol, phospholipid, and bile acid concentrations, cholesterol saturation index, and nucleation time.Results—There was a significant reduction in mean (SEM) fasting volume (12.5 (1.7) ml v 26.4 (2.5) ml; p<0.001) and mean (SEM) residual volume (4.34 (0.9) ml v14.7 (0.98) ml; p<0.001), and increase in mean (SEM) ejection fraction (65.7 (4.2)% v 43.6 (5.52)%; p<0.001) and mean (SEM) rate constant of gall bladder emptying (−0.031/min v−0.020/min; p<0.01) in patients who had been subjected to endoscopic sphincterotomy. Median nucleation time was significantly longer (17 days v 6 days; p<0.006) in treated patients. There was a reduction in total mean (SEM) lipid concentrations (6.73 (0.32) g/dlv 7.72 (0.84) g/dl; p<0.05), cholesterol (5.6 (1.5) mmol/l v 10.3 (2.23) mmol/l; p<0.001) and CSI (0.72 (0.15) v 1.32 (0.31); p<0.001). There was no significant change in mean (SEM) phospholipid (25.6 (3.5) mmol/l v23.4 (6.28) mmol/l) and bile acid (93.7 (7.31) mmol/l v105.07 (16.6) mmol/l) concentrations.Conclusions—After endoscopic sphincterotomy there was enhanced contractility of the gall bladder, accompanied by a prolongation of nucleation time and reduction in cholesterol saturation index.

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Patients' perceptions of dental hygiene student social and clinical behavior

Journal of Dental Education ◽

10.1002/j.0022-0337.1989.53.10.tb02358.x ◽

1989 ◽

Vol 53 (10) ◽

pp. 590-592

Author(s):

PM Clark ◽

CA DeVore ◽

HL Whitacre ◽

PL DeVore ◽

JA Joseph

Keyword(s):

Dental Hygiene ◽

Clinical Behavior

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The Effect of Real-Time Feedback Using a Smartwatch on the Clinical Behavior of Novice Student Clinicians

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp2.sig11.79 ◽

2017 ◽

Vol 2 (11) ◽

pp. 79-90

Author(s):

Courtney G. Scott ◽

Trina M. Becker ◽

Kenneth O. Simpson

Keyword(s):

Real Time ◽

Rating Scales ◽

Qualitative Interviews ◽

Communication Disorders ◽

Preliminary Evidence ◽

Single Subject ◽

Clinical Behavior ◽

Stimulus Response ◽

Treatment Data ◽

Computer Monitors

The use of computer monitors to provide technology-based written feedback during clinical sessions, referred to as “bug-in-the-eye” (BITi) feedback, recently emerged in the literature with preliminary evidence to support its effectiveness (Carmel, Villatte, Rosenthal, Chalker & Comtois, 2015; Weck et al., 2016). This investigation employed a single-subject, sequential A-B design with two participants to observe the effects of implementing BITi feedback using a smartwatch on the clinical behavior of student clinicians (SCs). Baseline and treatment data on the stimulus-response-consequence (S-R-C) contingency completion rates of SCs were collected using 10 minute segments of recorded therapy sessions. All participants were students enrolled in a clinical practicum experience in a communication disorders and sciences (CDS) program. A celeration line, descriptive statistics, and stability band were used to analyze the data by slope, trend, and variability. Results demonstrated a significant correlative relationship between BITi feedback with a smartwatch and an increase in positive clinical behaviors. Based on qualitative interviews and exit rating scales, SCs reported BITi feedback was noninvasive and minimally distracting. Preliminary evidence suggests BITi feedback with a smartwatch may be an effective tool for providing real-time clinical feedback.

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Primary Carcinoma of the Gall Bladder with Gall Stones in Secondary Deposits in the Liver

Gastroenterology ◽

10.1016/s0016-5085(52)80043-5 ◽

1952 ◽

Vol 21 (3) ◽

pp. 429-432

Author(s):

Madeline K. Keech

Keyword(s):

Gall Bladder ◽

Primary Carcinoma ◽

Gall Stones

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Incidence of Gall Bladder Disease in “Normal” Men

Gastroenterology ◽

10.1016/s0016-5085(59)80010-x ◽

1959 ◽

Vol 36 (2) ◽

pp. 251-255 ◽

Cited By ~ 23

Author(s):

Richard S. Wilbur ◽

Robert J. Bolt

Keyword(s):

Gall Bladder ◽

Gall Bladder Disease ◽

Bladder Disease ◽

Normal Men

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Papilloma of the Gall Bladder

Gastroenterology ◽

10.1016/s0016-5085(57)80062-6 ◽

1957 ◽

Vol 32 (4) ◽

pp. 666-674 ◽

Cited By ~ 4

Author(s):

Raymond A. Gagliardi ◽

Philip D. Gelbach

Keyword(s):

Gall Bladder

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Chronic Cholezystitis Misleading as Tumor of the Gall Bladder with Concomitant Liver Abscess

Swiss Surgery ◽

10.1024/1023-9332.7.1.28 ◽

2001 ◽

Vol 7 (1) ◽

pp. 28-31 ◽

Cited By ~ 2

Author(s):

Teebken ◽

Bartels ◽

Fangmann ◽

Nagel ◽

Klempnauer

Keyword(s):

Gall Bladder ◽

Liver Abscess ◽

Solide Tumoren ◽

Fand Sich ◽

Histologische Untersuchung ◽

Chronische Entzündungen

Ein 58jähriger Mann wurde mit Übelkeit, Oberbauchschmerzen, einem palpablen Tumor im rechten oberen Epigastrium und begleitendem Fieber aber fehlender Leukozytose und CRP-Erhöhung aufgenommen. Sowohl die Ultraschalluntersuchung als auch eine im Anschluss durchgeführte Computertomographie deuteten auf einen malignen Tumor der Gallenblase mit Infiltration der Leber und begleitender Abszessformation in den Segmenten 4b und 3 hin. Die Indikation zur Entfernung des Tumors im Sinne einer Hemihepatektomie links mit Cholezystektomie und Abszessdrainage wurde gestellt. Intraoperativ fand sich dann jedoch eine chronisch-eitrige Cholezystitis ohne Beteiligung der Leber selbst, sodass nur eine Cholezystektomie durchgeführt werden musste. Die histologische Untersuchung der Gallenblase erbrachte keinen Hinweis auf ein malignes Geschehen. Der Patient erholte sich gut von dem operativen Eingriff und konnte sieben Tage später entlassen werden. Diese Fallbeschreibung zeigt die Probleme auf, die bei der Differentialdiagnostik von entzündlichen und malignen Gallenblasenerkrankungen mit Beteiligung von angrenzenden Strukturen, insbesondere der Leber, bestehen. Trotz apparativer Untersuchungen wie Sonographie und Computertomogramm ist die letztendlich richtige Diagnose häufig nur intraoperativ zu stellen und erst dann die adäquate Therapie festlegbar. Chronische Entzündungen der Gallenblase können als solide Tumoren imponieren und dann als maligne Prozesse der Gallenblase und der angrenzenden Lebersegmente fehlinterpretiert werden.

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