Pediatric Biliary Dyskinesia: Evaluating Predictive Factors for Successful Treatment of Biliary Dyskinesia with Laparoscopic Cholecystectomy

2018 ◽  
Vol 84 (9) ◽  
pp. 1401-1405
Author(s):  
Yamuna T. Krishna ◽  
Kristine L. Griffin ◽  
Robert L. Gates
Keyword(s):  
Ejection Fraction ◽  
Pediatric Patients ◽  
Epigastric Pain ◽  
Iminodiacetic Acid ◽  
Biliary Dyskinesia ◽  
Study Patient ◽  
Duration Of Symptoms ◽  
Symptom Resolution ◽  
Persistent Symptoms ◽  
Postoperative Symptom

Biliary dyskinesia (BD) is a motility disorder of the gallbladder that can result in right upper quadrant (RUQ) pain, nausea, vomiting, and diarrhea. Cholecystectomy is considered the standard of care for BD. Up to 23 per cent of pediatric patients who undergo surgery for BD have persistent symptoms postoperatively. We performed a retrospective review to identify preoperative factors significantly associated with symptom resolution after cholecystectomy. We retrospectively reviewed pediatric patients aged 10–17 years diagnosed with BD who underwent cholecystectomy between 2006 and 2016. Patients were divided into two groups based on postoperative symptom resolution. Chi-squared and student t tests were used to compare patient groups. Two hundred and thirty-six patients were included in the study. The most common preoperative symptoms included RUQ pain (80.1%), nausea (54.2%), postprandial pain (44.5%), vomiting (32.6%), and epigastric pain (19.9%). The rate of postoperative symptom resolution was 68.6 per cent. Comparative analysis showed patients who presented with RUQ pain, nausea, postprandial pain, or constipation experienced significantly higher rates of symptom resolution postoperatively. In addition, patients with ejection fraction <35 per cent or pain reproducible with cholecystokinin were found to have significantly higher rates of symptom resolution as well. To date, it remains difficult to predict successful outcomes for pediatric patients undergoing cholecystectomy for BD. In our study, patient demographics and duration of symptoms did not affect postoperative outcomes. Pediatric patients who presented with RUQ pain, nausea, postprandial pain, constipation, an ejection fraction of <35 per cent on hepatobiliary iminodiacetic acid, or pain reproducible with cholecystokinin injection, were found to have significantly higher rates of symptom resolution.

Laparoscopic Cholecystectomy for Biliary Dyskinesia in Children: Report of 100 Cases from a Single Institution

2008 ◽  
Vol 74 (7) ◽  
pp. 587-593 ◽  
Author(s):  
Constantinos Constantinou ◽  
Iswanto Sucandy ◽  
Max Ramenofsky
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Ejection Fraction ◽  
Primary Care Physicians ◽  
Pediatric Population ◽  
Biliary Dyskinesia ◽  
Successful Outcome ◽  
Symptom Duration ◽  
Functional Abdominal Pain ◽  
Biliary Stones ◽  
Persistent Symptoms

Laparoscopic cholecystectomy (LC) is increasingly performed in the pediatric population. Biliary dyskinesia (BD) is largely responsible for this increase and is presently the most common indication for LC in this age group. In our institution the diagnosis of BD is made in patients with biliary symptoms, absence of biliary stones, and an ejection fraction <35 per cent on hydroxy iminoadiacetic acid (HIDA) scan. We reviewed our experience of 100 children with BD that underwent LC. Data that was prospectively collected and entered into electronic medical records by gastroenterologists, primary care physicians, and pediatric surgeons was reviewed and analyzed. Patients were symptomatic for an average of 15 months before undergoing surgery. Seventy-seven per cent reported resolution of symptoms from 6 months to 5 years following LC, whereas the rest complained of persistent symptomatology. When the two groups were compared, patients with persistent symptoms were more likely to be female and to have longer symptom duration. An ejection fraction <35 per cent reliably predicts successful outcome of LC in patients with BD. The diagnosis of BD should be entertained early in the differential of functional abdominal pain in children and referred to Pediatric Surgery when its presence is confirmed.

HIDA Scan with Ejection Fraction is over Utilized in the Management of Biliary Dyskinesia

2015 ◽  
Vol 81 (7) ◽  
pp. 669-673 ◽  
Author(s):  
Amanda H. Eckenrode ◽  
Joseph A. Ewing ◽  
Jennifer Kotrady ◽  
Allyson L. Hale ◽  
Dane E. Smith
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Ejection Fraction ◽  
Iminodiacetic Acid ◽  
Biliary Colic ◽  
Symptom Improvement ◽  
Symptom Resolution ◽  
Atypical Symptoms ◽  
Hida Scan ◽  
Normal Ultrasound ◽  
Upper Abdominal

Patients with upper abdominal pain, nausea, and vomiting are often evaluated with ultrasound to diagnose symptomatic cholelithiasis or cholecystitis. With a normal ultrasound, a hepatobiliary iminodiacetic acid (HIDA) scan with ejection fraction (EF) is recommended to evaluate gallbladder function. The purpose of this study was to evaluate whether the HIDA scan with EF was appropriately utilized in considering cholecystectomy. Over 18 months, we performed 1533 HIDA scans with EF. After exclusion, 1501 were analyzable, 438 of whom underwent laparoscopic cholecystectomy. Patients were divided into two groups: those with typical and atypical symptoms of biliary colic. Our primary endpoint was symptom resolution of those who underwent laparoscopic cholecystectomy. Symptom resolution was assessed by chart review of postop visits or readmissions. In patients with typical symptoms, resolution occurred in 66 per cent of patients with positive HIDA and 77 per cent with negative HIDA ( P = 0.292). In patients with atypical symptoms, resolution occurred in 64 per cent of patients with positive HIDA and 43 per cent with negative HIDA ( P = 0.013). A HIDA scan with EF was not useful in patients with typical symptoms of biliary colic and negative ultrasounds, and should not be used to make a decision for cholecystectomy. However, this test can be helpful in patients with atypical symptoms, as it does predict symptom improvement in this group.

Hyperkinetic Gallbladder: An Indication for Cholecystectomy?

2013 ◽  
Vol 79 (9) ◽  
pp. 882-884 ◽  
Author(s):  
Erika B. Lindholm ◽  
J. Brannon Alberty ◽  
Faith Hansbourgh ◽  
James R. Upp ◽  
John Lopoo
Keyword(s):  
Pediatric Patients ◽  
Symptomatic Relief ◽  
Iminodiacetic Acid ◽  
Study Patient ◽  
Biliary Colic ◽  
Hida Scan ◽  
Postoperative Symptoms ◽  
Low Ejection Fraction ◽  
Gallbladder Removal

Cholecystectomy may benefit children with biliary colic without stones on ultrasound (US) or low ejection fraction on cholecystokinin-hepatobiliary iminodiacetic acid (CCK-HIDA) scan. Children with symptomatic biliary colic and abnormal HIDA scan, specifically those with high ejection fractions, may benefit from cholecystectomy. All patients younger than 18 years old undergoing cholecystectomy from 2008 to 2012 in our practice were reviewed. Patients with a negative US and CCK-HIDA ejection fractions 80 per cent or greater were included in the study. Patient data were extracted from charts, whereas postoperative symptoms were obtained by phone interviews. Of 174 patients who underwent cholecystectomy, 12 (7%) met study criteria. All patients (12 of 12) had evidence of cholecystitis on the final pathology note. All 11 patients contacted had relief of colic after gallbladder removal with a mean follow-up of 16 months. A subset of pediatric patients with high ejection fractions on CCK-HIDA and symptomatic biliary colic may have symptomatic relief with cholecystectomy.

scholarly journals The Differential Diagnosis of Sterile Pyuria in Pediatric Patients: A Review

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199371
Author(s):  
Donald W. Bendig
Keyword(s):  
Differential Diagnosis ◽  
Pediatric Patients ◽  
Systemic Disease ◽  
Common Finding ◽  
Extensive Literature ◽  
Sexually Transmitted ◽  
Persistent Symptoms ◽  
Sterile Pyuria ◽  
Extensive Literature Search ◽  
Definition Of

Sterile pyuria is a common finding in pediatric patients. Literature describing the diagnoses as well as clinical characteristics of children with sterile pyuria is lacking. This review was performed to establish an evidence-based approach to the differential diagnosis by way of an extensive literature search. The definition of pyuria is inconsistent. The various causes of pediatric sterile pyuria identified were classified as either Infectious or Non-Infectious. Sub-categories of Infectious causes include: Viral Infection, Bacterial Infection, Other Infections (tuberculosis, fungal, parasitic), Sexually Transmitted Infections, Recent Antibiotic Therapy. Non-Infectious causes include: Systemic Disease, Renal Disease, Drug Related, Inflammation adjacent to Genitourinary Tract. Clinicians that encounter pediatric patients with sterile pyuria and persistent symptoms should consider the substantial differential diagnosis described in this study.

Symptom Resolution in Pediatric Patients With Lyme Disease

2018 ◽  
Vol 8 (2) ◽  
pp. 170-173 ◽  
Author(s):  
Mattia E Chason ◽  
Maureen Monaghan ◽  
Jichuan Wang ◽  
Yao Cheng ◽  
Roberta L DeBiasi
Keyword(s):  
Lyme Disease ◽  
Pediatric Patients ◽  
Symptom Resolution

Abnormal gallbladder nuclear ejection fraction predicts success of cholecystectomy in patients with biliary dyskinesia

1993 ◽  
Vol 166 (6) ◽  
pp. 672-675 ◽  
Author(s):  
Marney K. Sorenson ◽  
Sara Fancher ◽  
Nicholas P. Lang ◽  
John F. Edit ◽  
J. Ralph Broadwater
Keyword(s):  
Ejection Fraction ◽  
Biliary Dyskinesia

scholarly journals Combined Cubital and Carpal Tunnel Release Results in Symptom Resolution Outside of the Median or Ulnar Nerve Distributions

2016 ◽  
Vol 10 (1) ◽  
pp. 111-119 ◽  
Author(s):  
Peter C. Chimenti ◽  
Allison W. McIntyre ◽  
Sean M. Childs ◽  
Warren C. Hammert ◽  
John C. Elfar
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Symptomatic Improvement ◽  
Patient Counseling ◽  
Symptom Resolution ◽  
Persistent Symptoms ◽  
Validated Questionnaires

Background: Resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution has been shown to occur following carpal tunnel release. We hypothesized that a similar effect would be found after combined release of the ulnar nerve at the elbow with simultaneous release of the median nerve at the carpal tunnel. Methods: 20 patients with combined cubital and carpal tunnel syndrome were prospectively enrolled. The upper extremity was divided into six zones and the location of pain, numbness, tingling, or strange sensations was recorded pre-operatively. Two-point discrimination, Semmes-Weinstein monofilament testing, and validated questionnaires were collected pre-operatively and at six-week follow-up. Results: Probability of resolution was greater in the median nerve distribution than the ulnar nerve for numbness (71% vs. 43%), tingling (86% vs. 75%). Seventy percent of the cohort reported at least one extra-anatomic symptom pre-operatively, and greater than 80% of these resolved at early follow-up. There was a decrease in pain as measured by validated questionnaires. Conclusion: This study documents resolution of symptoms in both extra-ulnar and extra-median distributions after combined cubital and carpal tunnel release. Pre-operative patient counseling may therefore include the likelihood of symptomatic improvement in a non-expected nerve distribution after this procedure, assuming no other concomitant pathology which may cause persistent symptoms. Future studies could be directed at correlating pre-operative disease severity with probability of symptom resolution using a larger population.

Gallbladder wall inflammatory cells in pediatric patients with biliary dyskinesia and cholelithiasis: a pilot study

2006 ◽  
Vol 41 (9) ◽  
pp. 1545-1548 ◽  
Author(s):  
Brian Rau ◽  
Craig A. Friesen ◽  
James F. Daniel ◽  
Adnan Qadeer ◽  
Ding You-Li ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pediatric Patients ◽  
Inflammatory Cells ◽  
Gallbladder Wall ◽  
Biliary Dyskinesia

scholarly journals Tubular approach to minimally invasive microdiscectomy for pediatric lumbar disc herniation

2018 ◽  
Vol 21 (5) ◽  
pp. 449-455 ◽  
Author(s):  
Julio D. Montejo ◽  
Joaquin Q. Camara-Quintana ◽  
Daniel Duran ◽  
Jeannine M. Rockefeller ◽  
Sierra B. Conine ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Pediatric Patients ◽  
Lumbar Disc ◽  
Low Back ◽  
Duration Of Symptoms ◽  
Patient Reported ◽  
The Mean

OBJECTIVELumbar disc herniation (LDH) in the pediatric population is rare and exhibits unique characteristics compared with adult LDH. There are limited data regarding the safety and efficacy of minimally invasive surgery (MIS) using tubular retractors in pediatric patients with LDH. Here, the outcomes of MIS tubular microdiscectomy for the treatment of pediatric LDH are evaluated.METHODSTwelve consecutive pediatric patients with LDH were treated with MIS tubular microdiscectomy at the authors’ institution between July 2011 and October 2015. Data were gathered from retrospective chart review and from mail or electronic questionnaires. The Macnab criteria and the Oswestry Disability Index (ODI) were used for outcome measurements.RESULTSThe mean age at surgery was 17 ± 1.6 years (range 13–19 years). Seven patients were female (58%). Prior to surgical intervention, 100% of patients underwent conservative treatment, and 50% had epidural steroid injections. Preoperative low-back and leg pain, positive straight leg raise, and myotomal leg weakness were noted in 100%, 83%, and 67% of patients, respectively. The median duration of symptoms prior to surgery was 9 months (range 1–36 months). The LDH level was L5–S1 in 75% of patients and L4–5 in 25%. The mean ± SD operative time was 90 ± 21 minutes, the estimated blood loss was ≤ 25 ml in 92% of patients (maximum 50 ml), and no intraoperative or postoperative complications were noted at 30 days. The median hospital length of stay was 1 day (range 0–3 days). The median follow-up duration was 2.2 years (range 0–5.8 years). One patient experienced reherniation at 18 months after the initial operation and required a second same-level MIS tubular microdiscectomy to achieve resolution of symptoms. Of the 11 patients seen for follow-up, 10 patients (91%) reported excellent or good satisfaction according to the Macnab criteria at the last follow-up. Only 1 patient reported a fair level of satisfaction by using the same criteria. Seven patients completed an ODI evaluation at the last follow-up. For these 7 patients, the mean ODI low-back pain score was 19.7% (SEM 2.8%).CONCLUSIONSTo the authors’ knowledge, this is the longest outcomes study and the largest series of pediatric patients with LDH who were treated with MIS microdiscectomy using tubular retractors. These data suggest that MIS tubular microdiscectomy is safe and efficacious for pediatric LDH. Larger prospective cohort studies with longer follow-up are needed to better evaluate the long-term efficacy of MIS tubular microdiscectomy versus other open and MIS techniques for the treatment of pediatric LDH.

Клиническое значение результатов исследования DAPA HF (Dapagliflozin and prevention of adverse-outcomes in heart failure) для пациентов и врачей. Консенсус совета Экспертов

2021 ◽  
Vol 1 (223) ◽  
pp. 2-14
Author(s):  
Gulmira Alipova ◽  
◽  
Anna Bazarova ◽  
Nazira Bazarova ◽  
Rimma Bazarbekova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Persistent Symptoms

The article presents the results of the DAPA-HF study - evaluating the efficacy of dapagliflozin, used at a dose of 10 mg once a day, in addition to the standard treatment for patients with chronic heart failure with reduced left ventricular ejection fraction, compared to placebo. An analysis of current clinical recommendations related to this issue was carried out, the results of recent clinical studies and metaanalyses conducted were highlighted. Based on the results of the study, the need is postulated to optimize drug therapy of this category to patients with persistent symptoms of heart failure, despite standard therapy, with the addition of dapagliflozin to reduce the risk of cardiovascular death and hospitalizations for heart failure, improve the course of the disease. Keywords: chronic heart failure, dapagliflozin, low ejection fraction, effects of type 2 sodium-glucose co transporter inhibitors, diabetes mellitus.

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