Optimal Management of the Hyperkinetic Gallbladder: A Comparison of Outcomes Between Operative and Nonoperative Approaches

2020 ◽  
pp. 000313482096628
Author(s):  
Michael L. Williford ◽  
Katherine T. Fay ◽  
Francis J. Simpson ◽  
Ann M. Defnet ◽  
David M. Schuster ◽  
...  
Keyword(s):  
Gallbladder Disease ◽  
Iminodiacetic Acid ◽  
Emergency Department Visits ◽  
Symptom Improvement ◽  
Optimal Management ◽  
Hida Scan ◽  
Symptom Profile ◽  
Institutional Review ◽  
Current Symptom ◽  
Surgical History

Background A hyperkinetic gallbladder is defined as a hepatobiliary iminodiacetic acid (HIDA) scan ejection fraction (EF) of >80%. This condition is poorly described, and there is no current consensus on optimal management. The intent of this study was to determine if cholecystectomy improves symptoms in patients with a hyperkinetic gallbladder when compared to those managed nonoperatively and if there were variables predictive of symptom improvement with or without cholecystectomy. Materials and Methods This retrospective study included patients from 3 academic hospitals in the Atlanta metro area between the years 2006 and 2018. All patients with an EF >80% were included. Following voluntary exclusion patients were contacted by phone. Each patient was administered a questionnaire regarding their surgical history, medical management, and current symptom profile via Otago score. Institutional Institutional Review Board approval was obtained. Results 4785 HIDA scans were performed, and 194 reported an EF >80% (incidence 15.7%). 96% of these scans were reported as normal by the radiologist. 68 patients were able to be contacted by phone and completed the questionnaire. 18 patients underwent cholecystectomy, and 89% reported that their symptoms attributed to gallbladder disease were no longer present. 50 patients did not undergo cholecystectomy, and alternate diagnoses, medication prescriptions, diet modification, emergency department visits, and Otago score were higher in this cohort. Discussion Patients who undergo cholecystectomy for a diagnosis of hyperkinetic gallbladder, on average, report improvement in symptoms when compared to patients managed nonoperatively. This study supports the practice of reporting and managing hyperkinetic gallbladders as a pathologic entity.

scholarly journals Familial Success in Allergen Desensitization

2019 ◽  
Vol 10 ◽  
pp. 215265671989031
Author(s):  
Marija Rowane ◽  
Ryan Shilian ◽  
Devi K. Jhaveri ◽  
Haig H. Tcheurekdjian ◽  
Theordore H. Sher ◽  
...  
Keyword(s):  
Immunoglobulin E ◽  
Predictive Biomarkers ◽  
Subcutaneous Immunotherapy ◽  
Symptom Improvement ◽  
Genetic Associations ◽  
Biologic Treatment ◽  
Institutional Review ◽  
Current Symptom ◽  
Allergy Treatment ◽  
History Of

Introduction Allergic rhinitis (AR) is a widely prevalent immunoglobulin E-mediated inflammatory nasal condition resulting from reexposure to an allergen in a sensitized individual. The genetic associations behind AR and other allergic conditions have been studied. However, familial success with AR therapies, specifically allergen desensitization through subcutaneous immunotherapy (SCIT), has never been reported in the literature. Pharmocogenetics has been gradually applied to link heritable genetic variants with drug responses, such as intergenic region variants APOBEC3B and APOBEC3C and β2-adrenergic receptor and glycoprotein ADAM33 polymorphisms as predictive biomarkers for biologic treatment response in asthma. We provide the first reported survey of familial success with SCIT. Methods We administered a month-long, institutional review board-approved (20190493) questionnaire to 200 adult patients receiving SCIT in a suburban allergy/immunology practice. The anonymous survey inquired about demographics, target allergens for their SCIT, current symptom improvement on SCIT, and family history of allergies and SCIT management. Results Twenty-six percent (52 of 200, 26%) SCIT patients reported familial success with the same allergy treatment modality. AR diagnosis and symptom improvement from SCIT was similar among previous/same (18 of 52, 38%; 26 of 52, 54%) and subsequent (10 of 52, 21%; 19 of 52, 40%) generations of family members. A combination of seasonal and perennial allergies was most prevalent (81%) among this population. Conclusion In a subpopulation of SCIT patients, there appears to be a familial success rate with this allergen desensitization treatment. This is the first reported pharmocogenetic evidence of assessing hereditary influence on effective AR therapy. Understanding pharmacogenetic associations involved with SCIT may improve allergists’ recommendations for this treatment option.

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.

scholarly journals Impact of a Pharmacy-Driven Transitions of Care Medication Reconciliation Following Hospitalization

2020 ◽  
Vol 36 (2) ◽  
pp. 68-71
Author(s):  
Rebecca L. Stauffer ◽  
Abigail Yancey
Keyword(s):  
Medication Reconciliation ◽  
Intervention Group ◽  
Emergency Department Visits ◽  
Transitions Of Care ◽  
Control Group ◽  
Medication Discrepancies ◽  
Institutional Review ◽  
The Impact ◽  
Medication Changes

Background: Medication changes are common after hospitalizations, and medication reconciliations are one tool to help identify potential medication discrepancies. Objective: To determine the impact of a pharmacy-driven medication reconciliation service on number of medication discrepancies identified. Methods: This was a retrospective cohort, chart-review study conducted at an internal medicine outpatient clinic. Patients at least 18 years of age were eligible for inclusion if they presented for a hospital follow-up appointment within 14 days of discharge between September 1, 2015, and May 31, 2016, from a system hospital. The 2 cohorts were patients with a pharmacist-completed medication reconciliation note written in the electronic health record on the date of their hospital follow-up appointment and those without. The primary outcome was number of medication discrepancies identified during medication reconciliation. Secondary outcomes included types of discrepancies, 30-day hospital readmission, and 30-day emergency department visits. This study was approved by the facility institutional review board. Results: Seventy-nine patients were included, and 38 patients had a pharmacist-completed medication reconciliation (48%). A total of 64 medication discrepancies were identified in 26 patients; of these, 49 discrepancies were resolved during the appointment (77%). There was an average of 2.46 medication discrepancies (±2.34) per patient. The most common discrepancy was missing medications. Thirty-day readmission rate was 5.3% in the intervention group and 19.5% in the control group ( P = .054). Conclusions: A pharmacist-completed medication reconciliation identified many medication discrepancies that were then resolved. From this study, pharmacist-led medication reconciliations following hospital discharge appear valuable.

Recurrent Pyogenic Cholangitis: ‘Sump Syndrome’ following Choledochoduodenostomy

1997 ◽  
Vol 27 (1) ◽  
pp. 51-52 ◽  
Author(s):  
T F Toufeeq Khan ◽  
Zaheer A Sherazi ◽  
Suseela Muniandy ◽  
Malik Mumtaz
Keyword(s):  
Abdominal Pain ◽  
Hospital Admissions ◽  
Late Complication ◽  
Iminodiacetic Acid ◽  
Endoscopic Retrograde ◽  
Percutaneous Access ◽  
Intrahepatic Calculi ◽  
Hida Scan ◽  
Recurrent Pyogenic Cholangitis ◽  
Upper Abdominal

An uncommon and late complication of side-to-side choledochoduodenostomy (CDD), the ‘sump syndrome’, developed in a patient 4 years after surgery. Recurrent right upper abdominal pain, fever with chills and rigors and latterly, mild jaundice made her seek repeated hospital admissions which were treated successfully with antibiotics. During the last admission, ultrasonography, endoscopic retrograde cholangiography (ERC), computerized scanning (CT) and hepatic iminodiacetic acid (HIDA) scan using Tc99m confirmed multiple intrahepatic calculi with proximal dilatation, debris in the distal blind segment and delayed excretion through the CDD. At surgery, the choledochoduodenostomy was taken down and a Rouxen-Y hepaticojejunostomy (RHJ) was fashioned after ductal clearance. The closed end of the Roux loop was placed subcutaneously for subsequent percutaneous access for cholangiography and removal of calculi. She is asymptomatic and well 28 months after surgery.

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.

Spontaneous Biliary Pericardial Tamponade: A Case Report and Literature Review

2020 ◽  
Vol 16 ◽  
Author(s):  
Ayman Battisha ◽  
Ahmed M Altibi ◽  
Bader Madoukh ◽  
Omar Sheikh ◽  
Khalid Sawalha ◽  
...  
Keyword(s):  
Literature Review ◽  
Iminodiacetic Acid ◽  
Pericardial Tamponade ◽  
Biliary Fistula ◽  
Pericardial Fluid ◽  
Rare Form ◽  
Pericardial Space ◽  
Hida Scan ◽  
First Case ◽  
Hispanic Male

Background: Biliary pericardial tamponade (BPT) is a rare form of pericardial tamponade, characterized by yellowish-greenish pericardial fluid upon pericardiocentesis. Historically, BPT reported to occur in the setting of an associated pericardio-biliary fistula. However, BPT in the absence of a detectable fistula is extremely rare. Case Presentation: A 75-year-old Hispanic male presenting with dyspnea and diagnosed with cardiac tamponade. Subsequent pericardiocentesis revealed biliary pericardial fluid (bilirubin of 7.6 mg/dl). Patient underwent extensive workup to identify a potential fistula between hepatobiliary system and the pericardial space, which was non-revealing. The mechanism of bile entry into the pericardial space remains to be unidentified. Literature Review: A total of six previously published BPT were identified: all were males, mean age of 53.3 years (range: 31-73). Mortality was reported in two out of the six cases. The underlying etiology for pericardial tamponade varied across the cases: incidental pericardio-biliary fistula, traumatic pericardial injury, and presence of associated malignancy. Conclusion: Biliary pericardial tamponade is a rare form of tamponade that warrants a prompt workup (e.g., Hepatobiliary Iminodiacetic Acid – HIDA scan) for an iatrogenic vs. traumatic pericardio-biliary fistula. As a first case in the literature, our case exhibits a biliary tamponade in the absence of an identifiable fistula.

P84 Cauda equina syndrome – an assessment of long-term outcomes following surgery

2019 ◽  
Vol 90 (3) ◽  
pp. e43.4-e44
Author(s):  
JE Hazelwood ◽  
I Hoeritzauer ◽  
A Demetriades
Keyword(s):  
Physical Function ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Bowel Dysfunction ◽  
Long Term Outcomes ◽  
Symptom Profile ◽  
Post Operative Pain ◽  
Current Symptom ◽  
Physical Dysfunction

ObjectivesData regarding long-term outcomes following surgery for cauda equina syndrome (CES) is scarce, especially concerning bowel and sexual function. This study aimed to assess long-term bladder, bowel, sexual and physical function in a CES cohort.DesignDescriptive.SubjectsA pre-existing ethically approved database was used to identify patients who had undergone surgery for CES between August 2013-November 2014.MethodsPatients were contacted over a one month period and completed validated questionnaires via telephone. These assessed bladder (Urinary Symptom Profile), bowel (Neurogenic Bowel Dysfunction Score), sexual (Arizona Sexual Experiences Scale) and physical function (SF-12). Patients were also asked which of their current symptoms they would most value treatment for and which NHS services they had accessed post-operatively.ResultsForty-six of 77 patients (response rate 72%, inclusion rate 59%) with a mean age of 45 years (21–83) and mean time since admission of 43 months (range 36–60) took part in the follow up study. The prevalence of bladder dysfunction was 76%, bowel dysfunction 41% with the majority (87%) reporting very minor symptoms, sexual dysfunction 39% and physical dysfunction 48%. Pain was the most deleterious current symptom in 57% but only 7% reported post-operative pain-management referral.ConclusionsThese findings confirm the high prevalence of long-term bladder, bowel, sexual and physical dysfunction in CES patients and provide useful data to guide the expectations of patients and clinicians.

Outpatient palliative care encounters in stage IV lung cancer care: An institutional review.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 128-128
Author(s):  
Sophia Rizk ◽  
Elizabeth Horn Prsic ◽  
William Rafelson ◽  
John Leonard Reagan ◽  
Angela Marie Taber
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Overall Survival ◽  
Stage Iv ◽  
Emergency Department Visits ◽  
Institutional Review ◽  
Significant Difference ◽  
Multidisciplinary Clinic ◽  
Stage Iv Lung Cancer ◽  
To Receive

128 Background: Palliative Care (PC) is becoming increasingly integrated into standard oncologic care (SC). Previous research suggests that patients receiving PC report better quality of life, and may have prolonged survival. This study evaluates the effect of PC integration in patients diagnosed with stage IV non-small cell lung cancer (NSCLC) at a single institution. Methods: All patients diagnosed with Stage IV NSCLC between January 2010 and January 2013 were considered for inclusion and retrospective analysis of their care. Charts were reviewed to identify patients who received outpatient PC with a licensed PC physician in addition to SC. There were no guidelines regarding the nature of the PC intervention. Retrospective analyses of multiple factors were assessed, including: receipt of chemotherapy and/or radiotherapy, utilization of emergency and sick visits, frequency and timing of hospice referral, and duration of hospice utilization. Overall survival was also assessed. Results: 136 patients fulfilled study inclusion criteria. 29 patients received PC in addition to SC, and 107 received SC alone. No statistically significant difference was noted between the groups with respect to age, sex, lines of chemotherapy administered, number of emergency department visits, or number of clinic sick visits. Hospice was offered more frequently in the PC group; however, there was no difference in the amount of time spent on hospice, and no difference in overall survival. There was a trend towards longer survival in the PC group (220 days vs. 254 days). Patients seen in a multidisciplinary clinic were significantly more likely to receive a PC evaluation (RR 1.28 CI 1.073-1.52, p < 0.006). Conclusions: This retrospective study examines how PC is integrated in actual clinical models. Multidisciplinary clinic patients were more likely to receive PC after controlling for comorbidities. There was no significant difference between PC and SC group outcomes. Although this study is small, it demonstrates common practice patterns, and identifies the need to identify the components of the PC encounter that are important in order to maximize the potential benefits of PC interventions.

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