Clinical Cases of Gallstone Ileus

Background. Gallstone ileus is a rare complication of cholelithiasis accounting for 0.3–2.1% total acute intestinal obstructions. The recent years are witnessing a sharply elevated incidence of cholelithiasis and its entailed complications. The major diagnostic biases are the atypical clinical presentation, instrumental and laboratory evidence, and a relative paucity of surgical cases.Aim. Highlighting to surgeons the feasibility of this rare reluctantly diagnosed form of acute small bowel obstruction.Materials and methods. The article presents the clinical observations of gallstone-induced small intestinal obstruction collected at a surgery unit of the Bashkir State Medical University Clinic. Patients had surgeries for cholecystoduodenal fistula embolisation, gastro/enterotomy and lithoextraction followed by gastro/enterotomy wound suturing.Results and discussion. Patients had a benign postoperative period are were discharged in a satisfactory condition on day 7–10 after surgery for outpatient surveillance.Conclusion. Surgeons need to contemplate this pathology to ensure timely diagnosis and treatment, as well as avoid possible complications. Mostly important still is a timely gallbladder resection upon diagnosing cholelithiasis via laparoscopic cholecystectomy as a “gold standard” in treatment for this disease.

Diagnostic Tools for Autism Spectrum Disorders by Gender: Analysis of Current Status and Future Lines

Studies on the prevalence of autism spectrum disorders have shown gender disproportion. In recent years, there has been an increasing interest in this investigation area. There are two main research lines; the first is focused mostly on gender-related biological reasons that could account for low ASD prevalence in women (i.e., related to some protective factors related to hormones or the immune system, among others), and the second research line studies possible diagnostic biases. In the present study, a review of the latter line of research is made based on two main objectives: (a) analysis of possible biases in diagnostic tools and (b) other nonbiological ASD prevalence explained by gender differences. As a result of our theoretical review, we found that the articles reviewed showed contradictory results and possible diagnostic biases, not only in their design but also in their assessment standards. We concluded that specific or complementary diagnostic tools and procedures differentiated by gender should be developed in order to reduce these biases.

Objective Assessments in Diagnoses and Treatment: A Proposed Change in Paradigm

For patients with psychiatric disorders, current diagnostic and treatment approaches are far from optimal. The clinical interview drives the standard approach—matching symptoms to diagnostic criteria—and results in standardized pharmacological and behavioral treatments, often, with inadequate outcome; but now, recent imaging advances can correlate behavioral assessments with brain function and measure them against normative databases to provide data critical for the reevaluation of patient diagnosis and treatment. This article addresses the data that support a redefinition of our current paradigm. We believe a neurobehavioral approach provides for more personalized treatment approaches unbound from classically defined diagnostic biases.

Hidden diagnosis behind viral infection: the danger of anchoring bias

Anchoring bias is one of the most common diagnostic biases that may lead to closed-minded thinking and could result in unnecessary tests, inappropriate patient management and even misdiagnosis. A 4-year-old boy was brought to the emergency department because of shaking chills. On the basis of bilateral swollen preauricular areas, high level of serum amylase and the prevalence of mumps, he initially received a diagnosis of mumps in spite of the shaking chills. However, blood culture turned out to be positive for two different kinds of bacteria. The patient finally received a diagnosis of polymicrobial bacteraemia resulting from suppurative appendicitis. We must consider and rule out bacteraemia in the differential diagnosis for patients who present with shaking chills, even in the presence of symptoms or information consistent with a more common viral infection such as mumps. In addition, intra-abdominal infection should be ruled out in the presence of polymicrobial enterobacteriaceae bacteraemia.