Mental health message appeals and audience engagement: Evidence from Australia.

Social media platforms are increasingly used to disseminate social marketing messages about mental health and wellbeing. This study presents a range of message appeals used in social media enabled mental health promotion and stigma reduction messages. Furthermore, it examines the relationship between the type of message appeals and audience engagement. A content analysis of 65 organisation-generated YouTube videos about depression and anxiety and stigma reduction was conducted. The most utilised message appeal was Sorrow, followed by Affiliation, Ease/Convenience, Hope, Humour, Guilt/Shame, Heroic/Successful, and Fear. Multiple regression analysis was used to examine the relationship between the type of message appeals and audience engagement in terms of the number of likes, comments, and shares. The analysis revealed that Sorrow is the most useful message appeal for generating audience comments. However, Sorrow is negatively associated with the number of likes and shares. The results suggest that mental health promotion messages may engage a larger audience through Affiliation and Hope as they have a positive impact on the number of shares. This could, in effect, turn audiences into vocal advocates for mental health promotion and stigma reduction messages.

Decision-Making for HIV AIDS Prevention: Altruism and the Moral Norm.

The purpose of this enquiry was to understand how gay men form and maintain their attitudes toward HIV transmission preventative behaviors. Autobiographical life histories of sixteen gay men showed that once they acquired knowledge of preventative behavior they consistently adhered to that behavior. They adhered because of fear of HIV infection and because they held a moral norm that obligated them to behave altruistically (Schwartz, 1977) to protect not only themselves, but also their sex partners, loved ones, and their positive self-evaluation. They saw their HIV negative status, and their adherence, as pre-requisite and enabler for achieving their goals in life. Dick and Basu's (1994) Framework for Customer Loyalty, a commercial marketing communications theoretical framework, explains development and maintenance of these men's loyalty (their consistent adherence). This understanding, within a marketing communications framework, will inform development of social marketing communications aiming to increase adherence to behaviors that prevent HIV transmission.

Negative health impact of tourists through pandemic: hospitality sector perspective.

Although the impact of tourism development on residents has received a lot of attention in the literature, the health impact of tourism has not been sufficiently addressed. Due to outbreaks of COVID-19, the importance of recognition of the negative health impact of tourism is relevant. Thus, the present study aims to identify the health impact of tourism through COVID-19 outbreaks considering residents' perspectives. In the current research, we gathered data from semi-structured interviews conducted from 10th August to 30 August 2020 to investigate community perception regarding the negative health impact of tourism through the COVID-19 era. We conducted 30 interviews with some Iranian residents. Data is analyzed by thematic analysis via MAXQDA software. Residents perceived negative health impacts through COVID-19 outbreaks as containing three subthemes including general negative impacts, direct negative impacts, and indirect negative impacts. The results also show that residents use two coping strategies to face these negative health impacts, namely negative coping strategies and positive coping strategies. Perceived negative health impacts, and residents' coping strategies are two major themes regarding Iranian residents' perception toward tourism negative health impacts through COVID-19 outbreaks.

Acute aortic occlusion in a child secondary to lap-belt injury treated with thromboendarterectomy and primary repair.

Abdominal aortic injury as a result of blunt trauma is a rare event and has been described in few children. A 6-year-old girl presented with acute bilateral lower extremity ischemia, and a triad of acute aortic occlusion, intra-abdominal visceral injury, and a lumbar chance fracture after sustaining a seat belt injury from a motor vehicle collision. An emergency aortic thromboendarterectomy and primary repair were performed. This represents one of the few reports of acute traumatic aortic thrombosis in a child and highlights the surgical treatment of acute abdominal aortic injury in a pediatric patient.

Traumatic bilateral carotid artery dissection.

INTRODUCTION: Bilateral carotid artery dissection following blunt trauma is a rare but potentially lethal injury if not diagnosed early and treated. CASE REPORT: We report a collision patient who suffered bilateral asymptomatic carotid artery dissections. He also had multiple fractures of the pelvis and upper and lower extremities. The patient was managed acutely with aspirin. He underwent open reduction and internal fixation of fractures without complication and was discharged home on aspirin. DISCUSSION: Carotid artery dissections are increasingly being recognized in blunt trauma patients. Management options include systemic anticoagulation versus antiplatelet therapy. The need to acutely address the carotid artery injury must be balanced with the need for hemostasis with associated solid organ injury and/or future operative procedures. CONCLUSIONS: Carotid artery dissections should be screened for in patients with appropriate mechanism of injury. This case report details the successful management of a patient of bilateral carotid artery dissection and other major orthopedic injuries using aspirin.

A contemporary experience of open aortic reconstruction in patients with chronic atherosclerotic occlusion of the abdominal aorta.

OBJECTIVE: To examine and report surgical results from a contemporary experience of open abdominal aortic reconstruction in patients with chronic atherosclerotic abdominal aortic occlusion (CAAAO). METHODS: Between January 1999 through May 2010, 54 patients with CAAAO were identified and retrospectively reviewed. CAAAOs were categorized into infrarenal aortic occlusions (IRAOs) and juxtarenal aortic occlusions (JRAOs) based on superior extension of thrombus and requirement for supra-renal aortic clamping to repair. Morbidity, mortality, hospital stay, and operative variables were assessed. The χ2 or Fisher test and the Wilcoxon rank sum test were used to compare demographic and operative variables between two aortic occlusion groups (IRAO and JRAO). Univariate and multivariate analyses were performed to assess factors associated with surgical outcomes and hospital stay. The Kaplan-Meier method was used to calculate survival and patency rates. RESULTS: Fifty patients underwent aortic reconstructions with aorto-bifemoral or iliac bypass, and three underwent a remote axillo-femoral bypass procedure. There were 35 (64.8%) males, and 19 (35.2%) females. Median age was 51.9 years (range, 32-72 years). Of the two CAAAO groups, there were 20 IRAOs and 33 JRAOs. Aorto-renal thromboendartectomy was performed in 26 (49.1%) patients; 26 (75.8%) among JRAOs versus 1 (5%) of IRAOs (P<.01). Proximal aortic clamps were required in 28 (85%) of JRAOs and 3 (15%) of IRAOs (P<.01). Thirty-day and in-hospital mortality was zero. Median length of hospital stay was 7 days (range, 4 to 66 days), and median intensive care unit length of stay was 3 days (range, 1-22 days). Complications included cardiopulmonary dysfunction in four (8%), postoperative renal insufficiency in 10 (18.9%), and other postoperative complications in 15 (28.3%). All 10 with renal insufficiency recovered renal function to baseline creatinine or a creatinine value<1.1 mg/dL. Mean increases in right and left ankle-brachial indicess were 0.54±0.25 and 0.59±0.22, respectively. On univariate analysis, coronary artery disease and African American race were predictors of postoperative complications (P=.048). Age was significantly associated with total complications. Patients with postoperative complications and/or renal insufficiency were older than those without such complications (P=.02) Independent predictors of prolonged hospital stay were intraoperative blood replacement (P=.003), postoperative complications (P<.01), and postoperative renal insufficiency (P<.01). Prolonged intensive care unit stay was predicted by JRAO (P=.04), postoperative complications (P=.02), and postoperative renal insufficiency (P=.013). Survival at 3, 5, and 7 years were 86.6%, 76.5% and 50.9%, respectively. The reduced survival rates were predicted by previous myocardial infarction and existing coronary artery disease (P<.01). CONCLUSION: Abdominal aortic reconstruction is a safe method for treating CAAAO with low associated morbidity and mortality. Aorto-renal thromboendartectomy with supra-renal aortic clamping and aortic replacement remains an effective treatment for those with significant pararenal aortic disease, and can be performed without significant renal impairment.

High chemokine receptor CXCR4 level in triple negative breast cancer specimens predicts poor clinical outcome.

INTRODUCTION: Basal-like tumors or triple negative breast cancers are those that lack hormone-receptor and HER-2 expressions. They are considered to be aggressive tumors, and molecular mechanism to account for this is poorly understood. CXCR4 is a chemokine receptor that has been linked to breast cancer invasion and metastasis. We postulate that high CXCR4 overexpression level in cancer specimens predicts a poor outcome in patients with triple negative breast cancers. METHODS: One hundred fifty-one patients with triple negative breast cancers were prospectively accrued and analyzed. All had undergone standardized treatment and surveillance protocols. From each specimen, CXCR4 levels were detected using Western blots. Results were quantified against 1 microg of HeLa cells (positive controls). CXCR4 expression was defined as high (>or=6-fold) or low (<6-fold). Primary endpoints were cancer recurrence and death. Statistical analysis performed included Kaplan-Meier survival analysis, log-rank test, and Cox proportional hazard model. RESULTS: At a median follow-up of 37 mo, patients whose tumors had high CXCR4 overexpression (>or=6-fold) had a significantly higher incidence of cancer recurrence (P=0.014) and cancer-related death (P=0.026) than those in the low CXCR4 group (<6-fold). After adjusting for tumor size and nodal status, the relative risk for cancer recurrence and death in the high CXCR4 group was 2.1-fold (P=0.007; 95% CI: 1.22 to 3.8) and 2-fold (P=0.047; 95% CI: 1.01 to 4.06) higher than those in the low CXCR4 group, respectively. CONCLUSION: High CXCR4 overexpression in cancer specimens predicts a worse outcome in patients who have triple negative breast cancer.

Giant pararenal abdominal aortic aneurysm.

Inflammatory aortic aneurysms are unusual vascular lesions and most commonly involve the infrarenal segment of the abdominal aorta. These complex aneurysms represent a challenge to the vascular surgeon and become even more difficult as the extent of the aneurysm and size of the inflammatory mass increase. Although well described, few cases of giant inflammatory aneurysms are reported. In this case, we review the clinical presentation and surgical management of a patient with a giant pararenal abdominal aortic aneurysm and highlight an uncommon morphologic pattern of aortic disease and provide a review of relevant literature.

Elevated chemokine receptor CXCR4 expression in primary tumors following neoadjuvant chemotherapy predicts poor outcomes for patients with locally advanced breast cancer (LABC).

Purpose Patients with locally advanced breast cancer (LABC) have a poor outcome. A molecular predictor to identify at-risk patients is sorely needed. CXCR4 is a chemokine receptor that has been linked to breast cancer invasion and metastasis. We postulate that in patients with LABC, CXCR4 overexpression levels in cancer specimens following neoadjuvant chemotherapy predict cancer outcome. Experimental design 54 patients with LABC were prospectively accrued and analyzed. All had neoadjuvant chemotherapy and definitive surgical therapy. Study homogeneity was maintained by standardized treatment, surveillance, and compliance protocols. A 1 cm(3) cancer from the surgical specimens of each patient was retrieved for analysis. CXCR4 levels were detected using Western blots, and results were quantified against 1 mug of protein from HeLa cells. CXCR4 expression was defined as low (<6.6-fold) or high (> or =6.6-fold). Primary endpoints were cancer recurrence and death. Statistical analysis performed included independent samples t-test, chi-square test, Spearman Rank analysis, Kaplan-Meier survival analysis, log-rank test, and Cox proportional hazard model. Results With a median follow-up of 30 months, patients with high CXCR4 overexpression (> or =6.6-fold) had a significantly higher incidence of recurrence (P = 0.0006) and cancer death (P = 0.0128) than those with low CXCR4 overexpression (<6.6-fold). The relative risks for recurrence and death in the high CXCR4 group were 27.3-fold (95% CI: 6.2-120.8; P = 0.001) and 4.8-fold (95% CI: 1.5-15.0; P = 0.0076) higher, respectively than those in the low CXCR4 group. Conclusion High CXCR4 overexpression in specimens from LABC patients receiving neoadjuvant chemotherapy was predictive of cancer outcome.

Correlation of TLK1B in elevation and recurrence in doxorubicin-treated breast cancer patients with high eIF4E overexpression.

BACKGROUND: Tousled-like kinase 1B (TLK1B), a mammalian threonine kinase, facilitates the repair of DNA breaks. Eukaryotic initiation factor 4E (eIF4E) overexpression leads to the upregulation of TLK1B. Doxorubicin, commonly used in the adjuvant setting for breast cancer, causes DNA breaks. We hypothesized that the degree of TLK1B elevation is correlated with eIF4E overexpression and translates clinically to an increased risk for recurrence in breast cancer patients treated with doxorubicin-based adjuvant chemotherapy. STUDY DESIGN: We prospectively accrued 152 patients with stage I to III breast cancer treated with a doxorubicin-based chemotherapy in an adjuvant setting. Standardized treatment and surveillance protocols were used. eIF4E and TLK1B protein levels were quantified using Western blots, and patients were divided into tertiles based on previously reported stratification of eIF4E and TLK1B levels. Primary end points were cancer recurrence and death. Statistical analysis included Spearman's correlation, Kaplan-Meier survival analysis, log rank test, and the Cox proportional hazard model. RESULTS: The degree of TLK1B overexpression was highly correlated with the degree of eIF4E elevation (r=0.25, p=0.0025, Spearman rank correlation). Patients whose tumors were in the highest tertile for eIF4E overexpression had a higher risk for cancer recurrence and cancer death (p=0.015 and 0.049, respectively, log rank test). After adjusting for T-stage, nodal status, age, and estrogen receptor and progesterone receptor status, patients with tumors in the highest tertile of TLK1B overexpression treated with doxorubicin were 1.7-fold more likely to suffer recurrence than those in the low TLK1B group treated similarly (p=0.0078, CI, 1.17 to 2.75, Cox model). CONCLUSIONS: TLK1B overexpression was highly correlated with the level of eIF4E elevation. High TLK1B in cancer specimens was associated with a higher risk for cancer recurrence in patients treated with doxorubicin-based adjuvant chemotherapy.

Positron emission tomography (PET) positive thyroid incidentaloma: the risk of malignancy observed in a tertiary referral center.

An incidental finding of focal thyroid uptake (thyroid incidentaloma) from an 18F-fluorodeoxyglucose positron emission tomography (PET) positron presents a diagnostic challenge. We evaluated the incidence of thyroid incidentaloma identified by PET scans and the likelihood of malignancy associated with this finding. Records from all patients from January 1, 2000 to November 30, 2003 who had focal thyroid uptake without any history of thyroid disease were culled. Of the 6241 PET scans performed, focal thyroid uptake was observed in 76 patients (1.2%). Only 14 patients (18%) underwent biopsy. Four of 14 patients (28.6%) had papillary thyroid carcinoma, 7 (50%) had hyperplasia, and 1 each had thyroiditis, nodular goiter, and follicular neoplasm. The incidence of PET thyroid incidentalomas was 1.2 per cent and the incidence of malignancy was 28.6 per cent. Given the high likelihood of malignancy, a further diagnostic workup for surgically fit patients is warranted.

"Cut them into little stars".

The following are excerpts from testimony given in favor of House Bill 849 before the Ways and Means Committee of the Louisiana House of Representatives on June 7, 2005. The bill asked for funding of a time sensitive illness and Homeland Security Emergency System for the State of Louisiana. Bill 849 was defeated by a vote of 9 - 2 in committee but subsequently rudimentary funding was secured in the joint conference committee of the House and Senate by Senate President Dr. Donald Hines. The prophetic poignancy of this plea and of so many other missed opportunities through the years should never be lost on the citizens of Louisiana.

Histoplasmosis presenting as pneumoperitoneum in patients with acquired immune deficiency syndrome: case reports and review of the literature.

Histoplasmosis is a rare, but important, disease process in patients with the acquired immune deficiency syndrome (AIDS). Initially reported in this patient population in 1982, over 100 cases of histoplasmosis have been reported throughout the United States. Most of these patients present with disseminated disease. Untreated, histoplasmosis will be the direct cause of death in over 80% of patients, but treatment with itraconazole can reduce this mortality to less than 25%. We present two cases of histoplasmosis in AIDS patients presenting as pneumoperitoneum.

Compliance and outcomes: do African Americans with advanced breast cancer fare worse?

Among women with advanced breast cancer, African Americans are thought to have a higher mortality rate than Caucasian. A number of factors, including intrinsic tumor biology, have been postulated for this survival difference. If similar treatment were offered, and actually completed, is there a survival difference? The objectives of this study were to determine 1) if the treatment regimens offered to African Americans and Caucasian were the same, 2) when treatment was offered, was compliance a factor, and 3) if the patients were compliant, was the outcome different? A retrospective review of 72 charts of patients with advanced stage breast cancer from 1988-present at our institution and an affiliated hospital was performed. Data collected include 1) stage of disease at diagnosis, 2) treatment offered, 3) compliance, and 4) outcome (disease-free survival and overall survival). African Americans were defined as those patients who described themselves as African American on their hospital face sheets. The treatment regimens offered were the same for both populations. There was not a significant difference in compliance between the African-American and the Caucasian women. There was no significant difference in disease-free survival or overall survival between the African-American and the Caucasian groups.

Diagnosis and management of enterovesical fistulas in patients with Crohn's disease.

The objective of this study was to investigate the clinical manifestations and diagnostic studies used to evaluate Crohn's patients with enterovesical fistulas (EVFs) and to assess outcome after surgical intervention. This is a ten year multi-institutional retrospective chart review of patients with Crohn's disease. Of 400 patients identified with Crohn's disease eight (2%) were diagnosed with EVF. The mean age at diagnosis was 27 years. No patients had prior surgeries for Crohn's. Duration of symptoms ranged from 6 months to 15 years. There were seven ileovesical and one colovesical fistula identified. One patient had associated perianal disease. Three had concomitant enteroenteral fistulae. Clinical features included pneumaturia in seven patients (88%), fecaluria in three (38%), hematuria in five (63%), and urinary tract infection symptoms in seven (88%). Diagnostic studies included CT scan in six, barium or gastrografin enema in four, and cystoscopy in four. Surgical therapy involved resection of the affected bowel. The bladder defect was closed primarily in two layers in all patients using absorbable suture, with omental patch in four. Two patients underwent ileostomy and one underwent colostomy, all taken down within 6 months. There were no bladder leaks and no anastamotic leaks. There were no perioperative deaths. The mean postoperative stay was nine days. The mean follow-up was 39 months. We conclude that pneumaturia is a strong clinical indicator of EVF. CT has been valuable in identifying gas within the bladder in these patients. Cystoscopy has proven useful in identifying the fistulous tract and in evaluation of the ureters. The presence of an EVF should heighten suspicion as to the presence of concomitant enteroenteral fistulae. Barium or gastrografin studies are useful in this capacity. Surgical treatment of EVFs should include resection of affected bowel. The bladder defect can safely be closed using absorbable suture.

Management of Fournier's gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment.

Fournier's gangrene is an infectious necrotizing fasciitis of the perineum and genital regions. It is a synergistic infection caused by a mixture of aerobic and anaerobic organisms. The mortality rate from this infection ranges from 0 to 67 per cent. One of the most important determinants of overall outcome is early recognition and extensive surgical debridement upon initial diagnosis. This is followed by aggressive antibiotic therapy combined with other precautionary and resuscitative measures. Our hypothesis is that early aggressive surgical debridement combined with broad-spectrum antibiotic coverage results in decreased mortality from Fournier gangrene. The objective of this study was to determine our morbidity and mortality as compared with other institutions. This was a retrospective review of 200 charts of patients from 1990 through 2001. The charts reviewed included patients with a diagnosis of male and female genital abscesses, cellulitis, necrotizing fasciitis, and vascular disorders. This resulted in 33 patients who had a final diagnosis of Fournier's gangrene. There were 26 (79%) males and seven (21%) females with a diagnosis of Fournier's gangrene. The patients ranged in age from 30 to 85 years (mean age 51.5). There were a number of predisposing factors that were examined. Thirteen patients (39%) were diabetic, 18 (55%) suffered from hypertension, 18 (55%) were obese, and 18 (55%) were cigarette smokers. Four patients (12%) had no predisposing factors. The treatment consisted of wide surgical debridement which was performed in all 33 patients. Most patients received multiple debridements ranging from one surgery to seven (mean 3.25) per hospital stay. The majority of patients received broad-spectrum antibiotic coverage. Three patients died, which resulted in a mortality rate of 9 per cent. Early recognition and aggressive surgical debridement is the most essential intervention in stopping the rapidly progressing infectious process of Fournier's gangrene. This intervention should be combined with aggressive triple-antibiotic therapy and other precautionary measures for supporting the patient who has the systemic effects of Fournier's gangrene. Our data do not reach statistical significance with regard to the use of triple-antibiotic therapy. However, we believe that it is an important part of the treatment regimen. The combination of aggressive surgical therapy and appropriate antibiotic coverage results in a reduction in mortality.

The sestamibi scan as a preoperative screening tool.

Sestamibi scan is generally recognized in the literature to play a role in the imaging of parathyroid adenoma. Most institutions quote sensitivities ranging from 80 to 100 per cent. There is still a question as to whether patients need preoperative localization studies. Preoperative localization can potentially result in less invasive surgery, shorter operative times, decreased hospital stays, and decreased need for re-exploration. Our hypothesis is that the sestamibi scan is a sensitive predictor of parathyroid adenomas. The objectives of this study are to determine the sensitivity of sestamibi scan in detecting parathyroid adenoma, and to determine whether either parathyroid hormone (PTH) level or calcium level is an independent predictor of a positive scan. One hundred patients were retrospectively reviewed at Louisiana State University Health Sciences Center-Shreveport and Louisiana State University Health Sciences Center-Monroe from March 1993 through December 2000. All patients had a preoperative sestamibi scan. This scan was performed using the dual-phase technique in which the parathyroid glands are visualized after washout of tracer from the thyroid. The scan was followed by either a unilateral or bilateral neck dissection. There were 82 female patients and 18 male patients who ranged in age from 23 to 78 years. The median weight of glands with a positive scan was 795 mg. The median weight of glands with a negative scan was 480 mg. This difference was statistically significant (P < 0.04). Overall there were 107 adenomas. Of these 93 had positive scans and 14 had negative scans. This results in a sensitivity of 87 per cent. There were 67 glands that weighed at least 500 mg. Of these 67 glands 61 had positive scans and six had negative scans. This resulted in a sensitivity of 91 per cent. There were 40 glands that weighed less than 500 mg. Of these 40 glands 32 had positive scans and eight had negative scans. This resulted in a sensitivity of 80 per cent. Using multiple linear regression analysis calcium level correlated with the weight of the gland (P < 0.01). Calcium level also correlated with the PTH level (P < 0.01). However, neither the PTH level nor the calcium level correlated with a positive sestamibi scan. Sestamibi scan is a sensitive predictor for parathyroid adenoma greater than 500 mg (91% sensitivity). Even in smaller glands (<500 mg) 80 per cent sensitivity was demonstrated. Although the calcium level correlates with the PTH level neither PTH level nor calcium level is predictive of a positive sestamibi scan.

"In as much as ye have done it unto the least of these": a tribute to the Louisiana State Medical Society Alliance.

The following tribute was delivered to members of the Louisiana State Medical Society Alliance at their Annual Convocation and Leadership Conference in Monroe, Louisiana, April 9, 2003, by Lester W. Johnson MD. For the last 40 years, these spouses of Louisiana physicians have raised over 1.7 million dollars through the AMA Foundation for the support of Louisiana's medical schools. These funds have been utilized to support academic scholarships for worthy students and in addition to support tutorial services for students in need of academic support. Dr. Johnson accepted a contribution on behalf of the Alumni Foundation of LSU Medical School New Orleans. Contributions were also given to Tulane and LSU Shreveport Medical Schools. The Alliance has set an example for all who are dedicated to the health of Louisiana.

Management of retroperitoneal soft-tissue sarcoma.

Retroperitoneal soft-tissue sarcoma is a rare and unusual entity, comprising about 0.1% of all tumors. Optimal outcome depends on a thorough understanding of its clinical behavior. These tumors tend to be large and have extensive regional involvement by the time they present. Complete surgical extirpation, which may require en-bloc resection of multiple organs, is the treatment of choice for patients who are deemed to be surgical candidates. Chemoradiation has not been proven to extend survival, and treatment toxicities may limit their usefulness. Re-resection of localized recurrent disease may extend survival and therefore should be attempted, when possible. Close follow-up with serial computed tomographic scans is recommended in order to detect early recurrent disease and should continue beyond 10 years.

Outcomes of surgical therapy for biliary dyskinesia.

Patients with biliary dyskinesia have biliary colic, a normal gallbladder ultrasound, and a gallbladder ejection fraction typically less than 35%. We report a retrospective review of 70 patients with biliary dyskinesia who underwent cholecystectomy. Seventy-seven percent of the patients were women. Average age was 40. The most common symptoms were right upper quadrant pain, nausea, vomiting, and fatty food intolerance. All patients underwent a cholecystokinin-hepatobiliary scan or cholecystokinin-oral cholecystogram. Average ejection fractions were 20.2% and 28.4% respectively. Average post-operation follow-up was 10.9 months. Eighty-four percent of patients (59 of 70) reported improvement at follow-up. Eight patients had ejection fractions greater than 35%; seven of them reported improvement after cholecystectomy. Eleven patients did not improve after cholecystectomy; their average ejection fraction was 25%. These patients also had atypical symptoms (mid-epigastric pain and reflux symptoms). We believe cholecystectomy is effective therapy for biliary dyskinesia. Surgical outcomes could be improved by careful histories distinguishing biliary colic from other complaints. Less reliance should be placed on the ejection fraction when the patient has biliary colic without another etiology of abdominal pain.