Surgical outcome in patients with biliary colic and atypical workup findings.

BACKGROUND: Surgical response of patients with symptomatic biliary colic but atypical findings of gallbladder polyps, hyper-dynamic gallbladder and otherwise negative biliary workup are underrepresented in the literature from community practice. METHODS: A clinical outcome study with a retrospective design compared the short term and long term symptomatic improvement reported by patients with pre-operatively diagnosed biliary dyskinesia to all other biliary colic patients with atypical pre-operative diagnoses. All patients underwent surgery at Meridian Surgery Center from the years 2010-2017.600 patients were reviewed for biliary dyskinesia, gallbladder polyps, hyper-dynamic gallbladder and negative workup. RESULTS: Short term and long term results were compiled from a total 182 patients. Short term response rates were assessed from 74 biliary dyskinesia, 40 hyperdynamic, 23 gallbladder polyps, and 45 negative workup patients. Long term responses were received from 19 biliary dyskinesia patients, 11 hyperdynamic patients, 9 polyp patients, and 7 negative workup patients. Long term improvement among biliary dyskinesia patients was 84%, and 83% among patients with atypical findings, representing a long term drop in symptoms. There is no significant difference between symptom recovery of patients with biliary dyskinesia and those with another atypical diagnosis: hyper-dynamic (82%), polyps (89%), negative workup (57%). CONCLUSION: These results allow us to conclude that there is a comparable biliary colic improvement between biliary dyskinesia, gallbladder polyps, hyper-dynamic gallbladder and negative workup patients after cholecystectomy in both short term and long term follow up.

Metabolic aspects of the development of experimental cardiac hypertrophy.

In three models of cardiac hypertrophy the significance of catecholamines and the adenylate cyclase-cyclic AMP-system was examined. Two approaches were utilized: 1. The time course of cyclic AMP alterations was correlated with the changes in adenine nucleotide and protein biosynthesis. 2. The effect of beta-receptor blockade on the obligatory increase in adenine nucleotide and protein synthesis was evaluated. In isoproterenol-elicited cardiac hypertrophy, the elevation of the cyclic AMP content was one of the earliest metabolic alterations preceding the enhancement of the biosynthesis of adenine nucleotides and proteins. beta-Receptor blockade with propranolol abolished the increase in adenine nucleotide synthesis. In pressure-induced cardiac hypertrophy due to constriction of the abdominal aorta, catecholamines and the adenylate cyclase-cyclic AMP-system were found not to play a significant role. In triiodothyronine-elicited hypertrophy, the cyclic AMP level was increased very early, but beta-receptor blockade did not prevent hypertrophy nor the enhancement of cardiac adenine nucleotide biosynthesis, although the positive chronotropic and inotropic effects of triiodothyronine were abolished. This result can best be interpreted to indicate a direct effect of triiodothyronine on myocardial carbohydrate metabolism including the pentose phosphate pathway.