The best management for 'crescendo biliary colic' is urgent laparoscopic cholecystectomy.
Gallbladder disease due to stones is well recognised as falling into two categories, presenting with either chronic symptoms or developing acute cholecystitis or other complications. We describe an intermediate group of 14 patients (11 women, three men, median age 31 years) presenting with 4-14 days of at least daily attacks of resolving biliary colic, who underwent early laparoscopic cholecystectomy within 24 hours of presentation. None had any evidence of acute inflammation, either at laparoscopy or on histology. Their surgery was straightforward with operating times ranging from 35-80 minutes and no complications. Patients with 'crescendo biliary colic' are often young women who can rarely afford invalidity. Rather than the current practice of analgesia for each attack and elective surgery weeks later, they are optimally managed by urgent laparoscopic cholecystectomy, preventing the development of complications and minimising the need for further medical involvement. (+info)
What is distinct about infants' "colic" cries?
AIMS: To investigate (1) whether colic cries are acoustically distinct from pre-feed "hunger" cries; (2) the role of the acoustic properties of these cries versus their other properties in accounting for parents' concerns about colic. DESIGN: From a community sample, infants were selected who met Wessel colic criteria for amounts of crying and whose mothers identified colic bouts. Using acoustic analyses, the most intense segments of nine colic bouts were compared with matched segments from pre-feed cries presumed to reflect hunger. RESULTS: The colic cries did not have a higher pitch or proportion of dysphonation than the pre-feed cries. They did contain more frequent shorter utterances, but these resembled normal cries investigated in other studies. There is no evidence that colic cries have distinct acoustic features that are reproducible across samples and studies, which identify a discrete clinical condition, and which are identified accurately by parents. CONCLUSIONS: The most reliable finding is that colic cries convey diffuse acoustic and audible information that a baby is highly aroused or distressed. Non-acoustic features, including the prolonged, hard to soothe, and unexplained nature of the cries may be specific to colic cries and more important for parents. These properties might reflect temperament-like dispositions. (+info)
Jejunoileal incarceration and strangulation through a splenic defect in a mare.
A 6-year-old, standardbred mare was presented for colic of 12 h duration. Transrectal palpation revealed intestinal distension of unknown cause. The mare was euthanized. At necropsy, segmental jejunoileal incarceration and strangulation through an opening in the spleen was observed. This opening was considered to be a congenital defect. (+info)
Intestinal adenocarcinoma causing recurrent colic in the horse.
An 8-year-old, Thoroughbred-cross mare presented with recurrent colic. Exploratory laparotomy revealed a large mass near the right dorsal colon; white, raised foci on the liver; and enlarged mesenteric lymph nodes. Cytological examination of biopsies revealed neoplastic cells. The diagnosis of adenocarcinoma was confirmed by histological examination. (+info)
How do we compare with our colleagues? Quality of general practitioner performance in consultations for non-acute abdominal complaints.
OBJECTIVE: To investigate what factors influence the quality of general practitioner performance in consultations for non-acute abdominal complaints and to establish the extent to which performance quality differs between general practitioners (GPs). DESIGN: Explorative study in two parts: (i) detection of variables influencing quality scores of consultations; and (ii) comparison of mean quality scores of the consultations, selected by each GP. SETTING: Sixty-two family practices across The Netherlands. SUBJECTS: Eight-hundred and forty consultations concerning non-acute abdominal complaints, first encounters; 62 GPs. METHOD: Multilevel analysis was carried out to detect factors that influence quality. After correction for the effect of significant factors the mean quality scores of individual GPs were calculated and compared. RESULTS: Eighty-eight per cent of the total variance in quality scores was located at the consultation/patient level, and 12% at the GP level. One consultation characteristic had significant influence on quality: quality scores were higher in consultations of longer than average duration (>15 minutes). Several patient characteristics were of significant influence. Consultation quality scores were higher in consultations for patients with upper abdominal or non-specific abdominal complaints. Quality scores were lower in consultations with female patients and with patients aged >40 years. Together these characteristics explained 20% of the variance at the GP level. None of the GP characteristics investigated in this study appeared to have significant influence on the quality of their performance. After correction of the scores for the effect of significant factors the differences in performance quality between GPs remained significant. CONCLUSIONS: Quality of performance is far more influenced by consultation and patient characteristics than by GP characteristics. After correction for influencing factors, the mean quality scores of GPs still differed considerably and significantly. For many GPs the quality scores varied substantially between different consultations; to a large extent this variation remained unexplained. Consultation quality can be improved by booking more time per patient and by giving more medical/technical attention to female and older patients. (+info)
Tansy ragwort poisoning in a horse in southern Ontario.
Bizarre behavior, apparent lameness, and colic were noticed in 1 of 3 horses on a pasture overgrown by weeds during a drought. Liver failure and hepatoencephalopathy were diagnosed, caused by pyrrolizidine alkaloid toxicosis associated with consumption of tansy ragwort. The horse made a full recovery when removed from the pasture. (+info)
Tyzzer's disease in an 11-day-old foal.
An 11-day-old pony became depressed, anorectic, and pyrexic 2 days after the topsoil of its paddock had been turned over. Rapid progression to colic and head pressing occurred, despite intensive therapy for Tyzzer's disease, and the foal died within 7 h of the appearance of central nervous system signs. (+info)
Fetal growth and infantile colic.
AIM: To describe how fetal growth and gestational age affect infantile colic, while considering other potential risk factors. STUDY DESIGN: A population based follow up study of 2035 healthy singleton infants without any disability born to Danish mothers. Information was collected by self administered questionnaires at 16 and 30 weeks of gestation, at delivery, and 8 months post partum. Infantile colic is defined according to Wessel's criteria, but symptoms are restricted to crying for more than three hours a day, for more than three days a week, and for more than three weeks. RESULTS: The cumulated incidence of infantile colic was 10.9%. Low birth weight babies (< 2500 g) had more than twice the risk (odds ratio = 2.7, 95% confidence interval 1.2 to 6.1) of infantile colic when controlled for gestational age, maternal height, and smoking. CONCLUSION: Low birth weight may be associated with infantile colic, and further research will be aimed to focus on fetal growth and infantile colic. (+info)