ABSTRACT
An estimated 20 million Americans have gallstones the majority asymptomatic. Yet traditionally many are often placed on low-fat or fat-free diets, presumably to reduce the risk of biliary colic. To assess the gallbladder dynamics in response to various meals, we studied 15 subjects (ages 21-54), each on 4 separate days. After an overnight fast, each subject was given, at random, either a breakfast containing greater than 30 g fat, less than 15 g fat, totally free of fat, or an infusion of C-terminal octapeptide of cholecystokinin. Gallbladder ejections at regular time intervals were measured using real time ultrasonography and the sum of cylinders technic corrected for the gallbladder shape. Considerable variability in the gallbladder dynamics and time response was noted with all the stimuli. However, among various meals, there were no statistically significant differences in the mean maximum ejection fraction or the mean maximum ejection time (p greater than 0.10). The mean maximum ejection fraction after cholecystokinin was somewhat greater (0.01 less than p less than 0.05) than that after meals, but the mean maximum ejection time was similar (p greater than 0.10). We conclude that the gallbladder dynamics in response to various meals are independent of a meal's fat content. Since the passage of gallstones into the cystic or common duct (biliary colic) is a random event unrelated to the type of food, fat-restricted diets offer no significant therapeutic advantage in the management of the large population with asymptomatic gallstones.
Subject(s)
Cholelithiasis/diet therapy , Dietary Fats/administration & dosage , Food , Gallbladder/physiology , Adult , Cholecystokinin/administration & dosage , Female , Humans , Male , Middle Aged , Time FactorsABSTRACT
Sonography is used infrequently for diagnosing acute pelvic inflammatory disease because the physical examination is highly sensitive, because the sonogram lacks specificity, and because the patient is often scheduled for surgery or laparoscopy or treated medically based on clinical findings, obviating the need for diagnostic studies. Sonography is usually reserved for identifying, localizing, and following pelvic abscesses complicating pelvic inflammatory disease. The sonogram is valuable in identifying the location of intrauterine devices because of the increased incidence of inflammatory pelvic disease in these patients. Postoperative and posttraumatic abscesses and abscesses of gastrointestinal origin may require the concomitant use of computed tomography and radionuclide studies, with ultrasonography performing a complementary function. The ultrasound examination may be valuable both in improving diagnostic confidence and providing guidance for aspiration. Because of the limited spectrum of appearances of numerous pelvic diseases, the most accurate diagnoses are obtained when the sonogram is interpreted in light of the detailed clinical information.
Subject(s)
Pelvic Inflammatory Disease/diagnosis , Ultrasonography , Abscess/diagnosis , Abscess/etiology , Adolescent , Adult , Bacterial Infections/diagnosis , Bacterial Infections/etiology , Diagnosis, Differential , Female , Humans , Immunosuppressive Agents/adverse effects , Intrauterine Devices/adverse effects , Kidney Transplantation , Middle Aged , Pelvic Inflammatory Disease/etiology , Pregnancy , Recurrence , Sexually Transmitted Diseases/complications , Sexually Transmitted Diseases/diagnosis , Tissue Adhesions/diagnosis , Tuberculosis, Female Genital/diagnosis , Uterine Diseases/diagnosis , Uterine Diseases/etiologySubject(s)
Kidney Neoplasms/diagnosis , Ultrasonography , Aged , Humans , Male , Posture , UrographyABSTRACT
A retrospective analysis of 251 proven cases of gynecologic masses was undertaken. Accuracy of gray scale sonography in determining the existence, size, location, and consistency of pelvic masses was approximately 91%. This is slightly higher than previously reported and could reflect increased accuracy of gray scale ultrasonography. Errors were primarily due to misinterpretation of loops of bowel, small lesions (2 cm or less in diameter), or poor technique. Since ultrasonograms are nonspecific, only rarely could a specific histologic diagnosis be made without accurate clinical information.
Subject(s)
Genital Diseases, Female/diagnosis , Pelvis , Ultrasonography , Diagnostic Errors , Female , Genital Neoplasms, Female/diagnosis , Humans , Pregnancy , Retrospective StudiesABSTRACT
Fetal biparietal diameter measurements were obtained simultaneously by gray scale and bistable ultrasonography. The bistable presentation was measured from leading edge to leading edge, while the gray scale presentation was measured from leading point to leading point and middle to middle of the band of echoes defining the fetal head. Statistical analysis of 50 patients demonstrated good reproducibility of the biparietal diameter measurement by each method and intraobserver variation fell well within the acceptable range. In all but one patient differences in measurements between observers and measurement methods were trivial and of no clinical significance. In the patients in whom there was a statistically significant difference, the variability was from 1 to 2 mm with the exception of one patient in whom the variability was about 4 mm.
