Preoperative symptom duration predicts success in relieving abdominal pain caused by biliary dyskinesia in a pediatric population.

PURPOSE: The objective of this study was to identify factors associated with symptom relief in pediatric patients treated with laparoscopic cholecystectomy (LC) for biliary dyskinesia (BD). METHODS: This was a case-control study of pediatric patients diagnosed with BD between January 2004 and June 2011. Controls were patients with symptom resolution and cases were patients who did not experience symptom relief. RESULTS: Fifty patients met study eligibility, of whom 43 were controls and 7 were cases. Mean follow-up for the cohort was 26.5months. Unadjusted comparisons suggested no significant differences (p>0.05) between the two groups in the distribution of demographic and clinical variables with the exception of preoperative duration of symptoms and presence of comorbidity. After adjusting for comorbidities, the only significant predictor associated with the resolution of symptoms after surgery was preoperative duration of symptoms (OR, 0.37; 95% CI, 0.15-0.94); 96% of patients with symptoms<12months had symptom relief versus 70% with symptoms≥12months. CONCLUSION: Symptoms associated with BD can be successfully relieved with LC. These data suggest patients with preoperative symptoms for less than 12months are the most likely to have symptom relief after surgery.

Non-enzymatic hydrolysis of creatine ethyl ester.

The rate of the non-enzymatic hydrolysis of creatine ethyl ester (CEE) was studied at 37 degrees C over the pH range of 1.6-7.0 using (1)H NMR. The ester can be present in solution in three forms: the unprotonated form (CEE), the monoprotonated form (HCEE(+)), and the diprotonated form (H(2)CEE(2+)). The values of pK(a1) and pK(a2) of H(2)CEE(2+) were found to be 2.30 and 5.25, respectively. The rate law is found to be Rate=-dCCEE/dt=k++[H2CEE2+][OH-]+k+[HCEE+][OH-]+k0[CEE][OH-] where the rate constants k(++), k(+), and k(0) are (3.9+/-0.2)x10(6)L mol(-1)s(-1), (3.3+/-0.5)x10(4)L mol(-1)s(-1), and (4.9+/-0.3)x10(4)L mol(-1)s(-1), respectively. Calculations performed at the density functional theory level support the hypothesis that the similarity in the values of k(+) and k(0) results from intramolecular hydrogen bonding that plays a crucial role. This study indicates that the half-life of CEE in blood is on the order of one minute, suggesting that CEE may hydrolyze too quickly to reach muscle cells in its ester form.