RESUMO
BACKGROUND: Acute calculous cholecystitis (ACC) is the most frequent complication of gallstones requiring cholecystectomy. These patients may have coexisting choledocholithiasis. We aimed to evaluate the role of current guidelines for choledocholithiasis in patients with ACC. METHODS: In this retrospective study, we included all patients diagnosed with ACC between December 2018 and May 2019. These patients were substratified according to the guidelines of the American and European Societies of Gastrointestinal Endoscopy (ASGE and ESGE) as having high, intermediate, or low likelihood of choledocholithiasis, and the diagnostic performance was measured. Binomial logistic regression analysis was applied to ascertain independent risk factors for choledocholithiasis. RESULTS: A total of 173 patients with ACC, mean age (±standard deviation) 49.89±15.74 years and 60.1% male, were included. Sixty-three (36.4%) had confirmed choledocholithiasis. ASGE high likelihood criteria had sensitivity and specificity of 61.9% (95% confidence interval [CI] 48.8-73.9) and 83.4% (95%CI 75.4-90.0) for predicting choledocholithiasis. ESGE high likelihood criteria had sensitivity and specificity of 49.2% (95%CI 36.4-62.1) and 87.3% (95%CI 79.6-92.9). On logistic regression analysis, an alkaline phosphatase level above the upper limit of normal (P=0.003; odds ratio [OR] 4.26, 95%CI 1.66-10.96) and a dilated common bile duct on ultrasound (P=0.001; OR 9.97, 95%CI 4.65-21.36) were independent positive predictors for choledocholithiasis, while acute biliary pancreatitis was an independent negative predictor (P=0.030; OR 0.36, 95%CI 0.14-0.91). CONCLUSIONS: The performance of the ASGE and ESGE guidelines' risk stratification criteria is inadequate in patients with ACC. We suggest the utilization of a separate predictive model for suspected choledocholithiasis in these patients.
RESUMO
BACKGROUND: Cardiac involvement in children with Kawasaki disease (KD) may present with repolarization abnormalities which are associated with increased risk of ventricular arrhythmias and sudden cardiac events. METHODS: Twenty children with history of KD without cardiac involvement in the acute phase were recruited along with age and sex-matched controls. Twelve-lead ECG was obtained from both groups using CARDIART 610T ECG system at 25 mm/sec and 50 mm/sec paper speed. ECG was repeated in 19 children in the study group after 9 ± 2 months. Measurements (QT dispersion (QTd), T-wave peak to end (Tp-Te) interval, and Tp-Te/QT ratio) were made using standard digital calipers. Statistical analysis was performed with student t-test and analysis of variance (ANOVA) using SSPS version 17.0. RESULTS: The mean value of QTd in the first ECG in cases was significantly high: 43.15 ± 14.13 versus 29.47 ± 8.637 in the controls (p = 0.001). The follow-up ECG in 19 cases showed a mean value of 46.26 ± 16.25 versus 43.89 + -14.53 at baseline (p = 0.440). QTd was increased in the follow-up ECG but was not statistically significant. There was no statistical significance seen in the Tp-Te interval and Tp-Te/Qt ratio as observed in Lead II and Lead V5. CONCLUSION: Significant increase in the QTd in children with KD indicates repolarization changes in the myocardium even in the absence of clinical carditis. The persistence of this change on follow-up could indicate a possible increased risk for ventricular arrhythmia and warrants long term assessment of the cardiovascular status.
