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Biomedical subjects

J E Dill

Publications and source records attributed to J E Dill.

At least 19 recordsLinked to original sources
PubMed1999

Biliary sludge.

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Animals↗
PubMed1998

Endosonography/bile drainage combination for difficult-to-diagnose gallbladder disease.

The diagnosis of cholecystitis and cholelithiasis is often straightforward, particularly when transabdominal ultrasound (TUS) reveals gallstones or other abnormalities of the gallbladder. There remain many patients, however, with typical biliary pain and normal findings on TUS. This latter group of patients, in which women constitute a large majority, often undergo considerable suffering. Their medical care can also be quite costly. Cholecystokinin cholescintigraphy and stimulated biliary drainage (SBD) have been proposed for difficult-to-diagnose gallbladder disease, but they both have limitations. Cholecystokinin cholescintigraphy may not predict postoperative outcomes with a high degree of reliability. The processing and interpretation of bile drainage specimens is not standardized, and the sensitivity of SBD is less than that of endoscopic ultrasound (EUS). Combined endoscopic ultrasound and stimulated biliary drainage (EUS/SBD) offers a high degree of sensitivity in the diagnosis of cholecystitis and microlithiasis. Positive EUS/SBD is also highly correlated with long-term symptom resolution or relief following cholecystectomy.

Bile↗
PubMed1998

Integrated diagnostic and treatment approach for the medical patient who has had psychologic trauma.

BACKGROUND: Physicians often treat patients with physical illnesses that have a functional component. Investigators have discovered that many of these patients have unresolved emotional problems associated with histories of trauma and abuse. METHODS: Abused and traumatized patients with medical complaints often seek medical help. Empathic nonpsychiatrist physicians play an important role in the care of these patients. The physician's efforts can be augmented by a trained RN to provide supportive stress training and nutrition education and by a mental health professional to provide psychotherapy when needed. RESULTS: In the case presented, the patient had symptomatic improvement when her physician empathically provided medical treatment, involved the staff and a trained RN in the healing effort, and made an appropriate referral to a mental health professional. CONCLUSION: This unified diagnostic and treatment approach for traumatized patients with medical problems can be rewarding, efficacious, and cost effective.

Adult↗
PubMed1997

Symptom resolution or relief after cholecystectomy correlates strongly with positive combined endoscopic ultrasound and stimulated biliary drainage.

BACKGROUND AND STUDY AIMS: Combined endoscopic ultrasound and stimulated biliary drainage (EUS/SBD) has been shown to have better sensitivity than transabdominal ultrasonography (TUS) in the diagnosis of subtle gallbladder disease. The aim of the present study was to obtain long-term postoperative outcome data on a group of patients diagnosed by EUS/SBD. PATIENTS AND METHODS: Eighty-one patients underwent cholecystectomy for biliary pain after negative TUS findings (except for gallbladder sludge in three cases), but with positive EUS/SBD findings. EUS/SBD was performed as previously reported, with a positive result defined as gallbladder sludge or small stones noted on EUS or a positive biliary drainage. Clinical outcome data were obtained by phone an average of 15.4 months postoperatively. RESULTS: All 81 patients had a positive EUS/SBD, and all underwent cholecystectomy. Seventy-six of the patients (93.8%) had abnormal gallbladder histopathology. It was possible to contact 80 patients an average of 15.4 months postoperatively (range of 7-27 months). Seventy patients (87.5%) remained free of biliary pain, and in seven (8.8%) the symptoms had improved. CONCLUSION: When EUS/SBD results are positive, this correlates strongly with long-term symptom resolution or relief (96.3%) after cholecystectomy. EUS/SBD demonstrated better sensitivity (93.8%) than TUS in diagnosing subtle gallbladder disease.

Adolescent↗
PubMed1996

Diagnosis and treatment of right upper quadrant abdominal pain.

A protocol, or algorithm, is presented for the diagnosis and treatment of right upper quadrant abdominal pain. This protocol incorporates modern technology such as endoscopic ultrasound and Sphincter of Oddi manometry in a clinically appropriate and cost effective manner.

Abdominal Pain↗
PubMed1995

Combined endoscopic ultrasound and stimulated biliary drainage in cholecystitis and microlithiasis--diagnoses and outcomes.

BACKGROUND AND STUDY AIMS: It is becoming increasingly evident from a number of studies that endoscopic ultrasound (EUS) is much more sensitive in the diagnosis of cholecystitis than transabdominal ultrasound (TUS). The present study was undertaken to further evaluate this relative sensitivity. PATIENTS AND METHODS: Sixty-six patients with biliary-type pain and a negative transabdominal ultrasound examination underwent combined endoscopic ultrasound and stimulated biliary drainage (EUS/SBD). Stimulated biliary drainage was obtained following intraduodenal infusion of magnesium sulfate or intravenous sincalide, a CCK analogue. EUS was considered positive if sludge or small stones were seen in the gallbladder. Stimulated biliary drainage was considered positive if calcium bilirubinate granules or cholesterol crystals were seen on microscopic examination of aspirated bile. RESULTS: At operation, 61 of the patients had cholecystitis documented histologically. Fifty-eight of the patients had gallbladder sludge or small stones on EUS. One patient had a negative EUS, but had calcium bilirubinate granules in the bile. Twenty-one patients were followed post-operatively for a period of seven to 17 months, with an average of 10.5 months. Nineteen patients (90.5%) remain free of biliary pain. CONCLUSIONS: Combined endoscopic ultrasound and stimulated biliary drainage (EUS/SBD) had a high sensitivity of 92.4% and a positive predictive value of 100% in the diagnosis of cholecystitis when transabdominal ultrasound was negative. A significant majority (90.5%) of patients with positive EUS/SBD who underwent cholecystectomy had resolution of their biliary pain.

Cathartics↗