Articles: colic.
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The veterinary journal · Sep 2013
Validation of two behaviour-based pain scales for horses with acute colic.
Two behaviour-based scales for evaluating abdominal pain in horses (Equine Acute Abdominal Pain Scales, EAAPS-1 and -2) and a numerical rating scale (NRS) were compared for reliability and validity. Forty-one equine veterinarians randomly assigned into three groups were each presented a different set of 28 moving picture films randomly chosen among 36 films of horses with colic and four controls. One randomly chosen film was embedded twice within each set. ⋯ Both EAAPS scales discriminated well between extreme groups (areas under the receiver operating characteristic curve, ROC, area under the curve, AUC, >0.9) to differentiate severe from mild pain, as judged by the NRS. Both EAAPS scales showed predictive validity comparable to NRS (AUCs for dichotomous treatment modality (none and medically treated vs. surgically treated or euthanased) and with mortality (dead vs. alive) between 0.6 and 0.7 for all three scales. EAAPS-1 was the most reliable of the three scales and both EAAPS scales demonstrated validity comparable to the NRS scale.
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Case Reports
Dynamic changes of common bile duct diameter during an episode of biliary colic, documented by ultrasonography.
Common bile duct stones frequently accompany gallstones and can be identified by a variety of imaging modalities. Little is known about the time course of dilatation of the common bile duct after acute obstruction or of normalization after spontaneous passage of an obstructing stone. We describe a case showing rapid fluctuations in common bile duct diameter during 72 hours in a patient presenting with epigastric pain and vomiting. ⋯ The patient was admitted, and during the course of hospitalization different imaging modalities reported fluctuations in common bile duct measurements, ranging from 4 mm on computed tomography to 14 mm on endoscopic retrograde cholangiopancreatography. This case demonstrates disappearance of an obstructing stone with normalization of a highly distended common bile duct during 5 hours, highlighting that gallstone disease may be highly dynamic, with the possibility of rapid changes of common bile duct diameter. Emergency physicians, who frequently depend on ultrasonography to diagnose biliary disease, should be wary of the potential for rapid changes of sonographic findings in these patients.
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Cochrane Db Syst Rev · Jun 2013
ReviewEarly versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic.
Uncomplicated biliary colic is one of the commonest indications for laparoscopic cholecystectomy. Laparoscopic cholecystectomy involves several months of waiting if performed electively. However, people can develop life-threatening complications during this waiting period. ⋯ Based on evidence from only one high-bias risk trial, it appears that early laparoscopic cholecystectomy (less than 24 hours after diagnosis of biliary colic) decreases the morbidity during the waiting period for elective laparoscopic cholecystectomy (mean waiting time 4.2 months), the hospital stay, and operating time. Further randomised clinical trials are necessary to confirm or refute these findings, and to determine if early laparoscopic cholecystectomy is better than the delayed laparoscopic cholecystectomy if the waiting time is shortened further.
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Multicenter Study
Association between childhood migraine and history of infantile colic.
Infantile colic is a common cause of inconsolable crying during the first months of life and has been thought to be a pain syndrome. Migraine is a common cause of headache pain in childhood. Whether there is an association between these 2 types of pain in unknown. ⋯ The presence of migraine in children and adolescents aged 6 to 18 years was associated with a history of infantile colic. Additional longitudinal studies are required.