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The article by Hilbert et al.1 analyzed data from a large number of patients with myotonic dystrophy (DM) 1 and DM2 enrolled in a national disease registry and documented high frequency of gastrointestinal symptoms, particularly dysphagia, constipation, and gallbladder problems. The authors emphasized the need for reliable diagnostic tests to assess swallowing function that can influence disease prognosis of patients with DM,1 since self-reported data have limited sensitivity in their diagnostic management due to cognitive involvement.2,3

The purpose of this study was to determine whether offline reported three-dimensional ultrasound (3DUS) is as accurate as standard two-dimensional ultrasound (2DUS) with regard to demonstrating gallbladder disease.The cohort comprised 80 consecutive patients referred for an abdominal ultrasound examination. The participants underwent routine 2DUS assessment of the gallbladder followed by the acquisition of two 3DUS volumes of the region of the gall bladder. The two techniques were reported independently of each other, and the diagnoses were compared for correlation.There was overall agreement of the two techniques in 89% of cases with a positive predictive value of 89%, negative predictive value of 91% and a specificity of 86%. Small polyps (sub-4 mm) were the only positive discrepancies. Cohen's kappa found that there was substantial agreement between the two techniques (p = 0.05 for a two-tailed kappa 0.67), and chi-squared test found no significant difference in diagnoses (p = 0.95).This study shows that 3DUS diagnosis correlates well with 2DUS with regard to most gallbladder problems and could be sufficient as a stand-alone technique.

Liver and gallbladder diseases are two of the most common digestive system problems around the world [1]. In the United States, there are about 20.5 million people with gallbladder disease, with an estimated annual cost for medical care of more than 6.4 billion dollars [2]. Gallstones account for the majority of gallbladder problems. Women are affected two to three times as frequently as men [3]. Race, heredity, gender, age, and obesity are some of the important known risk factors for gallstones (Table 9.1.1). Between the ages 60 and 74, the prevalence of gallbladder disease is as high as 25.3% in men and 33.1%% in women (Table 9.1.2), and it is relatively more common among the Mexican Americans (Table 9.1.3). The highest rate among the Americans is found in the Pima Indians of Arizona [4]. By the teenage years, as many as 10–13% of Pima Indian girls develop lithogenic bile, and by 35–44 years, about 71% develop gallstones. Almost 90% of Pima Indian women over the age of 65 develop gallbladder disease, and the prevalence is much higher than in Pima Indian men.

Laparoscopic cholecystectomy has been advocated for the treatment of uncomplicated symptomatic gallstone disease, but has not been widely advocated for the management of more complicated gallbladder disease such as acute cholecystitis, previous surgery, or common duct stones. During the last 9 months, 360 patients underwent laparoscopic removal of their gallbladder. A total of 138 had a complicated presentation, making surgery more difficult. This article discusses the management of these patients with acute cholecystitis, previous surgery, or common duct disease. Using the described techniques, there were no complications or mortality. Laparoscopic management of difficult gallbladder problems is safe and effective.