Thesis (M. P. H.)--University of Hong Kong, 2007. / Also available in print.

A Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the Degree of Masters of Medicine in the branch of General Surgery, Johannesburg 2018 / Gallbladder cancer (GBCa) has a dismal prognosis, with poor short-term and long-term outcomes, even following surgery and all current adjuvant therapies. Routine submission of all postcholecystectomy gallbladder specimens (GBS) for histopathology to detect cancer is standard practice at all University of the Witwatersrand (Wits) hospitals, as at many institutions globally. The cost-ineffectiveness associated with the results adding no value to overall patient care is debated. The low reported rate of GBCa – between 0.27% and 3.6% of all GBS –prompted advocacy for selective GBS submission based on demographic, clinical, and macroscopic features as indications for evaluation, considered logical from a practical and cost-effective perspective, especially in resource-constrained healthcare systems. Retrospective analysis of histopathology reports of 1194 adult GBS was performed. The histopathology findings of GBS submitted to the National Health Laboratory Service (NHLS) between January 1, 2010 and December 31, 2012 from three Wits hospitals were entered into spreadsheets, categorised into malignant, premalignant, and benign, and analysed, allowing determination of the profile of gallbladder disease. The frequency of GBCa determined, multivariate analysis of demographic and diagnostic subtypes was used to identify associations or risk factors for GBCa. The mean age of adult patients was 46.62 years (standard deviation, 17.81; range, 34-87); 925 (77.5%) female and 269 (22.5%) male. Benign diseases were documented in 1159 (97.1%) adult GBS with acute and chronic cholecystitis, in 705 (59.04%) and 401 (33.58%) specimens, respectively, representing 92.6% of total GBS. Forty-five (4.43%) and 33 (2.7%) specimens were ‘normal’ and benign tumours, respectively. GBCa and premalignant diseases composed 20 (1.67%) and 8 (0.7%) specimens, respectively with incidental GBCa found in 7 (0.59%) of 20 GBCa cases. Surgeon’s macroscopic appearance assessments were inadequately documented, so the value of this practice could not be determined. A small number (48) of GBS were obtained from paediatric patients <18 years of age where-in acute cholecystitis was most commonly diagnosed, no malignancies but one case of cytological atypia detected. The GBS disease profile and incidence of GBCa in this study were consistent with reports from international literature. No single demographic or clinical factor was identified to guide the surgeon in being more selective in submitting GBS. However, with only 7 cases of incidental GBCa in 1194 adult specimens, the routine submission of all GBS specimens to rule out malignancy cannot be justified and is not cost-effective. / XL2018

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Masters Abstracts International, Volume: 46-01, page: 0315. Adviser: Irwin Horwitz. Includes bibliographical references.

Thesis (M.S.)--University of Adelaide, Dept. of Surgery, 1999? / Bibliography: leaves 143-165.

Background: The most common investigations used in the pre-operative diagnosis of choledocholithiasis are ultrasound and liver function tests (LFTs). These modalities have a low sensitivity for detecting common bile duct stones amongst the intermediate-risk groups. Aim: Identify pre-operative findings which predict choledocholithiasis in intermediate-risk groups. Describe the implications of a positive intra-operative cholangiogram (IOC). Method: A retrospective study of all consecutive laparoscopic cholecystectomies with IOC performed. Data were collected over two years between 1st January 2015 and 31st December 2016. Standard demographic variables, preoperative symptoms, LFTs, IOC findings, abdomen ultrasound, and postoperative symptoms were included. Results: 23 cases were planned for IOC. The median age was 41 years. Seventeen cases were females. Indications were 12 biliary colic, eight gallstone pancreatitis, two cases of acute cholecystitis, and one case was for ascending cholangitis. Four cases had a positive IOC, and in this group, the median age was 44.5 years with one male. The mean common bile duct diameter was 6.5 mm. Two patients had biliary colic, one patient gallstone pancreatitis and one acute cholecystitis. One patient had a history of jaundice, and all four cases had elevated GGT above 40 mmol/l, three cases had ALP above 98 mmol/l. Post-operative, out of 23 cases, five cases had an ERCP, repeated ultrasound in three cases, persistence symptoms in four cases. Conclusions: GGT was the strongest predictor of choledocholithiasis. A normal GGT seems to be quite good at ruling out CBD stones. ALP was less accurate. Gallstone pancreatitis is not a good predictor, but it is importance to exclude choledocholithiasis before/during cholecystectomy. There is no relation between the IOC and persistent symptoms.

Thesis (M.S.)--Ball State University, 2009. / Title from PDF t.p. (viewed on Mar. 25, 2010). "November 18, 2008." Research paper (M.S.), 3 hrs. Includes bibliographical references (p. 111-114).

Lic.-avh. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 2 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Objectives: Study wanted to explore the factors that will affect the total medical expense in the patients who receive laparoscopic cholecystectomy (LC). We also to confer the influencing factor that will associate with the difference of reports the expense under the case payment system. Methods:Retrospective study . Collected from year 2003 to 2007, received LC in a general teaching hospital in Kaohsiung city. We also adopt the chart review and combined with the health insurance expense data to explore the important factors that were associated with total hospitalized expenses, declaration of expense differences, and profits. The methods of multiple linear and logistic regressions were needed. Results: 1539 subjects, 613 male and 926 female. The average age was 54.4 , and 1313 subjects were hospitalized from outpatient. All subject¡¦s average hospitalized days were 3.79 and medical expenses were 42528.1 dollars. The frequencies of the type of declaration about ¡¥not exceed¡¦, ¡¥exceed but actually¡¦, and ¡¥exceed but no actually¡¦ were 88.8%, 8.6%, and 2.6%, in sequence. The average declaration of expense differences was 14484.1 dollars. The significant factors that were associated with total hospitalized expenses were the age, surgical year, source of hospitalize, major symptom, combine disease, a complication after surgery, hospitalized days, type of declaration. In the other linear regression model, we found the age, surgery year, source of hospitalize, major symptom, high technology examination before surgery, combine disease, a complication after surgery, hospitalized days, and physician¡¦s surgery quantity per year had been statistically significant with the declaration of expense differences. For the odds of hospital¡¦s profits, the significant factors include the surgery year, source of hospitalize, major symptom, high technology examination before surgery, and hospitalized days. Conclusion: We found a few significant factors that were associated with dependent variable in three regression models in this study. The major factor is hospitalized days that were a stronger influence total hospitalized expenses, declaration of expense differences, and hospital¡¦s profits. The hospital¡¦s superintendent can carry on the management through the appropriate method to control the medical resource consumes.