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The diurnal change of gallbladder size was clearly measured with a real time ultrasonography. To visualize the gallbladder, 21 diabetic patients and 11 healthy subjects were scanned right subcostally in the supine position nine times between 8:00 a.m. and 8:00 p.m. Photographs of the images were produced on Polaroid film, and the area of gallbladder was calculated. The diurnal changes of the gallbladder size were expressed as the percentage of the size measured at 8:00 a.m. after an overnight fast. The gallbladder in normal control started contracting immediately after breakfast and reached 57.2 +/- 7.6% at 9:00 a.m. In the diabetic patients with and without autonomic neuropathy the gallbladder contracted to 80.9 +/- 14.5% and 72.4 +/- 14.8%, respectively, at 9:00 a.m. while the nadir of the diurnal profile curve in healthy subjects was 24.5 +/- 3.6% at 3:00 p.m., in the diabetic patients with and without autonomic neuropathy those were 57.7 +/- 6.1% at 6:00 p.m. and 41.3 +/- 8.3% at 8:00 p.m., respectively. This implies that the gallbladder contraction was delayed and poor in diabetic patients. In this paper, the gallbladder tonicity index is proposed, which is useful for the easy evaluation of autonomic state of gallbladder in diabetes mellitus.

Diurnal profile of gallbladder size in diabetic patients: Ultrasonographic evaluation of diabetic neurogenic gallbladder.