The ultrasound findings in 5 cases of primary carcinoma of the gallbladder are described. A mass protruding into or replacing the gallbladder or abnormal gallbladder wall were found in all cases. Four of the patients had gallstones and a dilated biliary tree. With careful technique in evaluation of the gallbladder wall in patients with gallstones early carcinoma of the gallbladder may be detected with greater frequency.

Objectives This study was undertaken to assess the usefulness of senior emergency medicine specialists' review of all 'did not wait' (DNW) patients' triage notes and the recall of at-risk patients. Methods A prospective study of all DNW patients was performed from 1 January to 31 December 2008. Following a daily review of charts of those who failed to wait to be seen, those patients considered to be at risk of adverse outcome were contacted by the liaison team and advised to return. Data were gathered on all DNW patients on the Oracle database and interrogated using the Diver solution.Results 2872 (6.3%) of 45 959 patients did not wait to be seen. 107 (3.7%) were recalled on the basis of senior emergency medicine doctor review of the patients' triage notes. Variables found to be associated with increased likelihood of being recalled included triage category (p<0.001), male sex (p<0.004) and certain clinical presentations. The presenting complaints associated with being recalled were chest pain (p<0.001) and alcohol/drug overdose (p¼0.001). 9.4% of DNW patients required admission following recall. Conclusion The systematic senior doctor review of triage notes led to 3.7% of patients who failed to wait being recalled. 9.4% of those recalled required acute admission. The daily review of DNW patients' triage notes and the recalling of at-risk patients is a valuable addition to our risk management strategy.Did not wait (DNW) patients represent an important subset of the emergency department (ED) population because of their high rates of representation and the potential for adverse outcomes. 1e7 The main reason for patients not waiting for medical assessment is prolonged waiting times. 1 2 5 8 Internationally DNW rates vary considerable from 0.1% to 15%. 2 7 9e12 In a previous study conducted by this group over a 14-week period the DNW rate in the research department was 7.47%.Previous international studies have focused on characterising the varying factors associated with DNW patients. These descriptive studies have found that younger male patients, arriving at weekends and at night with lower acuity problems, are more likely to leave without seeing a doctor. 11e14 A number of researchers have focused on the outcome of DNW patients through phonebased follow-up and mailing after time periods ranging from 24 h to 4 weeks. 3 5 7 12 15e17 While the rates of reported adverse events are low, a large proportion of patients are unaccounted for due to poor response rates and consequently accurate outcomes are unknown. A very limited number of studies have suggested an intervention to address this potentially worrying group of patients. 18e20 On a background of a high DNW rate it was decided to implement a risk assessment and management intervention strategy with the aim of reducing the potential for adverse outcomes. This research was performed to assess the usefulness of the strategy. METHODSA prospective study of all ED DNW patients was performed over a 1-year period between January and December 2008. It took place in a teac...