Comparing the efficacy of preoperative magnetic resonance cholangiopancreatography with intra-operative cholangiography in patients suspicious to biliary stones

This study was performed to compare the efficacy of preoperative magnetic resonance cholangiopancreatography [MRCP] and intra-operative cholangiography [IOC] methods in patients suspicious to gall stones. According to previous studies, it is recommended that common bile duct investigation should be done in order to rule out choledocholithiasis in all patients with symptomatic cholelithiasis. IOC is an invasive procedure with probable complications, it would seem that MRCP could replace the direct cholangiography. In a diagnostic clinical trial, Fifty-nine patients with symptomatic biliary stones or cholecystitis were recruited in this study. The included patients had normal size biliary ducts in sonography but high serum alkaline phosphatase level. Preoperative MRCP and IOC were performed for the patients and the obtained results were analyzed and compared. The positive predictive value for IOC was 88% and for MRCP was 43%. The diagnostic accuracy of IOC and MRCP were 98% and 85% respectively, suggesting that IOC is much more diagnostically accurate. There were no significant difference in specificity and sensitivity of these two methods. According to the results, we can conclude that MRCP may not obviate the need for IOC. The suggestion for routine use of MRCP instead of IOC and as a substitution of that procedure needs further investigations on more patients

Evaluation of efficacy, survival rate and complications of peritoneal catheter placement of patients with end-stage renal disease

Peritoneal dialysis [PD] as an equivalent to hemodialysis [HD] is one renal replacement therapy [RRT], which has several advantages compared to hemodialysis. However, most nephrologists are reluctant to apply this method. The purpose of this study is to assess the catheter efficiency, survival rate and complications of PD catheter placement in end-stage renal disease [ESRD] patients. From September 2002 to September 2003, 21 patients were operated by PD catheter placement in Imam Hossein Hospital, Tehran, Iran. The kind of catheter and surgical technique were identical in all patients. After surgery, patients were observed for 6 months. Out of the 21 patients, 13 [61%] were males and 8 [39%] were females. Diabetes and hypertension were the most common cause of nephropathy, mean age was 51.2 years and mean time between operation and from the beginning of PD was 9 days [range 1-14 days]. In 8 [38%] patients, the 2 weeks break-in period was ignored. Complications observed were as follows: peritonitis in 2 [9.5%], leak of dialysate in 2 [9.5%], abdominal wall hernia in 2 [9.5%], catheter malfunction in 2 [9.5%] and abdominal wall hematoma in 2 cases [9.5%]. The catheter lasted 6 months in all cases. However, 12 patients who previously received hemodialysis were more satisfied with PD. From the point of prevalence, our complications were not significantly different from previous studies. The 6-month survival rate and efficiency of catheter was very high. In addition, the rate of satisfaction of patients who received PD was also high. We suggest that more accurate studies on ESRD patients should be carried out to evaluate the use of PD in the primary stage of ESRD instead of HD