Routine operative cholangiography during laparoscopic cholecystectomy: feasibility and value in 107 patients.

OBJECTIVE: Laparoscopic cholecystectomy is becoming a popular alternative to open cholecystectomy. However, the technical aspects of this new procedure increase the risk of injuring the bile ducts. The purpose of this study was to determine the feasibility and value of performing cholangiography during laparoscopic cholecystectomy. MATERIALS AND METHODS: We retrospectively reviewed the clinical and operative cholangiographic findings of the first 107 patients undergoing laparoscopic cholecystectomy at Hôtel-Dieu de Montréal between August 1990 and August 1991. RESULTS: Operative cholangiography was attempted in 98% of patients; the success rate was 71%. Eight anatomic anomalies of the biliary tract that were of surgical importance were found as well as 10 cases of stones in the common bile duct, eight of which were unsuspected. No biliary tract injuries occurred. With experience, surgical cannulation of the cystic duct for injection of contrast material can be done quickly without major difficulty, and cholangiograms of excellent diagnostic quality can be obtained. CONCLUSION: Our results show that operative cholangiography is feasible and useful in patients undergoing laparoscopic cholecystectomy.

Mucosal diaphragm and enteroliths of the small bowel causing obstruction in an adult.

A case of an ileal mucosal diaphragm with enteroliths causing obstruction in a 67-year-old man is reported. The distal site of the mucosal diaphragm, its relative patency, and the late formation of enteroliths, are thought to be the reasons for the delayed clinical manifestations of intestinal obstruction leading to the diagnosis of the abnormality.

Bowel displacement due to psoas muscle hypertrophy.

Extrinsic compression of the medial border of the ascending colon and bilateral small bowel displacement at the lumbosacral level were observed in a sportswoman. Psoas muscle hypertrophy was confirmed by computed tomography. This entity should be added to the differential diagnosis of bowel displacement.

Manual dexterity test in relation to obesity and hyperostosis frontalis interna in elderly women.

A manual dexterity test was performed in a population of elderly women. Obese subjects with hyperostosis frontalis interna (HFI) had a poorer performance than subjects with either HFI alone or obesity alone. The combined effects of cerebral arteriosclerosis and HFI is suggested as a possible explanation for these findings.

The tangential x-ray investigation of the patellofemoral joint: x-ray technique, diagnostic criteria and their interpretation.

The X-ray technique for the tangential visualization of the patellofemoral joint is described; 3 X-ray signs (patellofemoral angle, patellofemoral index and patellofemoral displacement) are proposed as diagnostic aids in cases of subluxation of the patella and chondromalacia patellae. Theoretically, the pathogenesis of chondromalacia patellae and patellofemoral osteoarthritis may be explained as manifestations of cartilage damage secondary to lateral patellofemoral hyperpressure and medial patellofemoral hyperpressure.

Computerized axial tomography and fine-needle biopsy in surgery of the pancreas.

Notable advances have been made in the investigation of pancreatic disorders. However, many of the diagnostic tests required are still of an invasive nature and are attended by difficulty and risk. The authors have found that the noninvasive method of axial tomography is highly reliable for the evaluation of pancreatic lesions, especially in cases in which a pancreatic mass is present or the duct of Wirsung is dilated. This procedure can also be helpful in the follow-up of patients who have suffered from acute or chronic pancreatitis. The same diagnostic problem is present at operation. To obtain a quick and reliable diagnosis of pancreatic lesions, the authors performed fineneedle aspiration biopsies followed by immediate staining and examination of the specimen. Among 43 patients an accurate diagnosis was obtained in 41 instances and no complication was ascribed to this diagnostic procedure.

Oropharyngeal dysphagia in patients with oculopharyngeal muscular dystrophy.

Sixteen patients with an established diagnosis of oculopharyngeal muscular dystrophy underwent clinical, radiologic and manometric assessment. Secondary pharyngo-oral and pharyngonasal regurgitations are usually associated with this condition and chronic aspiration with consequent bronchorrhea is common. Such patients may present with marked oropharyngeal dysphagia. Cineradiologic findings correlated well with the mamometric results. The pharynx showed very weak contractions of longer duration than those observed in normal subjects. The proximal esophageal sphincter had a normal resting and closing pressure; however, relaxation and coordination of the sphincter were substantially different from those in a control group. Eleven patients underwent cricopharyngeal myotomy. All had notable improvement of their symptoms. Surgery on the sphincter results in a substantial decrease in its resting pressure; pharyngeal contraction remains unaltered.

The abnormal lateral patellofemoral angle: a diagnostic roentgenographic sign of recurrent patellar subluxation.

On roentgenograms made with the patient supine, the knees flexed 20 to 30 degrees, the x-ray tube between the ankles, and the cassette held proximal to the knees and perpendicular to the x-ray beam, it was found that a line between the femoral condyles and a line between the margins of the lateral facet of the patella formed the lateral patellofemoral angle, an angle that was of diagnostic value in patients with subluxation of the patella. In 100 clinically normal patients, these lines were parallel in three and formed an angle open laterally in ninety-seven. In thirty patients with subluxation of the patella, the lines were parallel in twenty-four and formed an angle open medially in six. In 100 patients with chondromalacia of the patella, however, the roentgenographic study was of no diagnostic value since the lines were parallel in ten and formed an angle open laterally in ninety.

An improved radiological method for the evaluation of Achilles tendon xanthomatosis.

Xanthomatous infiltration of tendons is a clinical feature common to many cases of hyperlipidemia. The xanthomas can be detected and only grossly assessed by palpation. This report describes a radiological technique used to assess these lesions at the Achilles tendon level. The "mammography technique" applied to the study of Achilles tendons was used in 32 normolipemic subjects and 32 hyperlipidemic patients. Both tendons could be observed in their entire length and their thickness, greatly increased in xanthomatosis, could be accurately measured. The results of this survey suggest that the radiological approach may provide a useful tool for the routine evaluation and follow-up of tendon xanthomas.