Intraoperative cholangiography. A review of indications and analysis of age-sex groups.

A retrospective review was performed of patients who had biliary tract stone formation as the primary diagnosis for hospitalization and indication for surgery. Five hundred and eighty-nine consecutive charts were reviewed of patients admitted between 1975 and 1979. Intraoperative cholangiography was performed in 166 patients of whom 22 had common duct exploration. Choledochotomy in this series was performed in 63 cases without utilizing pre-exploratory cholangiography. A normal intraoperative cholangiogram was found to be 100% accurate; however, an abnormal cholangiogram was associated with a 16% false positive rate of exploration of the common duct. The incidence of unsuspected common duct stones detected only by intraoperative cholangiography was 2.3%. Age-sex analysis confirms a 10-year mean age difference between men and women within the population of this study (p less than 0.001). This age-sex difference is maintained in patients without common duct pathology as well as in patients with sterile bile. However, the mean age difference between male and female patients with either demonstrable common duct obstruction by stones or infected bile as determined by routine intraoperative culture is not statistically significant. A review of the role of intraoperative cholangiography, and the experience at Northeastern Hospital is discussed.

Prevalence and implications of multi-drug abuse in a population of methadone-maintained women.

Within our study population of 100 women for whom 3,980 urine toxicology reports were accomplished, 98 percent were multi-drug users. This proportion is far greater than would have been calculated from the percent of urines that were positive for the drugs of abuse and is a more realistic estimate of the extent of the problem than is often reported. Despite this high percentage of multi-drug use, due to the uniqueness of our patient population (pregnant women), it is not possible to deny them pharmacologic therapy for their addiction. Therefore, the use of urine toxicology reports in our clinical setting has broader implications than adherence to the methadone regulations. These reports serve as excellent devices to assess newborn abstinence symptomatology, in addition to helping us monitor the physical and psychological status of our patients. The implications are that self-medication may be used to achieve a particular effect concomitant with methadone therapy. The effects are generally to enhance the action of methadone and to decrease undesirable side effects.