Early definitive surgery for acute pancreatitis associated with cholelithiasis.

Since the natural history of pancreatitis associated with cholelithiasis is one of recurrence, surgery for the biliary tract disease is mandatory. But appropriate timing of the surgery remains controversial. Seventy-eight patients have been treated with early surgery once a diagnosis of cholelithiasis associated pancreatitis was made. Eighteen patients had previous episodes of nonalcoholic pancreatitis. Utilizing Ranson's prognostic signs, 52 patients had mild pancreatitis and 26 severe. Sixty-eight patients (87%) had surgery within 72 hours after admission and ten patients (13%) within 5 days. All patients had a cholecystectomy and operative cholangiogram performed. Fifty-six (72%) positive operative cholangiograms were obtained and common bile duct exploration revealed choledocholithiasis in 42 patients (75%). No mortality occurred, and four had six complications including mild persistent pancreatitis (two), wound infection (one), urinary tract infection (one), cardiac arrhythmia (one) and heart block requiring permanent pacemaker (one). The average hospital stay was 10.4 days. T-tube cholangiogram done prior to discharge was normal in all patients, and there have been no episodes of recurrent pancreatitis. Early definitive surgery for pancreatitis associated with cholelithiasis is recommended and can be accomplished with minimal morbidity and mortality coupled with judicious utilization of hospital resources.

Bilateral amyloidosis of the ureter associated with carcinoma.

We report a case of coexisting amyloid and neoplasm in a localized ureteral lesion. This case also represents the third reported instance of sequential bilateral ureteral amyloidosis. Right nephroureterectomy revealed amyloid and an in situ focus of low grade transitional cell carcinoma. Three years later amyloid in the distal left ureter was resected and the gap was bridged by a bladder hitch and Boari flap. Subsequent followup has been uneventful.

Excisional breast biopsy and roentgenographic examination for mammographically detected microcalcification.

Sixty-two women had excisional breast biopsy for areas of microcalcification detected by mammography with no associated palpable mass. Carcinoma was discovered in 20 patients (32 percent). These cancers ranged in size from 0.6 to 14 mm in greatest diameter. Six patients had multicentric carcinoma, including one synchronous bilateral lobular carcinoma. Axillary metastasis was present in three patients (15 percent), each with multicentric lesions. Chronic cystic mastopathy (55 percent) was the most common finding associated with microcalcification. In six patients (30 percent) with carcinoma, the microcalcification was present only in adjacent tissue and ducts. Generous excisional biopsy, verification of excision of the site of microcalcification by roentgenographic examination of the specimen, and thorough histologic examination by paraffin section are mandatory to detect these early and potentially curable breast carcinomas.