Carcinoma of the gallbladder: review of the literature and report on 56 cases at the Beth Israel Medical Center.

Fifty-six patients with carcinoma of the gallbladder were treated at the Beth Israel Medical Center, New York City, during the 17-year period 1969-1987. The disease was most common among elderly women with cholelithiasis. Of the 56, 42 patients (75%) had liver metastases at operation; therefore, the majority underwent only exploratory laparotomy and biopsy. In 50 patients (89%), the tissue diagnosis was adenocarcinoma. Cholecystectomy was performed in 19 patients. Long-term survival occurred in patients with an incidental diagnosis of carcinoma of the gallbladder. The average survival in 44 patients for whom data were available, including long-term survivors, was 20 months. Of this group, 5 patients (11.3%) were still alive 5 years after diagnosis. Excluding those with an incidental diagnosis of gallbladder cancer, 1 patient (2.2%) survived longer than 5 years after diagnosis. Survival data in 3 of 4 patients who underwent extensive surgical treatment, such as liver wedge resection or hepatic lobectomy, averaged 23 months. Although no defined protocols were used, the addition of adjuvant chemotherapy or radiation therapy in patients treated surgically appeared to improve survival. Five patients survived more than 5 years after diagnosis, and 2 patients were alive after 17 years.

Roentgenographic marking using surgical staples after in situ saphenous venous bypass.

A method to localize A-V fistulas is described herein, using sterile staples as makers with angiography. This may decrease the operative time spent searching for A-V fistulas and may diminish morbidity and help improve the patency of the graft.