Duodenal diverticula and jaundice: percutaneous transhepatic cholangiography may be misleading.
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Biomedical subjects
Publications and source records attributed to B Moule.
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Fine-needle percutaneous transhepatic cholangiography (PTC) was performed in a series of 46 patients with jaundice or suspected biliary tract disease. The ductal system was successfully outlined in each of 20 patients with dilated intrahepatic ducts and in 19 of 26 patients with intrahepatic ducts of normal calibre. There were two episodes of septicaemia after PTC, one of them fatal. Valuable accurate diagnostic information was obtained in all cases with biliary tract obstruction. A programmed approach to diagnosis of suspected obstructive jaundice is outlined. Fine-needle PTC is an acceptably safe procedure and need not be followed by immediate laparotomy.
A double-contrast barium meal has been carried out on 37 patients in whom there had been disagreement in diagnosis between the routine barium meal and subsequent oesophago-gastro-duodenoscopy. There was an 81% agreement between the endoscopic diagnosis and the diagnosis obtained with double-contrast barium meal. Confirmation of the endoscopic and double-contrast radiological diagnosis was obtained all 11 patients who had surgical treatment. These findings suggest that a double-contrast barium meal should be routinely used in the diagnosis of dyspepsia.
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The accuracy of preoperative assessment in determining invasion of the mandible by intraoral squamous cell carcinoma was analyzed in 48 patients who underwent mandibulectomy, and the results correlated with the histopathological reports of the resected specimens. Only 50% of the patients underwent the "ideal" surgery based primarily on clinical judgement, whereas 10 patients in the series were significantly undertreated. Clinical judgement and routine preoperative x-rays are accurate in cases where there is gross involvement of the mandible (17 of 19) but are significantly less successful in determining early bone invasion, invasion of the periosteum, or periosteal new bone formation. In such cases (26 of 48), a technetium-99m bone scan provides additional information. A grading system for reporting orthopantomographics (OPTs) and bone scans has been developed and utilized to form a reference grid to determine the optimum extent of mandibular surgery. The results show that using this protocol, unnecessary mandibular surgery may be reduced and inadequate surgical excision avoided.