The consequences of a major bile duct injury during laparoscopic cholecystectomy.

Bile duct injury is perhaps the most feared complication of laparoscopic cholecystectomy. The focus of this study was on the immediate and short-term outcome of patients who have undergone repair of major bile duct injuries with respect to hospital stay, perioperative interventions, and reoperations. The records of patients who underwent surgery at three academic hospitals in Philadelphia (Hospital of the University of Pennsylvania, Thomas Jefferson University Hospital, and Graduate Hospital) from 1990 to 1995 for repair of a major biliary injury following laparoscopic cholecystectomy were reviewed.

A correlation of air plethysmography and color-flow-assisted duplex scanning in the quantification of chronic venous insufficiency.

Purpose: Air plethysmography has been useful in assessing patients who have chronic venous insufficiency. Limb reflux times determined by color-flow-assisted duplex scanning have been shown to correlate with the severity of chronic venous insufficiency. The purpose of this study was to compare air plethysmographic measurements with reflux times obtained by color-flow-assisted duplex scanning in patients with chronic venous insufficiency.

Analysis of American College of Surgeons trauma consultation program.

Objective: To identify the criteria deficiencies found during peer consultation of hospitals and the relationship to subsequent verification.

Methods: Between September 1987 and December 1992, 52 hospitals had consultation visits using American College of Surgeons criteria. Each report was studied for deficiencies, frequency of deficiencies, and relationship to verification.

Barium intravasation during an upper gastrointestinal examination: a case report and literature review.

Barium ingestion is a routine practice in the radiologic examination of the alimentary tract. Barium intravasation is a rare complication, often resulting in the rapid onset of hypotension and death. The literature on this type of complication is sparse.

Management of anomalous rotation in adults.

Rotational anomalies of the gut are infrequently encountered in the adult population. Management of this population is debatable because of a few anecdotal reports and small patient series. We present the successful surgical correction of a patient with symptomatic nonrotation and review our experience with six asymptomatic patients with anomalous rotation discovered incidentally at laparotomy for another disease process.

American College of Surgeons Verification/Consultation Program: analysis of unsuccessful verification reviews.

Unlabelled: This study was designed to document the reasons hospitals have been unsuccessfully peer reviewed as potential trauma centers.

Method: 120 trauma center reviews were performed by a peer review program between September 1987 and December 1992 using the American College of Surgeons (ACS) criteria. Fifty-four hospitals had criteria deficiencies.

Distribution and quantification of venous reflux in lower extremity chronic venous stasis disease with duplex scanning.

Purpose: The purpose of this study was to use color-flow duplex scanning to identify the anatomic distribution of venous reflux and to quantify venous reflux times in patients with various stages of chronic venous insufficiency (CVI).

Methods: Color-flow-assisted duplex scanning was used to identify the anatomic distribution of venous reflux and to quantify reflux times in the deep and superficial venous systems of patients with symptomatic (CVI). Two hundred two patients with class I to III CVI were examined.

Percutaneous interventional gallbladder procedures: personal experience and literature review.

Our experience with 58 percutaneous gallbladder procedures in 48 patients are discussed. Diagnostic procedures consisted of needle aspiration of bile (n = 5) to evaluate the gallbladder as a source of infections and transcholecystic cholangiography (TCC) (n = 32) for bile duct visualization. Percutaneous cholecystostomy (PC) (n = 21) was performed for gallbladder or bile duct decompression or stone dissolution.

Status of trauma center designation.

1) In 1986 20 states are designating trauma centers. 2) ACS guidelines appear to be the accepted standard. 3) Almost all of the states providing designation retain the power of final designation but allow individual hospitals to initiate the process.

Trauma systems. Current status--future challenges.

The national status of regional trauma system development was evaluated by a survey sent to all state emergency medical services directors and state chairpersons of the American College of Surgeons Committee on Trauma. Eight essential components of a regional trauma system based on criteria set forth by the American College of Surgeons were listed. Only two states were found to have all components and statewide coverage.

Refractory afferent loop problems: percutaneous transhepatic management of two cases.

Complications of the afferent loop are traditionally managed only by surgical revision. Transhepatic biliary drainage was used in the palliative treatment of two different afferent loop problems in critically ill patients for whom surgery was unsuccessful. Transcholecystic cholangiography was used to opacify the nondilated bile ducts and proved valuable for the transhepatic biliary catheterization procedure.

Interventional radiology of the biliary system and pancreas.

In recent years, newer techniques have become available to the clinician for the diagnosis and treatment of biliary and pancreatic disease. This article emphasizes interventional procedures through the liver, such as percutaneous transhepatic cholangiography, percutaneous transhepatic biliary drainage, and ancillary techniques. Also discussed are the nonsurgical management of bile duct calculi and the diagnosis and treatment of pancreatic tumors, abscesses, and pseudocysts.

Atherosclerosis and the hypoplastic aortoiliac system.

Between January, 1965, and December, 1975, 204 patients (138 men and 66 women) underwent aortoiliac reconstruction for atherosclerotic occlusive disease. Eighteen patients (9%) had a hypoplastic aortoiliac segment and an analysis of these 18 patients constitutes the basis of this report. There were 17 women and one man, and their ages ranged from 28 to 60 years, with an average of 43 years.