Physicians seem to learn best from their peers, yet the impact of opinion leaders on physician behavior is unclear. Because colon cancer staging has been identified as being suboptimal in Ontario, Canada, we sought to evaluate the influence of expert and local opinion leaders for colon cancer on optimizing colon cancer lymph node assessment.Design, Setting, Participants: A cluster-randomized trial including all hospitals in Ontario that identified a local opinion leader with intervention between January 5 and June 17, 2004.

Common bile duct (CBD) injury during surgical procedures is a serious complication. Partial injury can usually be managed by a combination of percutaneous and/or endoscopic techniques. However, the management of complete transection of the CBD is very challenging. There are small case series of nonsurgical management of complete CBD transection during laparoscopic cholecystectomy. In this particular case, a 55-year-old female patient had multiple operations because of malignant pheochromocytoma with liver metastases. She developed a complete CBD transection during right hepatectomy. A biloma was managed with image-guided percutaneous drainage. However, both attempts of percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) for CBD stent were unsuccessful, as the native CBD was partially resected during the injury. A rendezvous procedure, in which a guidewire was placed through the distal CBD and into a biloma by ERCP and subsequently snared with PTC, allowed for a biliary-duodenal catheter to be placed successfully and achieve continuity of the patient's biliary tree.

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