Flexible choledochoscope was used in 16 patients undergoing common bile duct (CUD) exploration for suspected stones. Stones were found in the CBD in 4 patients in whom introperative cholangiogram was normal. T-tube cholangiogram done between the 10th and 14th postoperative days was normal in all 16 patients. None of the patients had symptoms suggestive of retained stones during follow-up ranging from 6 to 19 months. We feel that the use of choledochoscopy in patients .,ndergoing CUD exploration will help reduce the incidence of retained stones.
The usefulness of plasma urea:creatinine ratio in predicting the site of bleeding was studied in 40 patients admitted with melaena. Patients presenting with frank haematemesis and those in whom the site of bleeding could not be ascertained were excluded from the study. In 26 patients the source of bleeding was above the ligament of Trietz, while in 14 the source was below this level. In 22 of 26 (84.6%) patients with upper gastrointestinal bleeding, the urea:creatinine ratio was more than 36. In only 2 of 14 patients with lower gastrointestinal bleeding the ratio was similarly raised (p < 0.001). Our study suggests that urea:creatinine ratio of 36 or more has a positive predictive value for upper gastrointestinal bleeding.
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