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The British/Belgian Gall Stone Study Group (BBGSG) post-dissolution trial was a prospective, multicentre, randomised, double blind trial of: (i) low dose ursodeoxycholic acid, (ii) placebo, and (iii) a high fibre, low refined carbohydrate diet in the prevention of gall stone recurrence in patients with complete gail stone dissolution. Further aims included establishing the timing and frequency of recurrence and its association with biliary symptoms, a comparison of the sensitivity of ultrasonography v oral cholecystectography in detecting recurrent stones, and a search for risk factors predicting recurrence. Ninety three patients entered the study, and 82 were followed up for up to five years (mean (SEM) 28 (1-5) months) with six monthly ultrasonography and yearly oral cholecystectography. There were 21 recurrences (26 by oral cholecystectography or ultrasonography, or both), only two of which were symptomatic, which were detected between 12 and 42 months after trial entry. This corresponded to an actuarial recurrence rate of 33*9 (7.0%) by lifetable analysis at 42 months and subsequently. There were four recurrences in the ursodeoxycholic acid, six in the placebo, and 11 in the diet groups, corresponding to 21*9 (9.9)%, 27-4 (10.1)%, and 45*8 (12-4)% respectively at 42 months by lifetable analysis (NS). Variables including age, obesity, menopausal state, pregnancy, and oestrogen containing drugs were not shown to affect recurrence rate. Men had more frequent recurrence than women (NS). Patients who had had multiple stones experienced more recurrences than did those with single stones (NS). Recurrence did not occur in patients who took non-steroidal anti-inflammatory drugs (NSAIDs) (p<0.02). The stone free interval between stone dissolution and trial entry proved to be important -those stone free>nine months had a recurrence rate of only 12.7 (6.0)% at 42 months compared with 55*4 (12-5)% in those stone free

In a five year study, 55 patients with radiolucent gall stones were treated with the combination of 7*5 mg chenodeoxycholic acid (CDCA) and 5 0 mg ursodeoxycholic acid (UDCA)/kg/daythat is, half the monotherapeutic doses. Side effects were few but four patients could not tolerate the prescribed bile acids because of diarrhoea or nausea. Analysis of fasting duodenal bile confirmed that CDCA+UDCA converted supersaturated into unsaturated bile but the saturation indices did not predict the dissolution response. By actuarial analysis, the confirmed (by ultrasound x 2) complete gail stone dissolution rates in all 55 patients were mean (SEM) 29 (7)% at 12 and 44 (8)% at 24 months. The advent of routine computed tomography before treatment enabled comparison of dissolution efficacy in those screened by computed tomography (n=24), whose maximum gail stone attenuation was <100 Hounsfield units, with that in those ndt screened (n=29). Although stone size and number were comparable, patients screened by computed tomography had significantly better dissolution rates (p<0025) than those not screened in this way. At 12 months, partial or complete gall stone dissolution rates were 93 (7)% in the screened and 55 (11%) in the nonscreened patients. At 18 months, complete dissolution rates were 64 (12%) and 20 (9)% respectively. Computed tomography before treatment is cost effective in selecting those patients likely to achieve gall stone dissolution on treatment with UDCA+CDCA.

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H. Cancer of the pancreas: diagnostic accuracy and survival statistics. Cancer 1978; 4 2 2494506. Peel ALG, Dillon E, Dellipiani AW. High bile duct cancer: incidence and pattern of investigation in the general hospital setting. Br J Surg 1981; 68: 459-62. Eyre-Brook IA, Ross B, Johnson AG. Should surgeons operate on the evidence of ultrasound alone in jaundiced patients? Br J Surg 12. 13. 14. 1983; 7 0 587-9. 8. Dixon JM, Armstrong CP, Duffy S, Davies GC. Statistical analysis of the factors affecting mortality and morbidity in biliary tract surgery. Gut 1983; 24: 845-52. Anderson JB, Cooper MJ, Williamson RCN. Adenocarcinoma of the extra-hepatic biliary tree. Ann R Coll Surg Engl 1985; 67: 13943. Blamey SL, Fearon KCH, Gilmour WH, Osborne DH, Carter DC. Prediction of risk in biliary surgery. Br J Surg 1983; 7 0 11. Feduska NJ, Dent T, Lindeneur SM. Results of palliative operations for carcinoma of the pancreas.

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