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.

The utility of HCT as a preoperative tool to evaluate CLM is inversely proportional to the time interval between imaging and surgery. This may explain conflicting reports of the accuracy of HCT in the current literature.

No abstract

Type VI choledochal cysts or cystic duct dilatation cysts are a relatively new and rare condition. We report the case of a 35-year-old man who presented with a history of recurrent episodes of epigastrium pain. Magnetic resonance cholangiography revealed a cyst lodged between the cystic duct and the right anterior sectoral bile duct. He underwent a laparoscopic right anterior sectorectomy with cholecystectomy. Pathological examination revealed a cyst with a fibrous wall, dense chronic inflammatory infiltration, lined by columnar epithelium. Due to its rarity, the diagnosis is often made intraoperatively. The treatment of cystic duct cysts includes cholecystectomy, complete cyst excision, recontinuity of the common bile duct. Type VI choledochal cysts are extremely rare. Preoperative diagnosis, using either magnetic resonance cholangiopancreatography or endoscopic retrograde cholangiopancreatography, is vital to prevent postoperative complications. Treatment of this type of cysts includes cholecystectomy and complete cyst excision and biliary-enteric reconstruction if necessary.