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We have reported the results of 121 examinations with the rigid choledochoscope performed by 13 different surgeons between 1969 and 1977. Pre-exploratory choledochoscopy was performed in 48 patients with a diagnostic accuracy of 94 per cent. Post-exploratory choledochoscopy was used in 73 patients to define whether the common bile duct had been adequately cleared of stones. Fifty-one patients were correctly assessed as having a clear duct and unsuspected residual calculi were demonstrated by choledochoscopy in 13 patients. However, choledochoscopy failed to identify 9 patients with retained stones. The accuracy of post-exploratory choledochoscopy alone was 87 per cent and the accuracy of post-exploratory cholangiography was 82 per cent, but when choledochoscopy was combined with post-exploratory cholangiography there were no errors. We conclude that the addition of choledochoscopy to conventional radiological techniques is likely to reduce the incidence of residual calculi after choledochotomy.
We have reported the results of 121 examinations with the rigid choledochoscope performed by 13 different surgeons between 1969 and 1977. Pre-exploratory choledochoscopy was performed in 48 patients with a diagnostic accuracy of 94 per cent. Post-exploratory choledochoscopy was used in 73 patients to define whether the common bile duct had been adequately cleared of stones. Fifty-one patients were correctly assessed as having a clear duct and unsuspected residual calculi were demonstrated by choledochoscopy in 13 patients. However, choledochoscopy failed to identify 9 patients with retained stones. The accuracy of post-exploratory choledochoscopy alone was 87 per cent and the accuracy of post-exploratory cholangiography was 82 per cent, but when choledochoscopy was combined with post-exploratory cholangiography there were no errors. We conclude that the addition of choledochoscopy to conventional radiological techniques is likely to reduce the incidence of residual calculi after choledochotomy.
Intraoperative angiography in carotid extracranial surgery demonstrates technical defects in 5% to 8% of patients. A simple and safe method of completion contact angiography (CCA) has been perfected by adapting dental x-ray equipment, small dental film cassettes, and a "shoe box" type of developing unit. The method is not technician dependent, requires only 5 ml of contrast medium, has a completion time of less than 5 minutes, and produces no measurable radiation to the operating team. CCA was performed with no complications in 40 patients undergoing carotid endarterectomy. Two unsuspected internal carotid artery defects (5%) were discovered: in one a stenosis was immediately repaired, and in the other small thrombi that were seen but not removed were probably the cause of a postoperative transient ischemic attack. Two complete occlusions and one prominent intimal flap in the external carotid artery were also identified. We believe that CCA after carotid surgery should be used routinely because it is safe and simple and reveals unsuspected operative defects that can be corrected immediately.
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