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Thirty patients having undergone choledochoduodenostomy for benign biliary diseases were studied by means of endoscopy. The endoscopic anatomy of the anastomosis was classified into two types. Inflammatory changes of the choledochal mucosa adjacent to the stoma were found in nine cases. Endoscopy of the proximal and distal (blind) segment of the common bile duct was accomplished in 19 and nine patients, respectively. It is very probable that these inflammatory mucosal changes could lead to complications. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about a study on acalculous gallbladder in common bile duct lithiasis patients.

This paper presents a fully automated method for segmentation of 3D SPECT ventilation and perfusion images. It relies on statistical information on lung shape derived by CT manual segmentation and its main processing steps are: shape model extraction, binary segmentation, positioning of mean shape in SPECT images and iterative shape adaptation based on intensity profiles and on what is considered `plausible' lung shape. The Active Shape Model is used to generate accurate anatomic results in SPECT images with functional information and thus unclear borders, especially in the case of pathologies. The method was compared against ground truth manual segmentation on CT images, using volumetric, difference dice coefficient, sensitivity and precision.

Background: Intrabiliary rupture is a common and serious complication of hepatic hydatidosis, and its treatment remains controversial., Methods: Sixty-seven patients who underwent surgery for rupture of a hydatid cyst in the biliary tree were studied retrospectively. The following data were analyzed: age, sex, clinical presentation, and so on., Results: In 55 patients, intrabiliary rupture was diagnosed preoperatively and in 12 patients intraoperatively. In 51 patients, partial pericystectomy and closed-tube drainage followed. Pericystorraphy was performed in 9 patients. Omentoplasty was performed in 5 cases. After the meticulous cleansing of the common bile duct, T-tube drainage (60 patients), choledochoduodenostomy (4 patients), or sphincteroplasty (1 patient) was added. In 4 patients, there was a persisting external biliary fistula. The mean length of hospital stay was 18 days. Follow up (1-35 years) elicited 4 recurrences and 1 postoperative death., Conclusions: Our results in intrabiliary rupture of echinococcal cysts are considered to be satisfactory. Surgical treatment can be improved with the modern methods of investigation, wider use of newer chemotherapeutics, and appropriate modification of surgical procedures.

Since portal hypertension affects the gastric mucosa, leading to congestive gastropathy and thus to increased incidence of bleeding, it is one of the possible causes of increased permeability of gastric mucosal capillaries. The aim of this study was the quantitative assessment of the permeability of the gastric mucosal endothelial cells. Eight CCl4-induced cirrhotic rats and eight matched controls were subjected to i.v. injection of FITC-albumin, and a morphometric evaluation of fluorescence in serial histological sections of the gastric mucosa was performed by a video image analysis system. Fluorescence was found to be 0.351 +/- 0.01% of the area scanned in experimental animals versus 0.073 +/- 0.005% in controls, i.e. it was significantly increased by the treatment, which implies a significant endothelial leakage into the extravascular space.

A 68-years old female patient suffering over a period of several weeks from fatigue, weight loss, recurrent diarrheas and mild fever was admitted in our clinic. A few months ago, sarcoidosis of a cervical lymph node had been diagnosed and had been treated with steroids. During the present admission, the extensive study of the gastrointestinal system revealed a tumor of the ascending colon, obstructing the lumen. The patient was subjected to laparotomy due to persistent symptomatology of intestinal obstruction. A right hemicolectomy was performed. The pathological findings were persistent with sarcoidosis of the large bowel. Post-operatively, the patient has been symptom-free over a period of more than one year.

Bleeding from esophageal varices is highly lethal in cirrhotics, the main cause of death being liver failure. Because adequate hepatic perfusion is a prerequest for the maintenance of liver function, the present study was designed to evaluate the influence of hemorrhagic shock on liver microcirculation in rats with portal hypertension due to cirrhosis of the liver induced by CCl4. In 16 cirrhotic rats and an equal number of controls, hepatic microcirculation was continuously assessed--by means of laser-Doppler flowmetry, through a self-adhesive probe attached to the liver surface, before and during a 15 min period of arterial hypotension (40 mmHg) induced by blood withdrawal. Our findings revealed that immediately following hemorrhage there is a statistically significant reduction of microcirculation in cirrhotics versus controls. The results of this study assist in the better understanding of the hemodynamic conditions which prevail in the cirrhotic liver during the first minutes of hemorrhage.

The relation of colorectal carcinoma and adenomatous polyps was studied retrospectively in 72 patients. Severe dysplasia was found in 47.8% and malignant transformation in 18.2% of the patients with adenomatous polyps and coincidental colorectal carcinoma. The incidence decreased to 21.4% and 7.1%, respectively, in patients with adenomatous polyps only. This difference between the two groups constitutes indirect evidence of malignant potential of adenomatous polyps associated with colorectal carcinoma. Moreover, when severe dysplasia of an adenomatous polyp is found, the patient should be carefully examined for synchronous colorectal carcinoma.

Objective: To find out if pedicle grafts of peritoneum and transversalis muscle could be used to repair large defects in the wall of the duodenum., Design: Experimental study., Material: 18 healthy mongrel dogs., Interventions: Defects were created in the second part of duodenum and repaired with pedicle grafts of peritoneum and transversalis muscle from the anterior wall of the right side of the abdomen., Main Outcome Measures: Postoperative complications, appearances on upper gastrointestinal radiography two and four months after operation, and histological examination of necropsy specimens., Results: There were no postoperative deaths or complications. Radiographs of the duodenum showed no abnormalities and in particular no signs of obstruction. Animals were killed at intervals from one week to eight months after operation, and the only abnormality was 20-30% stenosis found in five dogs killed within two months of operation, which did not affect gastric emptying. Histological examination showed that by four months after operation the patch was completely covered by neomucosa that was similar to normal duodenal mucosa. By six months the site of the defect was well healed and the histological appearance was the same as at four months., Conclusion: Pedicle grafts of peritoneum and transversalis muscle may be useful in the treatment of patients with large defects in the wall of the duodenum.