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Patients with cancer of the common bile duct (the lower biliary duct system outside the liver) can be more easily treated surgically and have a better chance of long-term survival than do patients with upper bile duct cancer, which is more common. A study was undertaken to evaluate the impact of diagnostic evaluation and surgery on outcome of 62 patients with common bile duct cancer. These patients accounted for 35 percent of all bile duct cancers seen. The ratio of men to women was 2:1, and the average patient age was 58. The first group of patients (39 patients) was treated before June 1978; the second group (23 patients) was treated between July 1978 and December 1988. Preoperative evaluation has changed with the improvement in computed tomographic (CT) scanning and ultrasound techniques, and the development of percutaneous transhepatic cholangiography and endoscopic retrograde cholangiopancreatography or ERCP. Seventy percent of group 2 patients had one or the other of these imaging procedures performed preoperatively. These technological improvements led to earlier surgery. The ability to remove these tumors is directly related to improvement in survival. Unfortunately, preoperative determination of malignancy is often difficult because of the difficulty to obtain an adequate tissue specimen. The most useful biopsies are obtained using choledochoscopic and incisional techniques. Biopsy could confirm cancer in only 60 percent of patients who had surgery. Without biopsy confirmation of malignancy, the surgeon in the operating room must rely on clinical findings and diagnostic tests to make his decision before beginning radical tumor removal. Treatment of common bile duct cancer currently involves a combination of surgery and chemotherapy, with or without adjuvant radiotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

It is estimated that 5 percent of the population in the United States is morbidly obese (over 200 percent of ideal body weight.) Surgical treatment of these patients may be helpful if traditional weight reduction methods have not been successful. Depending on the type of surgery performed, various aspects of digestive tract functioning are altered, and some long-term complications have occurred. Many obese patients are undergoing revision of the original bariatric (obesity control) surgery. A review was undertaken of all patients who bariatric surgery over a 37 month period; 32 patients were identified who required one or more additional operations as a result of complications of the original bariatric operation. The average age of the patients was 44 and there were 25 women and seven men. The patients averaged 2.6 operations due to complications; 23 patients (71.8 percent) required more than one operation. Abnormal metabolism (nutrition) in 12 patients and weight-related problems in 11 patients were the main causes of the second operation (first revision procedure). The causes of the final operation were more urgent and possibly life-threatening. These included bowel obstruction (41 percent), intra-abdominal sepsis (poising by infection) (12 percent) and stomach or bowel bleeding (6 percent). There were four deaths. It is concluded that revision of initial bariatric surgery should be carefully considered; there is a potential for major complications and this must be balanced against the possible benefits. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cancers of the bile ducts are not common, but often their small size and location preclude surgical removal. Advances made over the last 15 years in the field of radiology have improved diagnosis; improvements in endoscopy have changed surgery; and research into hyperbilirubinemia (excess bile in the blood) and jaundice and their implications has changed patient care. The assess the impact of these changes, treatment records of patients treated in the last 10 years were compared with those of patients treated between 1954 and 1978. There were 96 patients treated in group 1, the earlier group, and 90 treated in group 2, the more recent group. Group 2 patients were generally diagnosed and treated sooner than those in group 1 (average of 2.1 months from onset of symptoms, compared with 4.9 months). This early diagnosis and treatment correlated with increased use of diagnostic methods such as ultrasound, computed tomographic (CT) scanning, transhepatic cholangiography, and endoscopic retrograde cholangiopancreatography. The rate of surgical deaths was lower in group 2 than in group 1 (4 percent compared with 12 percent). The location of the tumor influenced the operative death; patients with lesions in the upper third of the biliary system (nearest to the liver ducts) in group 1 had 23 percent operative mortality, compared with 0 percent in group 2. Overall one-year survival for group 1 was 43 percent, compared with 59 percent for group 2. Five-year survival was 8 percent for group 1 and 7 percent for group 2, despite a higher percent of upper system tumors in group 2. Significant improvements have been made in diagnosis and treatment of these patients over the last 10 years. (Consumer Summary produced by Reliance Medical Information, Inc.)