Is there a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography and magnetic resonance cholangiopancreatography?

BACKGROUND AND STUDY AIMS: It is still unknown whether there is a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP). PATIENTS AND METHODS: The test performance and potential clinical impact of EUS and MRCP, had each investigation been performed as the first examination method, were compared prospectively in 163 patients admitted for and examined by endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The accuracies of EUS and MRCP were 0.93 and 0.91, respectively (no significant difference, P > 0.05). Had EUS or MRCP been performed as the first investigation in the 75 patients who had a presumed high probability for needing therapeutic ERCP, only 15 and nine patients, respectively, would have avoided ERCP. In this group of patients, one patient needed other diagnostic investigations following EUS compared with 11 patients following MRCP ( P = 0.004). For the 57 patients with an intermediate probability of needing endoscopic therapy, EUS and MRCP would have spared 37 and 38 patients, respectively, from the need to have an ERCP. In 31 patients with a presumed low risk of needing endoscopic therapy, 30 and 29 patients would have been spared from ERCP had EUS and MRCP, respectively, been performed initially. CONCLUSIONS: There was no difference in the diagnostic accuracy and clinical impact between EUS and MRCP in the majority of the patients. The impact of EUS or MRCP on the ERCP workload was highly dependent on the presumed probability of needing endoscopic therapy.

Surgical repair of vesicovaginal fistulae--a ten-year retrospective study.

OBJECTIVE: Vesicovaginal fistulae in the western world generally occur as complications to pelvic surgery or radiation therapy of pelvic cancers. We have reviewed our results of vesicovaginal fistula closure procedures over a 10-year period. PATIENTS AND METHODS: From 1985 to 1996, 55 patients were referred to our department due to vesicovaginal fistulae. Five patients had fistulae due to malignant recurrence and one patient was considered inoperable. Thus, 49 patients were operated on. Thirty patients had fistulae resulting from pelvic surgery. Nineteen of the 25 patients admitted with fistulae secondary to radiation therapy of pelvic cancers were operated on. RESULTS: Of the 30 patients with postoperative fistulae, 23 had an abdominal repair and 7 a vaginal repair. A success rate of 90% was achieved after a first closure procedure, as 3 patients within a month experienced a recurrence. These three recurrences were all successfully closed in a second operation, augmenting the success rate to 100% in this group of patients. In the group of patients with fistulae caused by irradiation, a urinary diversion was performed in 12 patients, and in 7 patients a primary attempt to close the fistula was made, either by an abdominal approach (2 patients) or by a vaginal approach (5 patients). The fistula recurred in 6 of these 7 patients. Despite several additional attempts to close the recurrent fistulae, only one patient was successfully operated on. CONCLUSION: It seems that vesicovaginal fistulae resulting from pelvic surgery, in our hands, can be managed successfully either by an abdominal or vaginal approach. For patients with vesicovaginal fistulae resulting from radiation therapy, a urinary diversion appears to be the method of choice.

[Abdominal actinomycosis. Two cases from a department of surgery]. / Abdominal actinomycosis. To sygehistorier fra en kirurgisk afdeling.

Two case stories of abdominal actinomycosis are described. Knowledge and proper treatment of this bacterial disease are important in order to prevent recurrent abscesses or major surgical operations.

Endoscopic treatment of oesophagoairway fistula with oesophageal balloon prosthesis.

OBJECTIVE: To describe our experience with a cuffed oesophageal prosthesis in the management of malignant oesophagoairway fistulas. DESIGN: Retrospective study. SETTING: Teaching hospital, Denmark. SUBJECTS: Nine patients treated with a balloon cuffed oesophageal prosthesis during the period 1987-93. MAIN OUTCOME MEASURES: Endoscopic assessment of the fistula compared with the results and complications of treatment. RESULTS: The prosthesis were inserted without complications. Eight patients had total relief of aspiration and were able to eat a semisolid diet. Three patients needed reintervention. Patients with little or no stenosis of the tumour seemed to be at considerable risk of dislodgement of the tube and those with large fistulas developed protrusion of the balloon into the tracheal lumen. CONCLUSION: Intubation with the cuffed oesophageal prosthesis is safe and relatively inexpensive. Other treatments should be considered in patients with minor stenosis of the tumour or a large fistula.

[Somatostatinoma in the pancreas]. / Somatostatinom i pancreas.

A case of a pancreatic somatostatinoma in a 54 year old male is presented. A pancreatic carcinoma with hepatic metastases were primary diagnosed, and the patient had a palliative choledochoduodenostomy and gastroenteroanastomosis. As he was still alive four years later, the histological samples were reevaluated. Immunohistochemically the tumor was found positive for somatostatin, neuron-specific enolase and pancreatic polypeptide. Symptoms, diagnosis, pathology and treatment in relation to somatostatinomas are discussed.

Giant ventral hernias and their repair. A 10 year follow up study.

A consecutive series of 32 repairs of massive incisional hernias have been followed up for a median of 45 months (range 8 months to 11 years). The reconstruction was based on the frontal leaf of the rectus abdominis and insertion of free fascia or pedicle flap from the tensor fascia lata muscle combined with transposition of the rectus muscle. Median size of the hernias was 20 x 17 cm (range 6-35 x 8-30). The incidence of risk factors for both recurrence as well as operative complications was high. During the median observation period of 45 months 9 hernias recurred, the main benefit of a successful reconstruction was relief of pain in the abdominal wall and the lower back. We conclude that the method is useful for the treatment of patients with large ventral hernias. Reduction of controllable recurrence risk factors is important, and the treatment requires substantial resources and expertise.