Routine computed tomographic scans, selective mediastinoscopy, and other factors in evaluation of lung cancer.

Routine computed tomographic scan is advocated as the best noninvasive method of evaluating mediastinal nodes for cancer spread. Positive studies should be confirmed histologically. Large size, central location, unfavorable cell type, poor cellular differentiation of the primary cancer, and weight loss also correlate with increased likelihood of mediastinal involvement.

A case of sinusitis presenting with spheno-cavernous syndrome: discussion of the differential diagnosis.

A 60 year old gentleman presented with a left spheno-cavernous syndrome resulting in impaired ocular motility, proptosis and visual loss in an otherwise clinically quiet eye. The history led to a clinical suspicion of posterior ethmoiditis, which was confirmed on C.T. scanning. Surgical drainage and antibiotic treatment resolved the symptoms, but visual impairment persisted. The differential diagnosis and management of spheno-cavernous syndrome is discussed in context with this atypical presentation of orbital cellulitis.

MRI versus arthroscopy in evaluating knee meniscal pathology.

The purpose of this project was to evaluate magnetic resonance imaging (MRI) accuracy for diagnosing and defining meniscal pathology. The charts of 45 patients who underwent both MRI and arthroscopy were viewed retrospectively. All cases were seen by one of two orthopedic surgeons. Magnetic resonance imaging scans were reviewed by staff radiologists at the University of Michigan Hospital Medical Center. Arthroscopy was used as the standard for comparing MRI results. Data were analyzed two ways with respect to questionable (code 3) MRI lesions. First, all code 3 lesions were interpreted as either true positives or negatives. Second, all code 3 lesions that corresponded with a negative arthroscopy finding were interpreted as false positives. The MRI accuracy was 87.8% when considering nonmatching code 3 lesions as true positives or negatives. The accuracy declined to 82.2% when considering code 3 lesions as false negatives. Magnetic resonance imaging sensitivity for medial meniscal and lateral meniscal tears was 84.6% and 87.5%, respectively, regardless of code 3 interpretation. The specificity for medial meniscal tears with and without the negative effect was 71.9% and 84.4%, respectively. The specificity with and without considering code 3 lesions as false positives was 89.2%, and 91.9%, respectively.

Laparoscopic cholecystectomy. Do preoperative factors predict the need to convert to open?

We reviewed our experience with the last 587 laparoscopic cholecystectomies performed between May 1990 and January 1993 to correlate preoperative findings that may predict the conversion of a laparoscopic cholecystectomy to that of an open procedure. The prediction of a need to convert to an open cholecystectomy would allow the surgeon to discuss the higher risk of conversion with the patient and also allow for an earlier intraoperative decision to convert if difficulty was encountered. In addition to routine demographic data, ultrasound reports were available for 526 patients and the following information was recorded: presence of stones, thickened gallbladder wall, common bile duct dilatation, gallbladder sludge, and cystic duct impaction. Overall, a two times higher rate of conversion was found for male patients and patients with a body mass index > 27.2 kg/m2. Additionally, a thickened gallbladder wall on preoperative ultrasound was correlated with a six times higher conversion rate to open cholecystectomy. As expected, the positive intraoperative cholangiogram was associated with a higher incidence of conversion. Additionally, finding a dilated common bile duct on ultrasound was found to be associated with a nearly seven times higher rate of positive intraoperative cholangiogram. No statistical significance was found between conversion and age, previous abdominal operations, the presence of stones, common bile duct dilatation, gallbladder sludge, cystic duct impaction, or a distended gallbladder. Thus, these predictive findings allow the surgeon to preoperatively discuss the higher risk of conversion and allow for an earlier judgment decision to convert if intraoperative difficulty is encountered.