A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography.

A prospective study was conducted from March 1999 to April 2000 that included 73 patients who underwent elective laparoscopic cholecystectomy for uncomplicated gallstone disease. The study was conducted at one surgical unit in the Department of Surgery and Department of Radio-diagnosis and one surgical unit in the Department of Surgery, Maulana Azad Medical College and the associated Lok Nayak Hospital, which is the largest referral hospital in northern India and is located in the capital of India. A preoperative ultrasound was performed just prior to surgery, and 4 ultrasonographic parameters were analyzed. namely gallbladder wall thickness, contracted gallbladder, impaction of gallstones at the neck of the gallbladder, and common bile duct stones. The surgical findings were objectively graded as difficult or easy laparoscopic cholecystectomy according to 5 operative parameters, namely total time taken for the surgery, time taken to dissect gallbladder bed, spillage of stones, tear of gallbladder during dissection, and conversion to the open procedure. Of the 73 cases, 17 (23.3%) were conversions to the open procedure. Of the 21 (28.76%) cases predicted to be difficult, 17 (23.3%) were technically difficult, of which 13 (17.8%) were converted to the open procedure. Of the 52 (71.23%) cases predicted to be easy on ultrasonography, only 7 (9.38%) were found to be difficult on surgery, of which only 4 (5.48%) had to be converted to the open procedure. Based on our results, we conclude that preoperative ultrasonography is of great value in selecting patients preoperatively for laparoscopic cholecystectomy and minimizing complications and conversion to the open procedure.

Duplex colour Doppler sonography - role in neck metastasis.

The present study was done to evaluate the rote of Duplex colour Doppler Sonography in neck metastasis. 30 patients with primary head and neck cancer were evaluated by Duplex colour Doppier sonography and results analysed. In more than 95% of cases, the vascular status could be established before any form of therapy was instituted. Compression and infiltration of carotids and internal jugular vein (IJV) could be demonstrated and a structured and dynamic relationship of metastatic nodes to the vessel wall was established.Doppier ultrasonography was found to be of high value in evaluating medium and large sized neck vessels but was of limited utility in the analysis of ncovascularisatlon within a metastatic node. This provided an operating roadmap for planning treatment. It is suggested that Colour Doppier Sonographic evaluation should be made a standard protocol in assessment of metastatic neck disease before instituting any form of therapy.

Gastrointestinal bleeding from a false aneurysm of the hepatic artery after cholecystectomy.

Acute gastrointestinal bleeding due to penetration of a partially thrombosed hepatic artery aneurysm into the duodenal bulb is rare but has been reported. Ultrasound, computed tomography, and angiography are the methods of choice for aneurysm detection. If clinical review and endoscopy are inconclusive in determining the cause of upper gastrointestinal bleeding, and no usual diagnosis can be established, a search for arteriointestinal fistula must be initiated.

Spinal dysraphism in achondroplasia.

The neurological complications in achondroplasia are commonly due to spinal canal stenosis. A case with rare coexistence of achondroplasia and dysraphic condition of the spine is presented wherein the neurological problem was presumably due to the latter.