Endoscopic retrograde cholangiopancreatography.

The ERCP report in the patient's chart was compared with findings on common duct exploration or cystic duct cholangiography in 72 patients and found to have a sensitivity of 90.4 percent, a specificity of 98 percent, and an accuracy of 95.8 percent. Factors having the potential to influence the accuracy of ERCP were errors in interpretation by the surgeon and the radiologist and the operative technique of cholecystectomy. Also, the interval between the performance of the procedure and operation was particularly important in the patient with multiple small gallstones or small common duct stones. Small gallstones may spontaneously pass from the gallbladder to the common duct, or small common duct stones may spontaneously pass into the duodenum; therefore, the longer the interval between ERCP and operation, the greater the likelihood of a discrepancy. At operation, gallstones may be squeezed into the common duct during manipulation of the gallbladder unless the cystic duct is obstructed before manipulation of the gallbladder. We found ERCP sufficiently accurate to make cystic duct cholangiography unnecessary in most patients with cholelithiasis having a preoperative ERCP examination.

Serum albumin and body weight as predictors of postoperative course in colorectal cancer.

The influence of preoperative serum albumin and percent ideal body weight on postoperative outcome was examined in 83 patients operated upon for colorectal cancer. Compared to patients with normal preoperative body weight and serum albumin, the following were noted: 1) those with low serum albumins had increased rates of complications (p < 0.02) and deaths (p < 0.02); 2) complications were increased in obese patients (p < 0.02); and 3) those with two nutritional abnormalities had increased rate of complications (p < 0.05) and deaths (p < 0.01). The group at highest risk, those with both low body weight and decreased serum albumin, had a complication rate of over 70% and a mortality rate of 42%.

The effect of four jaw relations on electromyographic activity in human masticatory muscles.

Significant differences were found in the electromyographic (EMG) activation between the masseter and temporalis muscles for the leaf gauge (LG), manually manipulated (CR) and neuromuscular (NM) bite positions during maximal static clench. The LG position consistently demonstrated the lowest EMG activity, while the NM position displayed the highest degree of muscle activity. Similarly, the ratio of the masseter/temporalis EMG activity during maximal clench was lower for the LG and CR positions and highest for the NM position. These data indicate that the NM position produced the greatest total muscle recruitment, with more masseter involvement during maximal clench, and enabled the subjects to generate greater clenching forces in the NM position as compared to the LG and CR positions.

Lysophosphatidylcholine acyltransferase activity during experimental cholelithiasis.

The accumulation of (1-palmitoyl)lysophosphatidylcholine, lysolecithin, in gallbladder bile was observed during the first week of cholesterol-induced experimental cholelithiasis using the prairie dog model for cholesterol gallstone formation. Gallbladder fluid transport function decreased as bile lysolecithin concentration increased. These observations suggest that lysolecithin plays an important, early role in the etiology of gallstone disease. Furthermore, the relative activities of hepatic and gallbladder mucosa lysophosphatidylcholine acyltransferase and acylcoenzyme a hydrolases may be responsible for the turnover of gallbladder bile lysolecithin.

The effect of different condylar positions on masticatory muscle electromyographic activity in humans.

OBJECTIVES: The purpose of this study was to determine a condylar position that permitted the greatest total temporalis and masseter muscle activity in maximum static clench. STUDY DESIGN: Twenty normal adults, 9 women and 11 men, were evaluated to determine masseter and temporalis activity in maximum static clench with mandibular condyles in different therapeutic positions. Bimanually manipulated, leaf gauge, centric occlusion, and neuromuscular condylar positions were studied. RESULTS: When mandibular condyles were placed anteroinferiorly in a neuromuscular position, total masticatory muscle recruitment was the greatest. In a bimanually manipulated or a leaf gauge position, mandibular condyles were positioned superoposteriorly, producing the least amount of muscle recruitment. CONCLUSIONS: The result of any therapeutic position should be an improvement in muscle function. With respect to balance and activation, a neuromuscular condylar position proved to be the position capable of recruiting the greatest motor unit activity when compared with a bimanually manipulated position, a leaf gauge position, and a neuromuscular position.

Cluster-like signs and symptoms respond to myofascial/craniomandibular treatment: a report of two cases.

Two cases with pain profiles characteristic of cluster-like headache, both within and outside the trigeminal system, are reported. One male patient would typically awaken from sleep with severe unilateral temporal head pain and autonomic signs of ipsilateral lacrimation and nasal congestion. A female patient exhibited severe unilateral boring temporal and suboccipital head pain with associated ipsilateral lacrimation and rhinorrhea. In addition, both patients presented with signs and symptoms of masticatory and/or cervical disorders. These two cases illustrate possible treatment alternatives, as well as possible influences from cervical and masticatory structures in the development of cluster or cluster-like headache.

Benign sequelae of a transorbital stab wound: an unusual case report.

A case of a benign steak knife wound to the left orbit is presented. The perioperative strategy for this and similar injuries is discussed.

A technical aid in transoral wiring of mandibular fractures.

A technique is discussed for drilling and securing the inferior border of mandible fractures by a complete transoral approach. It simplifies the passage of interosseous wires and provides a stable fixation.