Reappraisal of percutaneous transhepatic cholangioscopic lithotomy for primary hepatolithiasis.

BACKGROUND: A review of the literature pertaining to percutaneous transhepatic cholangioscopic lithotomy (PTCSL) showed that more than 50% of reported patients had undergone earlier biliary surgery. METHODS: A retrospective study investigated 74 patients undergoing initial PTCSL for hepatolithiasis who had undergone no prior biliary surgery or manipulation. The patients were followed for 1 to 23 years after PTCSL for effective evaluation of the procedure outcome. RESULTS: Complete clearance of hepatolithiasis was achieved for 61 (82%) patients. The incomplete clearance rate was higher for patients with intrahepatic duct stricture (11/37 [30%] vs 2/37 [5%]; p < 0.05), although it showed no relation to the actual lobar distribution of hepatolithiasis (left: 7/41 [17%] vs right: 2/11 [18%] vs bilateral: 4/22 [18%]; p < 0.05). The recurrence rate for hepatolithiasis also was higher for patients with intrahepatic duct stricture (18/26 [69%] vs 13/35 [37%]; p < 0.05), but the recurrence rate showed no relation to the lobar distribution of hepatolithiasis (left: 18/34 [53%] vs right: 4/9 [44%] vs bilateral: 9/18 [50%] p > 0.05) or the presence of gallbladder stones (5/12 [42%] vs 26/49 [53%]; p > 0.05). Patients showing the coexistence of retained or recurrent hepatolithiasis demonstrated a higher incidence of recurrent cholangitis (57% [13/23] vs 14% [7/51]; p < 0.01) or cholangiocarcinoma (17% [4/23]) vs 0% [0/51]; p < 0.01). CONCLUSIONS: The findings show that PTCSL is effective for treating primary hepatolithiasis, and that complete stone clearance is mandatory to diminish the sequelae of hepatolithiasis. Intrahepatic duct stricture was the main factor contributing to incomplete clearance and stone recurrence.

Racial differences in ischemic cerebrovascular disease: clinical and magnetic resonance angiographic correlations of white and Asian patients.

OBJECTIVES: We explored racial differences in ischemic cerebrovascular disease. METHODS: Clinical and magnetic resonance angiographic (MRA) features were compared in 21 white and 21 Asian patients with symptomatic ischemic cerebrovascular disease. RESULTS: When all carotid artery sites were combined and compared, whites had more stenotic lesions of internal carotid artery origin, and Asians had more stenotic lesions of the middle cerebral artery (MCA) stem. In the vertebrobasilar territory, there were no significant differences in the distribution of extracranial and intracranial stenotic lesions between the two races. In symptomatic territories, the distribution of extracranial and intracranial stenosis were not significant differences for white and Asian patients. In asymptomatic territories, whites had a higher tendency for isolated extracranial stenosis, whereas Asians had an increased incidence of isolated intracranial stenosis. In the combined symptomatic and asymptomatic, carotid and vertebrobasilar territories, there was an increased incidence of extracranial carotid stenotic lesions in white patients and intracranial anterior circulation stenotic lesions in Asians. Demographic factors alone seemed to explain the difference. CONCLUSIONS: Racial differences in the occurrence of extracranial and intracranial lesions raise the possibility of different pathophysiologic abnormalities.