In five of seven patients with acute pancreatitis, Tc-99m HIDA scintigraphy failed to visualize the gallbladder. In all five patients the gallbladder was later found to be normal and in three of them normal filling was obtained at a repeat examination performed after the attack had subsided. Transient nonvisualization of the gallbladder in acute pancreatitis is probably due to disturbed motility of the biliary tree.
Patients with acute cholecystitis without common duct stones were studied pre- and postoperatively with 99mTc-HIDA scintigraphy. The resulting hepatic time-activity curves were analyzed. Preoperative serum bilirubin levels were closely correlated with hepatic discharge but not with hepatic uptake of the radiopharmaceutical. Cholecystectomy resulted in prompt improvement of hepatic discharge but did not affect uptake. In acute as well as in chronic cholecystitis cholangiograms taken before removal of the gallbladder were compared with those taken after. In acute cholecystitis the former view frequently showed medial displacement of the biliary tract and incomplete filling of its proximal part. Displacement of the duct was also apparent in comparisons of pre- and postoperative scintigrams. Jaundice in acute cholecystitis is due to reduced excretion which may be caused by pressure on the ducts by the distended gallbladder.
Abstract Background The aim of the present randomized trial was to compare the Shouldice procedure and the Lichtenstein hernia repair with respect to recurrence rate, technical difficulty, convalescence and chronic pain. A further aim was to determine to what extent general surgeons in routine surgical practice were able to reproduce the excellent results reported from specialist hernia centres. Methods Three hundred patients with primary inguinal hernia were randomized to either a Shouldice repair or to a tension-free Lichtenstein repair. In a pretrial training programme the five participating general surgeons were taught to perform the two techniques in a standard manner. Follow-up was performed after 8 weeks, 1 year and 3 years. The last examination was performed by an independent blinded assessor. Results There was a significant difference in operating time in favour of the Lichtenstein technique. After a follow-up of 36–77 months seven recurrences were found in the Shouldice group (95 per cent confidence interval (c.i.) 1·3 to 8·1) and one in the mesh group (95 per cent c.i. 0·0 to 2·0). Chronic groin pain was reported by 4·2 and 5·6 per cent in the Shouldice and Lichtenstein groups respectively. It was characterized as mild or moderate in all except two patients who had the Shouldice operation. Conclusion Lichtenstein hernia repair was easier to learn, took less time and resulted in fewer recurrences. It was possible to achieve excellent results with this technique in a general surgical unit.
This paper evaluates 420 ski injuries occurring in Northern Sweden in 1977. Our main aim was to correlate knee injuries with types of skiing and to note a change in incidence with evolution of equipment. Fifty-eight lesions (13.8%) affected the knee joint which is about the same frequency as 10 years earlier nor has introduction of high stiff boots in downhill skiing increased incidence of knee injuries. Cross-country and long-distance skiing produced more knee injuries (24.7%) than downhill skiing (11.4%). Cross-country skiers were older and more women in this group sustained knee injuries. The use of non-release type bindings is probably the main reason for this higher incidence but age and different skiing techniques seem to contribute.
Patients with normal gallbladders were subjected to computer-assisted Tc-HIDA cholescintigraphy at fixed intervals after major surgery. Hepatic time--activity curves showed that hepatic excretion of the material was first reduced and later a reduction of hepatic uptake followed. The gallbladder responded first by dilatation and reduction of motility and later by delay in or even absence of visualization. Postoperative dilatation was confirmed with real-time ultrasonography. No tracer passed into the duodenum in the early postoperative stage indicating spasm of the sphincter of Oddi. Healthy volunteers were studied with and without morphine and with and without a 24 h fast. The sphincter of Oddi closed after morphine but not after fasting. Transient non-visualization of the gallbladder after surgery makes the diagnosis of postoperative cholecystitis more difficult.
