Abstract:
BACKGROUND:The ideal treatment algorithm for suspected choledocholithiasis is not yet well defined. Imaging options include magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and intraoperative cholangiogram (IOC). MRCP is diagnostic, while the other two modalities can also be therapeutic. Each of these modalities for diagnosis and treatment carries its own set of risks, benefits, and institutional costs. We hypothesized that there would be a significant difference between the biochemical profiles and characteristics of patients who undergo ERCP vs. MRCP vs. operative intervention as the initial choice of treatment/imaging modality. METHODS:We performed a retrospective review of the electronic medical records for all patients with a coded diagnosis of choledocholithiasis from 2011 to 2014. The initial diagnostic modality was assessed for each hospital encounter. The statistical characteristics of MRCP as compared to fluoroscopic imaging of the biliary tree (ERCP, IOC) were analyzed. RESULTS:Overall, 527 hospital encounters were identified. Initial intervention included ERCP in 63%, MRCP in 12%, and cholecystectomy in 25% of patients. Patients undergoing cholecystectomy first, compared to MRCP or ERCP, tended to have lower values for alkaline phosphatase (P < 0.001) and AST (P = 0.002) as well as be of younger age (P < 0.0001). Of the patients that underwent MRCP as their initial procedure, 82% subsequently underwent either ERCP or laparoscopic cholecystectomy. In patients who underwent an initial MRCP followed by either ERCP or IOC, the predictive performance of MRCP was as follows: sensitivity = 0.90, specificity = 0.86, positive predictive value = 0.97, negative predictive value = 0.60, agreement (Cohen's Kappa) = 0.64. CONCLUSIONS:There is a significant difference in the laboratory evaluation and demographics of patients undergoing ERCP, MRCP, and laparoscopic cholecystectomy. MRCP was followed with a more invasive test a majority of the time. Since MRCP did not change the management of patients with suspected choledocholithiasis, its utility in this patient population should be questioned. Further research is needed to better define the pretest characteristics which would predict which patients do not need further intervention after MRCP as well as defining the most cost-effective strategy.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Badger WR,Borgert AJ,Kallies KJ,Kothari SNdoi
10.1016/j.amjsurg.2016.10.025subject
Has Abstractpub_date
2017-08-01 00:00:00pages
251-255issue
2eissn
0002-9610issn
1879-1883pii
S0002-9610(16)30456-1journal_volume
214pub_type
杂志文章,评审abstract:BACKGROUND:The purpose of this study was to determine the axillary recurrence rate in breast cancer patients with a negative sentinel lymph node who did not have an axillary node dissection. METHODS:Sentinel lymphadenectomy for breast cancer patients, without axillary node dissection if the node was negative, was intr...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(02)00956-x
更新日期:2002-10-01 00:00:00
abstract:BACKGROUND:Capsule endoscopy (CE) is a new device that enables visualization of areas of the small bowel that were previously inaccessible through other noninvasive procedures. The purpose of this study is to evaluate this new diagnostic tool and its efficacy in finding occult GI tract pathology. METHODS:A single-inst...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2005.08.015
更新日期:2005-12-01 00:00:00
abstract:BACKGROUND:Our institution utilizes an esophagectomy pathway to guide postoperative management. Our aim was to identify risk factors associated with missing pathway goals. METHODS:Retrospective review of esophagectomies from 2010 to 2015. Multivariate logistic regression models identified risk factors for missing post...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2018.01.036
更新日期:2018-05-01 00:00:00
abstract::A 24-year-old woman with no significant past medical or surgical history presented with diffuse abdominal pain and distention with decreased frequency of bowel movements for 1 month. A computerized tomography scan showed a massively dilated cecum suggesting obstruction. Exploratory laparotomy revealed bowel obstructio...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2009.10.030
更新日期:2012-11-01 00:00:00
abstract::Fifty-three patients with upper gastrointestinal bleeding and proven esophageal varices were treated by intravascular injection sclerotherapy of the varices using a mixture of ethanolamine oleate, bovine thrombin and cephalothin. An intraesophageal balloon was used to impede craniad flow during the injection. Except i...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(82)90191-x
更新日期:1982-04-01 00:00:00
abstract::In an attempt to determine the late effects and associated morbidity of radiotherapy on normal tissue, patients with squamous carcinoma of the oral cavity and oropharynx were retrospectively reviewed. Between 1964 and 1975, 569 patients with cancer of the floor of the mouth, oral tongue, tonsil, and retromolar trigone...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(83)90247-7
更新日期:1983-10-01 00:00:00
abstract:BACKGROUND:Laparoscopic adrenalectomy is now the standard for pheochromocytoma. We report two decades of institutional experience with pheochromocytoma adrenalectomy. METHODS:A retrospective review was undertaken of pheochromocytoma adrenalectomy patients between 1997 and 2017. Clinical variables and postoperative com...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2019.03.016
更新日期:2019-05-01 00:00:00
abstract::Intragastric illumination using a flexible light source is described as a technical aid in the management of gastric bleeding. The flexible light source can be recommended for illumination of the proximal intragastric area to facilitate surgical control of bleeding from Mallory-Weiss lacerations, ulcers, varices, and ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(77)90173-8
更新日期:1977-06-01 00:00:00
abstract::Chronic granulating wounds were established in rats by excising burns inoculated with Escherichia coli. Recombinant human basic fibroblast growth factor was applied at dosages of 1, 10, and 100 micrograms/cm2 to the wounds of three groups of 20 animals on days 5, 9, 12, 15, and 18 after injury. The rate of wound closu...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(92)90004-b
更新日期:1992-03-01 00:00:00
abstract::Controversy continues about how often a negative laparotomy should be accepted in the management of patients with blunt and penetrating trauma. A key issue is the complications, especially small bowel obstruction. To define these complications, the charts of 248 patients who underwent negative laparotomy for trauma we...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(88)80549-x
更新日期:1988-12-01 00:00:00
abstract:BACKGROUND:Changes in the surgical training landscape have sparked an interest in developing new educational models anchored on entrustment assessment. We sought to optimize the validated OpTrust entrustment assessment tool by comparing ratings from short-course video reviews to previously validated intraoperative asse...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2017.10.036
更新日期:2018-07-01 00:00:00
abstract::The human papillomavirus (HPV) has been shown to be associated with neoplasms of the human colon using immunohistochemistry and in situ hybridization. We now report our use of the polymerase chain reaction and Southern blotting to investigate that same association. We selected 38 carcinomas, 21 adenomas, and 24 normal...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80690-7
更新日期:1993-12-01 00:00:00
abstract::The clinical efficacy and safety of cefotetan was assessed in two multicenter clinical trials involving 335 evaluable patients hospitalized with obstetric and gynecologic infections. In Study I, cefotetan was compared with moxalactam and in Study II, cefotetan was compared with cefoxitin. The clinical response rate in...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章
doi:10.1016/s0002-9610(88)80214-9
更新日期:1988-05-31 00:00:00
abstract::Fifty-six patients undergoing elective colonic resection were prospectively randomized into two groups either with or without postoperative nasogastric decompression. The results demonstrated only minimal differences between the two groups. Postoperative abdominal distention was more common in patients without nasogas...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-9610(87)90233-9
更新日期:1987-12-01 00:00:00
abstract::The results achieved by liver resection for metastatic cancer in more than 400 patients have been studied in a collected review. Certain conclusions seem justified: The liver is no longer the surgeon's "no-man's-land," and local excision of metastatic tumor can achieve clinical cure in some patients. The risk-benefit ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(78)90072-7
更新日期:1978-03-01 00:00:00
abstract::Eighty-two femoropopliteal reconstructions were performed on sixty-six consecutive patients. Of seventeen late failures, thirteen were secondarily reconstructed. Clinical and angiographic studies demonstrated the reasons for failure in all patients except one. Seven patients were improved and six unimproved by reopera...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(78)90107-1
更新日期:1978-02-01 00:00:00
abstract:BACKGROUND:Biopsy of a breast abscess wall has been performed for years without evidence. Aspiration of breast abscesses has been increasing in popularity without widespread acceptance. METHODS:A 10-year retrospective review of 206 surgical biopsies after incision and drainage of breast abscesses. A literature review ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2006.08.060
更新日期:2006-12-01 00:00:00
abstract::We have tested the interaction between serotonin and secretin in pentagastrin-induced gastric acid secretion in six dogs prepared with Thomas gastric and duodenal cannulas. We further examined the effect of methysergide, a serotonin antagonist, on gastric acid secretion. The intravenous administration of serotonin or ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(85)80007-6
更新日期:1985-01-01 00:00:00
abstract:BACKGROUND:Although informed consent is vital to patient-physician communication, little training is provided to surgical trainees. We hypothesized that highlighting critical aspects of informed consent would improve resident performance. METHODS:Eighty (out of 88) surgical postgraduate year 1 surgical residents were ...
journal_title:American journal of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.amjsurg.2014.12.044
更新日期:2015-09-01 00:00:00
abstract::Much literature supports the value of performance-based tests for obtaining an overall assessment of clinical skills; however, these tests can also identify specific deficits in medical curriculum and student learning. This study, conducted over a period of 2.5 years, used standardized patients to identify deficiencie...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80072-8
更新日期:1994-07-01 00:00:00
abstract:BACKGROUND:Recent literature suggests that peritoneal drainage (PD) is not helpful after elective pancreatectomy and may be detrimental. Data specific to distal pancreatectomy (DP) have not received prior evaluation. METHODS:We performed a retrospective review of patients who underwent DP. Factors examined included po...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2012.02.005
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:This study was designed to evaluate the impact of changes made to our morbidity and mortality (M&M) conference. METHODS:A 23-item survey using corresponding Likert-type scales was created. Faculty and residents were asked to anonymously complete the surveys in June 1999. Based on this information, specific ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(02)00791-2
更新日期:2002-03-01 00:00:00
abstract::Severe fasting hypoglycemia and hypoinsulinemia occurred in a sixty-six year old woman with an intrahepatic mesenchymal tumor. An extract from the tumor was potent in inhibiting the arginine-induced glucagon secretion from the isolated perfused porcine pancreas. This observation supports the theory recently advanced t...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(78)90095-8
更新日期:1978-02-01 00:00:00
abstract:BACKGROUND:To evaluate the clinical and laboratory characteristics of patients submitted to subtotal splenectomy during the immediate and late postoperative period. METHODS:The study was conducted on 34 patients, 25 of whom were submitted to subtotal splenectomy (group I), and 9 to total splenectomy without preservati...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(02)01407-1
更新日期:2003-04-01 00:00:00
abstract::Five patients with infected abdominal aortoiliac aneurysms were treated. The diagnosis was made preoperatively based upon fever, leukocytosis, positive blood culture findings, and presence of an aneurysm in all five patients. Two patients had salmonella species, two had staphylococcus species, and one had bacteroides ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(88)80137-5
更新日期:1988-05-01 00:00:00
abstract::Sixty-nine patients with pancreatic pseudocysts were reviewed. Chronic alcohol abuse was associated with pancreatitis in 78 percent of the patients. Presenting signs and symptoms were nonspecific. Ultrasonographic and computerized axial tomographic scans were most commonly used to established the diagnosis. Twenty pat...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(85)90407-6
更新日期:1985-12-01 00:00:00
abstract::Forty-six infants and children with primary malignant liver tumors were studied. Thirty-three had hepatoblastomas, 9 hepatocellular carcinomas, and 4 had sarcomas. Thirty-eight patients underwent liver biopsy or excision of the tumor. Nineteen patients were treated between 1952 and 1971 (mean survival 5.5 months) and ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(83)90381-1
更新日期:1983-08-01 00:00:00
abstract:BACKGROUND:Academic institutions have increasingly focused on educating physicians and surgeons in concepts of value-based care, including quality improvement (QI). The extent to which QI curricular competencies are addressed in specialty surgical residency training is unclear. METHODS:A survey instrument was develope...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2020.09.036
更新日期:2020-09-29 00:00:00
abstract::An analysis of unsuccessful extractions of retained biliary calculi using basket catheters reveals more than half the failures are related to the selection, placement, and size of the T tube. A new T tube has been developed which will improve postoperative access to the common duct and facilitate removal of retained c...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(78)90164-2
更新日期:1978-06-01 00:00:00
abstract::Ostomy closure following the Hartmann procedure is perceived to be associated with higher morbidity and mortality rates than is ostomy closure following divided colostomy, loop colostomy, and divided ileostomy-colostomy so that ostomy closure after Hartmann procedure may be denied to certain patients. To test that per...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(91)90125-w
更新日期:1991-12-01 00:00:00