Screening Examination For Patients Research Articles

Study protocol for FASTRAK: a randomised controlled trial evaluating the cost impact and effectiveness of FAST-MRI for HCC suRveillance in pAtients with high risK of liver cancer

IntroductionThe surveillance of hepatocellular carcinoma (HCC) using semi-annual liver ultrasound (US) is justified in patients with cirrhosis. In this context, US has a low sensitivity (<30%) for the detection of...

#3121 THE EFFECTIVENESS OF A GLUTEN-FREE DIET IN PATIENTS WITH IGA NEPHROPATHY

Abstract Background and Aims Modern data from the world literature confirm the association of IgA nephropathy (IgAN) and celiac disease. The inclusion of a gluten-free diet (GFD) in the diet has a beneficial effect not only on gastrointestinal symptoms, but also reduces the clinical and laboratory activity of IgAN. The aim of this study was to evaluate the effect of a gluten-free diet on the course of IgAN using general clinical and immunological tests 6 months after the start of its use. Method 65 patients with morphologically confirmed IgAN were included in the study. To detect a violation of gluten metabolism, screening determination of the level of IgA antibodies to tissue transglutaminase (Anti-TTG IgA) and IgA antibodies to deamidated gliadin peptides (Anti-DPG IgA) was performed. According to the results of the screening examination, a group of patients with the level of antibodies exceeding the reference values were formed (group 1, n = 13) and a group of patients in whose blood did not exceed the reference values, or were absent at all (group 2, n = 52). Patients of both groups were recommended GFD for a period of at least 6 months. The effectiveness of GFD was evaluated by the following indicators: protein in urine (g/l); red blood cells in urine (RBCs) (hpf); daily proteinuria (g/day); blood creatinine (mmol/l), GFR calculated by the formula CKD-EPI (ml/min /1.73 m2) at the beginning of the study and 6 months after the inclusion of dietary recommendations. Statistical analysis of the data obtained was carried out using the statistical program SPSS Statistics 26.0 (IBM, USA). When comparing quantitative indicators, the distribution of which differed from normal in two related groups, the Wilcoxon criterion was used. The null statistical hypothesis about the absence of differences and connections was rejected at p&amp;lt;0.05. Results among the examined patients there were 61 men (93.8%), 4 women (6.2%). The average age of men was 39.0±8.2 years, women - 34.7±9.7 years. The duration of the underlying disease at the time of inclusion in the study was 55.98 [40.67-71.28] months. 57 people (85.1%) received ACE inhibitors/sartans in therapeutic doses as the main therapy, 8 people (11.9%) did not receive drug therapy. It was possible to evaluate the effectiveness of GFD in patients from group 1 in 9 people. During the follow-up period, 2 patients from group 1 showed progression of the disease to the End-Stage Renal Disease (GFR according to CKD-EPI &amp;lt;15 ml/min/1.73 m2), which required their exclusion from the study, in 2 more patients it was not possible to evaluate the effectiveness of GFD due to insufficient follow-up periods (less than 6 months.) GFD was also recommended to patients from group 2. Dietary restrictions were applied to patients with daily protein loss &amp;gt; 0.5 g/day and/or anti-TTG IgA and anti-DPG IgA levels in the range of pre-reference values, thus it was possible to evaluate the effectiveness of GFD in patients of group 2 in 21 people. According to the results of the analysis, a statistically significant decrease in daily proteinuria (p = 0.028) and microscopic hematuria (p = 0.018) was revealed. After 6 months from the start of compliance with GFD, daily proteinuria decreased in 66.7%; microscopic hematuria – in 77.8% in group 1 patients. Among group 2 patients, a statistically significant decrease in microscopic hematuria (p = 0.05) was observed in 76.2% of those included in the study. Conclusion the inclusion of GFD in the diet of patients with IgAN is justified in patients with the presence of gluten antibodies in the blood serum, as it allows to significantly reduce the severity of proteinuria, microscopic hematuria in these patients. Screening examination of patients with IgAN for gluten metabolism disorders will expand therapeutic possibilities, and GFD can become part of a nephroprotective strategy.

Screening Digital Breast Tomosynthesis: Radiation Dose Among Patients With Breast Implants.

To compare the mean glandular dose (MGD), cancer detection rate (CDR), and recall rate (RR) among screening examinations of patients with breast implants utilizing various digital breast tomosynthesis (DBT)-based imaging protocols. This IRB-approved retrospective study included 1998 women with breast implants who presented for screening mammography between December 10, 2013, and May 29, 2020. Images were obtained using various protocol combinations of DBT and 2D digital mammography. Data collected included MGD, implant type and position, breast density, BI-RADS final assessment category, CDR, and RR. Statistical analysis utilized type II analysis of variance and the chi-square test. The highest MGD was observed in the DBT only protocol, while the 2D only protocol had the lowest (10.29 mGy vs 5.88 mGy, respectively). Statistically significant difference in MGD was observed across protocols (P < 0.0001). The highest per-view MGD was among DBT full-field (FF) views in both craniocaudal and mediolateral oblique projections (P < 0.0001). No significant difference was observed in RR among protocols (P = 0.17). The combined 2D (FF only) + DBT implant-displaced (ID) views protocol detected the highest number of cancers (CDR, 7.2 per 1000), but this was not significantly different across protocols (P = 0.48). The combination of 2D FF views and DBT ID views should be considered for women with breast implants in a DBT-based screening practice when aiming to minimize radiation exposure without compromising the sensitivity of cancer detection. Avoidance of DBT FF in this patient population is recommended to minimize radiation dose.

Resident Perspectives 56-5

Resident Perspectives 56-5

Contrast-Enhanced Digital Mammography Screening for Intermediate-Risk Women With a History of Lobular Neoplasia.

OBJECTIVE. The objective of this study was to assess to the role of contrast-enhanced digital mammography (CEDM) as a screening tool in women at intermediate risk for developing breast cancer due to a personal history of lobular neoplasia without additional risk factors. MATERIALS AND METHODS. In this institutional review board-approved, observational, retrospective study, we reviewed our radiology department database to identify patients with a personal history of breast biopsy yielding lobular neoplasia who underwent screening CEDM at our institution between December 2012 and February 2019. A total of 132 women who underwent 306 CEDM examinations were included. All CEDM examinations were interpreted by dedicated breast imaging radiologists in conjunction with a review of the patient's clinical history and available prior breast imaging. In statistical analysis, sensitivity, specificity, NPV, positive likelihood ratio, and accuracy of CEDM in detecting cancer were determined, with pathology or 12-month imaging follow-up serving as the reference standard. RESULTS. CEDM detected cancer in six patients and showed an overall sensitivity of 100%, specificity of 88% (95% CI, 84-92%), NPV of 100%, and accuracy of 88% (95% CI, 84-92%). The positive likelihood ratio of 8.33 suggested that CEDM findings are 8.3 times more likely to be positive in an individual with breast cancer when compared with an individual without the disease. CONCLUSION. CEDM shows promise as a breast cancer screening examination in patients with a personal history of lobular neoplasia. Continued investigation with a larger patient population is needed to determine the true sensitivity and positive predictive value of CEDM for these patients.

The 1-min animal test as a mental status screening examination in patients with diabetes

BackgroundDetecting and treating dementia at an early stage are important. Although the Revised Hasegawa Dementia Scale (HDS-R) is commonly used to detect dementia, it takes about 10 min to complete. In contrast, the 1-min animal test (OMAT) takes only 1 min to complete and may be a helpful screening test for general practitioners in deciding whether to proceed with administering further diagnostic tests such as the HDS-R. We sought to examine the relationship between the OMAT and HDS-R scores, and determine the cut-off OMAT score that balanced the sensitivity and specificity in identifying HDS-R-positive patients.MethodsA total of 122 consecutive patients with diabetes who visited the outpatient clinic at the Fujiidera Municipal Hospital were enrolled. The patients underwent the OMAT and HDS-R on the same day. Tests were conducted in a single-blinded manner. The relationship between the OMAT and HDS-R scores was examined using Spearman’s rank correlation. Receiver operating characteristic curve analysis was performed to identify the optimal cut-off score of OMAT that will determine whether to proceed with further diagnostic tests.ResultsA strong positive correlation between the OMAT and HDS-R scores was observed (r = 0.70). The sensitivity and specificity of OMAT using cut-off scores of 12/13, 13/14, and 14/15 for HDS-R-positive patients were 0.87 and 0.66, 1.00 and 0.51, and 1.00 and 0.40, respectively among all the subjects. Similar results were obtained in a subgroup of subjects aged ≥ 65 years.ConclusionsA cut-off score of 13/14 on the OMAT balanced the sensitivity closest to 1.00 and allowed for the highest specificity for the HDS-R not only among all the patients, but also among just the patients aged ≥ 65 years. The OMAT may be an optimal screening test to determine whether to proceed with further diagnosis using HDS-R.Trial registration UMIN UMIN000025260. This study is retrospectively registered on December 13th, 2016

The Edinburgh Cognitive and Behavioral ALS Screen (ECAS): a Russian version.

To translate into Russian and adapt the Edinburgh Cognitive and Behavioral ALS Screen (ECAS) for patients with amyotrophic lateral sclerosis (ALS). Medical care for ALS patients requires participation of a multidisciplinary team. More than one third of patients with ALS suffer from cognitive and behavioral disturbances, and it influences decisions of the team, patients and family. The scale for measuring of these disturbances should be rapid and understandable for evaluation and take into account the specificity of cognitive and behavioral impairments in ALS. ECAS met these criteria and allows screening examination of patients with ALS at different stages of movement impairment.

Usefulness of Calcium Scoring as a Screening Examination in Patients With a History of Kawasaki Disease

Subsets of patients with a remote history of Kawasaki disease (KD) have coronary artery aneurysms with associated risks of late morbidity. In a pilot study, we previously showed that computed tomography (CT) coronary artery calcium (CAC) scoring detects late CAC in patients with aneurysms and a remote history of KD. We performed CT calcium volume scoring in 166 subjects (median age 19.5years) with a remote history of KD (median interval from KD to CT 15.1years). Coronary arteries were classified as normal (n= 100), transiently dilated (n= 23), persistently dilated (n= 10), remodeled aneurysm (n= 9), or aneurysm (n= 24) based on echocardiography. All subjects with coronary arteries classified as normal, persistently dilated, or remodeled aneurysm had zero CAC. Of the 24 subjects with coronary aneurysms, all but 5 had CAC (median volume 542mm3; range 17 to 8,218mm3). For subjects imaged ≥9 years after their acute KD (n= 144), the presence of CAC had a sensitivity of 95% and a specificity of 100% for detecting coronary artery abnormalities (defined as coronary artery aneurysm and/or stenosis). In conclusion, coronary calcification was not observed in subjects with a history of KD who had normal coronary arteries by echocardiography during the acute phase. Coronary calcification, which may be severe, occurs late in patients with coronary aneurysms. Therefore, CAC scanning may be a useful tool to screen patients with a remote history of KD or suspected KD and unknown coronary artery status.

EXPERIENCE OF USING OF POCKET-SIZED VISUALIZATION TOOL IN EMERGENCY DEPARTMENT

The article is about experience of using handheld ultrasound tool by emergency physicians for screening examination of patients, hospitalized in Emergency Department

The diagnostic value of non-contrast enhanced quiescent interval single shot (QISS) magnetic resonance angiography at 3T for lower extremity peripheral arterial disease, in comparison to CT angiography

BackgroundThe high incidence of renal insufficiency in patients with Peripheral Arterial Disease raises the concern for nephrogenic systemic fibrosis (NSF) with respect to contrast enhanced MRA. The risk of NSF is eliminated with non-contrast enhanced magnetic resonance angiography. The purpose of the current study is to compare image quality and diagnostic performance of non-contrast enhanced Quiescent Interval Single Shot (QISS) magnetic resonance angiography at 3 T versus CT angiography for evaluation of lower extremity Peripheral Arterial Disease (PAD).Methods32 consecutive patients (23 male, 9 female, age range 40–81 years, average age 61.97 years) with clinically suspected lower extremity PAD underwent QISS MRA and CTA. 19 of 32 patients underwent Digital Subtraction Angiography (DSA). Image quality of MRA was compared with CTA by two radiologists with 10 and 8 years’ experience according to a 4-point scale. The Kappa test was used to determine the intermodality agreement between MRA and CTA in stenosis assessment, and interobserver agreement with each method. Sensitivity and specificity of CTA and MRA in detecting hemodynamically significant stenosis (≥50 %) were compared, with DSA serving as reference standard when available.ResultsImage quality of QISS MRA was rated 3.70 ± 0.49 by reader 1, and 3.72 ± 0.47 by reader 2, significantly lower than that of CTA (3.80 ± 0.44 and 3.82 ± 0.42, P < 0.001 for both readers). Intermodality agreement between MRA and CTA was excellent for assessment of stenosis (Kappa = 0.923 ± 0.013 for reader 1, 0.930 ± 0.012 for reader 2). Interobserver agreement was 0.936 ± 0.012 for CTA and 0.935 ± 0.011 for MRA. For readers 1 and 2 respectively, the sensitivity of QISS was 94.25 and 93.26 % (versus 90.11 and 89.13 % for CTA, P > 0.05), and specificity of QISS was 96.70 and 97.75 % (versus 96.55 and 96.51 % for CTA, P > 0.05). For heavily calcified segments, sensitivity of QISS (95.83 and 95.83 %) was significantly higher than that of CTA (74.19 and 76.67 %, P < 0.05).ConclusionQISS is a reliable alternative to CTA for evaluation of lower extremity PAD, and may be suitable as a first-line screening examination in patients with contraindications to intravenous contrast administration.

Occurrence of antibodies to Anaplasma phagocytophilum in patients with suspected tick-borne encephalitis.

Human granulocytic anaplasmosis (HGA) is an emerging tick-borne infectious disease caused by Anaplasma phagocytophilum. In Europe, the first serological evidence of HGA was described in 1995 in Switzerland, and the first clinical case was confirmed in 1997 in Slovenia. Since then, many European countries, including Slovakia, have reported the occurrence of HGA. The aim of this study was to examine the occurrence of IgG antibodies against A. phagocytophilum in blood sera of humans with suspected tick-borne encephalitis. 181 people were examined for the presence of anti-A. phagocytophilum IgG antibodies; 113 were patients with suspected TBE (65 males, 48 females), and 68 from the control group (18 males, 50 females). Respondents were aged 2-80 years (mean age: 31.39; STD: 17.1). Anti-A. phagocytophilum IgG antibodies were detected by the IFA IgG test. Relative risk (RR) and their 95% confidence intervals (95% CI) were estimated for the occurrence of IgG A. phagocytophilum antibodies. Of the total number of 181 people examined, 32 (17.7%) showed positive for IgG antibodies against A. phagocytophilum, 22 of whom were patients with suspected TBE (19.5%) and 10 people from control group (14.7%). The RR of occurrence of IgG A. phagocytophilum was 1.3-times higher in the patients with suspected TBE than in the control group. None of the examined patients with suspected TBE had the disease confirmed. Hoever, as shown by the results, the relative risk of occurrence of anaplasmosis is higher in people examined for some another vector-borne disease (in this case TBE). Therefore, the performance of screening examinations in patients suspected of having any tick-borne disease is very important.

1533: The Usefulness of Ultrasonography for the Initial Diagnosis of Deep Vein Thrombosis in Patients with Swollen Extremities

Pulmonary embolism (PE) causes respiratory distress and often fatal. Detecting deep vein thrombosis (DVT), as a source of embolisms, is helpful as a prevention of aggravation or recurrence. We will present the usefulness of ultrasonography(US) for diagnosing DVT noninvasively in patients with swollen or painful limbs, and for diagnosing recurrent DVT or post-thrombotic syndrome. For 9 years, 45 patients (female: 35) with DVT (acute stage: 16, Complicated with PE: 6 , Location of thrombus: Iliac vein 9, Femoral 26, Popleteal 5, calf/soleal vein 5) were diagnosed in 968 patients visited at our medical office due to swollen limbs. Chronic venous insufficiency, thrombophlebitis, cellulitis, ruptured Baker's cyst, subcutaneous or intra-muscle hematoma, torn gastrocunemial muscle, disuse edema and lymphedema are diagnosed finally by noninvasive US after having differentiated from systemic edema (i.e. congestive heart failure, nephrotic syndrome, hepatic failure, etc). Also calf vein thrombus, which extend to involve the proximal veins and cause PE, is identified reliably by US. Because noninvasive US can be easily performed in medical office, it is extremely useful in the screening examination for patients with swollen limbs. Pulmonary embolism (PE) causes respiratory distress and often fatal. Detecting deep vein thrombosis (DVT), as a source of embolisms, is helpful as a prevention of aggravation or recurrence. We will present the usefulness of ultrasonography(US) for diagnosing DVT noninvasively in patients with swollen or painful limbs, and for diagnosing recurrent DVT or post-thrombotic syndrome. For 9 years, 45 patients (female: 35) with DVT (acute stage: 16, Complicated with PE: 6 , Location of thrombus: Iliac vein 9, Femoral 26, Popleteal 5, calf/soleal vein 5) were diagnosed in 968 patients visited at our medical office due to swollen limbs. Chronic venous insufficiency, thrombophlebitis, cellulitis, ruptured Baker's cyst, subcutaneous or intra-muscle hematoma, torn gastrocunemial muscle, disuse edema and lymphedema are diagnosed finally by noninvasive US after having differentiated from systemic edema (i.e. congestive heart failure, nephrotic syndrome, hepatic failure, etc). Also calf vein thrombus, which extend to involve the proximal veins and cause PE, is identified reliably by US. Because noninvasive US can be easily performed in medical office, it is extremely useful in the screening examination for patients with swollen limbs.

急性感音性難聴を示した海綿状血管腫の一症例

The origin of vertigo is difficult to identify since a similar symptom occurs in either central or peripheral impairment. An initial evaluation of the patient's clinical history, as well as his clinical manifestations are important for correct diagnosis. Final diagnosis typically depends on conventional imaging techniques, such as CT and MRI. Here, we describe a patients whose functional examination was quite helpful to identify the lesion. The patient was case a 44-year-old man with cavernous hemangio-ma in the brainstem presenting acute hearing loss with vertigo. Initially he was diagnosed as having peripheral vertigo by neurological examinations together with CT images. Later a rare cavernous hemangioma was identified by head MRI. In the process of diagnosis, the result of auditory brainstem response (ABR) strongly suggested brainstem impairment. This case reveals that conventional imaging procedures, such as CT, are inadequate for diagnosis, whereas functional exams, such as the auditory brain stem response (ABR), are quite helpful for clinical evaluation. ABR can work as a screening examination for patients with vertigo to rule out brainstem lesion even in patients with normal hearing.

Metastatic spine tumors.

Cancer is the second leading cause of death in the United States, and vertebral body metastases often occur in systemic malignancy. Metastatic spinal tumors may present with pain or neurologic deficit, or may be detected during screening examinations in patients with known malignancy. Management of spinal metastases remains controversial. The role of surgery, especially decompressive laminectomy without stabilization, has been questioned. Recent series attest to the beneficial role of surgery, emphasizing anterior and combined decompression and stabilization procedures. We review the relevant literature on metastatic spinal tumors, assessing imaging strategies, adjuvant treatment, patient selection, and results and complications. Operative decompression and stabilization is an important tool in the management of spinal metastatic disease. Patient selection and appropriate use of anterior and/or posterior decompression and stabilization are necessary to optimize surgical results.

頚動脈エコー 頚動脈エコーによる頚動脈病変の評価

Carotid ultrasonography (CUS) is essential for evaluating the carotid artery lesion in the following reasons. First, CUS is useful as a screening examination for patients with risk factors, because of its noninvasiveness and feasibility. Patients with hypertension, DM, hyperlipidemia or cardiovascular diseases have frequently progressive carotid artery lesions. CUS is recommended in patients with such risk factor who are symptom. Second, CUS is used to follow up carotid artery lesions, because of its non-invasiveness. Carotid artery stenosis often progresses increasing stroke risks, while the stenosis is retracted in some patients. Third, CUS can evaluate the nature of plaque not only morphologically but also pathologically. Plaques are classified into echolucent, echogenic and hyperechoic from their echogenesity, and these classifications reflect atheroma/thrombus, fibrous tissue and calcification, respectively. Such tissue characterization is useful to evaluate the plaque vulnerability. Forth, CUS allows us to recognize the plaque mobility. Recently some plaques were found to strain with heartbeat, although the existence of floating thrombus attached to plaques has been known for many years. Strained plaques are considered reflect acute intra-plaque hemorrhage, and this finding is the serious sign of unstable plaque.

Traumatic and psychosocial distress in patients with acute tumors

For patients, being diagnosed with cancer means being confronted with a life-threatening illness and can thus be considered a traumatic experience. This situation is compounded by the fact that having cancer is usually not an isolated event but is generally a long-term stressor. The aim of the present study was a) the assessment of psychotraumatic and comorbid distress in tumor patients both in the acute stage (T1) and over time (T2), b) the identification of possible protective factors, and c) the identification of risk factors for the development of a posttraumatic stress reaction (PTSR) following the diagnosis of a tumor. The sample consisted of 46 patients who had to undergo surgical treatment for a newly developed tumor for either diagnostic or therapeutic purposes. The following psychosocial factors were examined: posttraumatic stress, dissociative reactions, anxiety, depression, cognitive-emotional distress, social support and processing the illness. More than 25 % of the patients demonstrated signs of a clinically relevant PTSR at the acute stage (T1) and almost 40 % did so four months later (T2). Significantly more women showed a PTSR at both points of measurement, but particularly at follow-up. No significant relationship could be found between the type of the tumor at T1 and the emergence of a PTSR at T2. Patients with PTSR at T2 showed higher scores for anxiety and depression. The most important predictors for the development of clinically relevant posttraumatic symptoms at the four-month follow-up examination were female sex, PTSR at T1 as well as elevated levels of depression. The results indicate the clinical relevance of psychotraumatic screening examinations in patients with acute cancer illnesses both for diagnostic as well as therapeutic investigations.

Importance of diastolic velocities in the detection of celiac and mesenteric artery disease by duplex ultrasound.

To assess the predictive value of ultrasound duplex scanning in the detection of superior mesenteric artery (SMA) and celiac artery (CA) occlusive disease. Thirty-nine patients in whom mesenteric ischemia was suspected were examined with duplex scan and arteriography. Duplex scan visualized both vessels in all examined patients. An absent Doppler signal from an adequately visualized SMA or CA was a pathognomonic sign for total occlusion of the arteries. Elevated diastolic velocities (peak diastolic velocity > 70 cm/sec for SMA and > 100 cm/sec for CA) were accurate predictors of arteriographically confirmed stenoses > or = 50%. Increased blood velocity was occasionally observed in a thyrotoxic patient with malabsorption-induced weight loss and abdominal pain but arteriographically-normal SMA. Further examinations of hyperthyroid patients showed systematic elevation of peak systolic velocity in the SMA greater than 300 cm/sec but normal diastolic velocities and resistivity indexes. Duplex ultrasound is a highly selective and specific method for detection of SMA and CA occlusive disease. The most accurate predictors of the disease were increased diastolic velocities, which in contrast to peak systolic velocity also correctly classified thyrotoxic patients. The method can be used before arteriographic evaluation as a screening examination of patients in whom mesenteric ischemia is suspected.

Musculoskeletal infections in patients with AIDS: CT findings.

The CT appearances of various musculoskeletal infections found in patients with AIDS are illustrated. Recognition of these infections is important for management of patients, but conventional laboratory tests may be inadequate in screening for infection or confirming the response of the host to therapy. As a screening examination for patients with AIDS, CT can suggest or confirm the presence of musculoskeletal infections even when infection has not been suspected.

Intestinal perforation due to cytomegalovirus infection in patients with AIDS

Intestinal perforation due to cytomegalovirus (CMV) infection in patients with AIDS is the most common life-threatening condition requiring emergency celiotomy in these patients. The authors describe a patient with AIDS with intestinal perforation due to CMV infection, and review 14 additional cases reported in the English-language surgical literature. The diagnostic triad of pneumoperitoneum on x-ray, evidence or history of CMV infection, and AIDS occurred in 70 percent of patients. The most common site of intestinal perforation was the colon (53 percent), followed in frequency by the distal ileum (40 percent) and appendix (7 percent); perforation usually occurred between the distal ileum and splenic flexure of the colon. Colonoscopy, rather than sigmoidoscopy, is recommended as a screening examination in patients with AIDS suspected of having colonic ulceration due to CMV infection. Multiple biopsies of ulcerated tissue should be obtained. Gross and microscopic analyses of involved intestinal tissue reveal the characteristic findings of ulceration and CMV infection. Despite aggressive therapy, the operative mortality rate in patients with AIDS with intestinal perforation due to CMV infection was 54 percent and the overall mortality rate was 87 percent. Postoperative complications occurred in most patients and consisted mainly of systemic sepsis and pneumonia caused by Pneumocystis carinii infection. An increased awareness of this syndrome by physicians frequently called on to manage patients with AIDS is recommended.

Operative cholangiography

The value of operative cholangiography in the management of biliary tract disease has been questioned. To better define the role of cholangiography, we reviewed 579 consecutive cholecystectomies done by 1 group of surgeons in a small rural practice over 8 years. Cholangiography demonstrated unsuspected common bile duct disease in 5% of the procedures, while 12% of the patients were spared an unnecessary choledochotomy after a normal cholangiogram was obtained. There was no morbidity, mortality, or prolongation of the hospital stay attributed to the cholangiographic procedure. These findings bolster the argument for routine cholangiography as a safe, effective, and helpful screening examination for patients who are at risk for having common bile duct disease.