Intraoperative cholangiography (IOC), used routinely or selectively, is the standard method for bile duct imaging during cholecystectomy. Laparoscopic ultrasonography (LUS) has emerged as a possible, safe and quick alternative. This study examined the evolving use and the performance of these two methods as primary technique for routine bile duct imaging, so as to detect common bile duct stones (CBDS) and to prevent common bile duct injury (CBDI). A prospective database permitted to evaluate the results of the two methods in 968 consecutive cholecystectomies. Nine hundered and twenty five were performed by laparoscopy, 18 (1.9%) by laparotomy and 25 (2.6) necessitated a conversion. The systematic use of the IOC was gradually replaced by a systematic use of the LUS. The success to delineate and evaluate the CBD, the detection of a CBDS, any type of bile duct complication, especially of CBDI, were registered. All the CBDS suspected by LUS were controlled by IOC. The patients were followed during 1 and 6 months. Six hundred and eighty five IOC and 269 LUS were performed. The procedure was technically unsuccessful in 35 IOC (5.1%) (mainly due to difficulty in catheterising the cystic duct) and in 2 LUS (1%) (due to steatosis). Concerning the detection of CBDS, 31 were detected by IOC (4.5%) and 16 by LUS (6%). Five IOC were considered as false positive, 1 as false negative (sensitivity and specificity of 96,9 and 99,2%) and 1 LUS as false positive (sensitivity and specificity of 100 and 99,6%). Five CBDI were detected in the complete seria: 2 during the dissection before the IOC, 1 thermic injury, 1 late stenosis, 1 lateral stenosis by the cystic clip detected by LUS. However none of these CBDI could have been prevented by IOC. In our experience, in this prospective study, LUS has been certainly as effective as IOC as a primary imaging technique for bile duct. It permitted to detect CBDS with a high specificity and sensitivity, and CBDS and was not followed by an increase in CBDI.

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Significant variation of the APE rate was observed. Adjustment for confounding factors as well as merging HR with APE rates were found to be important for the assessment of performances.

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Pathologic-histologic and immunocytologic as well as serologic findings from a total number of 50 recently dead or euthanatized moribund harbor seals (Phoca vitulina) are described. In 14 of 31 histologically examined brains of affected seals alterations corresponding to canine distemper encephalitis (CDE) were found. Immunofluorescence-serologic tests using polyclonal as well as monoclonal antibodies against canine distemper virus (CDV) resulted in positive findings in organ sections of 24 dead seals. An agent was isolated from organs of dead seals and subjected to several passages in vero cell cultures as well as in primary seal lung-cell cultures. The agent was able to be identified as canine distemper-like virus with both antibodies.CDV neutralising serum-antibodies were detected in 13 out of 19 serum specimens. Further interdisciplinary investigations are required to determine whether the virus induced alterationsstill to be interpretated only in a purely qualitative senseshould be considered as the manifestation of contributing ecological factors, or as the primary cause of the still present deaths of harbor seals.