The routine use of peroperative (pre-exploration) cholangiography was prospectively studied in 433 consecutive patients undergoing elective cholecystectomy. Satisfactory peroperative cholangiography was achieved in 396 patients using a C-arm image intensifier with image retention facility. Clinical indications for exploration of the common bile duct were noted for each patient but the decision for choledochotomy was determined by the cholangiographic results. Two hundred and forty-nine (63 per cent) patients had no clinical indications for duct exploration and cholangiographic findings were all normal. Of the 147 patients with positive clinical criteria, 39 (9.8%) had abnormal cholangiograms and required exploration of the common bile duct. In three patients duct exploration was negative giving a false positive rate of 0.73 per cent. The use of the image intensifier allowed dynamic study during cholangiography and optimum evaluation of the duct system. The results support the view that peroperative cholangiography could be restricted to patients with clinical indications for exploration of the common bile duct.

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Appendicitis occurring during pregnancy presents a difficult problem for both the treating gynecologist and the surgeon. We studied retrospectively the cases of 52 consecutive patients seen during a four-year period at Riyadh Central Hospital, a large and busy general hospital. The incidence of appendicitis in various stages of pregnancy, along with its symptomatology, physical signs, laboratory results, and operative findings, were analyzed. The rates of complications, especially maternal and fetal mortality, were also analyzed and findings compared with those reported elsewhere. There was no maternal mortality and a 4% fetal mortality. We concluded that an aggressive approach in the diagnosis and surgical management of these patients reduces the maternal and fetal mortality.

A 22-year old woman presented with unilateral painless sudden loss of vision due to a solitary choroidal granuloma with exudative neurosensory retinal detachment. Her medical history was negative. Her systemic examination was unremarkable except for a positive tuberculin skin test and mildly enlarged cervical lymph nodes, the biopsy of which confirmed the diagnosis of tuberculosis. Fundus fluorescein angiography showed the choroidal lesion with multiple small hyperfluorescent spots and central pigment epithelial detachment. Choroidal tuberculoma resolved completely, with full recovery of vision following antituberculous treatment. To the best of the authors″ knowledge, this is the first report of a tuberculoma of the choroid leading to the diagnosis and treatment of tuberculous lymphadenitis.

The proposed benefits of the technetium ( 99m Tc) scan in the screening of patients with clinically solitary thyroid nodules were assessed. One hundred seventy-eight patients with such lesions underwent Tc scanning followed by surgical resection. The solitary nature of the lesion was confirmed by Tc scanning in 153 (86%) patients. In the remaining 25 (14%), the scan showed patchy uptake by the thyroid gland, suggesting subclinical multinodularity. Of these 25 patients with conflicting clinical and scan findings, the lesion was confirmed to be solitary by operative and pathological findings in ten (40%) patients, of whom two patients had thyroid malignancies that might have been misdiagnosed as multinodular goiter. In the other 15 (60%) patients, the scan was accurate in detecting subclinical multinodularity, but again, two patients in this group had thyroid malignancies that might have been misdiagnosed as multinodular goiter. These findings indicate that the 99m