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Diagnosis of Cholelithiasis-Reply

Thomas McKenzie, MB, FRCS (Edin), CCFP
JAMA. 1985;253(1):40. doi:10.1001/jama.1985.03350250047011.
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In Reply.—  Venu et al have made a solid contribution. I do not dispute their thesis. Indeed, so persuasive is the argument that it runs the risk of being enshrined as dogma. Therefore, it seemed appropriate to enter an early caveat for the unwary. Their report dealt mainly with gallbladder stones, it is conceded, but in several instances common bile duct stones were also involved. Clearly, I do not advocate "blind" laparotomy as a routine procedure. It should not be necessary to state that the patient's interests are best served by adequate preoperative investigations and diagnosis, and all our efforts should be directed to this end. The newer technologies push us increasingly nearer to this ideal.The admonition is by now common-place that the techniques and interpretation of ultrasound and ERCP should be in the hands of well-trained and experienced practitioners. Dr Venu reiterated this point in his reply. Less


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