Guidelines for radiologically guided lung biopsy.
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Ambulatory Surgical Procedures↗
Biomedical subjects
A Manhire
Publications and source records attributed to A Manhire.
HyCoSy--as good as claimed?
Hysterosalpingo contrast sonography (HyCoSy) has been compared favourably in the literature with hysterosalpingography (HSG). It does not require ionizing radiation and demonstrates the uterus and ovaries. HyCoSy is reported as being a safe, well tolerated, quick and easy investigation of Fallopian tube patency. Over a 1-year period HyCoSy was performed by two operators on 118 consecutive women who were thought likely to have patent Fallopian tubes. The examinations were graded using a local scale to assess discomfort and were correlated with tubal patency. HSG was performed on 116 patients by the same operators and discomfort recorded. 15 patients underwent both examinations. The degree of pain or reaction was graded 0 (no pain) to 4 (maximum) according to a locally devised scale. Costs of the two examinations were estimated. 89 patients examined by HyCoSy were graded 0-2. However, 23 had severe protracted pain and/or vasovagal reactions with bradycardia and hypotension. Of these, seven required resuscitation owing to prolonged symptoms, requiring treatment with atropine. 19 of the 23 had bilaterally patent Fallopian tubes. Where subsequent HSG was performed, tubal occlusion was confirmed in 8 of 15 women. Other pathologies were noted in 29 of the HyCoSy patients and there were six technical failures. During the same period no severe adverse reactions occurred in 116 patients having HSG performed by the same operators. Three of the HSG examinations were technically unsuccessful. Discomfort following HyCoSy was much greater than that reported previously. Possible mechanisms are discussed but it does not appear to be related to tubal occlusion. Diagnostic accuracy, costs and discomfort compare unfavourably with HSG.
Fallopian Tube Patency Tests↗
How do general practitioners respond to reports of abnormal chest X-rays?
General practitioners (GPs) in the UK have long had direct access to hospital radiological services, which in theory shortens investigation time and improves the quality of service. Chest X-rays (CXRs) account for a substantial proportion of requests, and we investigated what happened when an abnormality was detected. In one year, 204 GPs in the Nottingham area requested CXRs in 605 patients. 362 were reported normal, 165 abnormal but hospital follow-up not indicated and 71 abnormal with radiological follow-up or hospital referral indicated (mass lesion suspicious of tumours 27, infective shadowing 35, other 9). 64 of the 71 were seen in hospital within three months, and in those with suspected cancer the median time to follow-up was 20 days. These results show that GPs do act on the results of abnormal CXRs, but only 37% of those with a mass suspicious of cancer were seen in hospital within two weeks as recommended by the British Thoracic Society. Time might be saved if GPs agreed to direct referral from the radiology department to respiratory physicians.
Adolescent↗
Importance of placement of intra-articular steroid injections.
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Adult↗
The role of computed tomography in assessing the operability of oesophageal carcinoma.
The reliability of CT scanning in assessing resectability in carcinoma of the oesophagus was investigated prospectively by direct comparison with the operative findings. Over 11 months, 38 patients judged potentially operable following conventional investigation underwent CT scanning from the thoracic inlet to the level of the adrenal glands. These patients were then explored surgically with a view to resection. The CT findings were assessed by two radiologists without access to clinical information. Operative findings were recorded by the surgeon. Comparison was made between the tomographic and surgical findings specifically assessing: longitudinal tumour extent, direct mediastinal infiltration, invasion of other mediastinal structures, lymph node involvement and the presence of hepatic and pulmonary metastases. The sensitivity and specificity of the scan for each feature was then calculated. Scan sensitivity was poor, ranging from 0%-66.7%. Specificity was better with a range of 70.8%-100% according to the criterion studied. We conclude that the poor sensitivity means that CT scanning is of little value in the preoperative assessment of resectability in oesophageal carcinoma.
Aged↗
A controlled study of hand function in nodal and erosive osteoarthritis.
Hand function using a standardised test of activities of daily living was assessed in (a) 57 patients (53 female, four male; mean age 69 years) with established (that is, symptom onset greater than 10 years before) nodal generalised osteoarthritis (NGOA); (b) 10 patients (nine female, one male; mean age 70 years) with established erosive osteoarthritis (EOA); and (c) 52 matched controls (48 female, four male; mean age 71 years) with asymptomatic, clinically normal hands. Although significant differences between controls and patient groups were observed for individual tasks, only minor global impairment was seen, the worst function occurring in patients with EOA. There was no consistent correlation between tested aspects of hand function and extent of radiographic change assessed by summated graded score for separate osteoarthritic features in individual joints. In controls increasing age correlated with longer time to complete all tasks and weaker power grip; a similar, less pronounced correlation occurred in patients. Differences between controls and patients with NGOA were most apparent in younger subjects; in the elderly (greater than 80 years) hand function was essentially the same. This study shows good functional outcome for patients with NGOA, and suggests that the OA process is of little functional importance to the aging hand.
Activities of Daily Living↗
HLA-A, B antigens and alpha 1-antitrypsin phenotypes in nodal generalised osteoarthritis and erosive osteoarthritis.
HLA-A, B and alpha 1-antitrypsin phenotypes were studied in 90 unrelated patients with established nodal generalised osteoarthritis (OA). Compared with standard reference populations, independently increased frequency of the HLA-A1B8 and MZ alpha 1-antitrypsin phenotypes were observed (27% v 11.5%, relative risk 2.79, and 12% v 3.6%, relative risk 3.73 respectively). These associations related to developed of nodal generalised OA rather than to severity as judged by the summated radiographic scores for hand OA. Ten patients had marked subchondral radiographic erosions and were further classified as erosive OA; these patients had an increased frequency of the MS alpha 1-antitrypsin phenotype (30% v 9%) and higher radiographic OA scores corrected for presence of erosions. This first report of two independent genetic markers in nodal generalised OA is of interest in relation to the increasingly recognised inflammatory component of the osteoarthritis process.
Aged↗
Five years' experience of fine-needle aspiration biopsy: 454 consecutive cases.
Four hundred and fifty-four unselected consecutive patients who underwent fine-needle aspiration biopsy between 1978 and 1983 were reviewed restrospectively. The overall sensitivity of the technique in the diagnosis of malignancy was 77%. When pancreatic and biliary masses were excluded, the sensitivity was 84%. The predictive value of a positive was 100% and of a negative, 65%. Reasons for false negative biopsies are analysed. Ways of increasing the sensitivity of the procedure and improving biopsy techniques are discussed. No significant complications were encountered. We conclude that the technique is valuable, safe and can be performed in any hospital with basic ultrasonographic and radiological equipment, provided that there is a cytology service.
Biopsy, Needle↗
Evacuation pouchography in the evaluation of ileoanal reservoir function.
Thirty four patients with restorative proctocolectomy and ileoanal pelvic reservoirs were studied by "evacuation pouchography" to determine why only some patients could evacuate spontaneously. The 50 per cent who were able had a significantly shorter distal segment (P less than 0.02) of mean length (8 +/- 3 cm) that filled on straining, compared with those who had to use a catheter to empty the pouch, in whom the distal segment was longer (mean 11 +/- 4 cm) and often failed to fill on straining. The longer the distal segment, the more likely it was to be angulated, causing difficulty in passage of the catheter with possible ulceration and stenosis from minor trauma. Stricturing in the distal segment was associated with minor nocturnal leakage. A short distal segment is recommended to allow spontaneous evacuation and avoid the risks of repeated catheterization.
Adolescent↗
Not just fibre--the nutritional consequences of refined carbohydrate foods.
The dietary intake of 28 volunteers was assessed over two 6-week periods while they ate, alternately, a diet containing refined carbohydrate foods in commonly consumed amounts and a diet virtually devoid of such foods. The following nutritional effects of refined foods were observed: increased energy intake (except in low consumers of sugar), decreased intake of dietary fibre, and decreased intake of nearly all the vitamins and minerals recorded in tables of food composition. These effects may have harmful consequences.
Adult↗
Pyrophosphate arthropathy: a clinical and radiological study of 105 cases.
105 consecutive patients who presented to a rheumatologist because of joint disease and who also had evidence of deposition of calcium pyrophosphate dihydrate (CPD) were studied clinically and radiologically. There were 76 women (mean age 73) and 29 men (mean age 62). Of only 18 patients below the age of 60 at presentation 12 were men. The majority of the younger male group suffered from acute attacks of synovitis, and had no clinical or radiological evidence of joint damage. In contrast the older female group had widespread destructive changes. Associated joint disease included generalised osteoarthritis (45), rheumatoid arthritis (8), joint hypermobility (13), previous knee surgery (8), and gout 92). Sixteen patients had received long-term steroid therapy. Severe destructive joint changes were seen in 16 patients. The radiological features in those with rheumatoid arthritis by ARA criteria were atypical. The relationship between CPD deposition and arthritis is discussed in the light of these findings.
Acute Disease↗
Dietary fibre and diabetes.
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Carbohydrates↗
Unrefined carbohydrate and dietary fibre in treatment of diabetes mellitus.
Sixteen diabetics were studied over six-week periods on two diets--a conventional carbohydrate-restricted diet and a diet which excluded all refined (fibre-depleted) carbohydrate but which allowed unrefined (fibre-intact) carbohydrate freely. On the latter, there was a substantial increase in dietary fibre intake. Despite this, there was no change in 24-h urinary excretion of glucose nor in blood glycosylated haemoglobin concentration, and there was only a modest improvement in post-prandial plasma glucose concentration. We suggest that simply switching from refined to unrefined cereal foods without increasing total carbohydrate intake is unlikely to produce much improvement in diabetic control.
Adult↗
Diet and the diabetic: the fallacy of a controlled carbohydrate intake.
The dietary intake of 16 well-established diabetics was recorded over six-week periods on two different diets--a conventional, carbohydrate-controlled diet and an unrestricted, carbohydrate diet which allowed free choice as to quantity of food eaten and time of meals. In all patients the carbohydrate intake varied considerably from day to day and the variation was as great on the supposedly controlled carbohydrate diet as on the unrestricted diet. In agreement with other studies, carbohydrate intake was often considerably higher on the usual diabetic diet than had been recommended or than the patient believed they were taking. It is suggested that present methods for controlling the carbohydrate intake of diabetics are ineffective and, in particular, do not ensure a regular intake from day to day.
Adult↗