Biomedical subjects

C I Bartram

Publications and source records attributed to C I Bartram.

At least 19 recordsLinked to original sources

PubMed1992

The value of age of onset and rectal emptying in predicting the outcome of colectomy for severe idiopathic constipation.

We have evaluated the predictive value of pelvic floor dysfunction (as characterized by abnormal contraction during defaecation straining or absent balloon expulsion) and evacuation proctography on symptomatic severe idiopathic constipation after colectomy with ileorectal or colorectal anastomoses for improvement and the use of laxatives. We also determined whether there was a relationship between the age of onset of symptoms and the symptomatic outcome after surgery. Forty-four women (mean age 34 years) were studied. Twenty patients had had a preoperative evacuation proctogram. Of these, 8 evacuated completely and 12 incompletely. Of the 29 patients in whom puborectalis electromyography was performed, 19 had paradoxal contraction on straining. There was no statistical relationship between symptomatic outcome and complete or incomplete evacuation on proctography, the presence or absence of puborectalis paradox or the age of onset of constipation (before or after the age of 10 years). Twenty-five patients had a preoperative balloon expulsion test. Of these, 14 were not able to expel a 50 ml water-filled balloon, and all 14 (100%) still experienced postoperative pain; 8 (57%) were still using laxatives. Of the 11 patients who were able to expel a balloon, 6 (55%) experienced pain and 1 (11%) still required laxatives postoperatively. The differences in postoperative pain and laxative requirements between those unable and those able to expel the balloon were statistically significant. Thus the balloon expulsion test may have predictive value when considering colectomy in patients with severe idiopathic constipation.

Adolescent↗

PubMed1992

Colonic preservation reduces need for parenteral therapy, increases incidence of renal stones, but does not change high prevalence of gall stones in patients with a short bowel.

Forty six patients with less than 200 cm of normal jejunum and no functioning colon were compared with 38 patients with similar jejunal lengths in continuity with a functioning colon. Women predominated (67%), and the most common diagnosis in each group was Crohn's disease (33 of 46 no colon, 16 of 38 with colon). All patients without a colon and less than 85 cm of jejunum and all those with a colon and less than 45 cm jejunum needed long term parenteral nutrition. Six months after the last resection 12 of 17 patients with less than 100 cm jejunum and no colon needed intravenous supplements compared with 7 of 21 with a colon. Between 6 months and 2 years, little change occurred in the nutritional/fluid requirements in either group, though there was weight gain. Of 71 patients assessed clinically at a median of 5 years, none with more than 50 cm of jejunum and a colon needed parenteral supplements. Most (25 of 27) of those without a colon who did not need parenteral supplements required oral electrolyte replacement compared with few (4 of 27) with a colon. None of the patients without a colon developed symptomatic renal stones compared with 9 of 38 (24%) with a colon (p < 0.001). Stone analysis in three patients showed calcium oxalate. Gall stone prevalence was high but equal in the two groups--43% of those without and 44% of those with a colon.

Calcium Oxalate↗

PubMed1992

Imaging of the stomach and duodenum.

Problems in the distinction between gastritis and gastric cancer on CT and the evaluation of cancer on endoscopic ultrasonography have been highlighted. Four cases of gastric cancer in Crohn's disease draw attention to this as a disease-related complication. Patient preference for barium upper gastrointestinal study compared with endoscopy has been challenged, as has the reliability of the radiologic diagnosis of duodenitis. CT in peptic ulcer disease is evaluated and there is continued interest for interventional feeding techniques, with two papers on the fluoroscopic placement of nasoenteric tubes.

Diagnostic Imaging↗

PubMed1991

Anal endosonography in the investigation of faecal incontinence.

Forty-four consecutive patients with incontinence of solid stool of traumatic or idiopathic aetiology were examined by anal endosonography and standard anorectal physiology tests. Anal endosonography showed an external anal sphincter defect in four out of 11 (36 per cent) patients with idiopathic (neurogenic) incontinence. In the remaining seven patients both parts of the sphincter were intact and a linear relationship was found between the resting anal canal pressure and the endosonographic thickness of the internal anal sphincter. Twenty-eight out of 33 (85 per cent) patients with incontinence of traumatic origin had external sphincter defects, confirmed by concentric needle electromyogram mapping in the 19 patients in whom this was performed. Eleven of these 28 (39 per cent) patients also had disruption of the internal sphincter. Anal endosonography has revealed significant abnormalities in patients with faecal incontinence and has a complementary role to anorectal physiology in the routine investigation of these patients.

Adolescent↗

PubMed1991

Comparison between anal endosonography and digital examination in the evaluation of anal fistulae.

A prospective trial was performed comparing the accuracy of digital examination and anal endosonography in defining the anatomy of anal fistulae. Before operation 38 consecutive patients were assessed by the consultant in charge of the case, by a research fellow and by anal endosonography involving two radiologists. These findings were compared with the operative findings. Consultants correctly identified 26 of 33 internal openings, 29 of 34 primary tracks and 15 of 21 secondary tracks. The research fellow correctly identified 26 internal openings, 24 primary tracks and 10 secondary tracks. There was no significant difference between the accuracy of consultants and the research fellow. Anal endosonography identified 10 internal openings based on initial criteria. This rose to 24 when revised ultrasonographic criteria were applied. There was no statistical difference between consultant assessment and anal ultrasonography in correctly identifying intersphincteric and transphincteric tracks. Ultrasonography is unable to assess primary superficial, suprasphincteric and extrasphincteric tracks or secondary supralevator and infralevator tracks. Consultant assessment of secondary supralevator and infralevator tracks was correct in 78 per cent of cases.

Humans↗

PubMed1991

Confirmation of endosonographic detection of external anal sphincter defects by simultaneous electromyographic mapping.

Anal endosonography was performed in 13 consecutive patients with post-traumatic faecal incontinence. Thirteen acoustic defects in the external anal sphincter (two hyperechoic, four of mixed echogenicity and seven hypoechoic) were analysed electromyographically by locating under ultrasound guidance the tip of a concentric needle within the defect. The electromyographic activity in this zone was compared with ultrasonically normal muscle. Eleven of 13 sonographic defects showed no electrical activity on electromyography, there was one technical electromyography failure, and one defect was too deep to be reached by the electromyography needle. The electromyographic response was normal in each case within ultrasonically normal muscle. Anal endosonography is recommended as the initial investigation to locate defects, which may be confirmed electromyographically thereby limiting the number of painful needle insertions required for complete mapping of the external anal sphincter.

Adult↗

PubMed1991

Sphincter injury after anal dilatation demonstrated by anal endosonography.

Anal dilatation is still used in the treatment of anal fissure and haemorrhoids. Using anorectal physiology and anal endosonography we have studied 12 men presenting with faecal incontinence following anal dilatation. Resting anal pressures were low, pudendal nerve latencies were normal; 11 men had a disrupted internal anal sphincter and in ten this was extensively fragmented. Three also had defects of the external anal sphincter. These findings demonstrate for the first time the nature of the structural injury which may be caused by anal dilatation.

Anal Canal↗

PubMed1991

Endosonographic variations in the normal internal anal sphincter.

Anal endosonography provides clear images of the internal anal sphincter. Forty-two controls have been studied to establish a range for thickness and echogenicity of the normal internal sphincter, and any physical correlate for these observations. No relationship was found between the thickness of the internal anal sphincter and body weight, height or gender, but there was a significant correlation for thickness with age (p less than 0.001), the 95% confidence interval being 2.4-2.7 mm less than 55 years and 2.8-3.4 mm greater than 55 years. Hyperechogenicity of the internal sphincter was significantly associated with an age greater than 55 years (p less than 0.01) and a thickness greater than 2.8 mm (p less than 0.05). This has not been observed previously and suggests a histological change in the sphincter as it ages.

Adult↗

PubMed1991

Length of residual small bowel after partial resection: correlation between radiographic and surgical measurements.

The capacity for absorption after a small bowel resection depends upon the remaining length of intestine. This is important in planning nutritional therapy and affects surgical policy should further resection appear necessary. In 18 patients, the remaining small bowel length from the duodenojejunal flexure had been measured at operation and found to be less than 200 cm; this was compared with a measurement obtained by one observer using an opisometer on a subsequent barium follow-through (BaFT) examination. A significant correlation (p less than 0.001) of 0.72 was found. Radiographic measurement was easiest when the bowel was short (less than 150 cm) and all seen on one film with no overlapping loops. A residual small intestinal length of less than 200 cm measured from a BaFT radiograph is sufficiently accurate to formulate management decisions.

Barium Sulfate↗

PubMed1991

Unsuspected sphincter damage following childbirth revealed by anal endosonography.

Anal endosonography was performed in 62 consecutive patients with incontinence of flatus or faeces following obstetric trauma, and in 18 parous controls. Of the incontinent group, 90% had defects in the external sphincter, 65% in the internal sphincter and 44% disruption of the perineal body, compared with none of the controls. This triad of lesions is pathognomonic of obstetric trauma. Anal endosonography revealed a higher prevalence of sphincter damage than expected from anorectal physiology tests, and therefore has a role in screening patients following complicated or difficult deliveries.

Adult↗

PubMed1991

Imaging of the stomach and duodenum.

Twenty-two papers are reviewed; one on double contrast upper gastrointestinal tract studies and two on technical points relating to these; two on the biphasic upper gastrointestinal tract study; two on gastric cancer; and five on varied gastric topics. Six papers demonstrate continued interest in transabdominal gastroduodenal sonography. Four papers cover interventional techniques relating to the stomach, one with a novel approach to the removal of ingested metallic objects and three relating to percutaneous gastrostomy or gastroenterostomy.

Diagnostic Imaging↗

PubMed1990

A comparison between electromyography and anal endosonography in mapping external anal sphincter defects.

Mapping of the external anal sphincter by anal endosonography was compared with the electromyographic findings in 15 patients with fecal incontinence after perineal trauma. Both examinations showed no defect in three patients. In the 12 patients with muscle defects, there was agreement on the quadrant involved in all patients. In seven patients, there was total agreement in the hours of the defect, in four there was a one hour discrepancy, and in one there was a two-hour difference in the measured defect. Correlation between the two techniques was high (r = 0.96; P less than 0.01). Anal endosonography is better tolerated by patients than electromyographic mapping and is a useful technique for assessing posttraumatic defects of the external anal sphincter.

Adolescent↗

PubMed1990

Barium studies and ileoscopy compared in children with suspected Crohn's disease.

The findings on barium follow through, ileoscopy and biopsy of the terminal ileum in 46 children with suspected chronic inflammatory bowel disease have been compared to the final clinical diagnosis. Ileoscopy and barium follow through agreed in 91%, barium follow through and biopsy in 80% and barium follow through, ileoscopy and biopsy in 76% of cases. A pronounced lymphoid hyperplasia pattern was present radiologically in 24%, and was a source of error in two cases. Barium follow through compared favourably to ileoscopy or biopsy individually, detecting 18 of 20 and 17 of 20 cases respectively; however, ileoscopy combined with biopsy diagnosed every case. The sensitivity of the barium follow through was 0.90 with a specificity 0.96 for the diagnosis of Crohn's disease in the terminal ileum.

Barium Sulfate↗

PubMed1990

Determining the minimal interval between cleansing water enema and double-contrast barium enema examination.

In a prospective study 59 consecutive outpatients having double-contrast barium enemas (DCBE) were randomised into four groups. Each group had their enema performed at either a 15, 30, 45 or 60 minute interval following the end of a 1.5 litre cleansing water enema. Review of the films by two radiologists demonstrated that adequate mucosal coating was obtained after 45 minutes. The DCBE should therefore be performed at a minimum time interval of 45 minutes following colonic lavage, and not beforehand.

Barium Sulfate↗

PubMed1989

Anal sphincter dysfunction in Parkinson's disease.

Striated anal sphincter function was studied electrophysiologically and radiologically in six patients with Parkinson's disease and chronic constipation. In five cases, there was paradoxic anal sphincter muscle contraction during simulated defecation straining resembling anismus-type pelvic outlet obstruction. Radiologic studies showed functional improvement of the defecatory mechanism following the administration of the dopamine receptor agonist apomorphine in four patients. Dysfunction of the striated anal sphincter musculature may be a significant cause of constipation in some parkinsonian patients, occurring as part of the generalized extrapyramidal motor disorder.

Anal Canal↗

PubMed1989

Anal endosonography in the evaluation of perianal sepsis and fistula in ano.

Anal endosonography has been performed in 22 patients with fistula in ano and perianal sepsis and compared with the operative findings. Using a special hard cone attachment to a radial 7 MHz probe the examination was well tolerated, rapid and generally accurate, detecting two unsuspected foreign bodies and all seven complicated fistula in ano preoperatively.

Abscess↗

PubMed1989

Rectodynamics--quantifying rectal evacuation.

A new technique is described which allows the graphic quantitation of voluntary rectal evacuation. The subject is asked to evacuate 100 ml of barium sulphate paste as rapidly and completely as possible. Using a weight transducer it is possible to determine the maximum emptying rate, time to achieve maximum emptying and proportion of barium evacuated. Normal subjects evacuate quickly and completely. Patients with severe constipation demonstrate a variable evacuation disturbance.

Adult↗

PubMed1989

Anal endosonography: technique and normal anatomy.

Anal endosonography using a specially designed hard cone attachment to a radial 7-MHz probe has been performed in 26 normal patients -3 patients following lateral anal sphincterotomy, 1 patient undergoing electromyophysiological mapping of the external and sphincter, and in 2 resected specimens. The examinations were rapid, simple, and well tolerated, and they provided high-resolution images of the five layers of the anal canal: mucosa, submucosa, internal and sphincter, intersphincteric plane, and external anal sphincter. Views of the ischiorectal fossa were limited. The configuration of the anterior part of the external anal sphincter differed between males and females.

Anal Canal↗