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C Tonge

Publications and source records attributed to C Tonge.

4 recordsLinked to original sources

Healing of residual screw holes after plate removal.

A single photon absorptiometric method of imaging residual screw holes after plate removal is described. Application of this technique to seven patients demonstrated that ingrowth into these defects is a protracted process which remained incomplete at 18 weeks in all seven patients. Bone mass at the site of the screw holes was, however, close to normal at 18 weeks in four young adults, lending support to the AO-ASIF recommendation that athletic activity should be avoided for 4 months after plate removal.

Absorptiometry, Photon↗

Ultrasound and HIDA: scanning in evaluating bile leaks after cholecystectomy.

Ultrasound and 99Tcm-HIDA scanning were compared in the evaluation of postoperative biliary leakage after cholecystectomy. In thirty-five patients the abdomen was scanned and imaged on the first postoperative day. Isotope activity in the right upper quadrant and whole abdomen was determined to obtain an activity ratio. Ultrasonography was also performed. Accumulation of 99Tcm-HIDA in the gall bladder bed or over the surface of the liver was regarded as evidence of a bile leak. Eleven patients had abnormal 99Tcm-HIDA images (activity ratios of 0.20-0.77, mean 0.51) but only five patients had loculated fluid on ultrasound scanning. Twenty-four patients had normal 99Tcm-HIDA images (activity ratios of 0-0.17, mean 0.21), but fifteen of these had loculated fluid on ultrasound scanning. We conclude that bile leaks occur in 30% of patients following cholecystectomy and are best detected by 99Tcm scanning rather than ultrasonography.

Adult↗

Bile leaks after simple cholecystectomy.

Drains after cholecystectomy are used commonly to avoid biliary leaks and subsequent peritonitis. Thirty-five patients who had had cholecystectomy without drainage underwent 99mTc-labelled dimethylphenylcarbamoylmethyliminodiacetic acid (HIDA) and ultrasound scans the morning after surgery. Biliary leaks detected by positive HIDA scans occurred in 11 patients. Subhepatic fluid collections were seen on 20 ultrasound scans. There was no relation between biliary leaks and subhepatic collections. Many of the collections were not seen on the HIDA scan, suggesting that they contained blood and not bile. Many of the patients with bile leaks showed no fluid collection. Clinical complications were few and evenly distributed between those with positive and negative scans. We conclude that bile leaks are not an occasional event but occur after 31 per cent of undrained cholecystectomies and that these bile leaks remain clinically unimportant.

Bile↗

Intestinal calcium absorption in patients after jejuno-ileal bypass or small intestinal resection and the effect of vitamin D.

A forearm counter and double-isotope technique were used to measure intestinal calcium absorption in 21 patients after jejuno-ileal bypass for obesity or small intestinal resection. In all but 2 patients calcium absorption was below the normal range for 10 male controls. 3 weeks treatment with 1-alpha-hydroxyvitamin D, 1 microgram b.d., or 1,25-dihydroxyvitamin D, 1 microgram b.d., was associated with significant increases in absorption whereas 3 weeks treatment with 24,25-dihydroxyvitamin D had no effect. This study demonstrates that oral 1,25-dihydroxyvitamin D or 1-alpha-hydroxyvitamin D are effective in increasing calcium absorption.

24,25-Dihydroxyvitamin D 3↗