Biomedical subjects
Publications and source records attributed to D J Morewood.
Two cases of pyeloduodenal fistula are described. Previously reported cases are reviewed with discussion of clinical aspects and the role of various radiological investigations. Conservative management with internal ureteric stenting (intraoperative or percutaneous) is suggested as an alternative to nephrectomy.
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A prospective study of the post-micturition radiograph in 539 consecutive intravenous urograms was performed. In only 1% of patients was a post-micturition residue demonstrated only on this radiograph and not on the control radiograph. The post-micturition radiograph helped in making a firm diagnosis in two out of six patients with vesico-ureteric junction calculi, which were suspected but could not be confidently diagnosed without it. It was also helpful in two out of 13 bladder patients with carcinoma, enabling a confident diagnosis to be established where the lesion had only been suspected. It would seem pertinent to restrict the post-micturition radiograph to cases of haematuria and possible vesico-ureteric calculi.
Pulmonary function tests and a radiological assessment of the larynx and cervical trachea were performed in 26 patients with acromegaly. Pulmonary function tests demonstrated six out of 26 patients to have upper-airways obstruction, while laryngeal tomography demonstrated 14 cases with marked narrowing of the true and false cords. The tracheal dimensions were normal. The thickness of both the true and the false cords showed a statistically significant increase, using the Mann-Whitney U-test, in both male and female patients compared with controls. The transverse tracheal diameter was significantly decreased in male but not female patients. These findings suggest that pulmonary function tests and radiological assessment are of value in indicating those patients with acromegaly who may be at increased risk when undergoing general anaesthesia.
Domperidone 8 mg intravenously and metoclopramide 10 mg intravenously, in patients given a standard barium sulphate preparation, were compared with a rapid-transit barium (E-Z-Paque, E-Z-Em) in a double-blind random controlled manner. E-Z-Paque and metoclopramide given with a standard barium preparation decreased small-bowel transit time and resulted in fewer radiographs being taken. Gastric emptying occurred most rapidly with metoclopramide and a standard barium sulphate preparation. There was no significant difference in the quality or diagnostic accuracy of the examinations with any of the three techniques, and no difference in the incidence of side-effects with the two drugs.
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A dose of 0.3 micrograms/kg body weight of ceruletide was assessed for its effect on gallbladder contraction and bile duct delineation following oral cholecystography. Nausea, vomiting, and abdominal pain sometimes occurred after ceruletide. No relationship was found after ceruletide administration between the radiologic appearances of the biliary tract and reproduction of the patients' biliary-type symptoms. Ceruletide cholecystography is regarded as an inaccurate investigation of biliary tract function.
A case of segmental dilatation of the ileum with an associated Meckel's diverticulum is reported in an 8-year-old child with anaemia. The pre-operative demonstration of this association has not previously been described in the literature.
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Many elderly patients with suspected colonic neoplasm are referred to radiology departments for barium enema. Despite routine use of laxatives and colonic washouts and employment of antispasmodic drugs, problems occur with faecal residue and poor retention of barium. This may lead to inadequate demonstration of the caecum. Over a 6-month period sonography following the barium enema allowed a confident diagnosis of a caecal mass lesion to be made in five such patients, whose barium enema had been suspicious but suboptimal. It is suggested that in some patients sonography, where positive, may shorten and facilitate investigation.