Biomedical subjects
Publications and source records attributed to D J Nolan.
The small bowel enema (barium infusion, enteroclysis) is a valuable radiological procedure that is easy to use and gives consistently good results. The technique is described and important aspects of the examination are discussed.
Two cases of abdominal aortic aneurysm presenting with duodenal obstruction following truncal vagotomy and pyloroplasty are described. Barium examination revealed the site and cause of obstruction in both. In one case the aneurysm was successfully resected.
During a 10 year period 49 patients were operated upon in Oxford for Meckel's diverticulum. Radiological imaging of the small intestine with radionuclide scintigraphy, small bowel barium enema or angiography was performed in 11 patients. Radionuclide scintigraphy was positive in one out of six patients investigated. The small bowel barium enema detected an abnormality in seven out of eight patients examined and identified the diverticulum in six. Angiography was performed in three patients and active bleeding was demonstrated in two. Our experience would indicate that the small bowel enema is the method of choice for the investigation of suspected Meckel's diverticulum. Patients with acute bleeding should, however, be investigated with angiography.
Clinical compliance with the Royal College of Radiologists' guidelines on the use of pre-operative chest radiology was examined in a random sample of patients in four hospitals in England and Wales. Pre-operative clinical data were abstracted from medical reports and, in one hospital, from special chest radiograph request forms completed by clinicians. Seventy-five per cent of patients had clinical indications warranting a pre-operative chest radiograph. This level of compliance is compatible with that found with other guidelines and would suggest that the pre-operative chest radiograph guidelines are suitable for wider implementation in the National Health Service.
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The Royal College of Radiologists' guidelines on the use of pre-operative chest X-rays were implemented for 1 year in four hospitals in England and Wales. The strategies adopted were: (1) the appointment of a utilisation review committee; (2) getting feedback on use to consultants; (3) the introduction of a new chest X-ray request form; or (4) the concurrent reviewing of chest X-ray requests by the radiology department. The lowest level of use (8.5 pre-operative chest X-rays per 100 elective operations) was achieved with the utilisation review committee after it displayed the guidelines in surgical wards. Information feedback produced a consistent reduction from 29.4 to 13.3 X-rays per 100 operations. Both the new request form and concurrent review had a moderate and intermittent effect. No change in practice occurred in a control hospital.
A retrospective analysis was made of 114 new patients attending a gastroenterology clinic, in whom the initial clinical diagnosis was irritable bowel syndrome. Barium enemas were performed in 84 patients (74%), 15 of whom were found to have significant other disease. In each case this would have been suspected from the routine haematological and biochemical screening tests. It is suggested that, in the investigation of patients under 50 years of age presenting to a gastroenterology clinic with a typical history of irritable bowel syndrome, a barium enema should only be performed if the clinical examination, sigmoidoscopy, rectal biopsy or routine blood tests are abnormal. This policy would reduce substantially the number of normal barium enemas performed.
Immobilization of the cervical spine is a common prehospital and emergency department maneuver. The ability of four different cervical collars to immobilize the cervical spine was studied using radiographic measurement in seven normal volunteers. Restriction of motion during flexion, extension, and lateral bending was studied. Differences between collars exist and require further study to identify the optimum device for immobilization of the cervical spine.
Plain radiographs and barium studies remain the primary imaging procedures in patients with known or suspected Crohn's disease or ulcerative colitis. The newer imaging modalities such as radionuclide studies, ultrasound and angiography have an important role in selected cases.
The radiological findings, using a single-contrast barium infusion technique, are described in a series of 13 patients with chronic radiation enteritis. The signs include evidence of submucosal thickening, single or multiple stenoses, adhesions and sinus or fistula formation. A combination of these signs characterises the condition. This technique is particularly suited to the investigation of radiation enteritis because of its ability to distend maximally the small intestine. A cause, stenosis and/or adhesions, was demonstrated in the eight of the 13 patients presenting with intermittent small-intestinal obstruction. Three patients had diarrhoea as their predominant complaint and a fistula was demonstrated in two.
The radiological features of five cases of primary adenocarcinoma of the jejunum are described and the differential diagnosis is discussed. Barium examination is the best method for detecting adenocarcinoma in the small intestine and angiography is useful for pre-operative assessment.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Primary carcinoid tumours are rarely detected in the small intestine by conventional radiological methods. The radiological features are presented of 11 patients with primary small-intestinal carcinoids, in whom the tumour was demonstrated by the barium infusion technique. In four of these patients the site of the primary tumour was also demonstrated angiographically. We have found these methods valuable in identifying primary carcinoid tumours and consider them to be the investigations of choice in evaluating patients with suspected or established carcinoid syndrome.
The effect of antishock trouser inflation on plasma renin activity during hypovolemic shock was studied in dogs. Following anesthesia, six dogs were bled to a systolic blood pressure of 60 mm Hg. Antishock trousers were inflated to 40 to 100 mm Hg for 20 minutes each. Plasma renin activity was measured before phlebotomy, after phlebotomy, and after each 20-minute period of antishock trouser inflation. Three dogs without antishock trousers served as controls. Experimental animals had a significant rise in blood pressure when the antishock trousers were inflated to 100 mm Hg. Plasma renin activity showed a marked increase following phlebotomy (experimental, 1.55 ng/mL/h to 13.63 ng/mL/h; control, 2.71 ng/mL/h to 19.7 ng/mL/h). Both groups had a continued small, statistically insignificant rise in plasma renin levels throughout the remainder of the experiment. Plasma renin level changes did not explain the observed rise in blood pressure following antishock trouser inflation. Plasma renin levels remained elevated in spite of improvement of blood pressure after application of antishock trousers.
The purpose of this study was to evaluate the cardiorespiratory demands inherent to the maintenance of continuous one- and two-man cardiopulmonary resuscitation (CPR) for 10 min. Ten male paramedics (X age = 26 yrs) certified to perform CPR participated. Each subject assumed the three possible roles for administering CPR: ventilator, compressor, and one-man technique. Cardiorespiratory responses were determined by impedance cardiography and open-circuit spirometry at 2 min intervals while performing CPR with a resuscitation manikin. Left ventricular performance was evaluated by impedance ventricular function indices (VFI) and systolic time intervals (STI). All three roles elicited an increase in oxygen uptake compared to kneeling rest, with the roles of one-man and compressor being the most demanding. There were moderate increases in cardiac output and heart rate during the exercise roles, but stroke volume remained similar to resting values. Pulmonary ventilation increased during exercise, with the greatest increase occurring for the one-man role. STI and impedance VFI reflected an enhanced ventricular performance while performing the roles of one-man and compressor. These findings suggest that the energetic demands placed on the rescuer depend upon the specific role assumed. Properly trained and experienced individuals can perform CPR efficiently for at least 10 min while eliciting only moderate physiological stress.
Complications of diverticular disease are among the most common causes of all acute hospital admissions. The barium enema is the most important investigation in these patients, both for establishing the diagnosis and planning their management. However, few comprehensive reviews have described the radiological appearances of the complications of diverticular disease. We describe the radiological features and emphasize the diagnostic difficulties that may occur.