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E J Adam

Publications and source records attributed to E J Adam.

At least 19 recordsLinked to original sources
PubMed2005

National audit of the sensitivity of double-contrast barium enema for colorectal carcinoma, using control charts For the Royal College of Radiologists Clinical Radiology Audit Sub-Committee.

AIM: To audit the sensitivity of double-contrast barium enema (DCBE) for colorectal carcinoma, as currently practised in UK departments of radiology. METHODS: As part of its programme of national audits, the Royal College of Radiologists Clinical Radiology Audit Sub-Committee undertook a retrospective audit of the sensitivity of DCBE for colorectal carcinoma during 2002. The following targets were set: demonstration of a lesion > or =95%; correct identification as a carcinoma > or =90%. RESULTS: Across the UK, 131 departments took part in the audit, involving 5454 examinations. The mean demonstration rate was 92.9% and the diagnosis rate was 85.9%, slightly below the targets set. The equivocal rate (lesion demonstrated, but not defined as malignant) was 6.9%, the perception failure rate was 2.8% and the technical failure rate was 4.4%. Control-chart methodology was used to analyze the data and to identify any departments whose performance was consistent with special-cause variation. CONCLUSION: When compared with the diagnosis rate (84.6%) and demonstration rate (92.7%) reported in the Wessex Audit 1995, [Thomas RD, Fairhurst JJ, Frost RA. Wessex regional audit: barium enema in colo-rectal carcinoma. Clin Radiol 1995;50:647-50.] a similar level of performance was observed in the NHS today, implying that the basic process for undertaking and reporting DCBE has remained relatively unchanged over the last few years. Improvement in the future will require fundamental changes to the process of reporting DCBE, in order to minimize the perception failure rate and accurately to describe lesions, so reducing the equivocal rate. Control-chart methodology has a useful role in identifying strategies to deliver continual improvement.

Barium Sulfate↗
PubMed2004

The addition of computer simulated noise to investigate radiation dose and image quality in images with spatial correlation of statistical noise: an example application to X-ray CT of the brain.

This study validates a method to add spatially correlated statistical noise to an image, applied to transaxial X-ray CT images of the head to simulate exposure reduction by up to 50%. 23 patients undergoing routine head CT had three additional slices acquired for validation purposes, two at the same clinical 420 mAs exposure and one at 300 mAs. Images at the level of the cerebrospinal fluid filled ventricles gave readings of noise from a single image, with subtraction of image pairs to obtain noise readings from non-uniform tissue regions. The spatial correlation of the noise was determined and added to the acquired 420 mAs image to simulate images at 340 mAs, 300 mAs, 260 mAs and 210 mAs. Two radiologists assessed the images, finding little difference between the 300 mAs simulated and acquired images. The presence of periventricular low density lesions (PVLD) was used as an example of the effect of simulated dose reduction on diagnostic accuracy, and visualization of the internal capsule was used as a measure of image quality. Diagnostic accuracy for the diagnosis of PVLD did not fall significantly even down to 210 mAs, though visualization of the internal capsule was poorer at lower exposure. Further work is needed to investigate means of measuring statistical noise without the need for uniform tissue areas, or image pairs. This technique has been shown to allow sufficiently accurate simulation of dose reduction and image quality degradation, even when the statistical noise is spatially correlated.

Aged↗
PubMed2002

Identification and robust control of an experimental servo motor.

In this work, the design of a robust controller for an experimental laboratory-scale position control system based on a dc motor drive as well as the corresponding identification and robust stability analysis are presented. In order to carry out the robust design procedure, first, a classic closed-loop identification technique is applied and then, the parametrization by internal model control is used. The model uncertainty is evaluated under both parametric and global representation. For the latter case, an interesting discussion about the conservativeness of this description is presented by means of a comparison between the uncertainty disk and the critical perturbation radius approaches. Finally, conclusions about the performance of the experimental system with the robust controller are discussed using comparative graphics of the controlled variable and the Nyquist stability margin as a robustness measurement.

Computer Simulation↗
PubMed2001

Tracheal stenosis due to brachiocephalic artery aneurysm successfully treated with stenting.

Tracheal stenosis secondary to an aneurysm of the great vessels is a rare presentation, previously thought to be unremediable to tracheal stenting. The introduction of covered, expandable, metallic stents has led to the successful treatment of a patient with tracheal stenosis secondary to an aneurysmal brachiocephalic artery without resorting to major cardiothoracic surgery.

Aged↗
PubMed2000

Effective dose at pneumatic reduction of paediatric intussusception.

AIM: The purpose of this study was to assess screening times and resulting dose implication at pneumatic reduction of intussusception in the paediatric age group and to examine the relationship with the outcome of the procedure. MATERIALS AND METHODS: We retrospectively reviewed the case notes and departmental records of 143 children who had undergone a total of 153 pneumatic reductions in our department over a 4-year period. Success rates, screening times and available dose-area products (DAP) were recorded. The DAPs were converted to effective dose (ED) for 77 procedures. RESULTS: A 76.5% (117/153) success rate was achieved with a recurrence rate of 6.5% and only one complication: a perforation. Screening times were recorded in 137 reductions and ranged from 15 s to 22.6 min. Although the longest screening time was associated with an unsuccessful outcome, the second longest time of 21 min was successful. This gave a DAP of 1278 cGy cm(2)and an ED of 12.73 mSv, which is equivalent to approximately 400 abdominal films for a 1-year-old. A lifetime risk of fatal cancer of one in 1000 was achieved, assuming the worst case, after a screening time of 30 min on our conventional fluoroscopy unit. CONCLUSION: Our success rate compares well with other centres. Our institution is a tertiary referral centre and the occasional long screening time may reflect the delay and complex nature of the patients referred. Persistence at air reduction may be successful and the success rate increases with delayed attempts but the risks of the increasing radiation burden must be weighed against the risks of emergency surgery and anaesthesia.Heenan, S. D. (2000). Clinical Radiology 55, 811-816.

Air↗
PubMed1998

Trends in the use of pelvimetry techniques.

Assessment of maternal pelvic dimensions is usually considered necessary where vaginal delivery is contemplated in a breech presentation or if reduced pelvic dimensions are suspected in a current or previous pregnancy. Pelvimetry techniques include computed tomography (CT), conventional radiography, digital fluorography and magnetic resonance imaging (MRI). The first three techniques result in a radiation dose to mother and fetus which, depending on how the technique is performed, can vary by up to 40-fold. Of the techniques using X-rays, CT pelvimetry with a lateral scanogram generally gives the lowest radiation dose and conventional radiography using an air gap technique with a single lateral view is a relatively low-dose alternative where CT is not available. A questionnaire was sent to 227 hospitals during 1993 and 1996 to assess whether there was a move towards lower dose techniques of pelvimetry. The results show a trend away from conventional pelvimetry (48.4% in 1993 to 28% in 1996) with a small proportion of centres using MRI (4%) in 1996. Of the centres still using conventional pelvimetry, relatively few were using a low-dose air-gap technique (2.1% in 1993 to 10.9% in 1996). An increasing majority of centres were using one-view CT (69.3% in 1993 and 80.4% in 1996) but a significant proportion were still performing more than one view. This study shows that there was a move towards lower dose techniques of pelvimetry but that there were still many hospitals that had not implemented a policy of reducing radiation exposure in these patients.

Female↗
PubMed1997

Different binding domains for Ran-GTP and Ran-GDP/RanBP1 on nuclear import factor p97.

Several proteins are required for the transport of nuclear proteins from the cytoplasm to the nucleus, including the nuclear location sequence receptor (NLS receptor), p97, the small nuclear GTPase Ran/TC4, and several nucleoporins. The interaction of Ran with p97 is thought to regulate the interaction of these transport components. Ran-GTP alone binds p97, but Ran-GDP binds p97 only in conjunction with RanBP1. Using site-directed mutagenesis and deletion analysis, we have identified two distinct but overlapping binding domains for Ran-GTP and Ran-GDP/RanBP1 on p97. A short acidic sequence in p97 is part of the Ran-GDP/RanBP1 binding domain, possibly functioning in a similar manner as the C-terminal acidic sequence in Ran. A conserved cysteine residue in p97, Cys-158, is required for binding Ran-GDP/RanBP1, but not for binding of Ran-GTP to p97. In a permeabilized cell protein import assay, a mutant p97 with alanine substituted for Cys-158 is unable to support import in the presence of NLS receptor and Ran. These results support a direct active role for Ran-GDP in the receptor complex and provide evidence that the activity of downstream effectors of small GTPases may be regulated by both GTP- and GDP-bound forms of the protein.

Alanine↗
PubMed1997

X-ray pelvimetry--which is the best technique?

AIM: To provide definitive data on the radiation doses given to both mother and fetus using different pelvimetry techniques at a number of centres. This data was combined with an assessment of image quality, to determine the optimum technique. PATIENTS AND METHODS: Multiple thermoluminescent dosimeters (TLDs) were used to measure patient and fetal doses inside an anthropomorphic phantom of a pregnant women at full term. Measurements were made at twenty hospitals that routinely perform pelvimetry using techniques including computed tomography (CT), conventional radiography, conventional radiography using an air-gap technique, and digital fluorography. To assess image quality the images obtained by the different techniques were reviewed by a panel of two radiologists and a senior radiographer. RESULTS: A wide range of absorbed doses and relative risks to mother and fetus was observed. The largest and smallest doses encountered in the study differed by a factor of approximately forty. CT pelvimetry was seen to give an average of 25% of the dose of conventional pelvimetry, and at some centres dose savings of over 90% would be possible by performing lateral CT scanograms in preference to plain film pelvimetry. However, a surprisingly wide variation in doses was observed between centres performing CT pelvimetry, and in some cases the potential dose saving would be small. An air-gap technique practised by one of the centres in the survey was found to give absorbed doses and relative risks comparable to average CT scanograms. A digital fluorography technique also gave a very low dose at one centre. However, a similar technique performed at another of the centres conferred little benefit over conventional pelvimetry. There was no observable correlation between the dose administered to the patient and image quality for any of the techniques, and CT and conventional pelvimetry both gave similar image quality. CONCLUSION: While CT deserves its reputation as a low dose technique for pelvimetry, in some cases there may be little dose saving over conventional techniques. The total mAs from the CT examination should be kept as low as possible. Low absorbed doses with good image quality may also be achieved without specialized equipment using an air gap technique. This method is highly recommended as an alternative to CT, for example if no CT scanner is available.

Female↗
PubMed1997

Intravascular contrast media: can we justify the continued use of ionic contrast agents?

Cost has been the major factor preventing the universal conversion to non-ionic contrast agents. We assessed the costs and potential benefits of making this change in our department. During a 10-month-period the use of all intravascular contrast agents and reaction rates were audited prospectively. One thousand three hundred and ninety-four examinations were included. A local protocol for the use of ionic and non-ionic contrast media was already in place, based on the Royal College of Radiologists Guidelines. For each patient the contrast agent used, risk factors, and presence or absence of a contrast reaction were recorded. Non-ionic contrast agent usage exceeded ionic by a factor of 10. Patients receiving ionic agents intravenously had a reaction rate of 16.8% compared with 2.7% for non-ionic contrast media. The use of ionic contrast media was subsequently suspended and the effect of this on overall costs assessed by retrospectively and prospectively analysing hospital expenditure on contrast agents. No increase in costs was found. The reasons for this are two-fold. Firstly in our institution the protocol in place and the nature of the workload resulted in relatively small volumes of ionic contrast media being used compared with non-ionic agents. Secondly, since our department is a bulk purchaser of non-ionic agents, substantial discounts could be negotiated. The benefits of non-ionic contrast media are well recognized and our experience suggests that cost may no longer be a barrier to conversion to these lower risk agents.

Contrast Media↗
PubMed1996

RanBP1 stabilizes the interaction of Ran with p97 nuclear protein import.

Three factors have been identified that reconstitute nuclear protein import in a permeabilized cell assay: the NLS receptor, p97, and Ran/TC4. Ran/TC4, in turn, interacts with a number of proteins that are involved in the regulation of GTP hydrolysis or are components of the nuclear pore. Two Ran-binding proteins, RanBP1 and RanBP2, form discrete complexes with p97 as demonstrated by immunoadsorption from HeLa cell extracts fractionated by gel filtration chromatography. A > 400-kD complex contains p97, Ran, and RanBP2. Another complex of 150-300 kD was comprised of p97, Ran, and RanBP1. This second trimeric complex could be reconstituted from recombinant proteins. In solution binding assays, Ran-GTP bound p97 with high affinity, but the binding of Ran-GDP to p97 was undetectable. The addition of RanBP1 with Ran-GDP or Ran-GTP increased the affinity of both forms of Ran for p97 to the same level. Binding of Ran-GTP to p97 dissociated p97 from immobilized NLS receptor while the Ran-GDP/RanBP1/p97 complex did not dissociate from the receptor. In a digitonin-permeabilized cell docking assay, RanBP1 stabilizes the receptor complex against temperature-dependent release from the pore. When added to an import assay with recombinant NLS receptor, p97 and Ran-GDP, RanBP1 significantly stimulates transport. These results suggest that RanBP1 promotes both the docking and translocation steps in nuclear protein import by stabilizing the interaction of Ran-GDP with p97.

Biological Transport↗
PubMed1995

Benign chest wall lipoblastoma of infancy producing underlying bone enlargement.

We report a case of a chest wall lipoblastoma first presenting in a 6-month-old infant. Clinical presentation was with a posterior chest wall mass. Chest X-ray showed expansion of the posterior ribs on the left, a feature not previously described in this condition. CT scanning delineated a mass of predominantly fat attenuation, which was invading between the ribs to line the extra-pleural space, and was causing compression and atrophy of muscles locally. There were two recurrences requiring further surgery. Histology showed a well-differentiated lipoblastoma.

Female↗
PubMed1995

Sequence and characterization of cytoplasmic nuclear protein import factor p97.

Nuclear location sequence-mediated binding of karyophilic proteins to the nuclear pore complexes is one of the earliest steps in nuclear protein import. We previously identified two cytosolic proteins that reconstitute this step in a permeabilized cell assay: the 54/56-kD NLS receptor and p97. A monoclonal antibody to p97 localizes the protein to the cytoplasm and the nuclear envelope. p97 is extracted from nuclear envelopes under the same conditions as the O-glycosylated nucleoporins indicating a tight association with the pore complex. The antibody inhibits import in a permeabilized cell assay but does not affect binding of karyophiles to the nuclear pore complex. Immunodepletion of p97 renders the cytosol inactive for import and identifies at least three other cytosolic proteins that interact with p97. cDNA cloning of p97 shows that it is a unique protein containing 23 cysteine residues. Recombinant p97 binds zinc and a bound metal ion is required for the nuclear envelope binding activity of the protein.

Amino Acid Sequence↗
PubMed1994

Identification of cytosolic factors required for nuclear location sequence-mediated binding to the nuclear envelope.

Nuclear protein import can be separated into two distinct steps: binding to the nuclear pore complex followed by translocation to the nuclear interior. A previously identified nuclear location sequence (NLS) receptor and a 97-kD protein purified from bovine erythrocytes reconstitute the binding step in a permeabilized cell assay. Binding to the envelope is specific for a functional SV-40 large T antigen NLS and is not ATP or temperature dependent. Modification of p97 with N-ethylmaleimide (NEM) decreases binding to the pore, but interestingly, NEM treatment of the NLS receptor does not. Nuclear envelope binding is inhibited by wheat germ agglutinin suggesting a possible mechanism for the inhibition of transport by the lectin.

Adenosine Triphosphate↗
PubMed1993

Abdominal ultrasound in Noonan syndrome: a study of 44 patients.

Noonan syndrome affects approximately 1 in 1500 live births. Affected individuals may have characteristic phenotypic features some of which are shared with Turner syndrome, although in Noonan syndrome the karyotype is normal, unlike the 45X karyotype of Turner syndrome. Renal anomalies have been described in both syndromes and in Turner syndrome they are both common and frequently severe. The frequency and spectrum of renal anomalies in Noonan syndrome have not been well documented. Upper abdominal ultrasound was performed to establish the frequency of renal anomalies in Noonan syndrome. Forty-four individuals with Noonan syndrome, aged between 9 months and 38 years, were studied. Sixteen scans (36%) were normal and 28 (64%) were abnormal. Five patients (11%) had renal anomalies. Twenty-three patients (53%) had splenomegaly, 6 of these with associated hepatomegaly. One patient had a choledochal cyst and a midgut malrotation. The frequency of renal anomalies in Noonan syndrome is 11%, which is lower than that seen in Turner syndrome. However, splenomegaly with or without hepatomegaly occurs commonly. Choledochal cyst and solitary kidney, previously unreported in Noonan syndrome, are documented.

Abdomen↗