Biomedical subjects
Publications and source records attributed to E P Wraight.
The joints of 56 patients with polymyalgia rheumatica were examined for evidence of inflammatory synovitis. x Rays, isotope scans, and thermography supplemented clinical examination. Control sternoclavicular joints were examined at necropsy. Peripheral and axial synovitis were uncommon and the results contrast with the findings of several recent studies.
To assess the value of oblique thyroid views during routine thyroid scanning 73 sequential euthyroid patients with focal or diffuse thyroid pathology were studied. Oblique thyroid images did not alter the scan report in 37 patients shown to have a multinodular goitre on the anterior image. However, in the remaining 36 patients oblique thyroid images altered scan category in 30% of patients, mainly demonstrating multiple nodules in thyroids which would have been reported as having a solitary nodule on the anterior image alone. Despite the extra imaging time required, both anterior oblique thyroid images should be obtained in all euthyroid patients presenting with focal or diffuse thyroid pathology in whom the anterior image does not clearly demonstrate a multinodular goitre.
Despite advances in radiological imaging techniques, the ideal management of antenatally diagnosed hydronephrosis remains controversial. A map, showing diagnostic and management pathways, has been designed in an attempt to provide maximum information from the most appropriate and minimum number of investigations.
Explore the source record for details and available documents.
In order to test in a prospective study the suggestion that there should be a shift from the intravenous urogram to DMSA scintigraphy for the diagnosis of suspected renal masses, both investigations were performed in 63 patients with painless haematuria. While the sensitivity of both investigations was similar in renal lesions, specificity was slightly less for scintigraphy. These findings, together with the intrinsic limitations of the DMSA scintigram in detecting lesions elsewhere in the urinary tract, lead us to conclude that the intravenous urogram should remain the initial investigation for painless haematuria unless there are specific contraindications.
Twenty patients were studied to assess the value of aerosol ventilation scintigraphy, using 99Tcm diethylene triamine penta-acetic acid (DTPA) as a screening test for bronchiectasis. All patients had previously undergone bronchography for suspected bronchiectasis. Nine had cylindrical bronchiectasis and 11 had no demonstrable abnormality. Only two of the 20 patients had features suggestive of bronchiectasis on their chest radiographs. Segmental defects in ventilation were demonstrated by scintigraphy in five of the nine patients with bronchiectasis (56%). Regional ventilation appeared normal in 26 of the 27 lungs which were bronchographically normal (96%). Whilst the sensitivity of aerosol ventilation scintigraphy in detecting bronchiectasis is low (56%), it compares favourably with that of the chest radiograph (22%) in this group of patients with mild disease and non-specific symptoms. Thus, in some, it may obviate the need for bronchography.
An intestinal permeability test with a combination of 51Cr-EDTA and 14C-mannitol was performed under routine conditions on 176 occasions in 161 adult patients. Of these patients, 116 were under investigation for possible coeliac disease, 33 were known to have coeliac disease, and 12 had inflammatory bowel disease. Small-bowel biopsies were performed in 61 patients. Expressing the results as the ratio of the 6-h urinary recoveries of the two probes was as sensitive as (95%) but more specific for histologic mucosal abnormality (62% versus 46%) than measuring the urinary recovery of 51Cr-EDTA alone. All but two of the patients with active inflammatory bowel disease, whether Crohn's disease or ulcerative colitis, had an abnormal ratio. The 51Cr-EDTA/14C-mannitol intestinal permeability test with a 6-h urine collection is a rapid and simple test of small-intestinal function suitable for routine use.
Systolic and diastolic ventricular function was assessed in patients with aortic regurgitation as the peak ejection and filling rates. The measured rate of change of volume was related to the ejection fraction when expressed in end diastolic volumes per second (EDV.s-1) but not when expressed as stroke volumes per second (STV.s-1) suggesting that an apparent variation in left ventricular volume change when expressed as EDV.s-1 may occur as a result of an increase in end diastolic volume rather than any absolute alteration in filling rate. There was a significantly greater increase in peak filling than peak ejection rate with increasing heart rate in patients with aortic regurgitation, and this relation was exaggerated compared with that in controls. No definite difference in these indices of left ventricular function was found in patients with aortic regurgitation of severity varying from mild to severe. Isolated measurements of left ventricular filling rate may not accurately reflect left ventricular compliance since other factors, particularly heart rate, must be considered.
Forty patients with chronic isolated aortic regurgitation were studied by phase analysis of equilibrium radionuclide ventriculography to see whether this technique could detect changes in left ventricular (LV) function before the onset of symptoms. This technique was compared to the radionuclide ejection fraction and echocardiography. The severity of LV volume overload was assessed using the radionuclide regurgitant index. Patients with clinically severe aortic regurgitation had severe volume overload (high regurgitation index), increased echocardiographic left ventricular dimensions and significantly increased phase spread (loss of synchrony of wall motion) compared to mild and moderate groups. All but one had well maintained global left ventricular function assessed by the ejection fraction. All seven patients with definite symptoms had a marked increase in phase spread and severe volume overload.
The severity of aortic regurgitation, as assessed by the radionuclide regurgitant index and Fourier amplitude ratio, was compared in 29 patients. Both methods were highly reproducible and agreed in patients with mild-to-moderate regurgitation. The regurgitant index fell with exercise. This change showed a linear relationship with heart rate, allowing the regurgitant index to be corrected for heart rate. There was general agreement between the radionuclide method and echocardiography, but the regurgitant index was unable to select patients with symptoms. The regurgitant index provides an overall guide to the severity of aortic regurgitation, but may be unreliable in the presence of deteriorating ventricular function.
The accuracy of functional parameters derived from multiple harmonic Fourier curve fitting of left ventricular time-activity curves (TACs) was assessed in simulated curves of exactly known characteristics. Curves were generated to represent TACs of equilibrium gated radionuclide ventriculography (ERNV) sampling at 16 frames cycle-1. Curves of varying shape and noise characteristics were studied. The number of harmonics used in the fitting process was variable, the number being determined by an automated 'goodness of fit' test based on the chi-squared test. The accuracy of measured peak ejection rate (PER) and peak filling rate (PFR) was independent of the shape of the curve, but the accuracy of the time to these slopes (TPER, TPFR) was dependent on the steepness of the slope. The accuracy of the measured parameters improved as the influence of noise decreased allowing more harmonics to be added. The values of PER and PFR in control subjects varied between individuals, and with heart rate. There was less variation in the ratio (PER/PFR) of the slopes between individuals, and the accuracy of the ratio was better than that of the individual values of PER and PFR. Functional parameters of predictable accuracy may be determined by Fourier curve fitting at the statistical quality of global or regional ventricular TACs derived from ERNV sampling at 16 frames cycle-1.
The accuracy of the phase value and closeness of curve fitting from Fourier first harmonic analysis is assessed in a range of simulated time-activity curves, of varying amplitude and noise characteristics at three heart rates, over the full and reduced R-R intervals. The accuracy of the phase value is not impaired by reducing the period to that of optimal fitting, whereas the closeness of fitting is improved, particularly at resting heart rates. The reliability of first harmonic Fourier analysis may be improved by reducing the period to which fitting is undertaken to the dynamic part of the time-activity curve.
The results of indium-111 tropolonate leucocyte scintigraphy in 105 patients with known inflammatory bowel disease are reviewed. Scintigraphy is as sensitive as radiology in detecting and assessing the extent of active colonic disease, and probably more sensitive in assessing small bowel disease. In a further 40 patients scintigraphy was successfully used as a screening test to identify, or exclude, bowel inflammation in patients with gastrointestinal symptoms. Scintigraphy has advantages over barium studies, being safe, non-invasive, more sensitive than small bowel radiology and giving additional information such as the bowel identification of intra-abdominal abscesses. The time required to label the leucocytes (about 2 hours) and the higher unit cost, unless many scintigrams are performed, are disadvantages.
One hundred and thirty-four sequential patients who underwent 99mTC HIDA cholescintigraphy have been studied. Patients were investigated for suspected acute cholecystitis, chronic cholelithiasis, enterogastric reflux or jaundice, and in the assessment of biliary tract drainage after transplantation of the liver and other operations of the biliary tract. The technique is most valuable in the diagnosis of acute cholecystitis when its accuracy rate is 96 per cent; it is also useful in the assessment of postoperative biliary drainage. It is least helpful in the investigation of jaundice and suspected chronic cholelithiasis.
Explore the source record for details and available documents.
A prospective study on 27 patients with suspected obstruction of the superior vena cava (SVC) and 10 control patients with no known chest disease was undertaken to determine the value of radionuclide venography in aiding diagnosis and treatment of the condition. The technique proved simple, safe and non-invasive and could rapidly confirm or exclude the diagnosis when in doubt. In addition, the technique had a role in radiotherapy planning, highlighting unsuspected superior mediastinal disease not visible on the chest radiograph. However, follow-up post-treatment scans were of little help due to the good clinical markers of obstruction of the SVC. The normal and abnormal scan appearances are described.
Twelve patients undergoing left ventricular aneurysmectomy were studied by combined phase and amplitude analysis of gated blood pool scintigraphy before and after operation, to establish whether the presence of paradoxical systolic movement, as defined by this method, influenced the result of surgical treatment. There was a significant increase in the ejection fraction after operation in those patients with paradoxical systolic movement and no improvement in those with akinesis. The extent of the increase in ejection fraction was related to the size of paradoxical segment resected. It is argued that this improvement in left ventricular function reflects a reduction in the left ventricular and diastolic volume and improved efficiency of ejection of the stroke volume, resulting from resection of the scar. Combined phase and amplitude analysis may help in selecting patients most likely to benefit from aneurysmectomy.
The technique of 99Tcm-labelled red cell scintigraphy as a means of detecting rebleeding was investigated in 33 patients with bleeding peptic ulcers. Scintigrams were performed twice during the 24 h period succeeding diagnostic endoscopy. There was scintigraphic evidence of rebleeding in 23 patients but this was clinically manifest in 14 patients only. Thirteen of the 14 patients with clinical rebleeding had positive scintigrams while only in one patient with clinical rebleeding was the scintigram negative (P less than 0.05). These results show that rebleeding is common and often clinically inapparent during the first 24 h following gastroscopy but that in the absence of scintigraphic rebleeding serious clinical rebleeding is unlikely to occur.