Clinical audit: don't look a gift horse in the mouth.
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Health Care Reform↗
Biomedical subjects
G De Lacey
Publications and source records attributed to G De Lacey.
Neuropsychological deficits and morphological MRI brain scan abnormalities in apparently healthy non-encephalopathic patients with cirrhosis. A controlled study.
By means of psychometric testing, we have determined the frequency of latent hepatic encephalopathy in a group of 19 cirrhotics with no clinical evidence of encephalopathy. Magnetic resonance imaging (MRI) of the brain was performed in order to determine whether morphological cerebral abnormalities were associated with latent encephalopathy. Nineteen age and educationally matched patients with normal liver function acted as controls. Significant differences (P less than 0.05) between cirrhotics and controls were found in tests of short-term visual memory and speed of reaction to light (cirrhotics 316 +/- 132 ms vs. controls 225 +/- 36 ms), sound (cirrhotics 361 +/- 152 ms vs. controls 236 +/- 52 ms) and choice (cirrhotics 651 +/- 190 ms vs. controls 406 +/- 101 ms) stimuli (all values mean +/- S.D.). Reitan trail test performance, however, was similar in both groups. (Trail A: cirrhotics 43 +/- 19 s vs. controls 35 +/- 13 s; Trail B: cirrhotics 105 +/- 66 s vs. controls 93 +/- 36 s.) In patients with cirrhosis, MRI revealed statistically significant increases in the maximum fissure width of right frontal sulci, right and left parietal sulci, inter-hemispheric fissure width and in bicaudate index. These changes, indicating cerebral atrophy, were largely confined to alcoholics. There was poor correlation between measurements of cerebral morphology and neuropsychological performance, only 10% of associations achieving statistical significance.
Adult↗
The fatty meal and acalculous gall-bladder disease.
The practice of routinely obtaining after fatty meal films during oral cholecystography has been questioned. A retrospective analysis of 45 cases of adenomyomatosis or polyps revealed that, in 28% of patients with adenomyomatosis, the gall-bladder appeared entirely normal before fat. It is concluded that, for the detection of acalculous gall-bladder disease, the fatty meal should be a routine part of oral cholecystography.
Cholecystography↗
Routine colonic lavage is unnecessary for double-contrast barium enema in outpatients.
Four different cleansing regimens were assessed in a prospective survey of 435 patients referred for barium enema. A regimen using simple dietary instructions and laxatives is as effective as a preliminary cleansing enema. It is suggested that routine cleansing enemas in outpatients represent an unnecessary and uncomfortable ritual that might usefully be abandoned.
Ambulatory Care↗
Peroperative colonoscopy in massive rectal bleeding.
Massive rectal bleeding can pose a difficult problem in management. We describe a new technique employing peroperative colonic irrigation and direct colonoscopy to identify the source of the bleeding, so avoiding blind colonic resection.
Colon↗
The double contrast barium enema: improvements to lateral decubitus views including the use of a wedge filter.
The prognostic importance of early detection of colonic carcinoma is emphasised and the contribution of an accurate barium enema technique is stressed. Horizontal beam lateral decubitus films are routine in double contrast barium enemas, and it is still common practice in many departments to support the cassette for these views either in the bucky tray or with sandbags. The lateral decubitus views of 100 patients using these methods of cassette support were reviewed. A large number of the films (67%) were technically so unsatisfactory due to unilateral under- or over-penetration that they did not provide acceptable visualisation of the colon. The cause of these technical faults, and the methods by which they may be overcome, are described. In addition, a wedge filter was designed to reduce the absorption by dependent soft tissues in obese patients.
Barium Sulfate↗