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Biomedical subjects

I Britton

Publications and source records attributed to I Britton.

9 recordsLinked to original sources
PubMed2005

Is primary care access to CT brain examinations effective?

AIM: Primary care access to CT head examinations could enable common neurological conditions to be managed within primary care. Outcome data from the first 8 years of a local service were used to identify effective referral criteria. METHODS: Primary care head CT results from 1 March 1995 to 31 October 2003 were categorized as normal, incidental or significant findings. Normal reports were cross-referenced for referral to secondary care. Case notes with incidental or significant CT findings were reviewed for secondary care attendance and outcome. RESULTS: Records of 1403/1645 CT head examinations (85%) were available for review. Of these 1403, 951 (67.8%) returned normal findings, 317 (22.6%) incidental findings and 135 (9.6%) significant findings. The commonest indication for referral was investigation of headaches (46.6%). Of the total 533 patients under 50 years of age, 13 (2.4%) yielded significant findings and all 13 showed other features in addition to headache. Of 314 cases presenting with focal neurology, 83 (26.4%) showed significant findings. 314 patients were referred from primary to secondary care. 189 had normal scans and 74 had findings described as incidental. 60% of secondary care referrals were for normal CT scans. In patients with focal neurology, 90 of 314 were referred, allowing 71% to be managed in primary care. Yield was also 0% for headaches, dizziness, visual disturbance or nausea and vomiting. CONCLUSION: Primary care access to CT brain examinations is effective for patients with focal neurology, neurological symptoms or a known malignancy, but not for patients aged less than 50 years, or with uncomplicated headaches, dizziness or diplopia.

Aged↗
PubMed2001

Immediate CT pneumocolon for failed colonoscopy; comparison with routine pneumocolon.

AIM: To assess the role and reliability of 2D CT pneumocolon in the diagnosis of colonic malignancy, and compare feasibility of referral sources. MATERIALS AND METHODS: A prospective study of 50 patients with suspected large bowel malignancy. Patients underwent bowel cleansing, rectal air insufflation and contrast enhanced CT with 5 mm collimation, 3 mm reconstruction and a pitch of 1.4. Subsequent correlation was with pathology (16), colonoscopy (13), barium enema (5), ERCP (1) and clinical follow-up alone (8). RESULTS: Diagnostic images were obtained in 43/50 patients (86% feasibility). Follow-up was obtained in 35/43 patients (one patient died of an unrelated cause, and seven patients were deemed unfit for further investigation). Seventeen colonic carcinomas were diagnosed (three false-positives: one ischaemic colitis, one diverticular stricture and one faecal mass), one diverticular stricture, one fistula, one pancreatic carcinoma and one ovarian malignancy. The remaining 14 were negative. Overall sensitivity was 100% (for lesions >1.5 cm) with a specificity of 94% for structural abnormalities, but only 82% for the correct identification of malignancy. CONCLUSION: Computed tomography (CT) pneumocolon is a reliable alternative to barium enema where colonoscopy is incomplete, with the advantage of extraluminal screening, and examination of the proximal bowel. In the frail elderly or young unfit patient, it is a valuable additional diagnostic tool.

Adult↗
PubMed1999

Ultrasound features of intussusception predicting outcome of air enema.

OBJECTIVE: To examine features identified on US which predict success or failure of air-enema reduction of intussusception. MATERIALS AND METHODS: A retrospective study of 117 consecutive episodes of intussusception, presenting for US over a 6-year period. The specific features examined were: free fluid within the peritoneum, small-bowel obstruction, colonic wall thickness, and fluid trapped between the colon and the intussusceptum. RESULTS: The overall reduction rate, irrespective of US features, over the 6-year period was 72 %. Reduction rates were significantly higher with the absence of free fluid, trapped fluid, or small-bowel obstruction (93 %). The presence of trapped fluid predicted an unfavourable outcome, with a significantly lower success rate (25 %). Colonic wall thickness did not predict outcome; in successful reductions, mean wall thickness was 7.2 mm and in failed reductions 7.6 mm. CONCLUSIONS: Where free fluid, small-bowel obstruction, and trapped fluid are absent, almost 100 % success with air-enema reduction should be achievable. Where trapped fluid is present, air enema should be performed cautiously to avoid perforation caused by overvigorous attempts at pneumatic reduction of an incarcerated intussusception.

Air↗
PubMed1998

Assessment of the role and reliability of sonographic post-prandial flow response in grading Crohn's disease activity.

PURPOSE: To investigate the value of pre and post prandial Duplex colour Doppler sonographic (DCDS) measurement of superior mesenteric artery (SMA) flow in the assessment of Crohn's disease activity, and its response to treatment. MATERIALS AND METHODS: SMA volume flow rates before and after a food challenge (200 ml of Ensure Plus) were recorded over 60 min in 11 controls, and 25 patients with proven Crohn's disease. Peak flow rates and the time interval to peak flow were recorded. Eleven patients with active disease were monitored longitudinally and their response following the introduction of systemic steroids was assessed. RESULTS: The time interval from food challenge to peak SMA flow rate was significantly lower in patients with untreated active disease (median 20 min, range 14.5-21.25) compared to inactive patients (median 33 mins, range 28.75-40.5, P = 0.0006). Longitudinal follow-up of active disease demonstrated prolongation of time to peak flow following clinical remission (P = 0.0024) CONCLUSIONS: This technique is useful in offering an immediate, noninvasive means of assessing disease activity. Further longitudinal follow up data is necessary to determine its utility in assessing response to treatment.

Adult↗
PubMed1998

Do supine oblique views provide better imaging of the cervicothoracic junction than swimmer's views?

OBJECTIVE: To determine whether a swimmer's view or supine (trauma) oblique views are more likely to visualise the lower cervical spine when a lateral view fails to show the cervicothoracic junction. DESIGN: A prospective study comparing two 20 week periods. In the first phase the swimmer's view was performed as an additional view when the cervicothoracic junction was not demonstrated. In the second phase paired supine oblique views replaced the swimmer's view. RESULTS: 230 patients were included in the first phase, of whom 60 required swimmer's views. In the second phase 62 of 197 patients required supine oblique views. Radiology analysis of 53 pairs of supine oblique views showed that the vertebral bodies were adequately demonstrated at the cervicothoracic junction in only 20 patients (38%) compared with 22 in the swimmer's group (37%). The facet joints and posterior elements were, however, clearly seen in 37 (70%) of the supine oblique patients compared with 22 (37%) of the swimmer's group (p < 0.001, chi2 test). Exposure dose calculations showed a substantial reduction for a pair of supine oblique views (1.6 mGy) over a single swimmer's view (7.2 mGy). CONCLUSIONS: In injured patients for whom the standard three view series fails to demonstrate the cervicothoracic junction, swimmer's views and supine oblique views show the alignment of the vertebral bodies with equal frequency. However, supine oblique films are safer, expose patients to less radiation, and are more often successful in demonstrating the posterior elements.

Cervical Vertebrae↗