Biomedical subjects
J O Mills
Publications and source records attributed to J O Mills.
Metachronous colonic lymphomas complicating chronic ulcerative colitis.
The gastrointestinal tract is the most common extranodal site of primary non-Hodgkin's lymphoma. Of these, 10-15% occur in the large bowel. Colonic lymphoma is a recognized complication of inflammatory bowel disease, particularly ulcerative colitis and, less commonly, Crohn's disease. We describe a unique case of two metachronous primary lymphomas of the large bowel in a patient with chronic ulcerative colitis.
Should radiologists talk to patients?
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Bile acids and the increased risk of colorectal tumours after truncal vagotomy.
An association between colorectal cancer and previous peptic ulcer surgery is reported. In a prospective screening study, 100 asymptomatic patients (80 men and 20 women) who had undergone truncal vagotomy at least 10 years previously were investigated by barium enema, colonoscopy and gallbladder ultrasonography. Control data were obtained from forensic autopsy subjects. The incidence of neoplasms greater than or equal to 1.0 cm in the vagotomized group was 14 per cent (11 adenomas, 3 carcinomas) and 3 per cent in controls (P = 0.01). Duodenal bile obtained at endoscopy from 21 vagotomized patients with normal gallbladders and from 21 control patients undergoing endoscopy was analysed by high performance liquid chromatography. The mean percentage of cholic (CA), chenodeoxycholic (CDCA), deoxycholic (DCA) and lithocholic (LCA) acids in the bile of vagotomized patients was 32.3, 45.6, 20.7 and 1.4 per cent respectively compared with 45.3, 36.2, 17.9 and 0.7 per cent respectively in controls. The increased proportions of CDCA and LCA and decreased proportions of CA in the duodenal bile of vagotomized patients were significant (P less than 0.001; P = 0.02; P = 0.007). Abnormalities in bile acid metabolism may help to explain the increased risk of colorectal neoplasia 10 years after truncal vagotomy.
Gastrointestinal bleeding due to multiple ileal duplications diagnosed by scintigraphy and barium studies.
A case of multiple ileal duplications presenting with gastrointestinal bleeding is described. Technetium-99m Pertechnetate scintigraphy in conjunction with barium studies provided the initial clue and accurately localised the abnormality pre-operatively.
Esophageal disruption: evaluation with iohexol esophagography.
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Radiological examination of the small bowel.
A retrospective study was made of 100 consecutive dedicated per-oral small bowel examinations. 33% of the studies were abnormal, of which almost half were due to Crohn's disease. When grouped according to clinical suspicion, 73.5% of those studies with a high index of clinical suspicion were abnormal. In the abnormal group a correct diagnosis was made in 90%, with two false positives. In the normal group a correct diagnosis was made in 91%, with no false negatives. It is suggested that the dedicated small bowel series offers a justifiable and practical alternative to other techniques such as intubation and direct infusion of contrast medium into the small bowel, or enteroclysis.
Cholecystectomy and the development of colorectal neoplasia: a prospective study.
One hundred asymptomatic patients over 60 years of age who had cholecystectomy carried out at least 10 years earlier underwent double contrast barium enema and sigmoidoscopy. The incidence of colorectal adenomas and carcinomas was compared with age and sex matched controls undergoing routine post mortems. In the post-cholecystectomy group 12% had tumours (8 adenomas greater than 1 cm in diameter, 4 carcinomas). In the control group 3% had tumours (3 adenomas); P = 0.02. This study confirms that patients with a history of cholecystectomy have an increased risk of developing colorectal adenomas and carcinomas.
Iopamidol in the diagnosis of suspected upper gastro-intestinal perforation.
Forty patients, mainly post-operative, were examined for suspected leakage from the oesophagus and/or stomach using iopamidol. Oesophageal leaks were demonstrated in seven patients, tracheo-oesophageal fistulae in two and an unsuspected gastro-jejunostomy intusussception in one. Only two cases were regarded as technically unsatisfactory due to poor coating. Normal examinations were found in 28 (70%) patients. This was confirmed by the subsequent clinical course. Aspiration into the bronchial tree occurred in five (12.5%) patients without ill-effects. Furthermore no adverse side effects as a result of the administration of iopamidol were recorded. It is concluded that a non-ionic medium such as iopamidol is the agent of choice in the detection of oesophageal and gastric perforation, particularly in post-operative patients where there is an increased risk of aspiration.
Acute large-bowel pseudo-obstruction.
The clinical and radiological features of acute large-bowel pseudo-obstruction occurring in 13 patients over a 7-year period are reviewed. Clinical features included atypical signs and symptoms of large-bowel obstruction and serious concomitant illness, including trauma in 10. The predominant radiological features were gross colonic dilatation, scant fluid levels, a gradual transition to collapsed bowel and a normal gas and faecal pattern in the rectum. Correct diagnosis was established by plain film and/or barium enema examination in the majority of cases (nine out of the 13). In the remaining four cases the diagnosis was made at laparotomy, although review of the radiographs suggested that the correct diagnosis could have been made pre-operatively in three. Instant barium enema is recommended in doubtful cases to rule out distal obstruction. Prompt recognition of the condition, with daily monitoring and conservative management, should eliminate unnecessary surgery and minimise the risk of caecal perforation.
Oesophageal function following transection for varices. An assessment using barium swallow, oesophageal scintiscanning and manometry.
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Adult duodenal webs: a rare cause of obstruction.
Two patients are described with congenital duodenal webs. Both presented with increasing heartburn, an unusual symptom for this condition. The radiological appearances at barium meal examination were misinterpreted in both cases. The radiological features of duodenal webs and their differentiation from intraluminal diverticula are discussed.
Caecal volvulus: a frequently missed diagnosis?
Fifty-eight patients with acute caecal volvulus are presented. Fifty-five patients had plain abdominal radiographs taken shortly after admission and the diagnosis was suspected in 29 (53%). Forty-five of these radiographs have been reviewed and, in retrospect, the diagnosis could have been made in 40 (89%). The dilated caecum usually assumes a 'comma-shape', retains its haustral markings and may be located anywhere within the abdomen but is most frequently seen centrally or occupying the left upper quadrant. Diagnostic difficulties were found in patients with peritonitis and when there was gross small bowel dilatation. Accurate diagnosis is vital as delay in the surgical treatment of this condition may lead to an increased incidence of gangrene of the caecum and a higher mortality.
Immediate radiological management of disasters.
During the past 13 years, 93 civil disasters have been dealt with by the Accident and Emergency (A/E) department of the Royal Victorial Hospital, Belfast. The average number of patients requiring hospital treatment was 30 per incident. Most of these needed some form of radiographic examination. The radiological work-load in one major disaster is described. The need for senior radiological, radiographic and clerical staff at such times is emphasised. The rapid and efficient management of patients is essential to avoid life-threatening delays. Radiological priorities in the immediate phase of trauma are discussed. Chest, spinal and pelvic X-rays usually take precedence. A review of 100 patients with significant intra-abdominal trauma showed a poor correlation with the plain-film appearances. Early resort to more accurate diagnostic methods, such as angiography and computed tomography, is suggested. The need for more active participation by radiologists in the A/E department is stressed.