Biomedical subjects
Publications and source records attributed to L Berman.
A case of unilateral haematocolpos correctly diagnosed by ultrasound is described in a 13 year old girl known to have a solitary kidney. The association of renal agenesis with Müllerian abnormalities is well recognised and in this case the ultrasound findings ensured that the correct surgical management was undertaken.
Two cases of pubic osteomyelitis presenting as a painful hip are reported. In both cases the diagnosis was delayed by the unusual presentation and by the limited radiological investigation. Pubic osteomyelitis is rare in childhood but should be considered in the differential diagnosis of the 'irritable hip'.
The calculation of femoral anteversion using a static ultrasound scanner has been compared with results obtained by computer tomographic (CT) scanning. Assuming the CT results to be accurate, the ultrasound method was frequently found to be unreliable.
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Several studies have documented the failure of neonatal clinical screening to reduce the incidence of hip dislocation later in infancy. In addition, the practice of splinting unstable hips is said to result in the treatment of many infants who would have developed normally if left unsplinted. Ultrasound provides a detailed image of the bony and cartilaginous neonatal hip. The results of conventional testing for hip instability were compared with ultrasound screening in 1001 neonates. As a result of the ultrasonic image 14 of 17 infants with hip instability were not splinted and developed normally. Two babies without detectable clinical signs were shown to have severe hip abnormalities. It is suggested that clinically normal but dysplastic hips do exist and that ultrasound will detect them. In addition, the overtreatment that is current practice might be avoided.
A case of impacted ion-exchange resin causing intestinal obstruction associated with intraluminal calcification is described. This cause of bowel obstruction with intraluminal opacification has not previously been reported.
In an attempt both to reduce gonadal irradiation incurred with conventional radiology, and to image the unossified structures of the neonatal hip, several groups have undertaken studies on aspects of hip ultrasound particularly with reference to the paediatric patient. The ultrasound anatomy of the unossified infant hip has been described by Graf in Austria. The same author has devised an ultrasonographic classification for hip dysplasias and dislocations which has gained widespread acceptance in mainland Europe. Two studies have appeared exploring the use of ultrasound for the measurement of femoral neck anteversion but as yet these have not been compared with CT or trigonometric methods of assessment. Ultrasound has been shown to be effective in the detection of hip joint effusions, but its role in the management of the "irritable hip" has yet to be defined.
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The assessments by radiographers of 1628 consecutive patients referred for radiography in the casualty department were analysed. The radiographers missed abnormalities in the radiographs in 68 of the cases. Casualty officers missed abnormalities in 63 cases, but only 35 patients were common to both groups. Twenty eight of the radiographs interpreted wrongly by casualty officers were interpreted correctly by radiographers; 16 of these 28 were thought by the accident and emergency consultant to be clinically important. It is suggested that a system whereby radiographers signal abnormalities should be standard practice.
Surveys have shown a consistent error rate in the detection of radiographically demonstrable abnormalities by casualty officers. A high incidence of medical litigation is related to casualty departments. For these reasons, a survey of hospitals in England and Wales was carried out to determine when and whether accident and emergency radiographs are reported. The practice in 146 hospitals was analysed. It was found that two-thirds of hospitals report all radiographs within 48 h. Seven per cent of hospitals either do not report any radiographs, report only radiographs of certain areas, or delay reporting for over 1 week. It is suggested that the patients attending as many as a quarter of all hospitals as casualties are at increased risk from errors which will inevitably be recognised late, and that these errors are directly attributable to shortage of staff.
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A diagnosis of Sjögren's syndrome or rheumatoid arthritis was made in five women in whom multiple myeloma was first suspected. All had mild symptoms of sicca or arthritis, positive tests for rheumatoid factor or antinuclear antibody, and markedly increased IgG immunoglobulins. A connective tissue disorder may produce the characteristic electrophoretic pattern of multiple myeloma.
Walking tests, frequently used to document effects of treatment on exercise capacity, have never been standardised. We studied the effects of encouragement on walking test performance in a randomised study that controlled for the nature of the underlying disease, time of day, and order effects. We randomised 43 patients with chronic airflow limitation or chronic heart failure or both to receive or not receive encouragement as they performed serial two and six minute walks every fortnight for 10 weeks. Simple encouragement improved performance (p less than 0.02 for the six minute walk), and the magnitude of the effect was similar to that reported for patients in studies purporting to show beneficial effects of therapeutic manoeuvres. Age and test repetition also affected performance. These results demonstrate the need for careful standardisation of the performance of walking tests, and suggest caution in interpreting studies in which standardisation is not a major feature of the study design.
This report presents a case of multicentric gastric carcinoid (gastrin containing) tumors of the fundus associated with achlorhydria and pernicious anemia. It is suggested that stimulation of the antral G cells and possibly fundic argyrophilic cells by achlorhydria associated with atrophic gastritis may lead to hyperplasia, and eventually to neoplasia in the latter, in the form of gastric carcinoid with gastrin production.
The effects of alfentanil-O2 and sufentanil-O2 anaesthesia on plasma catecholamines and cortisol were investigated in 32 patients undergoing coronary artery bypass grafting operations. After lorazepam-atropine premedication and pancuronium pretreatment, alfentanil was given to 16 patients at a rate of 3 mg.min-1 and sufentanil was given to 16 patients at 300 micrograms.min-1 until the patients were unconscious; at this time they were given succinylcholine and were intubated. After intubation an amount of alfentanil or sufentanil equal to the dose producing unconsciousness was infused over the next 30 min, at which time the operation began. Additional alfentanil or sufentanil were given whenever systolic arterial blood pressure increased more than 15 per cent of preanaesthetic values. Arterial blood samples were obtained for epinephrine, norepinephrine and cortisol assay and cardiovascular dynamics were recorded prior to anaesthetic induction, 5 min after tracheal intubation, immediately prior to and five min after incision, ten min after maximal sternal spread, just prior to beginning and after 30 and 60 min of bypass and at the end of operation. Cardiovascular dynamics were little changed throughout anaesthesia and operation. Plasma epinephrine and norepinephrine were not significantly changed until bypass. During bypass both hormones became increased and remained increased at the end of operation. Plasma cortisol decreased after incision and remained decreased until the end of operation. These data indicate that alfentanil-O2 and sufentanil-O2 anaesthesia produce similar changes in plasma catecholamines and cortisol as does fentanyl-O2 anaesthesia and hormonal effects are, therefore, not an explanation for any advantages the newer narcotics may have over fentanyl.
In Nippostrongylus brasiliensis rats, tracheal sensitivity to worm allergens developed prior to intestinal sensitivity and correlated with the early local synthesis of reaginic antibody in the mediastinal (bronchial) lymph nodes. Skin and intestinal sensitivity to worm allergens more nearly correlated with serum reaginic antibody and its synthesis by mesenteric lymph nodes and other tissues. Prostaglandins appeared to modulate intestinal responsiveness to worm allergens. Thus, local reagin synthesis and other microenvironmental factors influence local tissue sensitization and responsiveness to allergens.
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Acute synovial rupture is encountered in several types of arthritis but is most common in rheumatoid arthritis. Chronic synovitis producing tense effusion in the knee may result in a posterior capsular tear. The clinical picture closely mimics acute thrombophlebitis, and failure to recognize the true cause often results in inappropriate anticoagulant therapy, with further deterioration of the leg. Ultrasonography is a useful screening procedure. When operation is undertaken, the posterior capsular defect must be repaired.