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Biomedical subjects

L K Harding

Publications and source records attributed to L K Harding.

At least 19 recordsLinked to original sources
PubMed1995

Bile acid absorption from ileoanal pouches using enema scintigraphy.

It is unclear whether bile acid absorption is affected by ileoanal pouch construction. Bile acid absorption was measured in the abdomen of 16 patients with pouches (nine with good and seven with poor pouch function based on a clinical score) and in six patients with an end ileostomy using a radiolabelled synthetic bile acid (75SeHCAT) enema and dynamic scintigraphy. The median (interquartile range) 75SeHCAT absorption was 81 (79-87) per cent in patients with ileostomy, 46 (43-53) per cent in patients having well functioning pouches, and 24 (18-38) per cent in the group with poor pouch function (P < 0.01). Log transformation of the absorption curves revealed a two-component uptake (fast component t1/2 = 1.4-7.2 min; slow component t1/2 = 16-144 min) in all patients with ileostomy, in eight of nine patients with pouches with good function, and in one of seven patients with a poorly functioning pouch (P < 0.05); in the other six patients with poorly functioning pouches, only the slow component of absorption was present. This test showed significantly reduced bile acid absorption in patients with an ileoanal pouch and gave an objective discrimination between well and poorly functioning pouches.

Adolescent↗
PubMed1995

Radiation protection issues associated with nuclear medicine out-patients.

This paper reviews the published data relating to the radiation hazards associated with nuclear medicine outpatients. It is discussed both in the context of the current UK advice as well as potential guidelines following the recommendations in ICRP 60. For diagnostic studies there is little need for restrictions. The main exceptions are for a prolonged journey home by public transport with high levels of 99Tcm and for the situation of an outpatient given 111In who has to look after a fretful infant. The main problem occurs following the administration of 131I therapy for thyrotoxicosis. The principal hazards are associated with external exposure; radiation doses from ingestion due to contamination are small. Restrictions should only be necessary for administered activities greater than 400 MBq (e.g. public transport, return to work, sleeping with partner). With such restrictions it is considered that 131I therapy for thyrotoxicosis can continue to be given on an outpatient basis.

Adult↗
PubMed1995

Reporting simplified colonic transit studies using radionuclides: clinician friendly reports.

This study describes a graphic presentation of the results of a simplified segmental colonic transit model. This study requires three sets of images on three consecutive days after intake of indium-111 resin capsule at each time point. The per cent of ingested activity is calculated in each region of the colon and in the faeces. The program uses standard PC compatible graphic package, CorelDRAW (Corel Corporation). The report for the patients' notes consists of three schematic diagrams of colon with regions identified and a pot representing the faecal activity. The per cent of administered activity in each region and pot is both printed and represented by shades of grey (white representing 0% and black 100% activity), for each region and the pot. The distribution of activity is clearly seen at each time point and the report is presented on single A4 size sheet of paper. Using a simplified colonic study protocol it is possible to produce clinician friendly reports on a single sheet of paper.

Colon↗
PubMed1995

Scintigraphic measurement of ileocaecal transit in irritable bowel syndrome and chronic idiopathic constipation.

This study investigated the hypothesis that some features of functional gastrointestinal disorders may be associated with abnormalities of ileocaecal transit by measuring ileocaecal transit using a scintigraphic technique in 43 patients with chronic constipation, 20 patients with irritable bowel syndrome (IBS), and 18 control subjects. Subjects ingested enteric coated capsules, which delivered 111-indium radionuclide to the distal ileum. Gammacamera images were acquired at hourly intervals until caecal filling was complete. Ileocaecal transit was defined as the time between peak scintigraphic activity in the terminal ileum and peak activity in the caecum. The mean (SD) ileocaecal transit of 103 (50) minutes in patients with IBS was significantly faster than that in control subjects (mean (SD) ileocaecal transit 174 (78) minutes, p < 0.002). There were no significant differences in ileocaecal transit between patients with chronic idiopathic constipation and the control subjects, or between patients with constipation predominant and diarrhoea predominant IBS. This study developed a practical scintigraphic method of measuring ileocaecal transit. The rapid ileocaecal transit in both the constipation and diarrhoea predominant forms of IBS suggests that bloating may not after all result from delayed ileal emptying.

Adult↗
PubMed1994

Cholesterolosis in patients with chronic acalculous biliary pain.

The outcome of patients with cholesterolosis was compared with that of those with chronic cholecystitis operated on for chronic acalculous biliary pain. A total of 55 patients with acalculous biliary pain with a median symptom duration of 24 (range 6-120) months were investigated by dynamic cholescintigraphy and followed for a median of 24 (range 12-60) months. Thirty-five patients underwent cholecystectomy, of whom 22 had a low gallbladder ejection fraction (under 35 per cent), with symptomatic improvement in 21 of these (P < 0.01). All four patients with a normal ejection fraction (35-50 per cent) improved after cholecystectomy but only four of nine with a high ejection fraction (over 50 per cent) did so. Results of histological examination were available in 32 patients and revealed cholesterolosis in 20. A low ejection fraction was found in 16 patients with cholesterolosis, of whom 15 showed symptomatic improvement after cholecystectomy; the other four patients had a high fraction and all improved after cholecystectomy. Overall, symptoms in 19 of 20 patients with cholesterolosis improved after cholecystectomy compared with only seven of 12 with chronic cholecystitis (P = 0.03).

Adult↗
PubMed1994

Radiation doses to those accompanying nuclear medicine department patients: a waiting room survey. EANM Task Group Explaining Risks. European Association of Nuclear Medicine.

In a multi-centre European trial we have assessed the radiation dose to those accompanying patients undergoing nuclear medicine investigations. Dosemeters were first calibrated against each other and then used to measure the radiation dose to the nurse or relative while they were in the waiting room. In departments where there was one waiting room the median radiation dose was 13 microSv, and the corresponding figures for where there were two waiting rooms and where the patients were allowed to leave the department with their nurse or relative were 12 and 11 microSv, respectively. These figures are not significantly different. However, we found that the median radiation dose to relatives was 13 microSv while that to nurses was 3 microSv (P < 0.01), although the waiting times were not significantly different. The reasons for these differences are discussed. Our data do not support the need for a second waiting room for injected patients in a nuclear medicine department.

Calibration↗
PubMed1994

Use of geometric center and parametric images in scintigraphic colonic transit studies.

BACKGROUND/AIMS: Scintigraphic studies give detailed information on colonic transit. In this study, several methods of presenting such data were compared and discussed. The aim of the study was to evaluate the role of geometric center (GC) and parametric images in interpretation of colonic transit studies. METHODS: Segmental colonic transit was measured in 117 patients: 50 with constipation, 24 with irritable bowel syndrome, 22 with fecal incontinence, 14 who were postsurgery, and 7 normal volunteers. 111In-labeled resin was administered in a pH-sensitive capsule, and images were acquired for 3 days. The percentage of activity in four regions of colon and in the feces was measured. RESULTS: Five patterns of colonic transit were identified (16 rapid transit, 48 intermediate, 14 generalized delay, 5 left-sided delay, and 34 right-sided delay). The geometric center (sum of fraction of activity x region number) was calculated at each time point. Using the geometric center, the groups could be differentiated (P < 0.01) except for those with left-sided delay. In individual patients, patterns of colonic transit could not be determined using the geometric center alone. Gray-scale presentation of percent activity in each region (parametric images) allowed patterns of colonic transit to be identified in individuals. CONCLUSIONS: Use of the geometric center is suitable for comparison of groups of patients, whereas parametric images identify patterns in individual patients.

Analysis of Variance↗
PubMed1994

Closing the audit loop: a patient satisfaction survey.

A patient satisfaction survey was carried out in a nuclear medicine department of a large acute hospital. Surveys were initially carried out by interview and postal techniques, with approximately 100 responders in each category. The responses to each question were not significantly different for the two types of survey, although overall there was a significantly larger number of dissatisfied responses in the postal survey (22%) compared with the interview study (12%). The postal survey was repeated after 1 year, thus completing the audit loop. A significant reduction in dissatisfied responses has occurred in those areas which had been addressed following the criticisms revealed by the first survey.

Hospital-Patient Relations↗
PubMed1994

Improving information for nuclear medicine department outpatients.

In two large inner city hospitals we have conducted a survey of the letters sent to patients before their attendance at a nuclear medicine department. The majority of questions asked for a graded answer (poor, fair, ok, good, excellent). Patients were handed the survey form when they had completed their test and the survey was continued until 100 valid replies had been received at each hospital. Information leaflets, as recommended by the British Nuclear Medicine Society (BNMS), were subsequently issued to all patients and at one hospital the patient information letters were rewritten. The surveys were then repeated. There was a significant (P < 0.001) improvement in patient satisfaction with the information provided. In some areas, for example, instructions about getting to the hospital, no different information was provided and there was no change between the surveys, as would be expected. Curiously, questions allowing free text answers were more often completed by patients from Dudley Road Hospital, Birmingham, than from Guy's Hospital, London. Some possible explanations for this difference are discussed. Particularly reassuring was that more women understood about precautions regarding pregnancy or breastfeeding as a result of the leaflets. We would recommend the advice of the BNMS to other nuclear medicine departments.

Data Collection↗
PubMed1994

Effect of agitation on the quality of platelet concentrates.

Platelet concentrates (PCs) were stored for 4 days at 22 degrees C in 400 ml second-generation (PL1240) platelet packs with either constant agitation, manual mixing once every 24 h or without agitation at any time. After 4 days storage, in vivo recovery, survival and biodistribution were determined following indium-111 labelling of platelets and infusion into autologous volunteers. In vitro assays of platelet function and biochemistry were likewise carried out after 4 days storage. The PCs stored without agitation had significantly lower in vivo recoveries, pH and aggregation responses to ionophore A23187 and a combination of collagen and epinephrine and significantly higher beta-thromboglobulin and indium-111 release than the agitated PCs. The manually mixed PCs were not significantly different from the constantly agitated PCs. PCs mixed simply once every 24 h remained viable with active oxidative phosphorylation and a pH above 6.74 in all but 1 case indicating that PCs stored at 22 degrees C for up to 4 days with only intermittent mixing are satisfactory for transfusion. A change from constant agitation would reduce capital costs in mixing equipment and simplify the transport of PCs from the transfusion centre to small hospital blood banks.

Blood Banks↗
PubMed1994

Simplified method for the measurement of segmental colonic transit time.

Segmental colonic transit has been measured in 101 patients. Two MBq of 111Indium absorbed on resin pellets and encapsulated in an enteric coated capsule was given at 7 00 am. Hourly images during the first day, and three images during each subsequent day were acquired for up to three days. Using all scan and patient data the scans were categorised in one of the five patterns of colonic transit: normal, rapid, right delay, left delay, or generalised delay. The geometric centres and per cent activity at each time point was compared between the five groups of colonic transit patients to find the best time for imaging and so to distinguish the five groups. During the first day, early images did not help in diagnosis of patterns of transit, however, in the later images (six hours onwards after the ingestion of the activity) the rapid transit groups could be identified. Images at 27 and 51 hours were both required to distinguish all five groups of patients from each other. Only in the 'normal' transit patients was there some excretion of the activity during the course of the second day, otherwise there was no difference in the images taken in the course of a day (second or third day). A simplified protocol requires a minimum of three images to distinguish all five patterns of colonic transit. The activity should be ingested in the morning (7 00 am) and the first image taken at the end of the working day (8-10 hours after ingestion), the second image on the morning of the second day, and the third image during the course of the third day. This simple protocol would provide all the clinically relevant information necessary for correct classification of the colonic transit.

Adolescent↗