Biomedical subjects
Publications and source records attributed to R Farrow.
Two patients with pelvic abscesses underwent fluoroscopic guided transrectal catheter drainage using a simple modification in standard technique. A 9F vascular sheath allows contrast to be instilled through the side port and the seal avoids any leakage back through the sheath. It also provides a safe, quick and precise needle puncture at the selected site.
PURPOSE: A prospective blinded randomized trial to compare oral sodium phosphate (NaP) solution with polyethylene glycol (PEG) preparations as bowel preparation prior to barium enema examination. PATIENTS AND METHODS: One hundred and ten patients consented to take part and each patient was randomly assigned to receive either NaP (Oral Fleet Prep) or PEG (Lyteprep). The barium enemas were reviewed by two radiologists blinded to the type of bowel preparation the patient had received. The colon was divided into six segments and each segment was assessed for the amount of stool and water present, the adequacy of coating, the ability to exclude inflammatory bowel disease and the presence of polyps. A score of 0-3 (failure to good) was assigned per segment on each of these criteria. RESULTS: The average individual score for the NaP group was 89.2. The average individual score for the PEG group was 88.81. No significant difference was found in the quality of bowel cleansing between the two agents. In particular there was no significant difference in the scores for water retention (two-tailed P = 0.748) and the difference for the quality of coating was considered not quite significant (two-tailed P = 0.0818). CONCLUSION: Oral sodium phosphate cleans the colon as well as polyethylene glycol solutions. The use of NaP will result in significant cost savings and improved patient compliance.
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Air has been traditionally used as the negative contrast agent in double contrast barium enema (DCBE) examinations, but causes abdominal pain in the 24 h following the procedure. The frequency of post-procedural pain is less when carbon dioxide (CO2) is used as the negative contrast agent. We evaluated patients following DCBE examinations (using either air or CO2) by means of a questionnaire, to determine whether active drainage of gas altered the post-procedural pain. There was no difference in the pain experienced in the groups receiving CO2 with either active or passive drainage, or in the group receiving air with active drainage. Compared with the other groups there was a significantly higher incidence and severity of pain in the group receiving air and passive drainage. We conclude that active drainage of air following a DCBE examination is as effective as using CO2 in reducing post-procedural pain and swelling.
Recently, focal fat collections adjacent to the intrahepatic portion of the inferior vena cava (IVC) have been described as a normal variant. We present seven similar cases, and demonstrate the computed tomographic and sonographic findings. The differential diagnosis is discussed. We believe that the origin of these masses has not yet been satisfactorily proven, and that they may arise within the IVC. They appear to be benign, but there is a risk that they may be mistaken for more sinister pathology.
Eight cases of aortic dissection with atypical CT appearances are described. Seven were clinical diagnoses, one was confirmed at operation. The findings were those of intramural haematoma, often crescentic and not necessarily compressing the aortic lumen. Evidence is presented to show that some intramural haematomas may subsequently develop ulceration, resulting in the appearances described in penetrating atheromatous ulcer of the aorta.
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RATIONALE AND OBJECTIVES: Differences in leukocyte phagocytosis following exposure to different classes of radiographic contrast media (RCM) may help in the development of less toxic alternatives and be useful as a guide to contrast selection in certain patient groups. The effect of RCM on leukocyte phagocytosis of Escherichia coli was examined. METHODS: Cell population phagocytosis and individual cell phagocytic activity were assessed in a control group and in samples exposed both to the ionic RCM diatrizoate and ioxaglate and to the nonionic RCM iohexol and iotrolan by using a flow cytometer. RESULTS: The percentage of granulocytes undergoing phagocytosis was 88.4% in the control population. Following exposure to RCM, this value fell to 79.2% with iohexol, 77.6% with iotrolan, 70.5% with diatrizoate, and 68.7% with ioxaglate. The number of bacteria phagocytosed by active leukocytes was not affected by RCM. CONCLUSION: RCM adversely affect the percentage of granulocytes involved in phagocytosis but not the number of pathogenic bacteria that are phagocytosed by individual granulocytes.
RATIONALE AND OBJECTIVES: Studies describing the effects of radiographic contrast media (RCM) in leukocyte chemotaxis have been contradictory. No studies have been performed after in-vivo exposure. The authors assess the effect of RCM on leukocytes following in-vivo exposure. METHODS: Seventeen patients were studied after intraarterial bolus injection of 75 mL of iohexol (300 mg/mL) or iotrolan (300 mg/mL), 30 minutes and 24 hours postinjection; chemotaxis was assessed using an ex-vivo whole-blood under-agarose method. RESULTS: With iohexol, there was a profound reduction in chemotaxis compared with the preinjection state (P = .001) at 30 minutes. No effect, however, was seen at 24 hours. With iotrolan, no significant reduction in chemotaxis was seen at 30 minutes or at 24 hours. CONCLUSIONS: Radiographic contrast media have differing effects on leukocyte chemotaxis. This may be of significance in the selection of appropriate RCM in certain patients.
The effects of radiographic contrast media (RCM) on leucocyte orientation in vitro were studied using a Zigmond chamber. Leucocyte orientation was assessed following exposure of the leucocytes to iotrolan, iohexol, ioxaglate and diatrizoate. The RCM used were diluted to a concentration similar to that obtained in vivo during routine angiography. At this concentration there was a significant reduction in leucocyte orientation for all RCM investigated but the effect was more pronounced in the monomeric than the dimeric RCM. The results may have significance when deciding which radiographic contrast medium to use in selected patients, particularly those who are immunosuppressed or septicaemic.
A 54-year-old woman with unoperated patent ductus arteriosus developed fatal cardiac tamponade due to a dissecting aneurysm of the pulmonary artery causing haemopericardium. Histology of the pulmonary artery showed the presence of cystic medial necrosis. Previous reports of this condition are reviewed and the role of pulmonary hypertension causing secondary cystic medial necrosis is discussed.
Phaeochromocytoma is rare and usually presents as paroxysmal or sustained hypertension; none the less, it can also cause severe acute pulmonary oedema in normotensive individuals. Six patients with phaeochromocytoma presenting in Cornwall and West Devon between 1982 and 1986 are described. Five of them died of pulmonary oedema within 24 hours of the onset of symptoms. At necropsy all five had normal sized hearts and in the four hearts examined by histology there was evidence of catecholamine induced heart disease in the form of focal myocardial necrosis. The sixth patient presented with arterial spasms and pulmonary oedema. Surgical removal of the causative tumour was successful in this patient.
Non-saponifiable cell extracts of wild type and sterol mutants of N. crassa were analysed by means of gas-liquid chromatography. The wild-type contained ergosterol and episertol in a 10:1 ratio. None of the mutants was able to synthesize ergosterol. Three of the mutants carry single recessive gene mutations cauisng blocks in the terminal steps of ergosterol biosynthesis: erg-1 has an inactive delta 8 leads to delta 7 isomerase erg-2 has an inactive 24(28) hydrogenase, and erg-4 has an inactive C-24 methyl transferase. Some of the mutants accumulated novel sterols as a result of their enzyme defects. The genes erg-1 and erg-2 were mapped close to inl on the right arm of chromosome V.
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Magnetic resonance (MR) imaging has proved useful in the evaluation of perianal and perirectal lesions resulting from Crohn disease. On T1-weighted MR images, sinus tracts and fistulas are hypointense due to their fluid content; on T2-weighted images, their signal intensity depends on their fluid content and the degree of surrounding fibrosis. Other pathologic entities, such as abscesses in the ischioanal fossa, may become evident at MR imaging even though they remain hidden at digital examination. Rectal wall thickening and perirectal inflammatory changes are often seen at MR imaging of the pelvis. The multiplanar capability of MR imaging greatly facilitates the detection of fistulous tracts that extend into the supralevator space. MR imaging can be helpful to both the surgeon and the gastroenterologist in the assessment of perianal and perirectal complications arising from Crohn disease and, when necessary, in the planning of surgical intervention. MR imaging also recommends itself to the patient because it is noninvasive and does not cause discomfort.