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Biomedical subjects

R G Gibney

Publications and source records attributed to R G Gibney.

At least 19 recordsLinked to original sources
PubMed2004

Minimal preparation computed tomography instead of barium enema/colonoscopy for suspected colon cancer in frail elderly patients: an outcome analysis study.

AIM: To evaluate the efficacy of minimal preparation computed tomography (MPCT) in diagnosing clinically significant colonic tumours in frail, elderly patients. MATERIALS AND METHODS: A prospective study was performed in a group of consecutively referred, frail, elderly patients with symptoms or signs of anaemia, pain, rectal bleeding or weight loss. The MPCT protocol consisted of 1.5 l Gastrografin 1% diluted with sterile water administered during the 48 h before the procedure with no bowel preparation or administration of intravenous contrast medium. Eight millimetre contiguous scans through the abdomen and pelvis were performed. The scans were double-reported by two gastrointestinal radiologists as showing definite (>90% certain), probable (50-90% certain), possible (<50% certain) neoplasm or normal. Where observers disagreed the more pessimistic of the two reports was accepted. The gold standard was clinical outcome at 1 year with positive end-points defined as (1) histological confirmation of CRC, (2) clinical presentation consistent with CRC without histological confirmation if the patient was too unwell for biopsy/surgery, and (3) death directly attributable to colorectal carcinoma (CRC) with/without post-mortem confirmation. Negative end-points were defined as patients with no clinical, radiological or post-mortem findings of CRC. Patients were followed for 1 year or until one of the above end-points were met. RESULTS: Seventy-two patients were included (mean age 81; range 62-93). One-year follow-up was completed in 94.4% (n=68). Mortality from all causes was 33% (n=24). Five histologically proven tumours were diagnosed with CT and there were two probable false-negatives. Results were analysed twice: assuming all CT lesions test positive and considering "possible" lesions test negative [brackets] (95% confidence intervals): sensitivity 0.88 (0.47-1.0) [0.75 (0.35-0.97)], specificity 0.47 (0.34-0.6) [0.87 (0.75-0.94)], positive predictive value 0.18 [0.43], negative predictive value 0.97 [0.96], positive likelihood ratio result 1.6 [5.63], negative likelihood ratio result 0.27 [0.29], kappa 0.31 [0.43]. Tumour prevalence was 12%. A graph of conditional probabilities was generated and analysed. A variety of unsuspected pathology was also found in this series of patients. CONCLUSIONS: MPCT should be double-reported, at least initially. "Possible" lesions should be ignored. Analysis of the graph of conditional probability applied to a group of frail, elderly patients with a high mortality from all causes (33% in our study) suggests: (1) if MPCT suggests definite or probable carcinoma, regardless of the pre-test probability, the post-test probability is high enough to warrant further action, (2) frail, elderly patients with a low pre-test probability for CRC and a negative MPCT should not have further investigation, (3) frail, elderly patients with a higher pre-test probability of CRC (such as those presenting with rectal bleeding) and a negative MPCT should have either double contrast barium enema (DCBE) or colonoscopy as further investigations or be followed clinically for 3-6 months. MPCT was acceptable to patients and clinicians and may reveal significant extra-colonic pathology.

Aged↗
PubMed2003

Technical report. Intra-operative ultrasound-guided needle localization for impalpable testicular lesions.

AIMS: To describe a new technique of intra-operative ultrasound-guided needle localization of impalpable intratesticular lesions. MATERIALS AND METHODS: Three patients with impalpable testicular lesions identified on ultrasound underwent needle localization under ultrasound guidance. The procedure was performed in the operating theatre under general anaesthetic using a 7.5-8 MHz linear array probe and a portable ultrasound machine. Under direct guidance, a 21 G needle was placed through the centre of the lesion allowing resection and immediate frozen section analysis. RESULTS: In two patients malignancy was confirmed and an orchidectomy was performed. In one patient a benign lesion was detected obviating the need for orchidectomy. CONCLUSION: Patients presenting with impalpable testicular lesions can pose a diagnostic dilemma and orchidectomy is often performed. We describe an ultrasound-guided intra-operative localization technique enabling direct pathological examination so surgical approach can be re-evaluated in the presence of a benign lesion. This is particularly important in the case of a solitary testicle in order to preserve testicular function.

Adult↗
PubMed2001

Post-partum ovarian vein thrombosis.

Post-partum ovarian vein thrombosis (POVT) is uncommon, but the true incidence is not known. Ninety per cent of cases present as right iliac fossa pain within 10 days of delivery. Anti-coagulation and intravenous antibiotics are the mainstay of treatment. We report three cases that were referred to our unit. These cases illustrate the difficulty in the clinical diagnosis of POVT and highlight the importance of its inclusion in the differential diagnoses of an acute abdomen in post-partum patients. POVT can be accurately diagnosed by appropriate noninvasive investigations and a laparotomy avoided.

Adult↗
PubMed2000

The role of hepatic arterial Doppler ultrasound after liver transplantation: an 'audit cycle' evaluation.

AIMS: To compare the diagnostic performance of hepatic arterial (HA) Doppler ultrasound post-liver transplantation for hepatic artery thrombosis and stenosis in our unit with the literature. To evaluate the role of the technique in clinical practice. MATERIALS AND METHODS: In a two-phase 'audit cycle' study, adult OLT patients had Doppler studies comprising detection of HA flow and measurements of peak systolic velocity, resistive index and systolic acceleration time. In phase I, patients had Doppler examinations 'routinely' and for any hepatic biochemical abnormality. In phase II, Doppler ultrasound was performed early post-OLT and later only if a senior transplant clinician suspected graft ischaemia. In addition to HA measurements the waveform was visually assessed. Clinical outcome was the 'gold standard'. RESULTS: Phase 1: 38 patients, 40 OLT operations, 125 Doppler studies; 14 arteriograms. Phase 2: 35 patients, 42 OLT operations, two HA angioplasties, one HA revision, one non-occlusive thrombus, 140 studies; 17 arteriograms. Results; Phase 1 [Phase 2]: sensitivity 80% [100%]; specificity 71% [81%]; PPV 28% [56%]; NPV 96% [100%]; incidence of HA abnormality 12.5% [19. 5%]; likelihood ratio of negative result 0.28 [0]; of positive result 2.8 [5.3]. CONCLUSION: Previously reported results are reproducible. Normal HA waveform should also be a criterion of normality. The technique is very sensitive but relatively non-specific. Predictive values improve with discriminate use. MacEneaney, P. M. (2000). Clinical Radiology55, 517-524.

Adult↗
PubMed1998

A comparison of a non-ionic dimer, iodixanol with a non-ionic monomer, iohexol in low dose intravenous urography.

A prospective, double-blind study of 392 patients randomized into four groups was performed to establish whether diagnostic intravenous urograms could be obtained with a lower dose of iodine when using the dimeric, non-ionic contrast medium iodixanol compared with the monomeric, non-ionic iohexol. Patients received iodixanol or iohexol containing either 9 or 12 g of iodine (gI). The primary parameter was the diagnostic quality of the 6 min film, assessed in a blinded fashion, by consensus, by four radiologists. Iodixanol at both doses was diagnostic in over 90% of cases. Iohexol was only diagnostic in 74% (9 gI) and 81.8% (12 gI). Pairwise comparisons revealed that iodixanol 9 gI was significantly better than both iohexol 9 gI (p = 0.0005) and 12 gI (p = 0.014). No significant difference was present for different doses within the same contrast medium group. Iodixanol resulted in poorer bladder distension than iohexol. Iodixanol caused significantly less discomfort than iohexol.

Adult↗
PubMed1996

Diagnosis and treatment of heel pain in chronic inflammatory arthritis using ultrasound.

The authors examined the role of ultrasound (US) in diagnosis and management of heel pain in chronic inflammatory arthritis. Nineteen patients underwent US examination. Eight patients (2 with previously unsuccessful nonguided injections), had 11 US-guided corticosteroid injections for treatment of retrocalcaneal bursitis (n = 6), plantar fasciitis (n = 3), and posterior tibial tenosynovitis (n = 2). US-demonstrated Achilles tendon rupture (n = 2), Achilles tendinitis (n = 8), posterior tibial tenosynovitis (n = 6), peroneus longus tenosynovitis (n = 2), retrocalcaneal bursitis (n = 13), and plantar fasciitis (n = 4). Loss of smooth bone contour (n = 13) correlated with bone erosions on plain radiographs in all but one case. Ten of 11 guided injections resulted in full resolution of heel pain. The diverse causes of heel pain are highlighted, and the ability of US to provide information with management implications is confirmed. US-guided corticosteroid injection is beneficial, especially after failure of nonguided injection.

Achilles Tendon↗
PubMed1995

Technical report: ultrasound guidance for injection of soft tissue lesions around the heel in chronic inflammatory arthritis.

We describe the use of ultrasound guidance for local steroid injection of the retrocalcaneal bursa and the tibialis posterior tendon sheath in patients with chronic inflammatory arthropathy. Ultrasound guidance may be the injection technique of choice but is particularly indicated for patients with lesions unresponsive to injections guided by palpation.

Adolescent↗
PubMed1994

Magnetic resonance imaging of rectal carcinoma: a prospective study.

Accurate preoperative staging of rectal cancer is necessary to identify patients who might benefit from adjuvant therapy. Magnetic resonance imaging (MRI) was evaluated in 20 consecutive patients with rectal cancer undergoing 'curative' surgery. Detailed histopathological examination of the resected lesion was correlated with findings of MRI. MRI staging concurred with histological staging in 18 of 20 patients using the Dukes or tumour node metastasis classification but in only 14 using the modified Astler-Coller system. MRI diagnosed transmural invasion in all but one patient with microscopic mural invasion (positive predictive value, 100 per cent; negative predictive value, 80 per cent; overall accuracy, 95 per cent). MRI correctly diagnosed tumour deposits or involved lymph nodes in 12 patients. MRI overstaged one patient, in whom nodes that were enlarged on imaging studies were negative at histological examination (positive predictive value, 92 per cent; negative predictive value, 100 per cent; overall accuracy, 95 per cent). MRI has a role in selected cases for the preoperative assessment of rectal carcinoma.

Aged↗
PubMed1993

Accuracy of computed tomography during arterial portography in the segmental localization of liver tumours.

The ability of computed tomography during arterial portography (CTAP) to identify and segmentally locate 20 hepatic tumours was prospectively assessed in 7 patients undergoing hepatic resection. All eight lesions greater than 2.5 cm in diameter were detected, but only two out of four and two out of eight of those measuring 1-2.4 cm and < 1 cm respectively. The overall segmental localization accuracy for detected lesions was 91%. Our results highlight the insensitivity of CTAP to hepatic lesions smaller than 1 cm in size, but have shown the accuracy of segmental localization for detected lesions.

Carcinoma, Hepatocellular↗
PubMed1993

The role of radiography and computed tomography in the diagnosis of acute dislocation of the proximal tibiofibular joint.

A cadaveric study was undertaken to determine the best radiographic method of diagnosing dislocation of the proximal tibio-fibular (PTFJ) joint. Three pairs of cadaver knees were used, the right side serving as a control in each case. Plain radiographs, antero-posterior (AP) lateral and 45 degrees oblique films, and axial computed tomography (CT) scans were obtained with the joints in each of three positions: (1) anatomical, (2) dislocated anteriorly and (3) dislocated posteriorly. Similar views were obtained in the control joints with the PTFJ undisturbed. The radiographs were assessed by eight independent observers and the results were analysed. The diagnostic accuracy with plain AP and lateral radiographs was 72.5%. This was unchanged with the addition of oblique views, but improved to 82% with the control films and 86% with the axial CT scans. The authors conclude that in the diagnosis of suspected dislocation of the PTFJ, axial CT scanning is the investigation of choice. Plain AP, lateral and comparison views are useful but less accurate, while oblique views are unhelpful and unnecessary.

Acute Disease↗
PubMed1992

Color Doppler imaging of the cystic artery.

Color Doppler ultrasonography was used to examine the gallbladder vascular supply in 30 volunteers and in 30 biliary lithotripsy patients pre- and 2 hours posttreatment. A preliminary study of 10 cases of acute cholecystitis was also performed. A cystic artery waveform was obtained in 24 of the volunteers, 18 pre- and postlithotripsy patients, and in 1 of 10 patients with acute cholecystitis. The mean pulsatility indices obtained were 1.04 in the volunteers, 0.98 pre- and 1.02 postlithotripsy (p greater than 0.1). This study shows that the normal gallbladder blood supply can be consistently identified using color Doppler flow imaging and that there is no appreciable difference in the cystic artery pulsatility index following medium-energy shock-wave extracorporeal lithotripsy. Preliminary results in acute cholecystitis suggest that flow is decreased below the sensitivity of the color Doppler imaging system used in this investigation.

Adult↗
PubMed1992

Radiological investigation in laparoscopic compared with conventional cholecystectomy--an early assessment.

The implications of laparoscopic cholecystectomy (LC) for radiology were assessed by comparing imaging investigations in 48 LC and 48 conventional cholecystectomy (CC) patients. In addition, we attempted to identify findings on pre-operative ultrasound (US) which predicted operative difficulties at LC. There were no per-operative or T-tube cholangiograms in the LC patients, but otherwise the pattern of investigation was similar in both groups. Forty of the 48 CC patients underwent cholangiography (per-operative cholangiography in 36, endoscopic retrograde cholangiopancreatography (ERCP) in two, and both in two) demonstrating calculi in eight (16.7%) cases. Only four LC patients had cholangiography (ERCP in all cases) demonstrating common bile duct (CBD) calculi in one (2.1%) case. Ultrasound failed to identify the gall-bladder with certainty in three of the five failed LC cases. Neither gall-bladder wall thickness, contraction nor calculus size on pre-operative US served as predictors of other per-operative difficulties. Our results indicate that there may be some patients with retained CBD calculi in the LC group. The role of pre-operative US in predicting operative difficulties needs further assessment in a prospective study.

Adult↗