Evaluation of a radiographer-provided barium enema service.

AIM: Radiographers performed and reported 5516 double contrast barium enemas (RDCBEs) over 4 years to October 2001. This study was undertaken to assess the accuracy of RDCBE and the sensitivity for diagnosing colorectal cancer (CRC). METHOD: A total of 224 consecutive outpatient RDCBEs were reported; normal (C1), diverticulosis (C2), diverticulosis with filling defect (C3), diverticulosis & other pathology (C4) and abnormal (C5). RDCBEs were then reported by a radiologist (AL, NS) and the two reports compared. Of 450 CRCs, 153 had undergone DCBE; 152 RDCBEs. Reports were analysed to establish concurrence between radiographer and radiologist and final CRC diagnosis. RESULTS: By category: C1 - 37%, C2 - 31%, C3 - 21%, C4 - 11%, C5 - 0%. C4s included polyps (50%), cancer (12.5%), disrupted anastomosis (8%) and colitis (4%). There was no discrepancy between RDCBE and radiologist reports. Radiology and CRC diagnosis agreed in 145 of 152 DCBEs. There were three exclusions: DCBEs occurred outside the study period (2), one only with raised possibility of malignancy. Of eight remaining RDCBEs, seven were false negatives and one false positive. Sensitivity score for RDCBE was 94.5%. Double reporting by a radiologist did not improve sensitivity. CONCLUSION: RDCBEs are as accurate as those performed by radiologists and have a very high sensitivity for CRC. In a time of ever increasing demands for complex staging investigations for CRC and interventional radiology, the ACPGBI needs to reconsider its guidelines on radiographers not only performing but also reporting DCBE.

An unusual cause for a colonic stricture: a case of Mycobacterium xenopi mimicking malignancy.

Colonic strictures are very common and are a frequent finding on double contrast barium examination; they very often reflect the presence of malignancy, diverticular disease, ischaemia, inflammatory bowel disease, and rarely mycobacterial disease. A case of mycobacterial disease mimicking malignancy is presented; this was due to a rare mycobacterial subtype and there was complete resolution of symptoms with antimycobacterial therapy.

A retrospective 5-year study on the accuracy of the barium enema examination performed by radiographers.

Barium enema examinations have been undertaken by radiographers at the Frenchay Hospital for more than 10 years. We have performed a retrospective study to assess the accuracy of this radiographer service by reviewing those patients who have been examined by both Barium enema and colonoscopy/flexible sigmoidoscopy to determine agreement, and reasons for disagreement. This paper does not attempt to compare the two techniques. In the 5 years between 1992 and 1996, 595 patients had both barium enema and colonoscopy or flexible sigmoidoscopy. In 488 (82%) of these patients the barium enema examination was performed by a radiographer. Comparisons with endoscopy indicate that 96% of polyps >1 cm, and 97% of carcinomas were detected radiologically. We conclude that radiographer performed barium enemas with double reporting produces a very high standard of examination with detection rates for significant lesions comparable with published data.

Combined laparoscopic and endoscopic treatment of gallstones and bile duct stones: a prospective study.

In patients with symptomatic gallstones the management of choledocholithiasis has been controversial since the introduction of laparoscopic cholecystectomy. A prospective study was made of 300 consecutive patients with symptomatic gallstones managed by laparoscopic cholecystectomy and preoperative endoscopic retrograde cholangiography (ERC) over 2 years. Fourteen patients were excluded either because urgent surgery was required or because they were unfit for laparoscopic cholecystectomy. ERC was performed on 96 patients (34 per cent) who were at risk of choledocholithiasis. The presence of bile duct calculi was confirmed in 59 patients (21 per cent of the total, 61 per cent of those undergoing ERC); stones were removed endoscopically in 53 cases (90 per cent of attempts). The remaining six patients underwent open cholecystectomy and bile duct exploration. Laparoscopic cholecystectomy was attempted in 280 patients (98 per cent); it was necessary to convert to open operation in only three (1 per cent). There were no deaths, no retained stones and no bile duct injuries, and only three patients (1 per cent) developed a significant postoperative complication. Symptomatic gallstones can be managed by preoperative ERC and laparoscopic cholecystectomy with minimal morbidity and mortality.

Intussusception in the adult: clinical, radiological and histological features.

Intussusception in the adult is an unusual cause of bowel obstruction. Unlike in childhood the clinical presentation is not clear cut and there are no distinct pathognomonic features. The radiological features are variable. Five patients presented to Frenchay Hospital over a five month period. The patients' clinical courses demonstrate the differing presenting features. Ultrasound investigation and CT scanning may show characteristic signs. Surgical treatment is mandatory as there is nearly always an underlying pathological abnormality which may be malignant.

Technical report: a 'new' tube providing rapid insertion for the small bowel enema.

Small bowel enteroclysis (SBE) is considered to be diagnostically superior to the conventional barium follow through examination (Sanders and Ho 1976; Maglinte et al., 1982; Herlinger, 1982) and would be more generally acceptable if jejunal intubation could be undertaken rapidly with minimum fluoroscopy and patient discomfort. Using a modified Merck 'Coresafe' tube 75 out of 80 patients referred for SBE were intubated, with considerably reduced fluoroscopic and intubation times. No tube related difficulty was encountered and patient tolerance was good.

Magnetic resonance imaging of the carpal tunnel.

Eleven wrists in eight patients with carpal tunnel syndrome were investigated by electrophysiological studies and magnetic resonance imaging (M.R.I.). The operative findings in ten wrists correlated with the M.R.I. evidence of synovial disease, carpal tunnel stenosis and median nerve compression.

The role of magnetic resonance imaging in the investigation of undescended testes.

The location of undescended impalpable testes is important because of the greatly increased risk of malignancy. Various imaging methods have been used in the past with only partial success. In many cases an exploratory laparotomy has been performed although even this has not proved completely successful. We describe the use of magnetic resonance imaging (MRI) in six adults with eight undescended testes. We were able to detect the position of six of the eight testes by this method. MRI does not use ionising radiation and is a useful method of locating these radiosensitive organs.

Sexual differentiation of the human midtrimester brain.

It is firmly believed that sexual differentiation of the brain is linked with external genital differentiation in timing as an in utero event in the human. An extensive search for oestrogen, androgen and progestin receptors failed to show their presence despite adequate controls in cytosols from human fetal brain of gestational ages 14-20 weeks. It is possible that the receptors are present in levels so low that they are undetectable by present-day methods. Our results would indicate that hormonally influenced in utero brain sexual differentiation is most unlikely to occur as a mid-trimester event.

Muscle acetylcholinesterase in childhood myopathies.

The activities and the molecular forms of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) were examined in 28 biopsies of quadriceps femoris muscle from children with a myopathic non-dystrophic disease. These cases were compared with biopsies from 7 children with a neurogenic damage, 14 children with muscular dystrophy and 12 controls. All the biopsies, histochemically stained for AChE, showed no endplates; electron microscopy of muscle fibers from diseased biopsies revealed a diffuse AChE reaction on the fiber surfaces which was not associated with any endplate structure. The AChE activities in NaCl/Triton X-100 extracts from the three groups of patients were all more or less the same, and average levels were similar to those evidenced in controls. The complete disappearance of heavy and medium forms of AChE was noted in 60% of myopathic non-dystrophic patients. We never observed the pattern characteristic to these patients in the biopsies from neurogenic and dystrophic patients or from controls, which displayed a high variability in the profiles of AChE molecular forms.

Assessment of the Meditech Euroscanner for clinical use.

In April 1983, Prototype I of the Meditech Whole Body CT Scanner (Euroscanner) was installed at Frenchay Hospital as part of a Department of Health and Social Security (DHSS) trial to assess its function and reliability. After a few months usage, several modifications were made to the machine. The official trial therefore commenced on Prototype II in the middle of January 1984 and lasted until the end of July 1984. During that time a planned changeover took place in the Neuroradiological Department, with the replacement of a ten-year-old EMI 1010 head scanner by an IGE 8800. This meant that from the beginning of May until the end of July, the Meditech Scanner was the only available CT scanner in a busy Regional Department with District Hospital commitments as well. This paper provides a summary of the clinical experiences resulting from the use of the machine, and is a rider to that in which Greensmith et al (1985) describe the physical properties of the machine.

Bronchospasm following intravenous injection of ionic and non-ionic low-osmolality contrast media.

Eighty patients were given either intravenous Hexabrix 320 or Niopam 300 for urography, and any bronchospastic effect was assessed by measurement of forced expiratory volume in 1 s (FEV1). No significant difference between pre- and post-injection FEV1 was shown with either contrast medium. Minor side-effects were comparable, the only significant difference between the two being the higher incidence of nausea and vomiting with Hexabrix 320.

Complications of T-tube drainage of the common bile duct.

The complications associated with T-tube drainage of the common bile duct following biliary surgery were studied prospectively. A high rate of complications especially associated with T-tube removal was found. Biliary leakage and bacteraemia were the two main problems though in most cases caused minimal clinical upset. Alternatives to T-tube drainage are discussed. It is suggested that if T-tubes are to be used broad spectrum antibiotic cover should be employed at the time of removal.

Xanthogranulomatous pyelonephritis: a pathological, clinical and aetiological analysis of 87 cases.

Analysis of 87 cases of xanthogranulomatous pyelonephritis ( XPN ) from 1958 to 1983 (14 males, 73 females, ages 13-85) revealed an incidence of 1.4 cases/100 000 population per annum which is apparently increasing. Clinical, radiological and pathological investigations demonstrated universal urinary obstruction (77.5 per cent calculi, 17.5 per cent pelviureteric junction obstruction) and pathogenic organisms such as E. coli or Proteus were cultured from the urine in 72 per cent of cases. Rare complications included sinuses or fistulae to bowel. We believe that the combination of urinary obstruction and infection by organisms of low virulence initiate XPN , and that associated lipid is derived from renal pelvic adipose tissue. Problems of differential diagnosis are discussed in relation to the use of immunocytochemistry and electron microscopy.

Oestrogen conjugation in mid trimester human fetal brain: a possible role in its sexual differentiation.

Mid-trimester human fetal brain cytosol incubated with [3H]-oestradiol gave a radioactive peak on 5% polyacrylamide gels, which migrated with the bromophenol blue marker (anodic peak) and which could be suppressed by the addition of 100 times molar excess of unlabelled ligand to the incubate. This anodic peak could only be destroyed by proteolytic enzymes if they were added at the beginning of the incubation, but not subsequently, indicating that it did not represent a protein-bound oestradiol. Competition studies show that the anodic peak can be suppressed with natural oestrogens and ethinyloestradiol, but not by the synthetic oestrogens, androgens and progestins tested. Butanol extraction of incubates, followed by t.l.c. in a number of systems, indicates that both oestrone and oestradiol are sulphated. The parent steroids could be liberated by hydrolysis of incubates with either 1N sulphuric acid or aryl sulphatase. This conjugation may effectively curtail the action in fetal tissues of high levels of oestrogens and hence play a role in brain sexual differentiation in the human.

Xanthogranulomatous pyelonephritis: a reappraisal.

A survey was undertaken of the clinical, radiological, ultrasonic, and pathological features of 80 patients with xanthogranulomatous pyelonephritis (XPN). The condition is a progressive granulomatous reaction to chronic renal inflammation which is often suppurative and usually caused by calculous urinary tract obstruction. The characteristic pathological features are large numbers of foam cells containing lipid, and the presence of inflammatory destruction of neighbouring renal tissue. XPN, which is commoner than generally recognised, may often be diagnosed preoperatively--the patient is usually a middle-aged female who presents with severe toxaemia, tender loin mass, and mild lower urinary tract symptoms. The diagnosis is confirmed by radiology and ultrasonography. Nephrectomy is curative.

Ontogenetic and imprinting-induced changes in chick brain protein metabolism and muscarinic receptor binding activity.

Over the 20-min period following exposure of young chicks to a flashing light as an imprinting stimulus there is an increased incorporation of [14C]leucine into an acidic (tubulin-enriched) protein fraction of the anterior dorsal forebrain in birds which have learnt the characteristics of the stimulus as compared with, either birds which have been exposed to an imprinting stimulus but learn poorly, or chicks kept in the dark. This brain region has been implicated in several studies as the locus for a number of biochemical modulations that accompany learning. The amount of [14C]leucine incorporated does not seem to be determined by precursor pool availability; it does, however, correlate with a well-validated measure of the extent to which birds have learnt to recognise the characteristics of the stimulus, as shown by a two-choice discrimination test. There is no change in the total content of tubulin dimer as assayed by colchicine binding under these conditions. Additionally, in birds which show evidence of learning, the binding of quinuclidinyl benzilate, an irreversible muscarinic ligand, is altered in both the posterior dorsal forebrain and midbrain regions. None of these effects could be simply the result of visual stimulation. The meaning of these changes is discussed.