Cognition and adaptive functioning in older people attending drug and alcohol services.

BACKGROUND: Substance use disorders in older adults are expected to increase dramatically in the coming years. Given the increased susceptibility to cognitive deficits in older substance users (defined here as aged 50+ years due to the accelerated health decline observed in this population), it is important to consider the functional correlates of cognitive impairment in these older adults. This study details the cognitive status of older individuals attending outpatient drug and alcohol (D&A) treatment services and seeks to determine of the association of cognitive impairment to self-reported daily functioning. METHODS: Ninety nine clients aged 50 years or over attending outpatient D&A treatment services in Sydney, Australia participated. Cognition was assessed using the Addenbrooke's Cognitive Examination - Revised (ACE-R). Recent substance use (Australian Treatment Outcome Profile), physical and mental health (SF12, Geriatric Depression Scale), social isolation (Lubben Social Network Scale), and activities of daily living (Bayer ADL Scale) were also assessed. RESULTS: Nearly two-thirds of participants screened positive for cognitive impairment on the ACE-R; 41% and 65% of clients met the cut-off scores for mild cognitive impairment (MCI) and more severe cognitive impairment, respectively. Self-reported seizure history was a predictor of cognitive impairment. CONCLUSIONS: The results suggest that cognitive impairment in this group is common. The assessment of cognitive status for this older group of patients should not only include the identification of cognitive impairment but also encompass mental health and social functioning. A greater understanding of the needs of this cohort will also enable better co-ordination with other health and welfare services tailored to this population.

The Royal College of Radiologists Breast Group breast imaging classification.

Standardisation of the classification of breast imaging reports will improve communication between the referrer and the radiologist and avoid ambiguity, which may otherwise lead to mismanagement of patients. Following wide consultation, the Royal College of Radiologists Breast Group has produced a scoring system for the classification of breast imaging. This will facilitate audit and the development of nationally agreed standards for the investigation of women with breast disease. This five-point system is as follows: 1, normal; 2, benign findings; 3, indeterminate/probably benign findings; 4, findings suspicious of malignancy; 5, findings highly suspicious of malignancy. It is recommended that this be used in the reporting of all breast imaging examinations in the UK.

Breast screening: the use of consensus opinion for all recalls.

The quality of a breast-screening programme is measured not only by it's cancer detection rates (sensitivity), but also by it's recall rates and positive predictive values (specificity). False positive screens, which lead to assessments with benign outcomes, can cause psychological and physical morbidity in previously well women. In 1999 the Wiltshire breast-screening programme adopted a novel recall strategy whereby all films marked for recall are subject to consensus opinion--even women "recalled" by both original readers may be returned to routine screening. Since 1999 our recall rates have fallen from above to below the national averages (prevalent 7.2% and incident 3.0% in 2001/02). Specificity has increased over the same period such that approximately one in seven women assessed will be diagnosed with cancer. The consensus meetings provide a forum for teaching and are very popular with our film readers, who all report reduced levels of stress.

Submucous lipoma of the ileocaecal valve presenting as caecal volvulus.

Caecal volvulus is a well described but unusual condition. We report here, a case of caecal volvulus in a 53-year-old Caucasian woman associated with intussuscepted submucous lipoma of the ileocaecal region. The imaging and pathology are presented. Submucous lipoma of the ileocaecal region is uncommon but well described. It can be mistaken as carcinoma of the ascending colon on barium enema and on computed tomography scan. The combination with caecal volvulus is a rare occurrence.

Paracetamol as a prophylactic analgesic for hysterosalpingography: a double blind randomized controlled trial.

AIM: To evaluate the effectiveness of paracetamol as a prophylactic analgesic for hysterosalpingography (HSG). DESIGN: A prospective double blind randomized controlled trial comparing one 1 g of paracetamol (SmithKline Beecham, Brentford, U.K.) to placebo taken 30 min before HSG. One hundred consecutive out-patients were studied prospectively. The analgesic effectiveness during the procedure and at 24 h and 1 week post procedure was analysed by a postal pain score questionnaire. Additional data on the ethnicity of the patient, sex and level of experience of the radiologist performing the hysterosalpingogram, the parity of the patient, the ease of the procedure, and whether pathology was identified were also recorded. RESULTS: Eighty-eight patients (88%) replied, 39 (44%) received paracetamol and 49 placebo (56%). During the procedure 3/39 (7%) of women in the paracetamol group were pain-free compared to 9/49 (18%) in the placebo group, which was not significant (P = 0.11). At 24 h, 15/39 (38%) of women in the paracetamol group were pain-free compared to 20/49 (41%) in the placebo group, which was not significant (P = 0.82). At 1 week, 27/39 (69%) of women in the paracetamol group were pain-free compared to 29/49 (59%) in the placebo group, which was not significant (P = 0.33). No significant difference in mean pain scores was determined during the procedure (P = 0.91), or at 24 h post procedure (P = 0.94). Similarly, no difference in mean pain scores was identified with regard to the ethnicity of the patient, the sex of the radiologist performing the procedure, the level of experience of the radiologist performing the procedure, or whether pathology was present or not. Difficult cannulations were associated with higher mean pain scores, however, there was no difference in mean pain scores between the paracetamol or placebo groups for both easy and difficult cannulations. CONCLUSION: Paracetamol is not effective as a prophylactic analgesic for HSG. If a prophylactic analgesic is considered necessary for pain relief during HSG we recommend that a non-steroidal anti-inflammatory drug (NSAID) is used.

Radiology of skeletal tuberculosis.

In recent years, the incidence of tuberculosis (TB) has increased, primarily in developing countries, but also in Europe and North America. The association between TB and human immunodeficiency virus infection is well-documented. In these cases, TB is more likely to be extrapulmonary. The spine is the most common site for skeletal TB. Atypical appearances may be present in immigrants. Plain radiography remains the cornerstone for imaging, but newer cross-sectional modalities such as computed tomography, ultrasonography, and magnetic resonance imaging are becoming increasingly valuable in early and accurate diagnosis. This article reviews the features of musculoskeletal TB and the role that imaging plays in diagnosis and management.

The radiological appearances after the endoscopic crico-pharyngeal myotomy: Dohlman's procedure.

The treatment of pharyngeal pouches (Zenker's Diverticulum) may be by either open surgical or endoscopic techniques. The endoscopic Dohlman's procedure is an ideal technique in the elderly. However, confusion has been created by the persisting presence of the pouch on the postoperative barium examination, creating the impression of surgical failure. We describe the subtle radiographic findings of the postoperative barium swallow by comparing pre- and postoperative examinations which may be used to indicate the success of the procedure. These include demonstration of the reduced height of the partition wall, the ease of passage of the barium down the ooesophagus and the height of barium supported in the substance of the residual pouch.

Juvenile chronic arthritis of the hip: value of contrast-enhanced MR imaging.

OBJECTIVE: The purpose of this study was to assess the value of contrast-enhancement in MR diagnosis of hip joint disease in patients with juvenile chronic arthritis. PATIENTS AND METHODS: Fourteen hips in seven children (four girls, three boys; mean age, 11 years; range, 7-17 years) with juvenile chronic arthritis for a mean duration of seven years (range, 3-15 years) were imaged on a 0.5T MR unit. One patient had an MR scan repeated after an 8-month interval. Axial and coronal T1-weighted spin-echo, and axial gradient-echo sequences were performed. T1 weighted axial sequences were repeated immediately after 0.1 mmol/kg of intravenous gadopentetate dimeglumine. Patients were assessed clinically for pain in the hip, range of motion at the hip joint, haemoglobin and erythrocyte sedimentation rate. Two radiologists, unaware of the patients symptoms, jointly assessed the unenhanced and contrast-enhanced scans for synovial hypertrophy (pannus), cartilage destruction and joint effusion. RESULTS: Pannus was underestimated on 75% of unenhanced MR scans (95% binomial confidence intervals 54% to 93%). Enhancing pannus was seen in 14 of the 16 hip MR scans. Enhancing pannus was associated with articular cartilage destruction in all cases, and joint pain in 13 of 14 scans. Joint effusions were overestimated on unenhanced scans in all cases. Pannus could only reliably be distinguished from joint effusion after contrast enhancement. Both cases of loculated joint effusion were only seen after contrast enhancement. CONCLUSION: Contrast-enhancement is recommended to aid MR detection of disease activity and extent in children with juvenile chronic arthritis of the hip.

Pneumoparotitis.

Pneumoparotitis is a rare cause of parotid enlargement. It is due to a reflux of air through Stensen's duct into the acini of the parotid gland with subsequent dilatation. We report a case which followed a long history of autoinflation of the middle ears by the Valsalva manoeuvre. The plain radiographic, sialographic and ultrasound findings are presented.

Serum lysozyme in inflammatory bowel disease.

Serum lysozyme (muramidase) concentrations were measured in three groups of patients: control, ulcerative colitis and proctitis, and Crohn's disease. The mean +/-SD for each group was: control, 7 +/- 2; ulcerative colitis and proctitis, 7 +/- 2; and Crohn's disease, 10 +/- 4. Although a significant difference was seen between values in patients with Crohn's disease and values observed in those with ulcerative colitis or control patients, an important overlap was found between these groups. Further studies are necessary to explain the disparate results between this study and previous reports.