Small bowel obstruction--the water-soluble follow-through revisited.

AIMS: The aim of the present study to examine the use of a modified water-soluble follow-through in the diagnosis and management of small bowel obstruction (SBO). MATERIALS AND METHODS: Sixty-two patients were recruited to the study: 33 into the control group and 29 into the study group. A modified small bowel follow-through (SBFT) was performed in the study group patients. The control group was managed conventionally. Assessment was made by questionnaire documenting initial surgical diagnosis and likelihood of operative intervention, final diagnosis and surgical outcome (operative versus non-operative). RESULTS: SBFT changed the diagnosis in 12/24 of the study group (p<0.01). In the study group 8/24 proceeded to surgery whereas 19/33 underwent laparotomy in the control group, representing a relative risk reduction of 52%, but this was not statistically significant (0.10>p>0.05, chi-squared test). CONCLUSION: SBFT remains a valid and useful tool in surgical management of SBO. In particular it aids diagnostic confidence in planning surgical intervention, particularly in uncomplicated patients.

The outcome of contact procedures for tuberculosis in Edinburgh, Scotland 1982-1991.

We have reviewed the records of 632 (80%) of the 788 index cases of tuberculosis notified in Edinburgh from 1982-1991 to assess the value of contact procedures for tuberculosis. Screening was by tuberculin testing and radiological follow-up for 6 months. Fifty (7.9%) of 632 notifications were detected by contact procedures and a further 35 contacts had recent infection qualifying for chemoprophylaxis. Tuberculosis was diagnosed at the first clinic visit in 38 (76%) cases and a further 11 (22%) were diagnosed at 3 months. Twenty-seven (54%) contacts with tuberculosis were in the 0-14 year age group. BCG vaccination offered 59% protection. Forty-two (84%) cases of tuberculosis were in contacts of sputum smear-positive respiratory index cases. Contact procedures continue to be effective in identifying new cases of tuberculosis in Edinburgh. Most cases occur in children who are close contacts of smear-positive respiratory index cases and are identified within 3 months of initiating screening. Screening of close contacts other than those of smear-positive respiratory disease is usually unnecessary.

Intracellular free magnesium in lymphocytes from patients with congestive cardiac failure treated with loop diuretics with and without amiloride.

Cellular Mg2+ depletion has been reported in patients on long term diuretic therapy. We therefore measured lymphocyte free Mg2+ concentrations in patients with congestive cardiac failure treated with loop diuretics or a frusemide/amiloride mixture (Frumil) and compared them with control subjects. There was no correlation between lymphocyte free Mg2+ levels and plasma Mg2+ concentrations. Patients treated with loop diuretics did not show lymphocyte intracellular free Mg2+ depletion compared with normal controls, and those on Frumil showed higher intracellular free Mg2+ levels than normal.