A study of constipation in the elderly living at home.

A cross-sectional survey of bowel habit has been carried out on 201 elderly patients living at home. Although symptoms of constipation were common, reported bowel frequency was similar to younger people. Constipation was most clearly associated with poor mobility and depression. Digital rectal examination was generally unreliable as an indicator of constipation. Using the abdominal radiograph as the final arbiter, true constipation was present in less than half of those complaining of constipation.

An investigation of colonic function in the elderly.

A straight abdominal radiograph can be used in the elderly to indicate a loaded colon. Two groups of patients were identified using radiology, one with faeces-filled caeca and the other with gas-filled caeca. Gastro-intestinal transit time measurements and breath methane analysis, an indicator of colonic bacterial activity, were used to investigate colonic function. An attempt was made to identify different colonic transit patterns by radiography after administering radio-opaque markers of various shapes on three consecutive days. Although the two patient groups showed no differences in gastro-intestinal transit time there were differences in the distribution of the pellets in the colon and in the excretion of breath methane. Straight abdominal radiography was of value in identifying two patient groups with different colonic function.

Malalignment of the shoulder after stroke.

One hundred and ten consecutive patients (51 men, 59 women) admitted to a stroke unit were studied for radiographic changes at the shoulder on the affected side. Malalignment was found in 51 (46%) patients, of whom 37 (72.5%) had changes on the initial x-ray film and a further 14 (27.5) developed malalignment over the following 12 months. These findings indicate that malalignment of the shoulder is common in the early stages of a stroke and may be missed unless radiographs are taken with the patient erect and the arm unsupported. Malalignment may lead to delay and limitation in restoration of function. The consequences of malalignment can be prevented by correct handling, positioning, and full passive movement of the shoulder from the onset of the stroke.

Grey-scale ultrasonography and percutaneous transhepatic cholangiography in biliary tract disease.

Fifty-one patients with suspected obstructive jaundice and 14 without jaundice in whom disease of the biliary tract was suspected but infusion cholangiography had been unhelpful were examined by grey-scale ultrasonography and percutaneous transhepatic cholangiography and the findings analysed retrospectively. Grey-scale ultrasonography distinguished between obstructive and hepatocellular jaundice in 35 out of 46 patients (76%) and indicated the site of the obstruction in 27 (58%) and the cause of the obstruction in 13 (28%). Percutaneous transhepatic cholangiography distinguished between obstructive and hepatocellular jaundice in 42 of the patients (91%) and indicated the site of the obstruction in 42 (91%) and the cause in 29 (63%). In the 14 patients without jaundice percutaneous transhepatic cholangiography showed bile-duct stones in one an ampullary stenosis in three. It is concluded that grey-scale ultrasonography and percutaneous transhepatic cholangiography are complementary examinations and that ultrasonography should always be undertaken first as it is a non-invasive procedure that may provide the surgeon with all the diagnostic information he requires. Percutaneous transhepatic cholangiography should be performed when grey-scale ultrasonography has shown dilated bile ducts but failed to provide adequate diagnostic information. Cholangiography is also required when preoperative percutaneous drainage of the bile duct is contemplated. In those patients in whom grey-scale ultrasonography shows non-dilated ducts endoscopic retrograde cholangiopancreatography is probably the contract examination of choice.

Percutaneous transhepatic cholangiography with the Chiba Needle.

Percutaneous transhepatic cholangiography using the Chiba needle has been performed on 102 patients. There was an overall success rate of 86 out of 102 cases (84%). Dilated bile ducts were successfully demonstrated in 61 out of 65 patients (94%) and non-dilated ducts in 25 out of 37 patients (70%). Gallbladder filling was achieved in 40 out of 70 cases (67%). The hepatic lymphatics were filled in 32 cases but dilated lymphatics were mainly seen in patients with biliary cirrhosis, inflammatory liver disease or lymphoma. It is suggested that an excessive radiation dose may be given to the radiologist's fingers unless the fluoroscopy diaphrams are kept well coned down. Complications requiring active medical intervention occurred in three cases and emergency surgery in one case.

Chilaiditi syndrome.

The features of the Chilaiditi Syndrome are described, together with the historial background, and a brief review of the literature on the condition is given. The prevalence in our geriatric population was found to be 1% and the 13 cases seen over 22 months are reported briefly. The prevalence increases with age and may be related to the consumption of drugs by the elderly; although in the majority it is asymptomatic, it may, particularly when associated with gastrointestinal symptoms, lead to unnecessary laparotomy. In the geriatric patient, interposition of the bowel should be considered in the differential diagnosis of air under the right hemidiaphragm.