[Double blinded prospective study of usefulness of bowel preparation on outpatients before intravenous urography.].

OBJECTIVE: The aim of this study was to examine whether or not a bowel preparation should be administered prior to intravenous urography (IVU) on outpatients at the Reykjavik Hospital. MATERIAL AND METHODS: In a period of seven months 89 outpatients remitted to IVU were randomly divided into two groups, A and B. Patients in group A went through bowel preparation before the investigation but patients in group B did not. The patients in group B were asked to consume only fluids, beginning the evening before the investigation. Five patients were excluded from the study. The remaining 84 patients were equally divided between groups A and B. Before the investigation all patients in both groups were asked to fill out a questionnaire giving their reactions to the preparation procedure. Three experienced radiologists performed image interpretation. Delineation of the urinary system, diagnostic ability and quality of cleansing were judged. The study was prospective and double blinded. The same type of contrast media, the same dose and the same type of film were used each time. A comparison of results between the two groups was carried out. RESULTS: The age distribution was the same for both groups. Most of the patients in group A (76%) experienced the cleansing procedure as uncomfortable and 12% as awful. In group B most of the patients felt the preparation was comfortable. No one in group B said that the preparation was uncomfortable. There was no difference between the groups according to delineation of the urinary system except for the urinary bladder, where the delineation was judged to be worse in group B. Air in the bowel was the main disturbing factor in group A, but both air and faeces in group B. The quality of cleansing was judged to be better in group A. There was no difference between the groups in terms of diagnostic ability. CONCLUSIONS: Bowel preparation on outpatients before IVU causes discomfort to the patients and does not improve the quality of the results.

Epidemiology of distal radius fractures in Iceland in 1985.

Between March 1985 and March 1986, 249 fractures of the distal radius in patients over 15 years of age were treated in the Reykjavik area, which had a total at risk population of 100,154. The incidence pattern was similar to what has been reported in recent Nordic studies except that the fracture risk of women was lower than in Oslo in 1979 and Malmö in 1980-81, and for men higher than in Fredriksborg in 1981. Fifty-seven percent of the patients had employment at the time of accident. The majority of accidents happened outdoors, especially on sidewalks and in streets, and were more common during the winter months.

Methotrexate treatment of rheumatoid arthritis: effects on radiological progression.

Radiological progression was evaluated in 15 patients with rheumatoid arthritis (RA) treated with methotrexate (MTX). Prior to MTX treatment, all the patients had failed on other slow-acting agents and all showed radiological deterioration. For each patient, three sets of radiographs of hands and wrists were evaluated: prior to MTX treatment while on other slow-acting agents, at the beginning of MTX treatment, and at the most recent evaluation on MTX. Two experienced radiologists evaluated the radiographs independently. The rate of radiological progression was calculated by dividing the change in radiological score by the number of months between sets of radiographs. The mean time from film set one to two (period one) was 29.4 months and from set two to three (period two) 32.5 months. The mean rate of radiological progression for period one was 0.576 and for period two, 0.381. Eight patients showed decline in radiological progression during MTX treatment.

Relation between bone erosions and rheumatoid factor isotypes.

Total rheumatoid factor (RF) activity and individual RF isotypes were measured in 62 patients with rheumatic diseases. Retrospective analysis of available x rays showed an association between IgA RF and the occurrence of periarticular bone erosions in hands. In contrast, IgG RF and IgM RF did not show any significant association with erosions. Furthermore, a close correlation was observed between the RF isotype levels in simultaneously drawn serum and synovial fluid samples. The possible significance of IgA RF in the pathogenesis of bone erosions is discussed.

Acromioclavicular dislocations treated by coracoacromial ligament transfer.

Forty-seven patients with acute Allman type-III acromioclavicular dislocations were treated with open reduction and coracoacromial ligament transfer. At follow-up 1.6-10 years (mean 6) post-operatively 44 patients (94%) had excellent or good functional results. Two of the three patients with unsatisfactory results had degenerative joint changes. No late dislocation was found but there were three subluxations (3-5 mm). Two of the three patients with subluxation in the acromioclavicular joint at follow-up had unsatisfactory results. Complications were infrequent and cosmetic results satisfactory.

The penetration of metrizamide into the brain after routine lumbar myelography as shown by cerebral computed tomography and its effect on auditory brainstem transmission time.

Metrizamide is a widely used contrast medium with some well known adverse reactions. In a preliminary study, CT scans and brain stem evoked potentials (BAEP) were done before and 18 hours following lumbar myelography on 12 patients. A statistically significant prolongation of the BAEP was observed. Metrizamide therefore seems to be a potent substance in clinical use as indicated by its effect on BAEP. BAEP should not be done within the first few days after myelography with metrizamide.

Fractures of the scaphoid bone. A follow-up study.

Fracture of the scaphoid bone is the most common fracture of the carpal bones (Dunn 1972). Primary diagnosis can be difficult, and misdiagnosis with subsequent inadequate treatment often results in a permanently painful wrist with reduced function of the hand. We have observed that the immobilization time for scaphoid fractures at this clinic is shorter than is usually reported (Cooney et al. 1980; Dunn 1972; Eddeland et al. 1975). We have also observed that in some cases major diastasis in the fractures coincided with delayed union or non-union. Since opinions on the treatment of these fractures have varied on some points, we find it worthwhile to present our results. The major aims of the study were to evaluate whether the short immobilization time has any bearing on the fracture healing and, furthermore, whether the presence of a significant diastasis of the fracture affects the healing.