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Biomedical subjects

A H Chapman

Publications and source records attributed to A H Chapman.

At least 19 recordsLinked to original sources
PubMed2000

Gastroduodenal obstruction from ovarian cancer: imaging features and clinical outcome.

OBJECTIVE: The purpose of this study was to describe the imaging features and clinical significance of gastroduodenal obstruction from ovarian cancer. MATERIALS AND METHODS: Eleven women with symptomatic gastroduodenal obstruction were identified over a 3-year period of prospective clinicoradiological review of cases managed in a specialist gynaecological oncology unit, during which period 438 women with ovarian cancer were managed. Imaging features were verified by surgery, intervention and clinicoradiological follow-up for a minimum of 12 months or until death. Management and outcome were independently reviewed by a medical oncologist not involved in primary care. RESULTS: The frequency of gastroduodenal obstruction was 2.5% (11 of 438 women). Disease stages of these women at initial diagnosis were: stage II (four women), stage III (six), stage IV (one). Histology was grade 3 in eight of the 11 women. Symptomatic gastroduodenal relapse occurred at 9-103 months after initial diagnosis (median 20 months). There were five cases of predominant involvement of the gastric body and six of the gastric outlet and duodenum. In six cases, focal mass disease resulted in obstruction, in two cases there was diffuse gastric invasion, and in three cases encysted malignant ascites in the lesser sac caused gastric compression/obstruction - the 'squashed stomach syndrome'. Diagnosis of obstruction was with CT in 10 of 11 cases. Palliative interventional procedures relieved symptoms in these three cases, surgery was performed in three cases and the remainder were treated with chemotherapy and other palliative measures. Two women are alive and well at 16 and 38 months who had loculated ascitic disease. Otherwise median survival was 5 months after symptomatic gastroduodenal involvement. CONCLUSIONS: Gastroduodenal obstruction is rare in women with ovarian cancer. Identification and drainage of encysted lesser sac ascites as its cause may be associated with long term survival, otherwise the prognosis is poor. CT accurately demonstrates the level and cause of obstruction and gives information about the wider extent of recurrent disease.

Adult↗
PubMed1999

The use, value and safety of herniography.

AIMS: To assess the safety, sensitivity and specificity of out-patient herniography when used to diagnose hernias in the presence of a normal or equivocal physical examination. MATERIALS AND METHODS: This retrospective study reviewed the symptoms, clinical findings, radiological findings, surgical findings and clinical outcome of 112 patients referred for herniography over a 5-year period. RESULTS: No significant complications were encountered. Thirty hernias were diagnosed. There was one false-positive and one false-negative examination giving herniography a sensitivity of 96.6% and a specificity of 98.4%. CONCLUSION: Herniography is a sensitive, specific, safe and reliable investigation which should be available to and used by all surgeons who perform hernia repair operations.

Adult↗
PubMed1998

Complications from inflation of a retention rectal balloon catheter in the vagina at barium enema.

We describe two complications arising from the inadvertent introduction and inflation of a retention rectal balloon catheter in the vagina. Barium entered the uterus, fallopian tubes and peritoneal cavity in one and caused a forniceal tear and venous intravasation in the other. In both cases the catheter misplacement was attributed to atrophy of the perineal body. Various recommendations have been made to reduce the risks associated with the use of balloon catheters but we wish to emphasize the importance of a digital rectal examination to define the perineal anatomy and the use of a gloved finger to guide the balloon catheter into the rectum.

Aged↗
PubMed1998

Folie à deux dissociative disorder in prepubertal children. Report of two cases with EEGs.

A case of folie à deux dissociative (dissociative hysteria) disorder in an 8 and 12 year-old sister and brother is presented. Illnesses of this type are very rare and there is little medical literature on this subject. Our patients, almost simultaneously, abruptly had complete loss of memory, disorientation, loss of awareness about who they were, and much anxiety, which lasted about 15 hours. Both patients were physically well and no abnormalities were found on physical examination, routines laboratory tests and EEG studies. Speculations about the emotional and interpersonal causes of this illness in these two patients are given.

Child↗
PubMed1997

Changing work patterns.

In the UK and elsewhere radiographers have taken over some of the work traditionally done by radiologists and this is blurring the boundaries between the two professions. Radiologists may wonder where such changes will lead. This article explores the reasons behind these changes, the practical and medicolegal constraints, and the effect of such changes on the provision of radiology services in the future.

Cost-Benefit Analysis↗
PubMed1997

Pseudolipoma of inverted Meckel's diverticulum: clinical, radiological and pathological correlation.

Three cases of isolated inverted Meckel's diverticulum are described. In two cases an initial pathological diagnosis of small bowel lipoma was suggested. In a third case central fat was demonstrated on CT and peristalsis of the intraluminal polypoid mass was observed during US examination. In all three cases small bowel enema examination demonstrated the lesion. Correlation of the clinical, radiological and pathological features is emphasised, as this will allow the correct diagnosis.

Adult↗
PubMed1997

Complications of barium enema examinations: a survey of UK Consultant Radiologists 1992 to 1994.

Questionnaires were sent to all Consultant Radiologists in the UK regarding complications from barium enema examinations. The 756 respondents performed a total of 738,216 examinations over the three year period 1992 to 1994. Seventy-seven Consultants (10.2%) reported a total of 82 complications including 13 deaths: an overall mortality rate of 1 in 56,786. Only three of 30 (10%) cases of bowel perforation died, as compared with nine out of 16 (56%) cases of cardiac arrhythmia. The only remaining death was a consequence of vaginal intubation. Details of all the reported complications are recorded. This was an entirely retrospective study.

Adult↗
PubMed1997

Retention balloon catheters and barium enemas: attitudes, current practice and relative safety in the UK.

Balloon catheters have been associated with increased morbidity and mortality leading some to believe they should be banned, yet others find them both useful and safe if used properly. Questionnaires were sent to all Consultant Radiologists in the UK to document current practice. Particular attention focused on whether eight safety aspects are considered during their use. In this entirely retrospective study complications with both balloon and standard tip catheters were recorded during the 3-year-period 1992 to 1994 to assess their relative safety. Twenty-two percent of UK Radiologists routinely used a rectal balloon. This was not associated with any increase in mortality, but extraperitoneal rectal perforation was increased by a factor of 2.5. The routine use of retention balloon catheters may not be justified.

Attitude of Health Personnel↗
PubMed1997

The changing face of emphysematous cholecystitis.

Emphysematous cholecystitis is a variant of acute cholecystitis characterized by the presence of gas in the gall bladder lumen, wall or pericholecystic tissues in the absence of an abnormal communication between the biliary system and the gastrointestinal tract. In the past, the diagnosis has relied on the plain abdominal radiograph (AXR), since there are no clinical features to separate this condition from simple acute cholecystitis. The apparently high mortality and morbidity associated with emphysematous cholecystitis has previously emphasized the importance of emergency cholecystectomy. We have reviewed eight cases of emphysematous cholecystitis presenting to this hospital over the last 5 years. The diagnosis was made on AXR in only one of these cases. Ultrasound (US) scans were performed in all eight cases, of which five were positive and three negative, due to non-visualization of the gall bladder. In the three negative cases, the diagnosis was made on subsequent CT scans. On initial clinical examination, only one of the eight patients appeared systemically unwell and conservative management was employed in five of the patients. The remaining three patients underwent cholecystectomy within 3-5 days because of continuing signs or symptoms. It is concluded that the AXR is relatively insensitive in the diagnosis of emphysematous cholecystitis. As a result of the regular use of US in suspected hepatobiliary disease, emphysematous cholecystitis is being diagnosed with increased frequency, uncovering a broad spectrum of disease ranging from mild to severe. Previously, failure to separate milder cases from simple acute cholecystitis may have been responsible for reports of unremitting severity and progression requiring emergency cholecystectomy. Based on clinical assessment, conservative surgical management is possible in a significant proportion of patients.

Acute Disease↗
PubMed1997

The concept of nemesis in psychoneurosis.

A patient who has a nemesis fear as the basic process in his psychoneurosis feels that he is destined to repeat the life course of one of his parents to eventual long-term psychosis, or incapacitating physical illness or death by illness or accident. He feels that this will occur at about the same age as that at which his parent suffered his misfortune. The patient during his childhood and adolescence had a traumatic relationship with this parent, and is haunted by guilt feelings about it, and fears that avenging destiny, or nemesis, requires that he pay with a similar misfortune for that which he feels he caused. These patients improve much in psychotherapy, but the underlying nemesis fear, though much reduced in severity, is not entirely eliminated.

Adult↗
PubMed1996

PEG -- is the E necessary? A comparison of percutaneous and endoscopic gastrostomy.

We describe our experience of 45 percutaneous gastrostomies using 12 F Wills-0glesby (Cook, Inc, Bloomington, IN, USA) catheters and 33 percutaneous endoscopic gastrostomies using 12 F Bower PEG's (Corpak, Inc, Wheeling, IL, USA). Tube displacement was a continued problem with the Wills-Oglesby catheter resulting in three patients developing peritonitis with one death. In view of this we would recommend as the preferred technique the endoscopic placement of Bower PEG catheters unless there are contraindications to the endoscopic technique.

Catheterization↗
PubMed1996

Selected issues in quality improvement and risk management.

OBJECTIVE: To provide an overview of selected issues in quality improvement and risk management. DATA SOURCES: Published articles, books, and standards pertaining to quality improvement and risk management. CONCLUSION: The changing health care environment has intensified the need for monitoring processes of home care, patient outcomes, and risk management issues. Quality improvement and risk management programs can provide guidelines for the home health staff to impact outcomes of patient care and patient and caregiver satisfaction. IMPLICATIONS FOR NURSING PRACTICE: Home health care nurses are involved in the evaluation of systems, processes, and outcomes. Their involvement in identifying problems, providing creative solutions, and successfully implementing systems and processes is essential for quality improvement. They also must be knowledgeable of risk management and be involved in the identification and resolution of potential risks to themselves and their patients.

Home Care Services↗
PubMed1996

Obsessions of infanticide and imminent psychosis.

In young mothers an obsession of infanticide, that is, fear that they may murder their children, may be coupled with an obsession of imminent psychosis, that is, fear that the first obsession is a sign of approaching insanity. Sixteen mothers with this clinical picture were evaluated in interviews. Seven of them entered psychotherapy and improved. The causative factors in childhood and adolescence wich led to the later development of these obsessive difficulties are analyzed. Even when psychotherapy was not possible, as was the case in nine patients, they should be strongly reassured and explanations should be given about the nature of the problem, for such encouragement and clarification helps them to improve to a significant extent. The prognosis of patients who have systematic psychoterapy is good.

Adult↗
PubMed1995

A barium enema training programme for radiographers: a pilot study.

We describe a training programme designed to instruct radiographers how to perform the double contrast barium enema (DCBE). The programme was assessed by comparing the first 50 unsupervised examinations with studies performed by senior registrars in radiology. Comparison was made by marking each study blind in terms of barium coating, colonic distension and visualisation of the colon in double contrast. A note was also made of the number of exposures, screening time, examination time and complications. No difference was found in any of these parameters when comparing the two groups. A further 50 patients were assessed at one year and this showed that standards had been maintained in terms of the above criteria. Follow-up at 3 years in the initial group has shown no missed pathology. We believe that delegation of the performance of the DCBE to radiographers is both acceptable to the patient and safe.

Barium Sulfate↗
PubMed1995

The influence of Nietzsche on Freud's ideas.

BACKGROUND: The striking analogies between the ideas of Freud and Friedrich Nietzsche, whose works were published from one to three decades before those of Freud, have been commented upon, but no previous systematic correlation of the ideas of Nietzsche and Freud has been made. METHOD: The major works of Nietzsche were read, and each possible analogy to an idea later broached by Freud was correlated by a systematic review of his works. Any references to Nietzsche in Freud's writings and reported conversation were culled. RESULTS: Concepts of Nietzsche which are similar to those of Freud include (a) the concept of the unconscious mind; (b) the idea that repression pushes unacceptable feelings and thoughts into the unconscious and thus makes the individual emotionally more comfortable and effective; (c) the conception that repressed emotions and instinctual drives later are expressed in disguised ways (for example, hostile feelings and ideas may be expressed as altruistic sentiments and acts); (d) the concept of dreams as complex, symbolic "illusions of illusions" and dreaming itself as a cathartic process which has healthy properties; and (e) the suggestion that the projection of hostile, unconscious feelings onto others, who are then perceived as persecutors of the individual, is the basis of paranoid thinking. Some of Freud's basic terms are identical to those used by Nietzsche. CONCLUSION: Freud repeatedly stated that he had never read Nietzsche. Evidence contradicting this are his references to Nietzsche and his quotations and paraphrases of him, in causal conversation and his now published personal correspondence, as well as in his early and later writings.

Austria↗