Biomedical subjects
Publications and source records attributed to A M Fink.
We report a case of a bleeding Meckel's diverticulum where scintigraphic and sonographic findings were thought to suggest an ileal duplication. We are not aware of previous reports of sonographic imaging of an uncomplicated Meckel's diverticulum.
UNLABELLED: Hyoscine butylbromide (Buscopan) is commonly used by radiologists in the UK as a hypotonic agent in double-contract gastrointestinal studies. A history of glaucoma is still taught to be the prime contraindication to its use, although the only individuals at risk are those with undiagnosed and therefore untreated angle closure glaucoma (ACG), who will not give a positive history. We conducted a postal survey of all members and fellows of the Royal College of Radiologists in the UK to establish current practice. RESULTS: Of the 1045 respondents who use Buscopan, 724 (81.6%) withhold it if the patient gives a history of glaucoma, and 631 (87.2%) of this group substitute glucagon. Of the 51 respondents who state that they understand that the patient who gives the positive history is not the one at risk, 22 continue to withhold Buscopan because of the established teaching. Only 429 (52.4%) substitute glucagon for Buscopan if the patient gives a history of heart disease. Eight respondents (0.8%) have seen an attack of glaucoma thought to have been precipitated by Buscopan, and 20 (1.9%) have seen cardiac complications. CONCLUSION: There are still widespread misconceptions about the contraindications to the use of Buscopan among radiologists in the UK. We recommend abandoning the practice of enquiring about a history of glaucoma, and substituting advice to seek urgent medical advice should eye pain and visual loss develop. Caution in the patient with heart disease appears to be of greater importance.
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A protocol for the management of irritable hip was assessed; this protocol avoids hospital admission while detecting all other serious causes of hip pain, in particular septic arthritis, at the earliest possible opportunity. Fifty children with painful hips were studied prospectively with immediate ultrasound guided aspiration and Gram stain of all hip effusions. Bone scintigraphy performed at an early stage was reserved for patients with unremitting symptoms. Thirty six hips were aspirated. Only two patients were admitted. The final diagnoses were transient synovitis (45 cases), Perthes' disease (three cases), fracture (one case), and septic arthritis (one case). The single case of hip sepsis was diagnosed on presentation. The traditional approach to management is questioned and the advantages of the protocol highlighted, including earliest diagnosis of sepsis and other serious pathology, avoidance of hospital admission, and the relief of pain by joint decompression.
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Ultrasound has become a routine investigation in the investigation of the painful hip in children. It has been recommended that all effusions demonstrated by sonography be drained. Based on the experience of 800 hip aspirations, the authors describe an approach to the demonstration and aspiration of hip effusions with some of the pitfalls that result in false positive and false negative diagnoses.
Inflammatory conditions of the aorta may present with non-specific clinical features, including unexplained fever. Indium-111 labelled leucocyte imaging may be performed in such patients to look for the presence of occult sepsis or to assess the activity of a known vasculitis. Of approximately 1100 patients to undergo leucocyte scintigraphy for these indications over a 5 year period, three had focal leucocyte uptake in the aorta. The final diagnoses were: (1) periaortitis in Wegener's granulomatosis; (2) aortic dissection in giant cell arteritis; and (3) streptococcal aortitis with impending rupture. In all three cases the uptake was initially not thought to be in the aorta, but in bowel, a paravertebral abscess and in the lumbar spine respectively. Further imaging with CT and MRI led to the correct diagnoses. As the aorta is a rare site of focal leucocyte uptake, errors in image interpretation are likely. The rapid diagnosis of inflammatory conditions of the aorta is essential, however, as they may be life-threatening if unrecognized; therefore awareness of the aorta as a potential site of uptake is important. Urgent referral for further imaging is imperative in these cases as a false or delayed diagnosis may lead to avoidable morbidity and mortality.
Necrobiosis lipoidica is a granulomatous skin condition typically occurring on the legs. A patient with this condition presented with gross bilateral induration of the eyelids sufficient to close both eyes.
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PURPOSE: Modern refractive surgery is effective in a large majority of cases in achieving a good first time result. Some attempts at correction, however, are less successful and require subsequent revision. METHODS: A case of secondary hyperopic astigmatism (+0.75 +1.50 x 45 degrees) is reported in a patient who had undergone radial keratotomy for myopia of -6.00 +0.75 x 90 degrees, 8 years previously. Preoperative uncorrected visual acuity was 20/120 improving to 20/20 with correction. Further refractive procedures were performed including arcuate keratotomy, posterior chamber phakic intraocular lens implantation and laser thermal keratoplasty to improve the uncorrected visual result. RESULTS: Final uncorrected visual acuity was 20/40, spectacle-corrected visual acuity was 20/20 with a manifest refraction of +0.50 +1.00 x 40 degrees. CONCLUSIONS: This case demonstrates how the consecutive application of several procedures can successfully refine an initially unsatisfactory refractive result. The potential for reduced predictability and additional complications with each procedure should not be forgotten.
Enlarged parietal foramina are believed to be benign and familial and due to a variable degree of defective intramembranous ossification of the parietal bones. We report 2 patients with this condition in whom fetal and neonatal MR imaging studies illustrate the antenatal and perinatal evolution of this condition and the associated persistence of a falcine sinus. We discuss its relationship to the spectrum of cephalocoeles.