An unusual osteochondral body in association with calcium pyrophosphate dihydrate crystal deposition disease.
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Biomedical subjects
Publications and source records attributed to B J Preston.
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Following the M1 air crash on 8 January 1989, 39 casualties were taken to the Queen's Medical Centre, Nottingham. A team of 31 radiographers and four radiologists used all five X-ray rooms adjacent to the Accident and Emergency Department. Patients with head and spinal injuries were further assessed in the CT suite by four radiographers and a neuroradiologist. The volume of work in the first few hours and in the subsequent days is described. All radiological examinations have been reviewed and the injuries, including those missed at initial assessment, are discussed. The role of the radiologists was to issue immediate reports, manage examinations so as to minimize any delay and assess the need for further specialized investigation. Important problems were identified, specifically: the call-out system; patient deterioration and lack of resuscitation equipment; patient flow; documentation; radiology equipment; and missed injuries. These problems are discussed and recommendations are made for X-ray Departments in dealing with disasters.
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Bone scans using technetium-99m phosphate complexes and a rectilinear scanner were carried out on 192 women with primary operable breast cancer four to six weeks after operation. The lymph node status of all these patients was assessed histologically from triple node biopsy specimens. Only nine patients had positive scans, although 94 patients had histological evidence that the tumour had already spread beyond the confines of the breast. Bone scanning, although accurate as a prognostic guide, is helpful only in a very few cases, and serves mainly to confirm prognostic information obtained more simply and less extensively by histological examination of lymph node biopsy specimens.
Fifty patients with pain and limitation of movement at the shoulder joint were investigated by arthrography. Normal findings using a double contrast technique are described. The main arthrographic patterns encountered were found in complete and incomplete tears of the rotator cuff, and capsulitis. Abnormalities of the bicipital tendon sheath were non-filling and leakage of contrast medium from the sheath. Extravasation of contrast medium from the bicipital tendon sheath and subscapularis bursa was considered to be due to over-distension of a joint with a reduced capacity. The accuracy of the procedure and the reasons for false negative arthrograms and surgical exploration are discussed.
Radiography and manometry have been used to study oesophageal motor function in a group of 31 diabetics, 23 of whom had alimentary or genitourinary symptoms attributed to autonomic neuropathy. Peristalsis was of diminished amplitude and oesophageal emptying in the 15 degrees Trendelen-Peristalsis was of diminished amplitude and oesophageal emptying in the 15 degrees Trendelenburg position was delayed. The lower oesophageal sphincter pressure was reduced. The changes seldom caused symptoms and they were not confined to those diabetics with alimentary or genitourinary symptoms attributable to autonomic neuropathy. They suggest that autonomic neuropathy in diabetes is widespread and often subclinical. Degeneration of the ganglion cells of the oesophageal myenteric plexus is associated with hypersensitivity of the oesophageal smooth muscle to cholinergic agents. Bethanecol, a cholinergic drug with muscarinic actions, accelerated oesophageal emptying and increased the lower oesophageal sphincter pressure to normal levels in our diabetics but the hypersensitivity to this drug found in the presence of ganglion cell degeneration was not seen. This implies that in diabetic autonomic neuropathy the predominant lesion is in the preganglionic fibres of the vagus rather than in the myenteric plexus of the oesophageal wall.
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Eight cases of non-Hodgkin's lymphoma presenting with bone symptoms are reported. The radiological appearances of these tumours are described. The importance of radiology in differentiating a primary lymphoma of bone from a lymphoma arising from other organs which has subsequently metastasised to the skeleton is briefly discussed.