Percutaneous interventional uroradiology.
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Humans↗
Biomedical subjects
D Rickards
Publications and source records attributed to D Rickards.
CT muscle scanning in the evaluation of patients with spinal muscular atrophy (SMA).
One hundred patients with spinal muscular atrophy (SMA) were assessed by CT scanning using a standardised technique. The spectrum of CT abnormality occurring in SMA was observed and by overall analysis the patients were divided into 4 groups. While the CT appearances of these groups correlated well with clinical assessment of severity of disease, the disease process was usually much more widespread than clinical examination suggested. CT abnormality was first observed in the leg and gluteal muscles, progressing to the posterior spinal, thigh, shoulder girdle and sternomastoid muscles. Hypertrophy of sartorius and gracilis was observed in a significant number of patients. Fascial planes were preserved in involved muscles in over half of the patients, even in late-stage disease. Asymmetrical muscle involvement was seen with increasing frequency as the disease process increased in extent as evaluated by CT scanning. There was no discernible difference in the CT appearances in those patients who clinically had limb-girdle, facioscapulohumeral or scapuloperoneal distribution of weakness.
Adolescent↗
A double-blind study comparing the efficiency, tolerance and renal effects of iopromide and iopamidol.
A randomized double-blind, group comparative study was carried out to investigate the diagnostic efficiency and side-effect profiles, with particular reference to renal tolerance, of iopamidol and a newer non-ionic contrast medium iopromide, when used in excretory urography. The trial demonstrated that, in a population of 137 patients undergoing excretory urography and being investigated from baseline up to 2 weeks after the administration of the contrast medium, there were no significant adverse effects on the indicators currently thought to reflect renal function. The efficiency of the two contrast agents proved to be very similar and the radiographic quality of opacification was adequate in nearly every case.
Clinical Trials as Topic↗
A technique for the removal of retained balloon bladder catheters.
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Catheterization↗
A percutaneous perineal approach for cystoscopy in male dogs.
A percutaneous perineal approach is presented as a further technique for rigid cystoscopy in male dogs. The anatomy of the urethra in the male dog prevents rigid cystoscopy by non-surgical means but a fine flexible fibrescope may be used. Perineal urethrotomy and prepubic percutaneous puncture techniques using rigid endoscopes have been described; however, both have possible serious complications. This new procedure allows access for visual examination, biopsy and resection as necessary and appears to have few adverse sequelae.
Animals↗
Dehydration, antidiuretic hormone and the intravenous urogram.
The efficacy and safety of attempts to dehydrate patients before intravenous urography in order to improve image quality have been called into question by several authors. Antidiuretic hormone (ADH) assays described here show that dehydration of outpatients as typically practised by radiology departments does not affect plasma ADH levels. Furthermore, the very act of contrast-agent administration causes a rapid rise in plasma ADH concentration to levels higher than would in any case be expected from modest dehydration. Since the likely effect on circulating ADH of attempted dehydration is dwarfed by the physiological response to a contrast agent, it is considered that such efforts are entirely superfluous.
Body Water↗
Interventional radiology.
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Bile Duct Diseases↗
Hexabrix and gallbladder visualisation.
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Chemical Phenomena↗
The radiology of incontinence.
Incontinence is defined by the International Continence Society (Bates et al, 1979) as an involuntary loss of urine which can be objectively demonstrated and causes a social or hygienic problem. It is therefore both a symptom and a sign. Medical and surgical treatments are available and radiological investigation is helpful in many patients.
Adult↗
Pressure changes in the dilated upper urinary tract on perfusion at varying flow rates.
The conventional Whitaker test assesses the pressure response to a constant perfusion rate of 10 ml/min. Twenty-eight kidneys were perfused at increasing flow rates up to 20 ml/min. Nine became obstructed at rates of 12 to 20 ml/min. The feasibility of such a high urine output has been tested and confirmed. The standard Whitaker test may therefore miss some cases with potentially obstructive hydronephrosis, the effects of which may be deleterious to renal function.
Adolescent↗
Micturition disturbance in Parkinson's disease.
Ten men with longstanding idiopathic Parkinson's disease (IPD) were investigated by urodynamic and electromyographic methods. The urodynamic studies were repeated after stopping anti-Parkinsonian medication for several hours. All patients showed a difference between the two studies, but the changes were unpredictable. Three patients who had high residual urine volumes in both studies were thought to have prostatic obstruction. EMG analysis showed no evidence of a lower motor neurone lesion affecting the striated urethral sphincter. It was concluded that micturition difficulty in the patient with IPD is due to detrusor hyperreflexia, influenced by the basal ganglia, which is not associated with impaired striated urethral sphincter activity.
Adult↗
Computed tomography of the anterior cruciate ligament.
The anterior cruciate ligaments of 20 patients with suspected pathology in one ligament were studied by thin-section computed tomography (CT) and reformating techniques. In 19 patients, the suspect anterior cruciate ligament was abnormal and this was confirmed by subsequent arthroscopy or arthrotomy in thirteen. Thin-section CT and reformatting techniques provide a useful means of non-invasively imaging the anterior cruciate ligament.
Female↗
Renal pelvic pressures in human chronic obstructive uropathy.
Resting renal pelvic pressure and premicturition bladder pressure have been measured by direct percutaneous puncture in 12 male patients with established chronic obstructive uropathy related to high pressure chronic retention. In 10 technically satisfactory cases the subtracted renal pelvic pressure was less than the intrinsic bladder pressure, showing that upper tract dilatation and diminished renal function in these patients were not due to direct extension of high resting bladder pressure into the upper tract. The mean resting upper tract pressure in chronic human obstructive uropathy was 10.7 cm of water.
Chronic Disease↗
Treatment of advanced prostatic cancer with LHRH analogue ICI 118630: clinical response and hormonal mechanisms.
9 of 12 patients with advanced metastatic carcinoma of the prostate treated with luteinising-hormone-releasing-hormone (LHRH) analogue ICI 118630 for a mean period of 6 months showed objective evidence of response to treatment. Of 8 patients with bone pain, 7 obtained relief. After 6 weeks of treatment testosterone concentrations were reduced to castrate levels (range less than 2 to 5.5 nmol/l) from a pretreatment mean value of 15.7 nmol/l (range 10.3-24 nmol/l). Basal gonadotropin levels and gonadotropin responses to acute LHRH stimulation were suppressed within 2 weeks of treatment. However, the testosterone response to stimulation with human chorionic gonadotropin was unimpaired 4 weeks after the start of treatment. Therefore suppression of the basal testosterone concentration by ICI 118630 was due to inhibition of pituitary luteinising-hormone secretion rather than direct inhibition of testicular Leydig-cell function. ICI 118630 offers an alternative treatment to orchidectomy and oestrogen therapy.
Acid Phosphatase↗
Computed tomography in adrenal disease.
Ninety-eight patients with suspected adrenal disease were examined by computed tomography (CT). In 73 patients adrenal disease was confirmed on biochemical and other grounds (Cushing's syndrome (38), primary aldosteronism (8), phaeochromocytoma (12), androgen excess (7), Addison's disease (1) and non-functioning adrenal masses (7)). The CT appearances of hyperplasia and benign and malignant adrenal tumours are described in detail. Ninety-six per cent of the adrenal glands were identified, and all but one of the 39 adrenal mass lesions were correctly identified and localised by CT. The failure to identify some adrenal glands and one adrenal tumour was related to a paucity of intra-abdominal fat. Two abdominal ectopic phaeochromocytoma were not identified (in one patient because the appropriate area was not scanned). The 25 patients examined with unproven adrenal disease had normal glands on CT. That some hyperplastic glands appear normal on CT precludes its use as a screening procedure for biochemically unproven adrenal disease. Computed tomography allows the differentiation of adrenal hyperplasia from functioning adrenal tumours, and the differentiation of benign from malignant lesions with a high degree of certainty; it is the method of choice for the identification and localisation of adrenal tumours.
Addison Disease↗
Computed tomography and transrectal ultrasound in the diagnosis of prostatic disease--a comparative study.
Computed tomography (CT) and transrectal ultrasound were performed in 88 patients with clinically and histologically proven prostatic disease. An ultrasound diagnosis of prostatic cancer was suggested in 49 of 54 patients with proven disease, whereas CT identified only 21 of those patients. There were no specific features of confined prostatic malignancy on CT and the most reliable feature of an unconfined tumour was infiltration of the posterior aspect of the bladder base. It was not possible on ultrasound to differentiate between prostatic inflammatory disease and a confined carcinoma but ultrasound was accurate in detecting defects in the prostatic capsule, the hallmark of unconfined prostatic malignancy.
Adult↗
Computed tomography in dystrophia myotonica.
The calves and thighs of ten patients with dystrophia myotonica and four normal controls were studied by CT. The morphology of the anterior and posterior muscle groups of the calf and the extensor, flexor and adductor groups of the thigh were studied and their attenuation values analysed. Clinical measurement of muscle force was compared with attenuation values in each muscle group. The principal morphological change observed in diseased muscle was fatty infiltration. The amount of fatty infiltration in the calf muscles paralleled the severity of clinically apparent disease. However, in the thigh, fatty infiltration was observed in the extensors of three of the five patients who clinically had involvement of calf muscles alone. Detailed analysis of attenuation values was no better in detecting diseased muscle except of the adductor group of the thigh in those patients with both proximal and distal lower limb involvement. Comparison between muscle force and attenuation values showed a significant correlation in only the anterior muscle group of the calf in the normal controls and in those patients with clinically apparent disease of the calf muscles alone.
Adult↗