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Biomedical subjects

G W Stevenson

Publications and source records attributed to G W Stevenson.

141 records · Page 8Linked to original sources
PubMed1979

Strictures and other late complications of neonatal necrotising enterocolitis.

Eighty infants have been treated for neonatal necrotising enterocolitis within a period of five years. Twenty-five per cent developed strictures of the small or large intestine. Four cases of atresia including two with multiple cyst formation were seen. Four patients developed severe malabsorption requiring hyperalimentation with slow recovery of small bowel function in two survivors. The radiological features of these complications is illustrated and the role of radiology in the management of these patients is discussed.

Constriction, Pathologic↗
PubMed1976

Prospective comparison of double-contrast barium meal examination and fibreoptic endoscopy in acute upper gastrointestinal haemorrhage.

Fibre-optic endoscopy was compared prospectively with double-contrast radiology in 53 consecutive patients admitted with acute gastrointestinal haemorrhage. The bleeding site was correctly identified by endoscopy in 94% of patients and the final diagnosis was correctly given in 89%. The corresponding figures with radiology were 83% and 74%. Among the 50 patients with a final diagnosis of a bleeding site in the upper gastrointestinal tract endoscopy indicated the site of bleeding in all and radiology indicated it in 88%. Both investigations were well tolerated by patients. Endoscopy is the investigation of choice, but when it is not available double-contrast radiology will show the site of bleeding in 80-90% of patients.

Aged↗
PubMed1975

Role of pelvimetry in active management of labour.

All cases referred for pelvimetry in 1970-1 and all breech presentations referred for pelvimetry in 1972-4 were reviewed. Indications for pelvimetry fell into four main categories: high head in the antenatal clinic (47-8%); high head in labour (13-9%); breech presentation (20-9%); and previous caesarean section (14-8%). In the first two categories pelvimetry rarely if ever influenced management, and it should not be performed routinely. In breech presentation and cases of caesarean section pelvimetry seemed to be of value, but in the latter group it should be performed puerperally to avoid the known radiation hazard to the fetus. A fairly close correlation between obstetric conjugate and pelvic capacity was shown, which suggested that a 3400-g baby might pass through a pelvis of obstetric conjugate of 10 cm as a cephalic trial of labour, but would need an obstetric conjugate of 11-7 cm for safe vaginal breech delivery.

Birth Weight↗
PubMedDate not supplied

Premature contraction of the cricopharyngeus: a new sign of gastroesophageal reflux disease.

BACKGROUND: A cricopharyngeal bar seen on barium fluoroscopy has been shown to be related to the presence of gastroesophageal reflux (GER). We investigated premature contraction of the cricopharyngeus (PCC) muscle, which may be a precursor of a fixed cricopharyngeal bar, to assess its significance in GER. METHODS: The prevalence of PCC on barium swallow was recorded in three groups: (1) 83 patients with non-cardiac chest pain who were investigated for possible GER; (2) 21 patients with severe GER undergoing fundoplication; and (3) 25 normal controls. RESULTS: Group 1: PCC was observed in 42 of 77 with documented GER (54.5%), and in two of six patients without GER. Group 2: PCC was present in 11 of 21 fundoplication subjects. Group 3: PCC was seen in five of 25 normal controls. The incidence of PCC in patients with GER was statistically significantly higher than in normal subjects (p = 0.002). The sensitivity of the presence of PCC as a predictor of GER is only 0.54, but the specificity is 0.774, with a positive predictive value of 0.883. CONCLUSION: We conclude that observing premature cricopharyngeal contraction during the first swallows of an upper gastrointestinal (GI) study should direct attention to the possibility of GER.

Barium Sulfate↗
PubMedDate not supplied

Digital subtraction in defecography.

BACKGROUND: Defecography is commonly used in investigation of pelvic floor and anorectal dysfunction, and incorporates measurement of pelvic floor movement during various maneuvers. These measurements are usually referenced to bony landmarks, particularly the ischial tuberosities. These bony landmarks may be difficult to visualize; theoretically, the use of digital subtraction in filming defecography studies should eliminate the need to pinpoint bony position. METHODS: We filmed 25 defecogram studies in both non-subtracted and subtracted formats, and interpreted each study blindly, subsequently comparing diagnoses and measurements. RESULTS: Subtraction was of limited benefit in only one case, was impossible in one case, added no useful information in 18 cases, and hindered visualization of abnormalities in five cases. CONCLUSIONS: Because of the multiple overlapping densities and the inability to restrict patient movement, digital subtraction is unhelpful in defecography.

Barium Sulfate↗
PubMedDate not supplied

Utility of flexible sigmoidoscopy as an adjunct to double-contrast barium enema examination.

BACKGROUND: There is controversy regarding the most appropriate investigation for suspected colorectal carcinoma. We offered these patients same-day flexible sigmoidoscopy (FS) and double-contrast barium enema (DCBE). METHODS: We reviewed the results of 117 consecutive adult patients. All patients underwent FS followed by DCBE on the same day. The radiographs were reviewed by two of the authors who were blinded to the clinical information, flexible sigmoidoscopy reports, and the original DCBE report. RESULTS: One hundred seventeen patients made up the study population. Thirty-four of the 117 patients had polyps and/or carcinoma. Three malignant tumours were detected by DCBE; one of these was also seen on FS, and the other two cancers were out of FS range. Fifty-three polyps were found by FS; nine were removed by biopsy prior to the enema examination. Of the 44 remaining polyps, DCBE failed to detect 87% of the 0-9-mm group and 67% of the >9-mm group. Ten polyps were seen only on DCBE; seven of these 10 were beyond the range of the sigmoidoscope, and the three remaining polyps were less than 5 mm. CONCLUSION: DCBE is insensitive in the detection of rectosigmoid polyps. FS should continue to be used as a complementary examination to DCBE in the investigation of suspected colorectal carcinoma.

Adult↗
PubMedDate not supplied

Pain following colonoscopy: elimination with carbon dioxide.

Fifty-six patients have been examined in a prospective randomized study on the effects of air and carbon dioxide on post-procedural discomfort following colonoscopy. A significant reduction in post-procedural pain was observed at 6 hours (p = < 0.0005) and was still present the next day (p = 0.01). This was associated with a difference in the grading of flatus at 6 and 24 hours (p = < 0.0001 and < 0.05, respectively). An abdominal radiograph 1 hour after the procedure showed minimal gas in the CO2 patients, while the patients who had air showed distention of large and small bowel (p = < 0.0001 and < 0.01, respectively). Seventeen of 29 patients who had air suffered post-procedural pain, compared with 2 of 27 of the CO2 patients. Fifty-seven percent of the patients who were given air had colonic diameters over 6 cm on a 1-hour post-colonoscopy radiograph and 18% over 10-cm diameter. Provision by equipment manufacturers of simple and safe devices for routine delivery of CO2 for lower gastrointestinal endoscopy is long overdue.

Carbon Dioxide↗