Biomedical subjects
Publications and source records attributed to I Beggs.
Hereditary pancreatitis is a rare form of chronic pancreatitis inherited as an autosomal dominant. Pancreas divisum results from a developmental failure of fusion of the dorsal and ventral parts of the pancreas and is associated with an increased incidence of pancreatitis. Co-existence of the two conditions in one patient is very rare. We report a case.
The liver is the most frequent site of Echinococcus granulosus cysts. The radiological features of 22 cases are described. The ultrasound and computed tomography (CT) appearances are emphasised and the literature is reviewed. Cysts can be single or multiple and appear uni- or multilocular. Calcification occurs in about a quarter of cases. The cyst wall is usually thin and well-defined but may be thick and can enhance on CT. Separation of the laminated membrane from the pericyst produces a 'split wall' appearance. Complete collapse of the laminated membrane results in an ultrasound 'water lily sign'. Daughter cysts are initially solid then become cystic. A fluid level can be due to hydatid sand but layering in a poorly defined cyst indicates an infected or complicated cyst. This paper does not deal with the appearances of liver disease due to Echinococcus multilocularis.
Simple excision of a hydatid cyst from the liver leaves a residual cavity. Depending upon the surgical management of the cavity this can appear cystic, hypoechoic or echogenic on subsequent ultrasound examination. Negative attenuation values on computed tomography are typical of omentoplasty. These appearances can mimic pathological lesions in the liver. Knowledge of the site and nature of previous surgery can prevent diagnostic confusion.
Double-contrast barium enemas can detect 96% of colonic carcinomas. This is similar to the detection rate for colonoscopy. Single-contrast enemas compare badly. Small sigmoid tumours are most likely to be missed. Inadequate bowel preparation, single-contrast examinations and observer error account for most barium enema failures.
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I report my impressions, as a British doctor, of American family practice and describe training schemes for family practice and the American approach to assessment and continuing education.