Biomedical subjects
Publications and source records attributed to I W McCall.
Arthrography following hip replacement has been reviewed. The problems encountered have been analysed with particular reference to technique and accuracy. The accepted criteria for loosening have not been consistently reliable and have led to false positive interpretation of loosening of the acetabular component. The reasons for false negative results are also considered.
Severe back-ache in young adults may present a difficult clinical problem when the absence of neurological signs results in delayed diagnosis. Fourteen patients, with discographic evidence of posterior annular fissuring are reported. The discrepancy between painful disability and negative radiographic examination including radiculography is stressed. Discography has proved to be the investigation of choice in these patients. This will demonstrate the morphology of the lesion and reproduce the symptomatology in the majority of cases. The clinical implications are discussed.
The clinical, radiological and pathological features of plasma cell granuloma in 4 patients are presented. The natural history of the condition is benign. 30% of cases occur in children. The radiological appearances are not specific and consist of an intrapulmonary mass which is not accompanied by pleural effusion. Tomography is helpful in demonstrating calcification and cavitation, but these features are unusual. Successful treatment requires surgical removal.
A prospective study of the renal abnormalities on excretion urography in 189 patients with homozygous sickle cell disease is presented. Demonstrable abnormalities were present in 69% but there was no correlation with symptomatology. Calyceal clubbing was the most common abnormality occurring in 39% of cases and its incidence increased with age. An unexpectedly high prevalence (23%) of papillary necrosis occurred and both sinuses and cavities were demonstrated. The reasons for this high prevalence are discussed. The urographic findings did not correlate significantly with hematological features of the disease.
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The prevalence of cholelithiasis in Jamaican adults with SS disease was studied by plain abdominal radiograph in 206 patients and by oral cholecystogram in 126 (61%) of these patients. Gallstones were found in 57 (28%) of patients, were more common in females than males, and increased with age and hemolytic rate. The majority of gallstones were visible on the plain abdominal radiograph, only 17% of patients with gallstones having only radiolucent stones. Nonfunctioning oral cholecystograms were common (10%) in agreement with observations by previous workers. Gallstones were noted in the common bile duct in 2 patients. In general there was no clear relationship between the presence of cholelithiasis and clinical symptomatology. Complications, such as pancreatitis and malignant change in the gall bladder, recognized to be associated with cholelithiasis in the general population, have not been clearly related to cholelithiasis in SS disease. More information is needed before a logical policy can be evolved for surgical intervention in cholelithiasis in SS disease.
Changes in plasma gastrin and lower oesophageal sphincter pressure were measured in 20 subjects after a standard protein meal. Significant increases in both gastrin and sphincter pressure were seen. Peak gastrin response occurred an average of 19-5 minutes and peak lower oesophageal sphincter response 40-0 minutes after the meal. Both gastrin and sphincter pressure showed a wide spectrum of response. In 5 subjects there was no appreciable rise (less than 5 pg/ml) in plasma gastrin after the meal, and 3 of these had symptoms of oesophageal reflux. In this group there was only a small but nervertheless significant rise in lower oesophageal sphincter pressure (mean pressure rise 18-0 per cent of fasting value, p less than 0.05). Greater increases in sphincter pressure (mean rise 54-2 per cent, p less than 0.005) were seen in subjects with a moderate (up to 50 pg/ml) rise in plasma gastrin, and those with the most marked gastrin response (less than 50 pg/ml) showed the greatest rise in pressure (mean rise 80-3 per cent, p less than 0.0025). These results suggest that endogenous plasma gastrin is the main stimulus to the rise in lower oesophageal sphincter pressure after food. Subjects with a poor gastrin response to the meal have only a small increase in sphincter pressure and as a result may be more liable to develop gastro-oesophageal reflux.
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Patterns of pain referral, induced from the posterior elements, have been studied in normal volunteer subjects. A series of intracapsular and pericapsular injections were performed at the L1-2 and L4-5 levels. The areas of pain referral indicate overlap between the upper and lower lumbar spine. It is also shown that the pericapsular and intrafacetal pain referral areas are similar and that the upper lumbar spine is more sensitive than the lower.
Twenty-five out of 41 adult patients suffering from their first attack of acute low-back pain were subjected to local anesthetic injection into the maximally tender lumbar apophyseal joints under controlled conditions. Two clinical syndromes can be identified according to whether the patients responded to the facet injection or not. Various clinical differences were statistically significant and included a wider than normal spinal canal in the responding group. The clinical significance of these two distinct groups is discussed in detail.