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Biomedical subjects

J G Duncan

Publications and source records attributed to J G Duncan.

At least 19 recordsLinked to original sources
PubMed1984

A colocutaneous fistula occurring 50 years after a shotgun injury.

Traumatic fistulae of the gastrointestinal tract are usually acute processes which occur at the time of, or shortly after, the injury. Because of its rarity, we report here a case of a colocutaneous fistula that developed 50 years after a shotgun wound of the abdomen.

Abdominal Injuries↗
PubMed1984

A comparison of computed tomography, ultrasound and scintigraphy in the diagnosis of alcoholic liver disease.

In 35 alcoholics with histologically proven liver disease, computed tomography (CT), grey scale ultrasonography and liver scintigraphy were evaluated for their abilities to detect an abnormal liver and to identify the patients with cirrhosis. Abnormal studies were present on CT in 83% of patients, in 64% on ultrasound and in 94% on scintigraphy. In 10 control patients specificity was 90% by CT, 100% by ultrasound and 70% by scintigraphy. CT and ultrasound were poor in identifying the alcoholics with cirrhosis. Scintigraphy suggested cirrhosis in all but one of the patients with this diagnosis. Similar images were obtained in half of the patients with fatty change without cirrhosis but, with the exception of one patient, this appeared to be due to co-existent hepatitis. The results suggest that scintigraphy is the best of the imaging tests for screening alcoholics for cirrhosis.

Fatty Liver, Alcoholic↗
PubMed1983

The localisation of parathyroid tumours--a comparison of computed tomography with cervical vein hormone assay.

Computed tomography has been employed for the localisation of parathyroid tissue in 26 patients with primary hyperparathyroidism. In 14 of these selective venous catheter studies with parathyroid hormone assay were also undertaken. Computed tomography proved unreliable, identifying only 39 per cent whereas the cervical venous hormone assay studies localised 69 per cent of lesions correctly--a figure which is in agreement with several other groups. On balance our results suggest that neither technique should be routinely employed pre-operatively but that, following unsuccessful parathyroid surgery, the most useful localisation technique remains venous hormone assay.

Adenoma↗
PubMed1982

Incidence and detection of occult hepatic metastases in colorectal carcinoma.

Isotope liver scan, ultrasonography, and computed tomography of the liver were performed during the postoperative period in 43 consecutive patients undergoing laparotomy for colorectal carcinoma. Obvious hepatic metastases were detected in six patients at the time of surgery. Eleven patients considered to have a disease-free liver at laparotomy developed hepatic metastases during the two-year follow-up period. These patients were considered to have had occult hepatic metastases at the time of surgery. Postoperative isotope liver scan, ultrasonography, and computed tomography detected the presence of overt metastases in four, five, and six patients respectively. Of the 11 patients with occult metastases, isotope liver scan, ultrasonography, and computed tomography detected one, three, and nine respectively. These observations suggest that 29% of patients undergoing apparently curative resection for colorectal carcinoma possess occult hepatic metastases and that computed tomography is superior to ultrasonography and isotope liver scan in detecting them.

Colonic Neoplasms↗
PubMed1982

Is an early ultrasound scan of value in acute pancreatitis?

Grey scale ultrasound scanning has been performed within 1 week of admission in 114 patients with acute pancreatitis in order to establish its reliability in detecting gallstones and to document early pancreatic changes. When the gallbladder was identified (69.4 per cent of patients), grey scale ultrasound was 96.1 per cent accurate in predicting the presence of gallstones. Of 85 patients (74.5 per cent), in whom adequate pancreatic imaging was achieved on the initial scan, 35 were reported within normal limits, 28 had generalized pancreatic swelling and 22 a localized pancreatic mass of cystic collection. These ultrasound findings did not correlate significantly with the objective assessment of severity of disease. However, all 9 patients (8.1 per cent) who developed a pseudocyst were in the group shown to have early localized pancreatic swelling. Grey scale ultrasound is a useful method of detecting gallstones in patients with acute pancreatitis, thus permitting early accurate biliary surgery. However, in almost one-third of our patients ultrasound failed to outline the gallbladder on the initial scan. While ultrasound scanning of the pancreas will detect the formation of pseudocysts and accurately chart their subsequent progress, we doubt whether an early scan is required to achieve this purpose. Although generalized pancreatic swelling is frequently reported, this finding was of no major clinical importance and did not relate to the severity of disease.

Acute Disease↗
PubMed1981

Pre-operative localization of aldosterone-secreting adrenal adenomas.

Techniques for pro-operative localization of aldosterone-secreting adrenal adenomas were studied in thirty-seven patients, each with hypertension and biochemical evidence of primary hyperaldosteronism and each later having adrenal surgery (thirty-two adenomas, five bilateral hyperplasia). Bilateral adrenal vein catheterization was attempted in all cases; it was successful on the left side in all patients and in 92% of cases on the right. Adrenal vein plasma samples were obtained from the left side in 92% and from the right in 73% of cases. Adrenal vein plasma aldosterone measurements correctly indicated the presence of tumour in twenty-eight cases but falsely predicted unilateral adenoma in two cases of bilateral adrenal hyperplasia. Adrenal venography also correctly predicted unilateral adrenal adenomas in twenty-six cases but falsely suggested the presence of tumour in three cases of bilateral adrenal hyperplasia. Computed tomography (CT) was used in the last eight cases. In seven instances the predictions (six adenomas, one bilateral adrenal hyperplasia) were confirmed at surgery. However, the remaining patient harboured an adenoma 20 mm in diameter which was not detected by CT although diagnosed both by adrenal venography and adrenal vein aldosterone measurements. Ultrasound detected adenoma in only three of twenty-two cases examined. Although further comparative studies of the type described here are required, the results of computed tomography are promising and suggest that this non-invasive technique might well become the first choice procedure in localizing aldosterone-secreting adenomas.

Adenoma↗
PubMed1981

Computed tomography in the localization of aldosterone-secreting adrenal adenomas.

Computed tomography (CT) has been shown to detect both adrenal glands in 88.5% of upper abdominal examinations and can visualize at least one gland in 96.5% of patients. However, in examinations carried out specifically to visualize the adrenals, the glands were located in 98% of cases. This technique was used in 18 patients with primary aldosteronism to localize aldosterone-secreting adrenal tumours and to distinguish these from non-adenomas (bilateral adrenal hyperplasia). The results were compared with quadric analysis, a statistical technique used to predict the likely surgical outcome. In seven patients the CT results were verified by operation (six adenomas, one adrenal hypertrophy). However, in one further patient a large adenoma (20 mm in diameter) which had not been predicted by CT scanning was found at operation. In the remaining ten patients who have been medically treated, results concordant with quadric analysis were obtained in eight cases. We would suggest that CT scanning should be the initial investigation for the pre-operative localization of adenomas but further comparative studies are required.

Adenoma↗
PubMed1979

The role of grey scale ultrasonography in the investigation of jaundice.

Sixty-seven patients were prospectively studied using grey scale ultrasound (GSU) to assess its possible role as part of a jaundice investigation programme. All scans were performed by one radiologist, without clinical information. When intrahepatic ductal dilatation was found an attempt was made to establish the level and cause of obstruction. The calibre of the intrahepatic bile ducts was correctly reported in 66 patients (98 per cent). Forty-three proved to have extrahepatic cholestasis, 24 had intrahepatic cholestasis. No patient with intrahepatic cholestasis had dilated ducts seen on ultrasound. In 43 patients with obstructive jaundice, GSU accurately detected the level of obstruction in 28. This accuracy varied with the cause of obstruction. A direct indication of diagnosis was possible in 45 of the 67 patients. In a unit specializing in the management of complicated hepatobiliary problems, GSU has been shown to be accurate in differentiating extra- from intrahepatic jaundice. Being non-invasive, it appears ideally suited for use as a screening procedure, permitting selection of appropriate invasive investigations to provide complete preoperative imaging of the biliary tree. In patients with jaundice due to gallstones, GSU may be the only imaging technique required before surgery provided good operative cholangiography is available.

Bile Ducts, Intrahepatic↗
PubMed1978

A prospective study of the clinical value and accuracy of grey scale ultrasound in detecting gallstones.

The accuracy and possible clinical value of grey scale ultrasonography in the detection of gallstones has been prospectively studied in 100 unselected patients presenting with recurrent biliary colic, acute cholecystitis or acute pancreatitis. Adequate visualization of the gallbladder was obtained in 79 cases, with 3 false positive and no false negative reports. Oral cholecystography remains the initial investigation of choice in patients presenting with recurrent biliary colic, but grey scale ultrasound has been shown in this study to be a reliable means of detecting gallstones in the 'acute' situation, when conventional contrast radiology is of limited value.

Acute Disease↗
PubMed1977

Diagnosis and management of post-cholecystectomy symptoms: the place of endoscopy and retrograde choledochopancreatography.

Endoscopic retrograde choledochopancreatography (ERCP) was employed in 52 patients symptomatic after cholecystectomy in whom barium meal studies and intravenous cholangiography had failed to yield a diagnosis. Cannulation of the papilla of Vater was carried out in 50 of the patients in a mean time of 10 min. Diagnostic information demonstrating a pathological lesion or a normal biliary and pancreatic ductal system was obtained by means of endoscopy and ERCP in 48 cases. There were no serious complications. A pathological lesion was demonstrated in all but one of the patients presenting with jaundice, cholangitis or pancreatitis but the diagnostic yield was not as high in patients with vague upper abdominal symptoms. Endoscopy and ERCP are the investigative procedures of first choice in complex post-cholecystectomy cases in whom intravenous cholangiography fails, gives incomplete information or suggests normality in the face of continuing symptoms or clinical evidence of residual biliary disease.

Adult↗
PubMed1977

The "negative chest radiograph" in acute pancreatitis.

Twenty-six patients with acute pancreatitis and normal chest radiographs on admission were studied. Twelve (46%) developed abnormalities in the first five days of illness. Twenty-four of the 25 patients tested developed an arterial pO2 of less than 10.6 kPa (80 mmHg) but severe hypoxia was present in a greater percentage of patients whose chest radiology became abnormal. Blood gases and chest radiographs should be checked on a regular basis in patients with acute pancreatitis.

Acute Disease↗