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Biomedical subjects

R Vallance

Publications and source records attributed to R Vallance.

At least 19 recordsLinked to original sources
PubMed2001

Immediate CT pneumocolon for failed colonoscopy; comparison with routine pneumocolon.

AIM: To assess the role and reliability of 2D CT pneumocolon in the diagnosis of colonic malignancy, and compare feasibility of referral sources. MATERIALS AND METHODS: A prospective study of 50 patients with suspected large bowel malignancy. Patients underwent bowel cleansing, rectal air insufflation and contrast enhanced CT with 5 mm collimation, 3 mm reconstruction and a pitch of 1.4. Subsequent correlation was with pathology (16), colonoscopy (13), barium enema (5), ERCP (1) and clinical follow-up alone (8). RESULTS: Diagnostic images were obtained in 43/50 patients (86% feasibility). Follow-up was obtained in 35/43 patients (one patient died of an unrelated cause, and seven patients were deemed unfit for further investigation). Seventeen colonic carcinomas were diagnosed (three false-positives: one ischaemic colitis, one diverticular stricture and one faecal mass), one diverticular stricture, one fistula, one pancreatic carcinoma and one ovarian malignancy. The remaining 14 were negative. Overall sensitivity was 100% (for lesions >1.5 cm) with a specificity of 94% for structural abnormalities, but only 82% for the correct identification of malignancy. CONCLUSION: Computed tomography (CT) pneumocolon is a reliable alternative to barium enema where colonoscopy is incomplete, with the advantage of extraluminal screening, and examination of the proximal bowel. In the frail elderly or young unfit patient, it is a valuable additional diagnostic tool.

Adult↗
PubMed1999

Evaluation of echocardiography in the management of elderly patients with heart failure.

OBJECTIVE: To determine the validity of a clinical diagnosis of systolic dysfunction in elderly patients with heart failure and assess the contribution of echocardiography to their management. SUBJECTS: 61 elderly patients with a diagnosis of heart failure in a geriatric assessment unit setting. METHODS: Prospective study determining sensitivity, specificity and predictive values of a clinical and radiological diagnosis compared with echocardiographic standard. Proposed management was compared before and after echocardiography. RESULTS: Clinical assessment was highly sensitive (93%) but lacked specificity (32%). Combining radiological and clinical diagnoses increased specificity to 58%. Echocardiography revised the lead cardiac diagnosis for 28% of patients and influenced patient management plans for 41%. CONCLUSION: For elderly patients with heart failure, echocardiography improves diagnostic accuracy and identifies those patients with potential to benefit from angiotensin-converting enzyme inhibitors.

Aged↗
PubMed1997

Does a chest x-ray alter the management of new patients attending a geriatric day hospital?

OBJECTIVES: Studies have suggested that routine chest x-ray is never indicated but all new attenders at our day hospitals have a chest x-ray carried out. Our aim was to determine if this investigation altered the clinical management of patients and to try to select those patients in whom a chest x-ray is indicated. DESIGN: A prospective study was carried out over a 7 month period from February to September 1995. All new patients had cardiorespiratory symptoms/signs documented and a management plan made. A chest x-ray was then carried out and change in management as a result of the x-ray report noted. SETTING: Knightswood and Drumchapel Geriatric Day Hospitals, West Glasgow University NHS Trust. SUBJECTS: All new Day Hospital attenders. RESULTS: Of 207 new Day Hospital attenders, 53 had no clinical indication for a chest x-ray and although 70% had an abnormal film in no case was patient management changed as a result of this. A chest x-ray was indicated in 154 patients and of these 114 (74%) had an abnormal film with a resultant change in management in 23 patients (this comprised either a change in drug treatment or a further investigation.) Of those whose management was changed as a result of the x-ray report 61% had respiratory symptoms. CONCLUSION: We would recommend that chest x-ray should be performed in those patients who have a clear clinical indication and that the diagnostic yield is highest in the presence of respiratory symptoms or signs.

Aged↗
PubMed1992

Case report: pancreatic mediastinal pseudocyst--an unusual cause of palpitations.

We describe a case of pancreatic mediastinal pseudocyst which presented atypically with palpitations due to marked cardiac compression. Computed tomography (CT) showed a large abdominal pseudocyst extending through the diaphragm into the posterior mediastinum. Surgical drainage produced rapid symptomatic relief and the pseudocyst resolved completely within 2 months.

Arrhythmias, Cardiac↗
PubMed1991

Prevalence of proximal faecal stasis in active ulcerative colitis.

Proximal faecal stasis may occur when faecal matter accumulates in the uninflamed colon above an area of active ulcerative colitis. This phenomenon is thought to be the cause of symptoms in some patients with distal disease. It is not known, however, how often patients with active distal colitis exhibit slow colonic transit. Fifty two consecutive patients with active ulcerative colitis each ingested 10 radio-opaque markers nightly for 14 days. Minimum colonic transit times were derived from counts of retained markers shown by plain abdominal radiography on the 15th day. The transit times for each patient were related to their disease extent and bowel frequency. Four patients had colonic transit times greater than one week and two others had evidence of relative stasis. The results indicate that approximately 10% of attacks of distal colitis are associated with faecal stasis.

Adult↗
PubMed1990

Does lymphangiography have any role in the management of early non-seminomatous germ cell tumours?

Since 1980, 51 patients with non-seminomatous testicular germ cell tumours (NSGCT) and normal or equivocal initial computed tomography (CT) imaging have also had lymphography performed. Radiological records of these patients were reviewed to determine the extent to which lymphography (LAG) contributed to patient management. Forty-nine patients were retrospectively confirmed to have normal CT but of these 14 (29%) were considered to have nodal metastatic disease on lymphography. These patients and seven others with marker only evidence of tumour received chemotherapy and all remain disease-free. Six of thirty-six patients relapsed, but the incidence was not significantly higher in patients who did not undergo LAG (2 of 8:25%) than among those whose initial LAG was normal (4 of 28: 14%). All relapsing tumours achieved a complete remission with chemotherapy. We conclude that although LAG may have resulted in earlier treatment for some patients, several may have been overtreated on the basis of radiological abnormalities which did not represent metastatic disease. We believe that the success of salvage chemotherapy means that LAG may be safely abandoned as a staging procedure for NSGCT.

Humans↗
PubMed1987

The efficacy of barium enema in the elderly.

Ninety-seven consecutive patients more than 70 years old (Group O) undergoing barium enema were studied to assess the usefulness of this investigation in their management. The patient's ability to co-operate was studied. Diagnostic yield was noted and compared to 70 consecutive patients less than 60 years old (Group Y). There was no correlation between mental test score, hearing or visual impairment and the patient's ability to co-operate. A significantly greater number of positive examinations was found in Group O (P less than 0.05). Following a positive examination, 55% of patients in Group O had a change in management. Surgical management was pursued in 14 patients, 11 of whom had a tumour.

Adolescent↗
PubMed1986

Arterio-venous shunting complicating occlusive atherosclerotic peripheral vascular disease.

Three cases of severe occlusive peripheral vascular disease are described in which spontaneous arterio-venous fistulae at the site of atheromatous occlusion have been demonstrated by angiography during the arterial phase. Although none of these patients exhibited specific clinical signs of an arterio-venous fistula, this phenomenon is considered to have been a clinically significant factor in the patients' peripheral ischaemia. In one case both the superficial femoral artery stenosis and the spontaneous shunts were effectively treated by percutaneous angioplasty.

Aged↗
PubMed1986

Diagnosis and decision making in lumbar disc prolapse and nerve entrapment.

This prospective study of 185 patients undergoing first-time lumbar surgery compared how accurately clinical criteria and water-soluble myelography predicted the operative findings. Clinical diagnostic criteria of nerve root pain, root irritation signs, and neurologic signs of root compression supplemented by myelography were shown to be much more accurate than myelography alone, both in predicting the presence or absence of nerve root involvement and in distinguishing disc prolapse from bony entrapment. Provided the clinical criteria were clearly defined, patients with three or more of the four criteria were usually found to have a disc prolapse while bony entrapment could frequently be identified with one or two criteria. It is concluded that although lumbar disc prolapse is well-recognized, in practice clinical assessment and diagnostic criteria need to be defined more clearly to match increasingly sophisticated radiology.

Adult↗
PubMed1985

Vascular complications of osteochondroma.

Apart from trauma, symptoms arising from peripheral arteries are very unusual in adolescents and young adults. Three cases of osteochondroma associated with rare vascular complications are presented, together with a review of the literature. The development of pain in relation to osteochondroma does not necessarily imply trauma or the onset of malignancy and vascular complications should be considered, particularly if the bone lesion occurs around the knee. In this situation, arteriography is considered essential in planning surgical treatment and the importance of angiography in two planes is emphasised.

Adolescent↗
PubMed1984

Recurrent varicose veins: a radiological approach to investigation.

Superficial venography was used in nine lower limbs of eight patients with recurrent varicose veins occurring after high ligation or stripping. This technique demonstrated four different types of recurrence and identified the cause in individual patients. The most common type of recurrence was not a missed tributary of the long saphenous or a missed perforating vein, but a tortuous leash of recanalised vein reconnecting the long saphenous and femoral veins. Implications for treatment of primary varicose veins are discussed.

Adult↗
PubMed1981

Haemodynamic assessment following iliac artery dilatation.

Fourteen patients with symptomatic atheromatous stenoses of common or external iliac arteries underwent percutaneous arterial dilatation. Twelve procedures were considered successful in terms of arteriographic and symptomatic improvement but the application of three haemodynamic indices (pressure index, pulsatility index and the papavarine test) indicated that only 8 patients had gained a significant improvement in blood flow. These results illustrate the need for quantitative measurements in the assessment of this new technique.

Angioplasty, Balloon↗