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Biomedical subjects

Richard M Mendelson

Publications and source records attributed to Richard M Mendelson.

11 recordsLinked to original sources
PubMed2005

Vascular complications of pancreatitis.

Vascular complications of pancreatitis are a major cause of morbidity and mortality. Arterial complications include haemorrhage from direct arterial erosion or pseudoaneurysm formation, and visceral ischaemia. Venous complications predominantly are related to splanchnic vein thrombosis. This review, with illustrative cases, describes the main manifestations of these complications and emphasizes the importance of early radiological diagnosis and intervention.

Adult↗
PubMed2004

Influences on participation in a community-based colorectal neoplasia screening program by virtual colonoscopy in Australia.

OBJECTIVE: To determine the effect of certain personal and health behaviour characteristics on participation in a community-based colorectal neoplasia (CRN) screening program using virtual colonoscopy. METHODS: The study population comprised randomly selected subjects from the State electoral roll; screening by virtual colonoscopy was offered through letter of invitation. For non-responders, a further invitation was sent a month later. Non-response after a further month led to subjects being considered non-participants. Non-participants were contacted by letter to complete a structured questionnaire; participants completed a similar questionnaire immediately after their screening virtual colonoscopy. RESULTS: Discussing the invitation to screening with someone else increased the likelihood of participation by 63% (prevalence ratio 1.63, 95% CI 1.38-1.93); knowing someone with cancer increased the likelihood of participation by 23% (PR 1.23, 95% CI 1.07-1.42). Among participants who discussed screening with another individual, the spouse was the most common (71%). Subjects who were single were less likely to participate (PR 0.79, 95% CI 0.67-0.94). The strongest reported influence for participation was information provided in the letter of invitation (29.8%). The most common reasons for non-participation were lack of time and perceived good health. CONCLUSIONS AND IMPLICATIONS: This study suggests that a simple strategy to facilitate participation is to encourage subjects to discuss screening with others; further, to recognise that this may be most difficult for those who are single. Information provided to subjects prior to screening positively contributes to participation.

Colonoscopy↗
PubMed2004

Community-based screening by colonoscopy or computed tomographic colonography in asymptomatic average-risk subjects.

OBJECTIVES: Visualizing the entire colorectum in screening is an advantage of colonoscopy, and also computed tomographic (CT) colonography, another potentially suitable screening test. Our objective was to compare screening CT colonography and colonoscopy in an asymptomatic average-risk population, and to determine whether providing a choice of tests increased participation. METHODS: One thousand and four hundred subjects from the general community, randomly selected from the parliamentary electoral roll, were allocated one of three screening groups: colonoscopy, CT colonography, or a choice of these tests, and were sent an institutional letter of invitation. Those with symptoms, colorectal cancer in first-degree relatives, or colonoscopy within 5 yr were ineligible. Outcome measures were participation, acceptability of screening, and yield for advanced colorectal neoplasia in participants. RESULTS: Of the subjects, 24.9% were ineligible; the overall participation rate was 18.2% (184/1,009). Participation in each screening group was not different. Both tests were accompanied by the same high levels of acceptability; most participants found colonoscopy (87%) and CT colonography (67%, p < 0.001) less unpleasant than expected. About 29% (26/89) CT colonography subjects had a positive screening test. The yield of advanced colorectal neoplasia was 8.7% (95% CI 5-14%), with no difference in yield between tests. CONCLUSION: Colorectal neoplasia screening by colonoscopy or CT colonography was associated with modest participation, high levels of acceptability, and similar yield for advanced colorectal neoplasia. Providing a choice of test did not increase participation.

Age Distribution↗
PubMed2003

Colorectal neoplasia screening with CT colonography in average-risk asymptomatic subjects: community-based study.

PURPOSE: To evaluate computed tomographic (CT) colonography as a screening tool for average-risk asymptomatic subjects with regard to participation, acceptability, and safety. MATERIALS AND METHODS: CT colonography for colorectal neoplasia screening was offered to 2,000 subjects aged 50-54 and 65-69 years. Only asymptomatic subjects at average risk of colorectal neoplasia were enrolled. Participants underwent CT colonography followed by colonoscopy if CT colonography findings showed any polyps. Acceptability was measured with a 100-point (0, most favorable; 100, least favorable) visual analogue scale (VAS). Chi2 statistic was used to compare participation rates among subgroups. Safety of CT colonography was evaluated by recording all important adverse events. RESULTS: A total of 1,452 subjects were eligible for screening. The adjusted participation rate was 28.4%. Participation was higher in younger subjects and in those from a high socioeconomic region. Major reasons for nonparticipation were insufficient time and perceived good health. Median VAS scores for pain, general satisfaction, embarrassment, and willingness to repeat screening were 13, 6, 8, and 5, respectively. Most subjects found CT colonography better than (60%) or same as (32%) expected. Ninety-three (27.4%) of 340 subjects were referred for colonoscopy, with polyps found in 67 (positive predictive value, 0.73). By adopting criteria that a positive finding at CT colonography is that of a single polyp larger than 5 mm or multiple polyps larger than 2 mm, 14% of CT examinations would have led to colonoscopy; 5.7% of CT findings were false-positive, with no significant impairment in large polyp detection. There were no important adverse events related to CT colonography, although four subjects had syncope or presyncope related to bowel preparation. CONCLUSION: Community-based colorectal neoplasia screening with CT colonography was accompanied by a participation rate that compares favorably with that of similar screening programs. CT colonography was highly acceptable to participants.

Aged↗
PubMed2003

Renal colic: a prospective evaluation of non-enhanced spiral CT versus intravenous pyelography.

The aim of this study was to compare non-enhanced spiral CT (NECT) and intravenous pyelography (IVP) in patients with suspected acute renal colic. Two-hundred patients presenting to the Emergency Department with suspected acute renal colic were randomized into groups undergoing NECT or IVP. The main outcome measures were diagnostic utility, incidence of alternative diagnoses, requirement for further imaging, length of hospital stay, urological intervention rates, radiation dosage and costs. Non-enhanced spiral CT was better than IVP in making a definitive diagnosis of ureteric calculus or of recent calculus passage (65/102 or 66% vs 42/98 or 41%; P = 0.003). Calculi were missed in two patients in the IVP group. Two patients in each group had alternative diagnoses by initial imaging. There was no difference in the length of hospital stay or intervention rate. More plain X-rays during admission and more IVPs during follow up were performed in the NECT group. Effective radiation dosages were 2.97 mSv (IVP) and up to 5 mSv (NECT). Non-enhanced spiral CT provided greater diagnostic utility in this randomized comparison but no difference in measured outcomes. The incidence of alternative diagnoses was low, probably due to patient selection. Financial costs for each modality are comparable in a public tertiary hospital. Radiation dosages are higher for NECT and, for this reason, it might be appropriate to consider limiting NECT use to patients who have do not have classical symptoms of renal colic, to older patients and those with a contraindication to the administration of intravenous contrast media.

Acute Disease↗
PubMed2002

Radiology.

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Australia↗
PubMed2002

Computed tomography colonography (virtual colonoscopy): review.

Computed tomography examination of the colon performed after bowel cleansing and distension of the lumen with gas goes by several different names--CT colonography (CTC) and CT colography perhaps being the most common. Strictly, the term 'virtual colonoscopy' (VC), should be reserved for the process of examining 3-D, simulated endoluminal images with a capability to navigate through the bowel using appropriate software. Computed tomography colonography appears to be the name that has gained favour among radiologists, although it is suspected that 'virtual colonoscopy' will persist as a generic term due to its attractive 'high-tech' connotations for non-radiological medical and lay persons. Whatever the name, the technique has been made possible through the advent of fast helical CT scanners which allow acquisition of a volume of data, and of proprietary software which enables multiplanar reformatting and 3-D endoluminal reconstructions. It is evident that if CTC/VC can be shown to be acceptable to patients, safe, affordable and accurate, it has enormous potential as a diagnostic and screening tool for colorectal neoplasia.

Colon↗