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Biomedical subjects

S Halligan

Publications and source records attributed to S Halligan.

106 records · Page 6Linked to original sources
PubMed1994

Quantification of evacuation proctography.

PURPOSE: This study was designed to determine if evacuation proctography provides a clinically acceptable estimate of the time and completeness of rectal evacuation. METHODS: Rectodynamics, using a weight transducer and chart recorder to quantify the weight and rate of contrast expelled, was combined with evacuation proctography to assess agreement between the evacuation times recorded and the weight of contrast expelled compared with the lateral area change on proctography. RESULTS: Mean difference of evacuation times measured by the techniques was 0.1 seconds and the standard deviation of the differences was 1.9 seconds with 95 percent agreement limits of +/- 3.9 seconds. The mean difference between the percentage of contrast evacuated by weight and the change in rectal area on proctography was 4.3 percent. The standard deviation of the differences was 11.9 percent with 95 percent agreement limits of -19.5 percent and +28.1 percent. CONCLUSION: Evacuation proctography provides a valid estimation of the time and completeness of rectal evacuation.

Barium Sulfate↗
PubMed1994

The distribution of small bowel Crohn's disease in children compared to adults.

Barium follow-through (BaFT) examinations in 67 children and 114 adults with proven Crohn's disease (CD) were reviewed. Forty-six (68.7%) children and 62 (54.4%) adults had evidence of small bowel CD on BaFT. The frequency of CD in the proximal, mid and distal small bowel was 30.4%, 45.7% and 80.4%, respectively for children and 14.5%, 59.7% and 93.5% for adults. Children had significantly more duodenal/jejunal disease than adults (chi 2 = 3.99, P < 0.05) and significantly less terminal ileal disease (chi 2 = 4.29, P < 0.05). There was no significant difference in mid ileal disease. Nine (19.6%) children had small bowel CD with a normal terminal ileum compared with four (6.5%) adults. Ileoscopy-negative children have more proximal small bowel CD than adults and less distal disease. BaFT examination is essential if small bowel CD is not to be missed in children.

Adolescent↗
PubMed1994

Radiological investigation of chronic inflammatory bowel disease in childhood.

The radiological investigations relevant to chronic IBD are described briefly with emphasis placed on compression techniques in small bowel studies. A classification for reporting small bowel Crohn's disease is proposed, where the disease is staged as early, advanced or complicated, and the extent of involvement measured directly from the film. The terminal ileum may be normal in 20% of children with proximal Crohn's disease, so that ileoscopy should not be used to exclude small bowel disease. Radiological assessment of the small bowel is important in management. Surgical referral was based on the radiological changes in 6% of patients, and in 24% the presence of extensive uncomplicated small bowel Crohn's disease led to treatment with elemental diet. The use of some specialized examinations, such as the instant and ileostomy enema, are discussed.

Child↗
PubMedDate not supplied

Evacuation proctography combined with positive contrast peritoneography to demonstrate pelvic floor hernias.

BACKGROUND: To demonstrate the pelvic peritoneal recesses during voiding, evacuation proctography was combined with positive contrast peritoneography. METHODS: In 30 constipated patients, peritoneography was performed, followed by proctography. RESULTS: During evacuation rectogenital herniation developed in 20 patients (66%), without visceral filling in 12 (40%). CONCLUSIONS: Posterior pelvic floor hernia is common during defecation. Less than half fill with bowel and many may not be apparent on standard proctography.

Adult↗
PubMedDate not supplied

Cisapride or metoclopramide to accelerate small bowel transit during barium follow-through examination?

BACKGROUND: Metoclopramide is commonly used to accelerate small bowel transit during barium follow-through (BaFT) examinations, but its action is unpredictable. Cisapride, commonly used to treat gastroesophageal reflux disease, also accelerates small bowel transit and may be a viable alternative. The two were compared in a prospective, randomized, blind study. METHODS: Patients attending for BaFT were randomized to receive either 10 mg cisapride or 20 mg metoclopramide orally 1 h before the barium suspension. BaFT was performed by using a standard technique, and small bowel transit and study quality were compared. Patients also noted any side effects experienced. RESULTS: Of 45 patients recruited, 27 received cisapride and 18 metoclopramide. Median transit time for the cisapride group was 30 min (range = 10-130 min) versus 67.5 min (range = 30-290 min) for the metoclopramide group (p = 0.019). Study quality was comparable. However, nine patients (33%) receiving cisapride experienced nausea versus only one subject (6%) receiving metoclopramide (p = 0.034). CONCLUSIONS: This study suggests that cisapride is a more effective prokinetic agent than metoclopramide, but this benefit is offset by a higher incidence of side effects.

Abdominal Pain↗
PubMedDate not supplied

Prospective assessment of interobserver agreement for endoanal MRI in fecal incontinence.

BACKGROUND: Endoanal magnetic resonance (MR) imaging is a new technique for the assessment of anal sphincter integrity in fecal incontinence and an alternative to anal endosonography. The present study aimed to determine interobserver variation for assessment of anal sphincter integrity using endoanal MR imaging. METHODS: Fifty-two consecutive anally incontinent patients underwent MR imaging by using a purpose-built endoanal receiver coil and static 1.0-T magnet. T2-weighted axial, coronal, and sagittal scans were independently assessed by two radiologists who noted external and internal sphincter integrity. Findings were compared and agreement was assessed with the kappa statistic. RESULTS: There was disagreement in 18 of 49 technically adequate studies (37%; kappa = 0.46), indicating "moderate" agreement. Agreement was strongest if the sphincters were either both intact or both disrupted. Observers agreed in only one diagnosis of an isolated internal sphincter defect and in no diagnosis of an isolated external sphincter defect. CONCLUSION: The overall interobserver agreement for assessment of sphincter integrity using endoanal MR imaging is "moderate." Interobserver agreement using endoanal MR imaging is less than that reported for anal endosonography.

Adolescent↗
PubMedDate not supplied

Adult Crohn disease: can ileoscopy replace small bowel radiology?

BACKGROUND: This study aimed to document the radiological features and distribution of small bowel Crohn disease (CD) in adults by using a barium follow-through (BaFT) technique and to determine whether disease would be missed or its distribution underestimated if only colonoscopy with ileoscopy were performed. METHODS: The BaFT examinations of 121 adults with proven CD were reviewed retrospectively with respect to the stage and distribution of disease. Colonoscopy with attempted ileoscopy was performed in 37 of these subjects, and the results were compared with radiological findings. RESULTS: A normal villous pattern was visualized in 89 studies (74%). BaFT showed small bowel CD in 71 (59%) of 121 patients studied. The terminal ileum (TI) was the most common site of disease, affecting 62 (87%) of patients with small bowel CD. Forty-six patients (65%) had more proximal small bowel disease, including nine (13%) with a normal TI. BaFT showed early mucosal changes of CD in 52 subjects (73%), which was the sole manifestation in 15 (21%). Ileoscopy was possible in the majority of patients colonoscoped but was not achieved in 14 (38%), nine of whom had CD on BaFT. Of the 23 patients in whom ileoscopy was performed, findings agreed with BaFT assessment of the TI in 22. CONCLUSION: BaFT adequately demonstrates the stage and extent of small bowel CD. The majority of patients with small bowel CD have disease proximal to the TI, which cannot be diagnosed by ileoscopy.

Adult↗
PubMedDate not supplied

Examination techniques for endosonography of the anal canal.

BACKGROUND: To determine whether patient position or sphincter contraction influences sphincter thickness or defect assessment. METHODS: Anal endosonography was performed on 35 consecutive patients (30 women, five men). Twenty-five were scanned in the left lateral and prone positions, and the internal sphincter thickness was measured. In 10 patients, the internal sphincter, longitudinal muscle, external sphincter, and length of any defect were measured at rest and during anal squeeze. RESULTS: There was no significant difference in internal sphincter thickness measured in the prone and left lateral positions (95% limits of agreement, -0.12 to 0.06). The thickness of the internal sphincter, longitudinal muscle, and external sphincter at rest did not change significantly during straining (95% limits of agreement, -0.44 to 0.3, -0.28 to 0.24, and 0.33 to 0.71, respectively). The squeeze maneuver did not influence defect appearance or length (95% limits of agreement, -2.845 to 2. 379). Greater symmetry of the anterior part of the external sphincter and improved visualization of perineum was achieved in the prone position. CONCLUSION: Examination in the prone position is preferred. Squeeze maneuvers are of no diagnostic benefit.

Adult↗
PubMedDate not supplied

Patient-administered nitrous oxide/oxygen inhalation provides effective sedation and analgesia for colonoscopy.

In a double-blind, randomized, placebo-controlled study of patients undergoing colonoscopy, sedation with an inhaled mixture of nitrous oxide/oxygen was compared with conventional intravenous sedation (pethidine 50 mg, midazolam 2.5 mg). In the patients studied, no significant differences were noted in number of pain episodes, need for additional intravenous sedation, or patient pain scores between the group receiving the nitrous oxide/oxygen mixture (n = 30) and those managed with conventional benzodiazepine/opiate injection (n = 29). Both methods were significantly more effective than placebo (n = 30). Six patients in the benzodiazepine/opiate group had oxygen desaturation, whereas none did in the nitrous oxide/oxygen group. Duration of stay after the procedure was significantly shorter in the gas inhalation group than in those receiving conventional intravenous sedation. Except for patients with severe chronic obstructive pulmonary disease, nitrous oxide/oxygen inhalation is a safe and acceptable alternative method of sedation and analgesia during colonoscopy.

Adolescent↗