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Introduction As hospitalized neonates are radiosensitive and often require numerous X-rays, institutions should investigate the optimal beam parameter combinations to deliver diagnostically acceptable quality images at the lowest possible entrance surface dose (ESD). Using a subjective approach, this study evaluated the effect of different beam parameter combinations on image quality. Methods and materials Five rabbits simulated the neonatal chest. The ESD was reduced using a variation of voltage, tube current and filtration. Eight radiology registrars, blinded to the dose parameter information, ranked the digital X-ray images of three anatomical regions from best to worst using a variation of the multiple rank order method. T-tests compared the average values, obtained from the scores assigned by each observer to images acquired at different ESDs, for each region. The calculated intraclass correlation coefficient (ICC) assessed observer agreement. Results Results showed that a 64% dose reduction was achievable by altering the beam parameters. Large variation among the observers was confirmed by an ICC value <0.5. A 95% confidence interval could not conclude that different ESD values, resulting in a 50–77% dose reduction compared to current practice, would result in different overall observed image quality. This was noted for all three regions indicating that no preference existed towards an image acquired with a specific beam parameter combination. Conclusions The large variation in observers’ opinion of acceptable image quality emphasizes the importance of subjective image quality evaluation in the clinical environment. The rabbit phantom and multiple rank order method are considered appropriate for these evaluations. [ABSTRACT FROM AUTHOR]

Background. South Africa's regulatory framework for electromagnetic medical devices has come under considerable criticism. Here it is reviewed in terms of how it has given form to protective measures against ionising radiation. The Hazardous Substances Act provides for effective protection against radiation, but has been undermined by poor administration and uncertainty about regulations and licensing conditions. The legal weight of enforcing licensing conditions through a website without proper consultation with all parties concerned is questionable and ineffective. Effective and legal radiation control is possible by activating the National Advisory Committee on Electronic Products, provided for in Regulation R326 published in 1979, but this has never been implemented. The possible impact of annual quality assurance tests currently enforced through licensing conditions on radiation dosage to the population is not cost-effective, as new training and accreditation structures have to be created.Conclusions. That more than 80% of overexposures are generally caused by human error is a clear indication that training of the regular users of X-ray equipment should be emphasised, and not the training and accreditation of the technicians responsible for a single quality assurance test per year. Constructive engagement with the professional bodies involved in the medical use of X-rays through a National Advisory Committee on Electronic Products may be a cost-effective solution for lowering radiation dosage to the population. [ABSTRACT FROM AUTHOR]

Evaluates the efficacy of percutaneous cholecystostomy (PC) in patients with acute cholecystitis. Diagnoses in critically ill patients; Clinical determinants of patient status and association with outcome; Result of catheter placement; Radiographic findings; Procedure-related variables; Survival rate.

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To determine whether exposure to proximal intestinal contents per se is an adequate stimulus for ileal adaptation of the magnitude seen after jejunectomy, rats were prepared by transposing 30 cm of distal ileum to the duodenojejunal junction or by sham operation. One month after surgery, mucosal mass (wet weight, protein content, and DNA content) and digestive enzyme activities were measured in segments of small intestine and compared between the groups. Measurements of mucosal mass in transposed ileum more than doubled those in control jejunum (p <0.001). Mean enzyme activities/cm bowel length in transposed ileum approached or surpassed measurements in control jejunum. In contrast to the other enzymes studied, mean sucrase specific activities were similar in transposed ileum and control jejunum, values five fold greater than that of control ileum (p <0.002). We conclude that exposure of ileum to proximal intestinal contents reproduces the adaptive response that follows jejunectomy, without requiring short bowel. Sucrase responds to this exposure in a unique fashion. [ABSTRACT FROM AUTHOR]

Chronically ill and neurologically impaired children may require enteric tube feedings indefinitely to maintain adequate nutrition. When transgastric feedings are not feasible, a permanent feeding jejunostomy may be required. Since 1979, we have constructed a continent feeding jejunostomy in 16 children using a shortened Maydl Roux-en-Y limb with an intussuscepted nipple-valve mechanism. The jejunostomy is matured as a stoma through the abdominal wall, while the nipple valve is stabilized in the abdominal cavity anchored to the posterior fascia and peritoneum. Bolus or drip feedings can be initiated when gastrointestinal function resumes. Between feedings, the tube is removed as the jejunostomy is continent and can be covered with a gauze pad. No deaths were attributed to the operation, although more than 50% of these children died within 2 years from complications of their primary disease. The jejunostomy functioned well and was completely continent in 14 patients. The creation of a feeding jejunostomy with an intussuscepted nipple valve assures continence, avoids the complications of chronic indwelling tubes, and decreases the risk of regurgitation. Furthermore, the continent jejunostomy permits bolus feedings and requires minimal care. The use of this procedure is advocated whenever permanent feeding jejunostomy is anticipated. [ABSTRACT FROM AUTHOR]