Search

TauroH-23-((75)Se)selena-25-homocholic acid (SeHCAT) retention has been used for the diagnosis of bile acid malabsorption since the early 1980s. Bile acid malabsorption has been increasingly recognized as an important cause of severe chronic diarroea with subsequent increase in the number of referrals for the SeHCAT test. In this study, we review and discuss the standard techniques for the measurement of SeHCAT retention and describe a simple and modified technique using a noncollimated whole-body scanner, suitable for most modern dual-headed cameras.

Objective Aspects of ileal pouch surgery remain controversial. The authors' single practice experience of 107 operations illustrates many of them. It was hoped that its study would contribute usefully to the debate. Patients and methods Details of all 107 restorative proctocolectomies carried out since the operation was started in Gloucester in 1984 until the study period ended have been kept prospectively. All patients had proctectomy by mesorectal dissection, and 106 had W pouch restoration. Four suffered functional failure requiring reversion to ileostomy and three patients have died. The remaining 99 were sent a questionnaire concerning pelvic visceral function and evidence of pouchitis. Records of all but one of the patients have been reviewed. Results Surgical morbidity was low with neither chronic pelvic sepsis, pouch related fistula, pouch haemorrhage nor pouch ischaemia. Mucosectomised patients had similar bowel control to the stapled group. The policy change from routine to selective protective ileostomy proved satisfactory. W pouch function was found to be comparable to that reported from major J pouch series, although anti-diarrhoeal usage was reduced, and was not influenced by either gender, age or time since surgery. Conclusion None of the following reasonably intuitive assumptions seem supported by our findings: that mesorectal excision necessarily poses a greater danger to pelvic visceral function than close rectal dissection, that the greater capacity of W pouches will be reflected in markedly less frequency, that mucosectomy would impair anal control, or that a defunctioning ileostomy is a mandatory precaution. Pouch frequency is less if wind can be passed separately; otherwise functional outcome seems determined by other, non-technical, factors.

Detrimental effects on the thyroid of the developing fetus as a result of iodine-131 treatment for thyrotoxicosis of the mother in the first trimester of pregnancy are discussed. Dose estimations under typical clinical circumstances yield a fetal thyroid dose of 100- 450 Sv. This dose may increase considerably if the blood concentration of (131)I in the mother remains high. Under such circumstances there may be fetal thyroid dysfunction, which can lead to severe abnormalities.

Patients who receive radioiodine (iodine-131) treatment for hyperthyroidism (195–800 MBq) emit radiation and represent a potential hazard to other individuals. Critical groups amongst the public are fellow travellers on the patient’s journey home from hospital and members of the patient’s family, particularly young children. The dose which members of the public are allowed to receive as a result of a patient’s treatment has been reduced in Europe following recently revised recommendations from ICRP. The annual public dose limit is 1 mSv, though adult members of the patient’s family are allowed to receive higher doses, with the proviso that a limit of 5 mSv should not be exceeded over 5 years. Unless the doses received during out-patient administration of radioiodine can be demonstrated to comply with these new limits, hospitalisation of patients will be necessary. The radiation doses received by family members (35 adults and 87 children) of patients treated with radioiodine at five UK hospitals were measured using thermoluminescent dosimeters mounted in wrist bands. Families were given advice (according to current practice) from their treatment centre about limiting close contact with the patient for a period of time after treatment. Doses measured over 3–6 weeks were adjusted to give an estimate of values which might have been expected if the dosimeters had been worn indefinitely. Thirty-five passengers accompanying patients home after treatment also recorded the dose received during the journey using electronic (digital) personal dosimeters. For the ”adjusted” doses to infinity, 97% of adults complied with a 5-mSv dose limit (range:0.2–5.8 mSv) and 89% of children with a 1-mSv limit (range: 0.2–7.2 mSv). However 6 of 17 children aged 3 years or less had an adjusted dose which exceeded this 1 mSv limit. The dose received by adults during travel was small in comparison with the total dose received. The median travel dose was 0.03 mSv for 1 h travel (range: 2 μSv-0.52 mSv for 1 h of travel time). These data suggest that hyperthyroid patients can continue to be treated with radioiodine on an out-patient basis, if given appropriate radiation protection advice. However, particular consideration needs to be given to children aged 3 years or younger. Admission to hospital is not warranted on radiation protection grounds.

Introduction Parastomal herniation is not uncommon and numerous surgical approaches to the problem have been employed including mesh reinforcement. Bowel wall erosion is a worrying potential complication of placing an edge of mesh around bowel. To reduce this possibility a simple modification is suggested. Method The polyproylene mesh repair is fashioned on the posterior rectus sheath. The required aperture for the bowel is marked appropriately on the mesh. Instead of simple removal of the marked circle, the aperture is fashioned by folding back and stitching in place the triangular flaps from the middle to form a rolled rather than sharp edge. Non-absorbable monofilament stitches reconstitute the mesh encirclement, and attach it laterally and medially to the aponeurotic tissue. A review of the case notes was conducted and each patient was contacted by a postal questionnaire. Results This technique has been used in 10 patients (7 end colostomies, 2 end ileostomies and 1 loop ileostomy) since 2000. Over a median follow-up period of 30 months (range 2 to 40 months) there have been no hernia recurrences, no infected meshes, no bowel damage attributable to the mesh and no troubles with stoma. The only complication encountered has been a segment of superficial wound breakdown in one patient. Conclusions This technique appears to offer a safe and reliable modification for mesh repair of parastomal herniation, in being designed to obviate the possibility of erosion of the stomal bowel wall by a sharp mesh edge but at the same time providing a sound herniorrhaphy by complete encirclement.

The radiation dose to accompanying nurses, relatives and other patients in a nuclear medicine department waiting room was assessed at 5 min intervals by observing the seating arrangement. The total radiation dose to each person was calculated, using fixed values of dose rate per 100 MBq activity for radionuclides, and applying the inverse square law. Radioactive decay and attenuation effects due to intervening persons were also taken into account. The median radiation doses to accompanying nurses, relatives and other patients were 2.3, 2.0 and 0.2 microSv with maximum values of 17, 33 and 5 microSv respectively. In all cases, the radiation dose received by patients was less than 0.2% of the radiation dose resulting from their own investigation. Also, the maximum radiation dose received by an accompanying nurse or friend was less than 1% of their appropriate annual dose limit. Similar values were obtained with calculations based on a 15 min time interval. The radiation doses received by those in a nuclear medicine department waiting room are small, and separate waiting room facilities for radioactive patients are unnecessary.

The biochemical disturbance produced by thiazide diuretics and by amiloride during treatment of moderate hypertension were compared. Two parallel studies were initiated. In one 40 patients with newly diagnosed hypertension were treated with metoprolol and a diuretic, either hydrochlorothiazide or amiloride. In a second study 38 patients receiving longstanding treatment with hypotensives and thiazides either continued the treatment or replaced the thiazide with amiloride. Initial biochemical assessments were compared with those after two years in the study. In previously untreated patients, thiazide produced a significant fall in plasma potassium and hyperuricaemia that did not occur with amiloride (p less than 0.001). Those patients receiving long term treatment for their hypertension who continued to take thiazides had persistent hypokalaemia and hyperuricaemia. Substitution with amiloride corrected the hypokalaemia and serum uric acid returned toward normal ranges, but this change was not statistically significant. Patients receiving long term treatment also had impaired glucose tolerance, this remained unchanged in those receiving thiazide but was corrected in those receiving amiloride. Compared with amiloride thiazides produced undesirable but reversible biochemical changes. As control of hypertension was equally effective with both preparations, we suggest that a combination of amiloride with a beta blocker in treatment of moderate hypertension in preferred.

Summary The application of the 1985 Ionizing Radiations Regulations and Approved Code of Practice to a typical Nuclear Medicine Department has been considered. References to the Regulations are given so that their implications in a given department may be examined. The radiopharmacy, radioisotope dispensary and injection room will need to be Controlled Areas. It will also be necessary to designate Controlled Areas if radiopharmaceuticals are injected in imaging rooms or on wards. Waiting rooms will need to be Controlled Areas. The area around individual patients will, however, not need to be Controlled except for some patients receiving therapeutic doses of 131I for thyrotoxicosis. It should not generally be necessary to designate employees as Classified persons. Major problems in implementing the Regulations are not envisaged in situations where the previous Code of Practice has been followed.

The present study compared the physiological responses to exercise, the anaerobic fitness, and the body composition of high-ability prepubescent wrestlers and normally active boys. The wrestlers (N = 15, mean age +/- S.D. = 11.3 +/- 0.30 yr) were recruited to participate in a summer wrestling camp. Their wrestling experience averaged 3.0 +/- 1.63 yr, during which time they won 78 +/- 10.5% of the matches. The comparison boys (N = 13, 10.7 +/- 0.36 yr) were volunteers from a local Boy's Club. Each subject performed a graded treadmill exercise test (Bruce protocol) and an anaerobic cycle ergometer test. Additionally, body composition was assessed using densitometry and skinfolds. There were no differences (P greater than 0.05) between the wrestlers and the comparison subjects for age or height. The wrestlers exercised for 1.5 min longer on the treadmill and obtained a higher VO2max (54.0 +/- 1.15 ml X min-1 X kg-1, P less than 0.05) than the comparison subjects (45.6 +/- 2.10 ml X min-1 X kg-1). Also, the wrestlers had higher anaerobic test scores, greater body densities, and lower subcutaneous fat totals at all sites than the normally active boys. These data indicate that the favorable fitness and body composition scores found previously for more mature wrestlers are already present in prepubescent wrestlers.

The effects of 10 wk of exercise training at low (40% VO2max) or high (75% VO2max) intensity on serum lipids and lipoproteins were compared in prepubescent boys and adult men. The final sample size consisted of: 8 boys (mean +/- SE age = 8.5 +/- 1.96 yr) and 8 men (36.6 +/- 3.18 yr) in low; 12 boys (8.0 +/- 1.40 yr) and 12 men (36.6 +/- 4.09 yr) in high; and 10 boys (9.0 +/- 2.08 yr) and 10 men (36.7 +/- 4.82 yr) in control. Training involved walking/jogging/running 3 d X wk-1 at a distance which progressed from 2.4 km X d-1 in the first week to 4.8 km X d-1 from the fifth week. Fasting blood samples, collected on 2 d during both pre- and post-training, were assayed for triglycerides, total cholesterol (CHOL), and high density lipoprotein cholesterol (HDL-C). Maximum aerobic power (VO2max) was determined from a treadmill test. Additionally, dietary intake was assessed from a 3-d dietary record and body composition from the sum of 6 skinfolds. The only statistically significant (P less than 0.05) changes occurred in HDL-C and CHOL for the high groups. HDL-C decreased following training. CHOL was lower for high than the other groups for the first day post-training only. There were no differences in the changes in HDL-C/CHOL ratio among the groups. VO2max only increased in the high groups. Dietary intake and body weight did not change. Further statistical adjustment in lipids for changes in sum of 6 skinfolds did not alter the results.(ABSTRACT TRUNCATED AT 250 WORDS)

Body composition and physical dimensions were compared between 23 young, experienced wrestlers (mean age +/- SE = 11.0 +/- 0.21 yr) and 23 school children (11.2 +/- 0.24 yr). The wrestlers were among the best wrestlers from local wrestling clubs and averaged 2.7 (+/- 0.27) yr of experience. They had won 72% (+/- 1.8%) of the total 75 (+/- 9.1) matches. The comparison group consisted of volunteers from local elementary schools. Standard densitometric and anthropometric techniques were used to measure the body composition and physical dimensions of each group. The wrestlers were 4 kg lighter (P less than 0.05) and had a smaller percent fat than the comparison group (13.3 +/- 0.66% and 20.0 +/- 1.13%, respectively). The weight difference between groups was due to the larger fat weight of the comparison group since lean weight differed by only 0.8 kg. Fat differences were also reflected in the larger skinfolds and "fat" circumferences of the comparison group. No group differences were noted in diameters. It is concluded that compared to other children young experienced wrestlers have similar skeletal structures and lean body weights. The comparison group possessed more body fat.

The radiation dose to the pulp of both index fingers has been measured in a radiopharmacy supplying 11 000 patient doses a year, in a hospital dispensary (4500 doses a year) and in its injection area. Tungsten syringe shields were used for one week and not used during the other week. In the radiopharmacy and the dispensary the highest finger dose recorded was 6.8 mSv, which corresponds to an annual figure of 330 mSv. Syringe shields gave a protection factor of less than two, and the dose to the left hand was approximately half that to the right. When giving injections the corresponding weekly and annual doses were 4.6 and 220 mSv respectively. If all injections had been given by a single person the corresponding annual dose would have been 430 mSv. Using syringe shields this could be reduced by factors of at least eight for the right hand but only 1.3 for the left hand. Dose rates for unshielded syringes expressed per 10 GBq handled are similar to other data in the literature. However, syringe shields reduce the dose rates less than anticipated. Tungsten 1.94 to 3.05 mm thick would be expected to give an attenuation factor of 27 to 178.

n/a

The present study compared the physiological responses to exercise, the anaerobic fitness, and the body composition of high-ability prepubescent wrestlers and normally active boys. The wrestlers (N = 15, mean age +/- S.D. = 11.3 +/- 0.30 yr) were recruited to participate in a summer wrestling camp. Their wrestling experience averaged 3.0 +/- 1.63 yr, during which time they won 78 +/- 10.5% of the matches. The comparison boys (N = 13, 10.7 +/- 0.36 yr) were volunteers from a local Boy's Club. Each subject performed a graded treadmill exercise test (Bruce protocol) and an anaerobic cycle ergometer test. Additionally, body composition was assessed using densitometry and skinfolds. There were no differences (P greater than 0.05) between the wrestlers and the comparison subjects for age or height. The wrestlers exercised for 1.5 min longer on the treadmill and obtained a higher VO2max (54.0 +/- 1.15 ml X min-1 X kg-1, P less than 0.05) than the comparison subjects (45.6 +/- 2.10 ml X min-1 X kg-1). Also, the wrestlers had higher anaerobic test scores, greater body densities, and lower subcutaneous fat totals at all sites than the normally active boys. These data indicate that the favorable fitness and body composition scores found previously for more mature wrestlers are already present in prepubescent wrestlers.