Timing of cyclical etidronate.

Objective: The importance of the timing of the etidronate component of cyclical etidronate was investigated in a study examining changes in lumbar spine BMD.

Methods: Seventy patients who had been taking cyclical etidronate for at least 1 year and who had baseline BMD studies and a further scan 1 year later were mailed a questionnaire asking about the time of day they took the etidronate component. Replies were received from 52 patients who were of average age 67.

Emergency small-bowel resection in a district general hospital.

Small-bowel resection has been identified as a core surgical skill that all general surgical trainees must acquire. Most of these resections are performed by the unsupervised higher surgical trainee on call. Reviewing 51 small-bowel resections performed over a five-year period in a district general hospital we found that, although the operation carried a high mortality rate (18%) and a high morbidity rate (21%), these had less to do with the operative technique than with the nature of the underlying disease and the hazards of emergency surgery in general.

Lessons to be learned: a case study approach: metastatic bronchogenic carcinoma presenting as a gluteal abscess.

It is well known that bronchogenic carcinoma frequently metastasises to the bony skeleton, but it is most unusual for it to present in the form of a musculoskeletal abscess. Presented here is the case report of a patient with what appeared initially to be a right sided gluteal abscess and which turned out to be the metastasis from a bronchogenic carcinoma. The Magnetic Resonance Image (MRI) scan carried out proved to be very helpful in arriving at a probable clinical diagnosis; however, it was histopathological studies of the abscess wall itself that ultimately gave the definitive diagnosis.

Time to abandon electroconvulsion as a treatment in modern psychiatry.

This review examines the evidence for the current use of electroconvulsive therapy (ECT) in psychiatry. The history of ECT is discussed because ECT emerged with no scientific evidence, and the absence of other suitable therapy for psychiatric illness was decisive in its adoption as a treatment. Evidence for the current recommendation of ECT in psychiatry is reconsidered.

South Thames quality standard for nuclear medicine equipment. South Thames Region Nuclear Medicine Specialty Service Committee.

A survey of the quality assurance of the nuclear medicine equipment in use in the South Thames Region was undertaken as part of the clinical audit process within the region. The results revealed the variation in practice across the region and highlighted the need for an agreed quality standard, together with the appropriate level of physics support to provide that standard.

Metastatic testicular teratoma of the nasal cavity: a rare cause of severe intractable epistaxis.

Malignant neoplasms of the nasal cavity and paranasal sinuses are uncommon. Choriocarcinoma is a highly malignant germ cell tumour occurring in the reproductive organs. Metastasis may be principally by the lymphatic route as in other germ cell tumours but choriocarcinoma is also known to spread haematogenously.

Prostatic infarction/infection in acute urinary retention secondary to benign prostatic hyperplasia.

Purpose: We assess the role of acute prostatic infarction and prostatic inflammation in causing acute urinary retention in patients with benign prostatic hyperplasia (BPH).

Materials And Methods: A prospective controlled clinicopathological study was undertaken comparing 35 patients who presented with acute urinary retention secondary to BPH with another 35 patients with symptomatic BPH. All 70 patients were treated with transurethral resection.

Orthopaedic manifestations of systemic disease.

Nuclear medicine studies can be initiated to detect or evaluate systemic diseases such as inflammatory arthritis or Paget's disease. This is usually because of the strengths of nuclear medicine studies such as high sensitivity, an ability to easily image the whole body, and typical diagnostic patterns of abnormalities. In other instances, a systemic disease may be incidentally suggested by a scintigram such as osteoporosis or hyperparathyroidism; or a focal abnormality such as a vascular necrosis may be detected that should indicate a systemic condition should be sought.

Long-term clinical results and quality of life after insertion of a self-expanding flexible endourethral prosthesis.

Objective: To evaluate the safety and efficacy of the Urolume self-expanding flexible endourethral stent, based on a long-term follow-up, and to determine its role amongst the various modalities of treatment available for the relief of bladder outlet obstruction (BOO) arising from benign prostatic hyperplasia (BPH).

Patients And Methods: From January 1991 to April 1992, the Urolume wallstent (American Medical Systems, USA) was placed successfully in each of 62 patients (aged 50-89 years) who had significant subjective and objective evidence of BOO. The stent was placed as a daycase procedure under general anaesthesia.

Bone scintigraphy in metabolic bone disease.

The bone scan has well-recognized appearances in metabolic bone diseases, with its main clinical value found in focal conditions or the focal complications of disease. In clinical practice, the bone scan is most widely used to detect fractures in osteoporosis and pseudofractures in osteomalacia and to evaluate Paget's disease.

Overview of role of BMD measurements in managing osteoporosis.

The advent of effective treatments and the opportunity to precisely and accurately measure bone mass have probably been the greatest advances in the field of osteoporosis in the last decade. Bone densitometry has become the most widespread noninvasive method for the detection of osteoporosis and to provide advice on risk of future fractures. It has achieved an unquestioned role in clinical decision making for the management of osteoporotic patients.

Benign polyps with prostatic-type epithelium of the urethra and the urinary bladder.

The clinico-pathological features of nine urethral and urinary bladder polyps with prostate-type epithelium are described. The average age of the patients was 46 years. Three patients previously had cystoscopy and the lesion was not noticed on the initial examination.

Liposarcoma of the spermatic cord: a report of two cases.

Liposarcoma of the spermatic cord usually occurs as a painless slow growing scrotal swelling and can present with sudden enlargement of the mass. Recurrences are frequent, owing to incomplete surgical removal of the tumour.

Clinical audit and standard setting for symptomatic breast imaging in South Thames region.

Audit is recognized as an important part of the UK National Health Service Breast Screening programme. This paper describes a simple method of auditing breast imaging in symptomatic women which was applied in the South Thames (East) Region of England. No appropriate standards were available before this audit started.

Measurement of the secretion of technetium-99m hexamethylpropylene amine oxime into breast milk.

There are no published data for the activity of technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) found in breast milk. The amount of radioactivity in breast milk following the administration of 500 MBq 99mTc-HMPAO for a brain perfusion study has been measured. The effective dose to the infant was calculated to be 0.

Isotope imaging.

Patients with a wide variety of rheumatological conditions can be usefully investigated by nuclear medicine techniques and particularly by bone scintigraphy. This aspect of nuclear medicine work is increasing and the trend can be expected to continue. The principal conditions that can be imaged are sports medicine injuries, osteomyelitis, avascular necrosis, reflex sympathetic dystrophy syndrome, enthesopathies and bio-mechanical stress lesions, inflammatory arthropathies, metabolic bone disease and miscellaneous bone conditions such as costo-chondritis.

Interstitial cystitis in men.

Interstitial cystitis is an uncommon disease reported predominantly in females. Recently we were involved in the management of 4 men who had the clinical, endoscopic and pathological features consistent with the diagnosis of interstitial cystitis. The rarity of occurrence of the disease in males prompted us to report these cases.