A. McLean

Indomethacin and postprandial gallbladder emptying

Patients with gallstone disease commonly have impaired gallbladder emptying. To see whether non-steroidal anti-inflammatory drugs (NSAIDs) prevent gallstone formation by improving gallbladder emptying, we assessed the effect of indomethacin on postprandial emptying in healthy subjects and in patients with gallstone disease. Subjects received indomethacin 25 mg three times a day for a week and matching placebo for another week. Compared with placebo, indomethacin improved postprandial gallbladder emptying in all 7 patients with gallstone disease. This finding was not recorded in healthy subjects with normal gallbladders. The prevention of gallstone formation associated with ingestion of NSAIDs may be due mainly to a prokinetic effect on the gallbladder since there is no evidence to suggest that these drugs affect cholesterol crystal nucleation at ordinary therapeutic doses in man or animals.

An audit of patient acceptance of one-stop diagnosis for symptomatic breast disease.

AIMS The impetus for optimizing outpatient provision of breast-care services has come both from the patient and management in order to reduce anxiety and make full use of scarce resources. The one-stop diagnostic clinic for the investigation of symptomatic breast lesions is a relatively recent concept with well-known service benefits. However, acceptance to the patient has not been previously investigated. RESULTS The results of this prospective audit demonstrate a high level of patient satisfaction with the multi-disciplinary, one-stop breast clinic.

Prone compression with the pneumatic paddle during barium studies

Prone compression with the pneumatic paddle is easy to perform, effective with high-density suspensions and less uncomfortable for the patient than other methods of compression. It provides accurate graduated compression over a wide field with an unimpeded view. Its routine use is recommended in double-contrast barium meals and all types of small-bowel examinations.

Food poisoning with radiological changes resembling lymphoma

A previously healthy 64-year-old man developed severe abdominal pain and vomiting an hour after eating chicken in white sauce in a restaurant on March 22, 1990. He recalled that he found the chicken rather stale and declined to finish the meal. He had no fever or diarrhea but the vomiting lasted for four days. He attended the Accident & Emergency Department on March 29, 1990 as he continued to have abdominal discomfort, flatulence, and distension. He appeared well and physical examination was essentially normal except for mild abdominal distension. A plain abdominal radiograph showed dilatation of the proximal small bowel. Routine hematology and biochemistry tests were normal. Microscopy, culture of the stool, and serology for Yersinia enterocolitica were negative. A repeat plain abdominal radiograph one week later continued to show marked dilatation of the small bowel (Figure 1). By this time the patient was asymptomatic except for mild distension of the abdomen. A barium follow through examination (April 2, 1990) showed a diffuse abnormality of the small bowel with nodularity, thickened folds, and dilatation suggesting infiltration of mesentery by either a neoplastic or inflammatory process (Figure 2). A CT scan nine days later showed thickening of the wall of the duodenum and jejunum with a prominent fold pattern. There was no mesenteric abnormality or significant lymph node enlargement, although a few small paraaoritc nodes were present. Lymphoma or an inflammatory process were considered possibilities. Gastroscopy, colonoscopy, endoscopic biopsies of stomach, duodenum, jeju-