Wayne M West

CT appearances of the Rapunzel syndrome: an unusual form of bezoar and gastrointestinal obstruction

Abstract The CT appearances of an unusual type of trichobezoar which causes the Rapunzel syndrome are described. This syndrome is characterized by intestinal obstruction secondary to a bezoar possessing a tail which extends to or beyond the ileo-cecal valve. Most cases of bezoar are diagnosed with plain films or barium meal, but CT may be requested in patients who present with abdominal masses. The Rapunzel syndrome may be diagnosed with a combination of the CT findings and the history.

The low frequency of reflux in Jamaican children.

Fifty consecutive micturating cystourethrograms (MCUG) performed at the UHWI between June 1989 and December 1991 were reviewed. There were forty boys and ten girls. Infants under the age of one year accounted for 58%. Urinary tract infection was the commonest presenting feature (72%), voiding difficulties (10%) and associated malformations (14%) were the other reasons for doing the MCUG. Only 10% of the children revealed vesico-ureteral reflux (VUR) which supports the view that reflux is less common in the non-caucasian population. In our population, the yield from MCUG is low. However, when detected, the reflux was of significant degree as to warrant active therapy. All but one of the VU refluxes diagnosed by MCUG had ultrasonographic abnormalities. Black children with single urinary infections have a low likelihood of VUR. A clear history of pyelonephritis and abnormalities on ultrasound or radionucleide cystogram may be used as criteria to select those in whom MCUG will be useful.

Ultrasound and white blood cell counts in suspected acute appendicitis

The use of radiological studies as diagnostic tools in patients with suspected acute appendicitis has increased recently. In this setting, abdominal ultrasonography is viewed as a possible means of avoiding unnecessary surgery. This retrospective study of patients who underwent laparotomy for suspected acute appendicitis was undertaken to determine the sensitivity and specificity of ultrasound in diagnosing acute appendicitis and the frequency of leucocytosis in patients in whom the diagnosis was confirmed by histology. The ultrasound and surgery registers were reviewed to identify 254 referrals for abdominal ultrasound between January 2001 and December 2002 because of a clinical suspicion of acute appendicitis. Of these cases, 223 did not proceed to surgery. The study sample comprised 31 patients who had appendectomies after abdominal ultrasonography. The ultrasound reports, pathological diagnoses and white blood cell counts of these patients were obtained and formed the basis for the analysis. A histological diagnosis was available for 30 cases, in 17 of whom appendicitis was confirmed In these patients, positive ultrasound and leucocytosis were present in five (29%) and nine (53%) respectively. Ultrasound showed 92% specificity and 29% sensitivity for the pre-operative diagnosis of appendicitis. The positive predictive value of ultrasonography (83%) was higher than that of leucocytosis (69%). The sensitivity and specificity of ultrasound and leucocytosis in this study indicate limited utility as preoperative diagnostic tools.

Bilateral psoas abscess in a case of granuloma inguinale

The authors present a case of disseminated granuloma inguinale with bilateral psoas abscesses. Infection with calymmatobacterium granulomatis is usually localized to the genital organs but rarely may be disseminated. A search of the literature revealed that only two cases of psoas abscesses due to calymmatobacterium granulomatis were previously reported

A comparison of statistical associations between oedema in the lumbar fat on MRI, BMI and Back Fat Thickness (BFT)

Purpose To compare the relationship between obesity markers Body Mass Index (BMI) and Back Fat Thickness (BFT) and oedema in the lumbo-sacral subcutaneous adipose tissue. Patients and methods A retrospective study was performed of consecutive Magnetic Resonance Imaging examinations on 149 adults (95 females and 54 males) scanned at 1.5T between October 1 and December 31, 2010. The extent of oedema was graded from 1 to 8 based on the number of involved anatomical segments on the Fat Sat sequence. A vertebra and the disc immediately inferior or any of the upper, middle or lower third of the sacrum was assigned 1 unit. BFT was measured superiorly at the upper border of L1 (BFT L1) and inferiorly at the lower border of L5 (BFT L5) on the T1 weighted image. BMI was computed at the time of the examination. The data were analysed using StatPlus 2009. The association between variables was evaluated using univariate and multivariate regression. Results 68 patients (45.6%), 50 females (33.6%) and 18 males (12.0%) were found to have oedema. Weight (p = 0), BMI (p < 0.001), BFT L1 (p < 0.001), BFT L5 (p < 0.001) and age (p = .01) were significantly associated with oedema. On forward stepwise multiple regression significant independent variables predicting oedema were found to be BMI, BFT L1 and Age. ANOVA indicated that BMI explained 23.6% (F = 45.5, p = 0), BFT L1 22.7% (F = 43.2, p = 0) and age 4.7% (F = 7.4, p = 0.007) of the variance of oedema. Conclusions Obesity markers BMI and BFT L1 are significant independent variables predicting oedema. Oedema is predicted to a variable extent by fat at different sites. The oedema may be, in part, a consequence of obesity.