Fifty-eight patients with uncomplicated diverticular disease of the colon took bran crispbread, ispaghula drink, and placebo for four months each in a randomised, cross-over, double-blind controlled trial. Assessments were made subjectively, using a monthly self-administered questionnaire, and objectively, by examining a seven-day stool collection at the end of each treatment period. In terms of a pain score, lower bowel symptom score (the pain score and sensation of incomplete emptying, straining, stool consistency, flatus, and aperients taken), and total symptom score (belching, nausea, vomiting, dyspepsia, and abdominal distension) fibre supplementation conferred no benefit. Symptoms of constipation, however, when assessed alone, were significantly relieved. Both fibre regimens produced the expected changes in stool weight, consistency, and frequency.It is concluded that dietary fibre supplements in the commonly used doses do no more than relieve constipation. Perhaps the impression that fibre helps diverticular disease is simply a manifestation of Western civilisation's obsession with the need for regular frequent defecation.
globulin have a strong but not exclusive influence.' Changes in albumin have only a minor effect, but paraproteins2 and lipoproteins3 also increase plasma and serum viscosity. For these reasons estimations of plasma fibrinogen from the difference of plasma and serum viscosity are unreliable and can be wrong by as much as 100",.1 According to the authors' own reasoning a quantitative plasma protein determination (electrophoresis) therefore should be more reliable as a predictor of early rheumatic conditions.
Summary: Stools have been tested for occult gastrointestinal bleeding in 278 outpatients and '170 hospital inpatients using the Haemoccult and Haemastix methods. Seventeen outpatients (6.1%) and 42 inpatients (24.7%) were positive with the Haemoccult technique. Thirty-three outpatients (11.9%) and 93 inpatients (54.7%) were positive with the Haemastix test. Following investigation of the Haemoccult-positive patients, only 2 cases (3.4%) were considered false positives. However, the false positive rate with Haemastix was 22.9% which is unacceptable in a screening test. Haemoccult may be useful as a screening test for asymptomatic general practice patients, but a test of greater sensitivity is needed for hospital patients.
SUMMARY The Trucut and Surecut liver biopsy needles have been compared in a prospective randomised study. Although the Surecut specimens were longer and heavier they tended to fragment during processing. Trucut specimens were subject to less artefact and were rated more highly by the histopathologist. However, the majority of biopsies obtained by both needles were satisfactory for diagnostic purposes.Needle biopsy of the liver is now established as a safe and useful diagnostic procedure.' A number of different needles are available but few formal comparisons of their respective merits have been made.2 We have evaluated a newly introduced modification of the Menghini needle (Surecut) and the Trucut needle in a prospective controlled study. Material, patients and methods MATERIALThe Trucut needle (Travenol Laboratories) combines an interlocking cannula and trochar which has a 2 cm long notch cut out of one side to receive the biopsy specimen. The outside diameter is 2-032 mm. It was used as previously described3 and needles were not reused.The Surecut needle (American Hospital Supply) is a disposable modified Menghini needle but with a central stilette attached to the plunger of an integral syringe. The stilette extends the whole length of the needle and emerges to form a pointed tip. The outside diameter of the needles used was 1.8 mm but a range of different sized needles is available.The skin and intercostal muscle are punctured in the usual manner but before the needle is inserted into the liver the plunger and stilette are withdrawn and held in position by a ratchet. The needle is then advanced into the liver and withdrawn, and the specimen is extruded from the needle by gently releasing the ratchet and advancing the stilette down the needle. Great care is needed to avoid fragmentation of the specimen. To obtain a straight cylinder of liver tissue, each specimen was mounted by the operator on a rectangular piece of rigid absorbent paper and fixed in neutral formalin. The specimen was sent to the laboratory without any indication of which needle had been used. In the laboratory the handling of the specimen at all stages was done by one MLSO. The specimen was separated from the paper, weighed, the number of fragments present was recorded and their total length measured. They were enveloped in filter paper and processed in an automatic processor within a metal cassette. The specimen was then embedded in paraffin wax and the number of liver fragments in the block were noted. Serial sections 4 ,um thick, parallel to the long axis of the cylinder and including the maximum possible area, were cut and mounted on eight numbered glass slides.The best slide was selected by the pathologist, who counted the number of separate fragments, measured their total length and total area and the length of the largest fragment. He then assessed the presence or absence of artefacts which could have arisen before fixation (diffuse crushing at the edges, 761 on 10 May 2018 by guest. Protected by copyright.
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