Background: There are national guidelines issued by all hospital radiology departments concerning the use of gonadal protection shields for taking X-rays of the pelvis. It is important to follow these guidelines especially when paediatric X-rays are taken. Gonads are very susceptible to radiation as they fall directly in the line of radiation exposure when pelvic X-rays are taken. Aim: To examine whether these guidelines were being followed. Methods: This audit considered 355 radiographs taken in a 6-month period on 149 patients, under the age of 16 years, attending the orthopaedic department at King's Mill Hospital. Results: In only 23% of the cases studied, the correct use of gonad protection shields had been performed. In 67% of the unprotected patients, the shields were not used at all. In the remainder, the shield was incorrectly applied. Out of all the patients, 45% had more than one X-ray thus exposing the gonads to unnecessary radiation. In addition, 8% of patients had a CT scan, 6% had fluoroscopy and 42% had radiographs of other regions of the body. Conclusions: Guidelines should be adhered to as far as possible and efforts always be made to decrease radiation exposure. Application of the current guidelines excludes the first X-ray exposure of the female pelvis and of the pelvis of trauma patients from the use of shields, thus adding to the number of the X-rays done without protection.
Fibromuscular dysplasia of the renal arteries usually presents with hypertension but, rarely, it can present with acute renal infarction. Of the four types of fibromuscular dysplasia, medial fibroplasia has been said not to progress to renal arterial occlusion (Schreiber et al, 1984) and not to predispose to arterial thrombosis or dissection (Stewart et al, 1970).
We report on three patients who presented with acute renal infarction, whose renal angiographic features were more suggestive of the medial fibroplasia type of fibromuscular dysplasia.
A 33-year-old man was admitted with severe right loin pain. The right kidney was non-functioning on intravenous urography, but an ultrasound examination of both kidneys was normal. A right retrograde pyelogram was normal, but dynamic renography (99Tcm-DTPA) revealed that the right kidney was not perfused.
At angiography the right renal artery was completely occluded by thrombus 3 cm from its origin (Fig. 1). The left main renal artery was irregular and two stenoses were seen in one of the segmental vessels (Fig. 2). The thrombus in the right main renal artery was treated with intra-arterial streptokinase to reveal a 75% stenosis. This was treated with balloon angioplasty but peripheral perfusion could not be restored and the kidney remained non-functioning. The angiographic appearances were thought to represent the medial fibroplasia form of fibromuscular dysplasia. Subsequent investigations failed to reveal any other cause of arterial thrombosis or embolism.
Impaired gallbladder contractility is a prerequisite for gallstone formation in animal models. Prostaglandins are important mediators of gallstone formation and may affect gallbladder contractility in animals. The aim of this study was to evaluate the effect of indomethacin, an inhibitor of prostaglandin synthesis, and misoprostol, a synthetic prostaglandin, on gallbladder contractility in man. Seven male volunteers (18-33 years old, mean age 23 years) were studied under blinded conditions after an overnight fast, during control periods and following ingestion of indomethacin 125 mg (75 mg at 10 PM, 50 mg at 6:30 AM) or misoprostol 800 micrograms (400 micrograms at 10 PM, 400 micrograms at 6:30 AM) orally. Gallbladder residual volume was determined by real-time ultrasonography before and 10, 20, 30, 40, and 50 min after ingestion of a standard liquid fatty meal stimulus. Fasting gallbladder volume (milliliters) was similar in all three periods [control 20.8 (1.6); indomethacin 20.8 (2.9); misoprostol 18.3 (1.6)]. The fatty meal stimulus caused prompt contraction, resulting in minimum residual volume of 7.5 (1.4) ml in the control period. Pretreatment with misoprostol or indomethacin did not affect the minimum volume obtained compared with control period [misoprostol: 5.8 (1.4) ml; indomethacin 5.9 (1.3) ml)]. Thus administration of indomethacin and misoprostol had no effect on fasting gallbladder volume or gallbladder contractility in humans as assessed by ultrasonography.
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