Neostigmine and glycopyrronium: a potential safe alternative for patients with pseudo-obstruction without access to conventional methods of decompression.

Intestinal pseudo-obstruction mimics bowel obstruction. However, on examination, no mechanical cause is identified. This condition will often resolve when managed conservatively, yet in some cases decompression is required to avoid the serious complications of bowel ischaemia and perforation. This is performed endoscopically, and due to the invasive nature and limited access to this service, an alternative treatment option is deemed appealing. Neostigmine has good efficacy in the decompression of pseudo-obstruction but is hindered by its wide side effect profile. In this context, neostigmine requires careful monitoring, which limits its appeal. This side effect profile is minimised when neostigmine is administered in conjunction with glycopyrronium.This case demonstrates the novel use of neostigmine and glycopyrronium in decompression of the bowel in a patient with pseudo-obstruction. Furthermore, it highlights its value, particularly when conventional techniques for decompression are not accessible.

Improving detection of colorectal cancer.

Colorectal cancer is the third most common cancer in the U.K., with an annual incidence of 36,100 in England and Wales. It is also the second leading cause of death from cancer in the U.K. However, there has been a significant increase in five-year survival over the past decade, from 22% to 50% despite more than 55% of patients presenting with lymph node or distant metastases. Around 80% of colorectal cancer is sporadic, i.e., caused by the interaction of genetic and environmental factors via the adenoma-carcinoma sequence and cancer may take up to ten years to develop in this way. Adenomas are more common with age and one in four of the population aged over 50 will develop one or more polyps, with 10% of these polyps progressing to cancer over time. Risk factors for colorectal cancer include: age over 60; K-ras and p53 mutations; a diet high in saturated animal fat and low in fibre and vegetables; lack of exercise, obesity and excessive alcohol intake. Inflammatory bowel disease is a risk factor for development of colorectal cancer through the association of chronic inflammation and development of malignancy. Around 20% of colorectal cancer cases are familial and in a primary care setting taking a family history may determine those with a higher than average risk who may need onward referral. A large proportion of patients with rectal or sigmoid cancers present with a combination of rectal bleeding and a change in bowel habit (usually an increased frequency of defecation and/or looser stools). Rectal bleeding in the absence of anal symptoms occurs in over 60% of those with cancer, and a palpable rectal mass with or without tenesmus is present in 40-80% of those with rectal cancer.

3D T(1)-mapping for the characterization of deep vein thrombosis.

PURPOSE: The aim of this work was to investigate fast T (1)-mapping for the characterization of deep vein thrombosis (DVT). METHODS: The accuracy and reproducibility of the T (1)-mapping sequence was tested in phantoms and in 8 healthy volunteers on a 1.5 T clinical scanner using a 32-channel array coil. Furthermore, the feasibility of the technique was tested in 5 patients diagnosed with DVT by measuring the volume and T (1) values of the thrombus at 5 time points over a period of 6 months. RESULTS: The results of the phantom and volunteer study showed a high accuracy and reproducibility for the quantification of T (1). The resolution of the T (1)-maps was high enough to identify small anatomical structures. T (1) values derived for normal blood and various other tissues were comparable to those reported in the literature. In all patients, the T (1) times of thrombi showed decreased values (T (1) = 843 +/- 91 ms) in the acute phase and recovered back to normal values of blood (T (1) = 1,317 +/- 36 ms) after 6 months. CONCLUSIONS: Measurement of all relevant T (1) values of acute thrombi and normal blood achieved accurate and reproducible results in vivo. Fast T (1) quantification of the thrombus can provide information about tissue characteristics such as thrombus resolution. Such a quantitative MRI technique may be valuable in studying the factors that influence natural resolution and in evaluating treatment effects that enhance this process.

Bicycle handlebar injury in a nine-year old causing a common hepatic duct tear.

A case in which a handlebar injury to the abdomen resulted in a common hepatic duct tear is presented. This injury has not been previously documented in the literature. The case emphasizes the diverse and potentially serious consequences of handlebar injuries in children, and reminds us that the presentation may be delayed.