An audit into the use of intravascular contrast media in Scotland. The Audit Committee of the Scottish Radiological Society and the Scottish Standing Committee of the Royal College of Radiologists.

A survey was conducted into the use of intravascular contrast media within Scotland during 1993-4 auditing the period from April 1992 to March 1993. The first phase of the study examined the use of low osmolar contrast media and high osmolar contrast media and this obtained a 100% response rate. All users were found to adhere to Royal College of Radiologists guidelines, but as an incidental finding, only 87% recorded adverse reactions and a separate register was not always maintained. A second follow-up questionnaire was issued to examine specifically the recording of adverse reactions. A 96% response rate was obtained. Although all departments recorded adverse reactions in some form, only 13% kept a separate register. Recommendations are made that all departments should maintain a separate adverse reaction register and that there should be standardisation of the grading of reactions. Annual returns to a central body are also recommended.

Dry bones: a paleopathological study of skeletal remains from a medieval graveyard in Dundee.

We report a study on human skeletal remains excavated from a medieval city centre graveyard. The remains of approximately 75 individuals were examined and radiographs were made of selected specimens. Many bones were normal and apparently from strong, young adults. The most frequent abnormality was osteoarthritis but we also noted osteoporosis, periostitis and an example of probable Paget's disease. From measurements of long bones and using appropriate formulae, we estimated stature. The average height for males was calculated to be 172cm (5' 7") and for females 157 cm (5' 2").

Case report: calcification in benign cystic peritoneal mesothelioma.

Benign cystic mesothelioma of the peritoneum is a rare multicystic tumour that occurs predominantly in middle aged women with strong predilection for the surface of the pelvic viscera. Our patient was a 79-year-old woman who presented with weight loss and left upper abdominal mass showing calcification on CT. This is the first reported case of benign cystic mesothelioma with calcification. Differentiation from an adrenal tumour and peritoneal teratoma was not possible preoperatively.

Fatal mediastinal compression as a late complication of surgical plombage.

Surgical plombage was used as a form of collapse therapy for pulmonary tuberculosis before the advent of reliable chemotherapy. A patient developed stridor, recurrent laryngeal nerve paralysis, and obstruction of the superior vena cava and eventually died as a result of haemorrhage into a large intrathoracic cyst, secondary to a polystan pack inserted 38 years previously.

Accuracy of morphological diagnosis of lung cancer in a department of respiratory medicine.

In view of the importance of determination of cell type in patients with bronchial carcinoma who are to be given chemotherapy a series of 140 histologically proved cases was analysed to assess the accuracy of pretreatment diagnosis by cytology and bronchial biopsy. Final histological diagnosis was made after thoracotomy (131 cases) or necropsy (9 cases). Before treatment, malignancy was diagnosed in 71% of cases with 91% accuracy in cell typing. Diagnostic yield was greatest in squamous carcinoma (81%) and least with adenocarcinoma (50%). Large-celled and small-celled anaplastic carcinomas gave yields of 61% and 68% respectively. Accuracy of cell typing was high (90-97%) except for large-celled anaplastic carcinoma (71%). All diagnostic methods were not employed in every case. In patients supplying samples the diagnosis was made by sputum cytology in 57%, by rigid bronchoscopy cytology in 57%, by fibreoptic bronchoscopy cytology in 71% and biopsy in 53%. Causes of diagnostic failures and possible means of increasing accuracy of pretreatment diagnosis were discussed.

Assessment of factors influencing the result of sputum cytology in bronchial carcinoma.

In a retrospective study of 377 patients with bronchial carcinoma, sputum had been reported positive or suspicious for malignant cells in 59.7%. The most important factors contributing to a positive result were the histological cell type and the site of the tumour as assessed at bronchoscopy. Significantly more positive results were obtained in epidermoid tumours and those with a visible bronchoscopic abnormality. A higher proportion of positive results also occurred in large tumours, lower lobe tumours, and those associated with collapse and consolidation. The physical condition of the patient and the presence of infection in the sputum were not important factors contributing to a negative result. Although adequate numbers of sputum samples were collected the predominant problem was the large number of unsatisfactory sputum specimens. The preparation of the sputum specimens in the laboratory is important and is also a potential source of error.

Controlled trial of supervised exercise training in chronic bronchitis.

In a controlled trial of exercise retraining in patients with severe chronic bronchitis, 33 subjects were followed for a mean period of 10.3 months. The exercise programme was supervised once a week, and daily training comprised a 12-minute walk and simple stair climbing exercises. The subjects in the exercise group showed a highly significant improvement in their walking distance, attaining a maximum increase of 24% after eight to 12 months. There was also considerable subjective improvement. The control group did not improve. No significant changes in cardiorespiratory function or muscle strength were seen. Simple exercise rehabilitation is of benefit to patients with disabling obstructive lung disease.

Assessment of tine tuberculin test.

Mantoux (10 tuberculin units) and tine tuberculin tests were performed in 190 subjects and the results recorded at 48, 72, and 96 hours. Altogether 1010 readings were recorded. Of these, 555 (55%) were Mantoux-test positive and 525 (52%) tine-test positive. While the tine test is marginally less sensitive, its advantages are simplicity and ease and speed of application. It thus provides a useful screening test for eliciting tuberculin sensitivity.

The role of radiology in the assessment of bladder cancer.

Bipedal lymphography and intravenous urography were carried out in 44 patients in an attempt to define the role of these procedures in the assessment of the patient with carcinoma of the bladder. Evidence of lymphatic involvement, even though unsupported by histological proof and a major abnormality on urography, conferred a worse prognosis than if these examinations were thought to be normal. Implications for therapy are considered.

Pulmonary complications of influenza: a radiological review of 30 cases.

Thirty patients with pulmonary complications of influenza are described, with particular emphasis on the appearance on the chest films. A wide spectrum of radiological changes was found, partly due to virus and partly to bacterial infection, both modified by the presence of other diseases.