Pharmacological effects of cefclidin on the central nervous system.

The effects of cefclidin (CFCL), a novel antibacterial agent, on the central nervous system (CNS) were examined in a variety of animal models. The effects of cefazolin (CEZ) were also examined for comparative purposes. In the animal models used CFCL whilst having some effects at the doses examined, failed to show an overall consistent effect on the CNS. In contrast CEZ produced changes in the parameters measured which were generally consistent with a proconvulsant action.

CT colonography: interpretative performance in a non-academic environment.

AIM: To investigate interpretative accuracy and reporting time for radiologists performing computed tomography (CT) colonography in day-to-day non-academic clinical practice. MATERIALS AND METHODS: Thirteen radiologists from seven centres, who were reporting CT colonography in non-academic daily clinical practice, interpreted a dataset of 15 colonoscopically validated cases in a controlled environment. Ten cases had either a cancer or polyp >10mm; one case had a medium polyp and four were normal. Correct case categorization and interpretation times were compared using analysis of variance to aggregated results obtained from both experienced observers and observers recently trained using 50 cases, working in an academic environment. The effect of experience was determined using Spearman's rank correlation. RESULTS: Individual accuracy was highly variable, range 53% (95% CI 27-79%) to 93% (95% CI 68-100%). Mean accuracy overall was significantly inferior to experienced radiologists (mean 75 versus 88%, p=0.04) but not significantly different from recently trained radiologists (p=0.48). Interpretation time was not significantly different to experienced readers (mean 12.4 min versus 11.7, p=0.74), but shorter than recently trained radiologists (p=0.05). There was a significant, positive, linear correlation between prior experience and accuracy (p<0.001) with no plateau. CONCLUSION: Accuracy for sub-specialist radiologists working in a non-academic environment is, on average, equivalent to radiologists trained using 50 cases. However, there is wide variability in individual performance, which generally falls short of the average performance suggested by meta-analysis of published data. Experience improves accuracy, but alone is insufficient to determine competence.

The use of non-ionic water-soluble contrast agents for small bowel follow-through examination.

In certain situations it is preferable to perform small bowel examination using water-soluble contrast agents. Generally, ionic agents are used, but non-ionic agents may be an alternative in certain circumstances. We retrospectively reviewed a consecutive series of small bowel examinations using non-ionic media in order to determine their efficacy. A total of 52 water-soluble non-ionic small bowel follow-through examinations were performed in 42 patients using 100 ml iohexol. Indications for the study and the reasons why barium sulphate suspensions were contraindicated were established. Studies were assessed for radiographic quality and clinical findings were noted, and comparison was made with operative findings and clinical outcome. Obstruction was diagnosed in 12 examinations and the radiological findings were confirmed in all 7 patients surgically treated. Fistulae were identified in 11 examinations and the radiological findings were confirmed in all 8 patients who were treated by laparotomy. Additionally, at laparotomy no obstruction or fistula was found in the 5 patients in whom prior contrast examination had been negative. Non-ionic water-soluble follow-through examination is easily performed and well tolerated, allowing accurate diagnosis of obstruction and fistula when barium suspensions are contraindicated.

Can barium enema indicate when colonoscopy will be difficult?

The barium enemas of 48 consecutive patients, who were technically difficult to intubate at colonoscopy, were compared to those of 46 patients who were not. Measurements were taken of colonic length and mobility, and an assessment made of diverticular disease. Rectosigmoid length (mean difficult group = 61 cm, mean control = 54 cm, P = 0.01) and total colonic length (mean difficult group = 157 cm, mean control = 140 cm, P < 0.0001) were greater in the difficult colonoscopy group as were transverse colon mobility (mean difficult group = 10 cm, mean control = 7 cm, P = 0.003) or redundancy (transverse colon reaching the true pelvis on the erect film); 65% difficult group vs 17% control group, P < 0.0001. The presence of moderate or severe diverticular disease was also greater in the difficult (23%) compared to the control (4%) group, P = 0.02. When available, assessment of a previous barium enema is a useful guide to probable technical difficulty of colonscopy. It may allow appropriate allocation of potentially difficult cases to specialist endoscopy lists.

Why is colonoscopy more difficult in women?

BACKGROUND: In our experience colonoscopy in women is more difficult than in men. A retrospective review of 2194 colonoscopies performed by a single experienced endoscopist (CBW) showed that 31% of examinations in women were considered technically difficult compared with 16% in men. METHODS: To investigate a possible anatomic basis for this finding, normal barium enema series from 183 female and 162 male patients were identified. From these barium enemas, measurements of colonic length and mobility were independently taken by two physicians who were unaware of each patient's gender. RESULTS: Total colonic length was greater in women (median, 155 cm) compared to men (median, 145 cm), p = 0.005, despite women's smaller stature (p < 0.0001). Although there were no significant differences in rectum plus sigmoid, descending, or ascending plus cecum segmental lengths, women had longer transverse colons (female median length, 48 cm; male median length, 40 cm), p < 0.0001. There were no differences in mobility of the descending colon and transverse colon between the sexes, but the transverse colon reached the true pelvis more often in women (62%) than in men (26%), p < 0.001. CONCLUSIONS: Colonoscopy appears to be a technically more difficult procedure in women. The reason for this may be due in part to an inherently longer colon.

General pharmacology of [2,2-dimethyl-6-(4-chlorophenyl)-7-phenyl-2,3- dihydro-1H-pyrrolizine-5-yl]-acetic acid in experimental animals.

[2,2-Dimethyl-6-(4-chlorophenyl)-7-phenyl-2,3-dihydro-1H-pyrrolizine-5- yl]-acetic acid (ML 3000) is a newly synthesized compound with analgesic, antipyretic and anti-inflammatory activity. The general pharmacological effects of ML 3000 following oral administration were investigated in experimental animals. The results showed that with regard to the CNS, ML 3000 did not affect behaviour in the Irwin test, locomotor activity or hexobarbital-induced sleep at doses of 30, 100 and 300 mg/kg. ML 3000, at a single dose of 100 mg/kg administered intraduodenally, had no notable effect on the cardiovascular system or respiration in anaesthestised rats and dogs nor on neuromuscular function in anaesthetised cats. No evidence of gastric damage or disturbance of peristalsis was observed following oral administration of ML 3000. In vitro, ML 3000 evoked a weak spasmogenic response in the guinea-pig ileum with a dose-related inhibition of acetylcholine, histamine and barium chloride-induced responses. A small transient reduction in urine volume was observed after the highest dose accompanied by decreases in electrolyte excretion at doses of 100 and 300 mg/kg in rats. The results demonstrate that ML 3000 has no notable general pharmacological effects under the experimental conditions reported.