The Cathlocator: A novel non-radiological method for the localization of enteral tubes

Safe placement of nasogastric tubes requires reliable positioning of the tip of the tube within the stomach. Radiology and aspiration are currently used to confirm tube position, but suffer from significant problems of cost and efficacy, respectively. We have developed a novel method to locate the position of a catheter tip within the body, using the detection of a low energy electromagnetic field generated in a coil located in the catheter with an external hand-held unit (Cathlocator). In vitro, the unit detected the distance of the coil from the detector with an accuracy of 0.1 cm over a range of 4–12 cm. In vivo studies were performed in 11 healthy volunteers using a purpose-built manometric assembly that incorporated the signal generating coil in its tip. In all subjects the Cathlocator showed the position of the signal generating coil to be cranial to the xiphisternum when manometric and transmucosal potential difference criteria showed it to be located above the lower oesophageal sphincter. When the coil was within the stomach, the Cathlocator identified its position within the epigastric, umbilical and left hypochondrial regions of the abdomen. The distance of the coil from the surface was significantly greater when in the duodenum mean (±s.e.m. 7.6±0.3 cm; P<0.001) and oesophagus (8.6±0.2 cm; P<0.002) than the stomach (5.0±0.4 cm). In one subject studied twice there was a close correlation between the location and depth measured by the device on each occasion. The Cathlocator is a novel non-radiological device that has the potential to be useful in the placement of gastrointestinal catheters.     

THE HALOSCALE "INFANTA" WRIGHT RESPIROMETER: An In Vitro and In Vivo Assessment

The performance of the Haloscale "Infanta" respirometer hasbeen assessed in vitro using ISO test compliances and resistances,and in vivo by comparison with pneumotachograph volumes in 13spontaneously breathing children and 13 children during intermittentpositive pressure ventilation. The Infanta was shown to be capableof registering volumes between 15 and 200 ml with an accuracyof ±5%. The registered volume decreased rapidly below15 ml, whilst above 200 ml over-registration developed.     

Granulomatous hidradenitis suppurativa and cutaneous Crohn's disease

Three patients with concurrent hidradenitis suppurativa and Crohn's disease are presented. The notable histological feature in each hidradenitis resection was the presence of numerous discrete epithelioid granulomas in areas of non-inflamed dermis. The purpose of the study was to determine the incidence of epithelioid granulomas in 101 hidradenitis patients and their significance in relation to systemic granulomatous disease. Discrete epithelioid granulomas were identified in 8% of the resections (10 patients). One patient had Crohn's disease and one other pulmonary sarcoidosis. Seven patients with granulomatous hidradenitis neither had nor developed any other disease during the 3-year follow-up period. Clinical review identified a further two patients with Crohn's disease but associated with non-granulomatous changes in the skin resections. Foreign body type granulomas were identified in 25% of the resections adjacent to ruptured hair follicles, sinus tracts or nearby degenerate sweat glands. The study shows that, although foreign body type granulomas are a common finding in hidradenitis, the presence of discrete epithelioid granulomas in the dermis away from the site of active inflammation is unusual and should alert the pathologist to the possibility of systemic granulomatous disease such as Crohn's disease or sarcoidosis.     

Studies of Antibody to Herpes Simplex Virus Fcγ-Binding Protein gE in Patients with Rheumatoid Arthritis, Juvenile Rheumatoid Arthritis and Normal Controls

IgG antibody to gE, the Fc gamma-binding herpes simplex 1 (HSV-1) viral glycoprotein, was studied in 49 rheumatoid arthritis (RA) patients and 43 normal controls. Antibody to gD, another important HSV-1 antigen, was assayed in parallel. No difference between RA patients and normal controls was found in levels of anti-gE antibody measured by reactivity of IgG F(ab')2 fragments reacting with gE coated to ELISA plates. No difference in anti-gD antibody was recorded between normals and patients with RA. Levels of IgG anti-IgE antibody did not correlate with quantitative elevations of serum rheumatoid factor (RF) in RA patients. When IgG anti-gE and anti-gD were assayed in 20 patients with juvenile rheumatoid arthritis and 22 children controls, no significant differences were noted. However, when individual RFs from patients with RA were tested for reactivity against a panel of affinity-isolated F(ab')2 antibodies to gE, some evidence for individual autospecificity was obtained. Four of 20 monoclonal IgM RFs produced from RA patients' B cells showed marked elevations of reactivity with some RA patients' F(ab')2 antibodies to gE. All four of the monoclonal RFs showing this specificity were derived from RA synovial tissue B cells. These findings may provide support for the concept that some RFs in patients with RA show individual specificity for internal image determinants of IgG antibodies to viral Fc gamma-binding proteins.     

ASSESSMENT OF OPIOID DEPENDENCE

Diagnostic criteria for opioid dependence is presented. Five methods are described to assess the presence and/or severity of the opioid dependence syndrome:

• 1 Self-report.
• 2 Physical examination
• 3 Toxicological analysis
• 4 Observation of withdrawal symptoms
• 5 Naloxone (Narcan) test.

Problems in determining actual amounts of heroin in “street deals’ is also discussed. It is emphasised that assessment of heroin-related problems in particular, requires a comprehensive lifestyle assessment in addition to the specific diagnosis of opioid dependence based largely on physical symptomatology as outlined in this paper.     

THE PREVALENCE OF SERUM IgG ANTIBODIES TO TYPE II COLLAGEN IN AMERICAN PATIENTS WITH RHEUMATOID ARTHRITIS

Serum IgG antibody levels to native and denatured bovine typeII collagen were elevated in 31.5 and 21.5% sera respectivelyfrom 200 American patients with RA. The prevalence of serumantibodies to native type II collagen is significantly higherthan previously found in large studies of the prevalence ofthis autoantibody in Britain and Japan when using the same methodology. KEY WORDS: Collagen, Type II, Antibodies     

IS THE CONSTRUCTION OF AN ILEOANAL POUCH ASSOCIATED WITH THE DEVELOPMENT OF ARTHRITIS?

The construction of an ileoanal pouch in patients who have undergonetotal colectomy for ulcerative colitis is claimed to be associatedwith the development of arthritis. The pattern and prevalenceof reported musculoskeletal symptoms in the 15 patients withileoanal pouches attending our hospital was not significantlydifferent to a control group of 60 patients with an ileostomyfor inflammatory bowel disease. There was no clinical or serologicalevidence of arthritis in the eight patients from the study groupreporting symptoms. We conclude that the majority of symptomsoccurring following pouch construction are not attributableto an inflammatory arthropathy. KEY WORDS: Arthritis, Ileoanal pouch     

CALCIUM PYROPHOSPHATE DEPOSITION DISEASE--INVOLVEMENT OF THE ACROMIOCLAVICULAR JOINT WITH PSEUDOCYST FORMATION

Two cases presenting with pseudocyst formation due to pyrophosphatearthropathy involving the acromioclavicular joint are described. KEY WORDS: Chondrocalcinosis, Pseudogout, Acromioclavicular joint