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1 CORRESPONDENCE

EFFICACYOF BARIUM ENEMAS procedure, as well as the right attitude and determination on the IN THE ELDERLY To the Edltor: Like Dr. Gurwitz and his colleagues [l], we have also audited the efficacy of the barium enema in the elderly over 75 years of age [2]. Between 1985 and 1988, 102 elderly patients of the Geriatric Department underwent barium enema examination. The results were classified as successful, compromised, or failed. The compromised examinations were those in which the entire colon could not be filled with barium (or barium and air) due to technical difficulties and those in which double-contrast visualization of the colon was incomplete, so that confident interpretation could not be made. Failed examinations were those that had to be abandoned and which yielded no significant information. The overall outcome was successful examination in 52%, compromised in 32.3%, and failure in 15.7% (16) of patients. Among the 16 failed examinations, 10 were performed by the registrars (training radiologists) and 6 performed by the consultant radiologists. Among the latter, i.e., a group of five consultants, it was interesting to note that four of the six failures were associated with one radiologist. In our view, successful examination requires: (1) adequate assessment prior to the enema in order to ensure that the patient can lie flat, can change position on the examination table, can cooperate with the radiologist, and does not have fecal loading, which was responsible for 14 of the 33 compromised examinations in our study; and (2) skill and experience in performing the

patients. All the serum samples were anti-HCV-positive by second-generation Abbott’s antipart of the radiologist. VHC enzyme immunoassay. LivG. h'. RAI,M.D.,Msc.,F.R.C.P. WhittingtonlRoyal Northern er biopsy showed persistent hepHospitals atitis in two patients and active London, England hepatitis in four patients. All pa1. Gurwitz JH, Noonan JP. Sanchez M. Prather W. tients had type II cryoglobulins Barium enemas in the frail elderly. Am J Med 1992; with an IgM monoclonal compo92: 41-4. 2. Phongsathorn V, McGann GM, Rai GS. The efficanent. Four of the six patients cy of barium enema audited. Care of the Elderly treated with interferon left the 1991; 3: 418-22. study after a median of 3 months Submitted April 7, 1992, and accepted April 20. (2 to 5 months) because of ineffi1992 cacy (three patients) or intolerance (one patient). The clinical symptoms resolved in the two other patients with normalization of the aminotransferase levels. Rheumatoid factor and seLOW-DOSEINTERFERON-aFOR rum complement activity reMIXED CRYOGLOBULINEMIA turned to the normal range and ASSOCIATEDWITH HEPATITIS cryoglobulins disappeared. ReC VIRUS sults of interferon therapy were To the Editor: evident within 3 to 4 weeks. ActuKnox and coworkers [l] de- ally, the effect of interferon conscribed one case of mixed cryo- tinued 3 and 6 months after disglobulinemia associated with continuation of the drug. hepatitis C virus (HCV) infecAs in the case presented by tion, responsive to interferon. Knox et al, our results suggest During the same time, we ob- that a lower dose of interferon-a may be considered as an interestserved 14 cases of chronic HCV associated with type II or III ing therapeutic approach, able to cryoglobulinemia. Six of them affect the pathogenetic mechawere treated by low-dose internism of mixed cryoglobulinemia feron-a2b (3 million units subcuassociated with HCV infection. taneously, three times per week The antiviral activity of interferfor 6 months). The patients in- on might greatly decrease the burden of HCV antigens .comcluded four men and two women (average age 64). In four of them, plexed to specific antibodies. a risk factor engendered by a preBRUNO TAILLAN,M.D. EMILEFERRARI,M.D. vious transfusion was present. All GEORGESGARNIER,M.D. patients had the typical clinical ALAIN~ESCE,M.D. triad consisting of purpura, JEAN-GABRIEL FUZIBET,M.D. PIERREDUJARDIN?M.D. weakness, and arthralgias. AlaHopital de Ctmiez nine aminotransferase levels Nice, France were 1.5 to 3 times higher 1. Knox TA. Hillyer CD, Kaplan MM, Berkman EM. than normal. Serum complement Mixed cryoglobulinemia responsive to interferon-a. activity was very low in all pa- Am J Med 1991; 91: 554-5. tients. Rheumatoid factor was in- Submitted May 1. 1992, and accepted May 13. creased (mean 138 KUI/L) in all 1992

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Efficacy of barium enemas in the elderly.

1 1 CORRESPONDENCE EFFICACYOF BARIUM ENEMAS procedure, as well as the right attitude and determination on the IN THE ELDERLY To the Edltor: Like Dr...
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