Colonoscopic Treatment of a Fecaloma at the Anastomotic Site after Colectomy

Fecalomas most commonly occur in constipated patients and are rarely reported after colectomy. A 55-year-old Japanese female presented with a fecaloma after colectomy, which was impacted at a functional end-to-end anastomosis (FEEA) site. Four and a half years ago, she underwent sigmoidectomy for colon cancer. A follow-up computed tomography (CT) scan revealed an 11 cm incidental fecaloma. The patient was advised to undergo surgery, but she desired nonoperative management because of minimal symptoms, and was referred to our institution. On the day of admission (day 1), mechanical fragmentation of the fecaloma was attempted during the first colonoscopy. Although a large block of stool was evacuated after a second colonoscopic fragmentation on day 8, the third colonoscopy on day 21 and CT scan on day 22 showed no significant change in the fecaloma. Frequent colonoscopic fragmentation was performed, with a fourth, fifth, and sixth colonoscopy on days 24, 29, and 31, respectively. After the size reduction was confirmed at the sixth colonoscopy, the patient was discharged home on day 34. The fecaloma completely resolved after the seventh colonoscopic fragmentation on day 44. Sixteen months after treatment, there is no evidence of recurrent fecaloma. According to the literature, risk factors for fecaloma after colectomy include female gender, left-side colonic anastomosis, and FEEA. FEEA might not be recommended for anastomoses in the left colon, particularly in female patients, to avoid this complication. Colonoscopic fragmentation is recommended for fecalomas at an anastomotic site after colectomy in patients without an absolute indication for surgery.

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Orthodontic Treatment Including Autotransplantation of a Mature Tooth

The Angle Orthodontist ◽

10.2319/122507-600.1 ◽

2009 ◽

Vol 79 (2) ◽

pp. 387-393 ◽

Cited By ~ 3

Author(s):

Kazuaki Nishimura ◽

Shinobu Amano ◽

Kimihisa Nakao ◽

Shigemi Goto

Keyword(s):

Orthodontic Treatment ◽

Tooth Movement ◽

Root Resorption ◽

Treatment Plan ◽

Primary School Student ◽

Appropriate Treatment ◽

Japanese Female ◽

Old Japanese ◽

Chief Complaints

Abstract The patient was a 24-year-old Japanese female. The chief complaints were crowding and masticatory dysfunction due to the missing right first molar. Her maxillary first premolars had been extracted when she was a primary school student. We planned orthodontic treatment with extraction of the mandibular first premolars and transplantation of the mandibular left first premolar into the maxillary right first molar area. We made a diagnostic setup model to initiate an appropriate treatment plan for the discrepancy in tooth size ratio. Following the diagnostic setup model, the space in the maxillary right first molar area was closed by a small amount of tooth movement, and a good occlusion was achieved. The patient had been in retention for 7 years, and the occlusion has been maintained very well during this time. In the follow-up, 10 years after autotransplantation, no signs of inflammatory or replacement root resorption were found, and marginal bone support appeared similar to that of neighboring teeth.

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170: Nonoperative Management of Blunt Renal Trauma: Is Routine Follow-Up Imaging Necessary?

The Journal of Urology ◽

10.1016/s0022-5347(18)30435-x ◽

2007 ◽

Vol 177 (4S) ◽

pp. 57-58

Author(s):

John B. Malcolm ◽

Reza Mehrazin ◽

Christopher J. DiBlasio ◽

David D. Vance ◽

Robert W. Wake ◽

...

Keyword(s):

Nonoperative Management ◽

Renal Trauma

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Suspected osseous recurrence visualized on a 68Ga- DOTATATE PET/CT scan during the follow-up of a patient with a resected pulmonary carcinoid tumour

Nuklearmedizin ◽

10.1055/s-0037-1621660 ◽

2011 ◽

Vol 50 (05) ◽

pp. N57-N59

Author(s):

S. Geiger ◽

S. Horster ◽

A. R. Haug ◽

A. Hausmann ◽

M. Schlemmer ◽

...

Keyword(s):

Ct Scan ◽

Carcinoid Tumour ◽

Pulmonary Carcinoid ◽

Pet Ct ◽

Pet Ct Scan

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Outcome of Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture

Bangladesh Journal of Urology ◽

10.3329/bju.v19i2.49365 ◽

2020 ◽

Vol 19 (2) ◽

pp. 64-68

Author(s):

Mrinmoy Biswas ◽

Sudip Das Gupta ◽

Mohammed Mizanur Rahman ◽

Sharif Mohammad Wasimuddin

Keyword(s):

Urethral Stricture ◽

Flow Rate ◽

Surgical Outcome ◽

Simple Technique ◽

Anterior Segment ◽

Maximum Flow ◽

Anastomotic Site ◽

Buccal Mucosal Graft ◽

Male Patients

Objective: To assess the success of BMG urethroplasty in long segment anterior urethral stricture. Method: From January 2014 to December 2015, twenty male patients with long anterior segment urethral stricture were managed by BMG urethroplasty. After voiding trial they were followed up at 3 month with Uroflowmetry, RGU & MCU and PVR measurement by USG. Patients were further followed up with Uroflowmetry and PVR at 6 months interval.Successful outcome was defined as normal voiding with a maximum flow rate >15ml /sec and PVR<50 ml with consideration of maximum one attempt of OIU after catheter removal. Results: Mean stricture length was 5.2 cm (range 3-9 cm) and mean follow-up was 15.55 months (range 6-23 months). Only two patients developed stricture at proximal anastomotic site during follow-up. One of them voided normally after single attempt of OIU. Other one required second attempt of OIU and was considered as failure (5%). Conclusion: BMG urethroplasty is a simple technique with good surgical outcome. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.64-68

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Individualized cancer follow-up supported by electronic Patient-Reported Outcomes: Development and evaluation (Preprint)

10.2196/preprints.18397 ◽

2020 ◽

Author(s):

Sissel Ravn ◽

Henriette Vind Thaysen ◽

Lene Seibaek ◽

Victor Jilbert Verwaal ◽

Lene Hjerrild Iversen

Keyword(s):

Ct Scan ◽

Advanced Cancer ◽

Patient Reported Outcomes ◽

Cost Benefit Analysis ◽

Cost Benefit ◽

Structured Interviews ◽

European Organization ◽

Individualized Care ◽

Patient Reported

BACKGROUND Cancer survivors experience unmet needs during follow-up. Besides recurrence, a follow-up includes detection of late side effects, rehabilitation, palliation and individualized care. OBJECTIVE We aimed to describe the development and evaluate the feasibility of an intervention providing individualized cancer follow-up supported by electronic patient-reported outcomes (e-PRO). METHODS The study was carried out as an interventional study at a Surgical and a Gynecological Department offering complex cancer surgery and follow-up for advanced cancer. The e-PRO screened for a priori defined clinical important symptoms and needs providing individualized follow-up. We included following questionnaires in the e-PRO; the general European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC validated for colorectal and ovarian cancer patients. To support individualization, we included three prioritized issues of the patient’s preference in each e-PRO. The response-algorithm was aggregated based on the severity of the patient’s response. To ensure the sensitivity of the e-PRO, we performed semi-structured interviews with five patients. All clinicians (surgeons and gynecologists) performing the consultations reviewed the e-PRO. The evaluation was divided in two, 1)The feasibility was assessed by a)Patients’ response rate of the e-PRO, b)Number of follow-up visits documenting the use of e-PRO and c)Patients’ prioritized issues prior to the consultation(‘yes’ / ‘no’), and after the follow-up 2)Patients assessment of a)The need and purpose of the follow-up visit and b)the support provided during the follow-up visit. RESULTS In total, 187 patients were included in the study, of which 73%(n=136/187) patients responded to the e-PRO and were subjected to an individualized follow-up. The e-PRO was documented as applied in 79% of the follow-up visits. In total, 23% of the prioritized issues did not include a response. Stratified by time since surgery, significantly more patients did not fill out a prioritized issue had a follow-up >6 months since surgery. In total, 72 % follow-up visits were evaluated to be necessary in order to discuss the outcome of the CT scan, symptoms, and/or prioritized issues. Contrary, 19% of the follow-up visits were evaluated to be necessary only to discuss the result of the CT scan. A range from 19.3–56.3% of patients assessed the follow-up visit to provide support with respect to physical (42% of patients), mental (56%), sexual (19%) or dietary (27%) issues. Further, a range from 34–60% of the patients reported that they did not need support regarding physical (43% of patients), mental (34%), sexual (63%) or dietary (57%) issues. CONCLUSIONS An individualized follow-up based on e-PRO is feasible, and support most patients surgically treated for advanced cancer. However, results indicate that follow-up based on e-PRO may not be beneficial for all patients and circumstances. A thorough cost-benefit analysis may be warranted before implementation in routine clinic.

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Reappraising the Role of Trans-Sphenoidal Surgery in Prolactin-Secreting Pituitary Tumors

Cancers ◽

10.3390/cancers13133252 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3252

Author(s):

Pier Paolo Mattogno ◽

Quintino Giorgio D’Alessandris ◽

Sabrina Chiloiro ◽

Antonio Bianchi ◽

Antonella Giampietro ◽

...

Keyword(s):

Pituitary Tumors ◽

Female Gender ◽

Clinical History ◽

Serum Prolactin ◽

Cure Rate ◽

Cross Sectional ◽

Unique Challenge ◽

Best Management ◽

Pituitary Diseases

Background: Prolactinomas represent a unique challenge for endocrinologists and neurosurgeons. Considering recent innovations in surgical practice, the authors aimed to investigate the best management for prolactinomas. Methods: A retrospective, cross-sectional and monocentric study was designed. Consecutive patients affected by prolactinomas were enrolled if treated with a first-line treatment with a dopamine agonist (DA) or trans-sphenoidal surgery (TSS). Patients carried giant prolactinomas, and those with a follow-up <12 months were excluded. Results: Two hundred and fifty-nine patients were enrolled. The first treatment was DA for 140 patients and TS for 119 cases. One hundred and forty-six of 249 patients (58.6%) needed a second therapy. The mean follow-up was 102.2 months (12–438 months). Surgery highly impacted on the cure rate—in particular, in females (p = 0.0021) and in microprolactinomas (p = 0.0020). Considering the multivariate analysis, the female gender and surgical treatment in the course of the clinical history were the only independent positive predictors of a cure at the end of 5 years follow-up (p = 0.0016, p = 0.0005). The evaluation of serum prolactin (24 hours after TSS) revealed that 86.4% of patients with postoperative prolactin (PRL) ≤10 ng/mL were cured at the end of the follow-up (p < 0.0001). Conclusions: According to our experience, surgery allows a high cure rate of prolactinomas, particularly in females with microadenoma, with a good safety profile. TSS for prolactinomas should be considered as a concrete option, during the multidisciplinary evaluation, in centers of reference for pituitary diseases.

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A Case Report of Tongue Lymphoepithelial Carcinoma with a Histological Diagnostic Dilemma

Diagnostics ◽

10.3390/diagnostics11061039 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1039

Author(s):

Daisuke Takeda ◽

Manabu Shigeoka ◽

Tenyu Sugano ◽

Nanae Yatagai ◽

Takumi Hasegawa ◽

...

Keyword(s):

Histological Finding ◽

Atypical Epithelium ◽

Diagnostic Dilemma ◽

Barr Virus ◽

Japanese Female ◽

Old Japanese ◽

Neoplastic Change ◽

Diagnostic Difficulties ◽

Epstein Barr ◽

Characteristic Features

Most head and neck lymphoepithelial carcinomas (LECs) arise in the nasopharynx and harbor Epstein–Barr virus (EBV). LEC is also a rare subtype of the oral squamous cell carcinoma (SCC). Morphologically, LEC is defined as resembling non-keratinizing nasopharyngeal carcinoma, undifferentiated subtype. The histological features and pathogenesis of oral LEC are not established. We describe a case of tongue LEC with histopathological diagnostic difficulties. A 72-year-old Japanese female presented with a whitish change on her left-side tongue. The diagnosis was atypical epithelium; neoplastic change could not be ruled out by a biopsy. Although the lesion was monitored at our hospital per her request, invasive carcinoma was detected 11 months later. Microscopically, conventional SCC was observed with the characteristic features as LEC confined to the deep part of the lesion. We briefly discuss this unusual histological finding and make a novel proposal for distinguishing oral LEC from LECs in other regions based on these histological findings.

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Factors That Cause Concerns after Cardioverter Defibrillator Implantation

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18116095 ◽

2021 ◽

Vol 18 (11) ◽

pp. 6095

Author(s):

Olimpia Karczewska ◽

Agnieszka Młynarska

Keyword(s):

Observational Study ◽

Secondary Prevention ◽

Negative Emotions ◽

Female Gender ◽

Multiple Regression Model ◽

Icd Implantation ◽

Cardioverter Defibrillator ◽

Input Method ◽

Two Stages

Background and Objectives: The aim of the study was to assess the factors that influence the occurrence of concerns and their intensification after the implantation of a cardioverter defibrillator. Materials and Methods: This was a prospective and observational study including 158 patients. The study was conducted in two stages: stage I before implantable cardioverter defibrillator (ICD) implantation and stage II follow-up visit six months after ICD implantation. Standardized questionnaires were used in both stages. Results: Age and female gender were significantly correlated with the occurrence and intensity of concerns. Patients who had a device implanted for secondary prevention also experienced higher levels of concern. Additionally, a multiple regression model using the stepwise input method was performed. The model was statistically significant and explained 42% of the observed variance in the dependent variable (p = 0.0001, R2 = 0.4215). The analysis showed that age (p = 0.0036), insomnia (p = 0.0276), anxiety (p = 0.0000) and negative emotions (p = 0.0374) were important predictors of the dependent variable and enabled higher levels of the number of concerns to be predicted. Conclusions: There is a relationship between the severity of the concerns related to an implanted ICD and age, gender, anxiety, negative emotions and insomnia. Indications for ICD implantation may be associated with increased concerns about ICD.

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Factors Affecting the Control of Chronic Rhinosinusitis With Nasal Polyps: A Comparison in Patients With or Without NERD

Allergy & Rhinology ◽

10.1177/21526567211003844 ◽

2021 ◽

Vol 12 ◽

pp. 215265672110038

Author(s):

Markus Jukka Lilja ◽

Anni Koskinen ◽

Paula Virkkula ◽

Seija Inkeri Vento ◽

Jyri Myller ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Nasal Polyps ◽

Female Gender ◽

Sinus Surgery ◽

Logrank Test ◽

Free Survival ◽

Factors Affecting ◽

Advanced Therapy ◽

And Gender

Objectives The aim was to compare the control of chronic rhinosinusitis with nasal polyps (CRSwNP) after endoscopic sinus surgery (ESS), in patients with/without nonsteroidal anti-inflammatory drug exacerbated respiratory disease (NERD). Study Desing: A retrospective hospital-based sample of CRSwNP patients with/without NERD with follow-up. Setting Tertiary rhinology centers. Methods Electronic patient record data from 116 CRSwNP patients (46 with NERD and 70 without NERD) undergoing ESS during 2001–17 were studied. Mean follow-up time was 9.9 years (range 1.1–15.3). Endpoints reflecting uncontrolled CRSwNP were revision ESS, and need for rescue/advanced therapy (e.g. antibiotics, oral corticosteroids and/or biological therapy) during follow-up. NERD was variable of interest and gender, age, asthma, allergic rhinitis (AR), smoking, Lund-Mackay (LM) score of sinus computed tomography scans previous ESS and baseline total ethmoidectomy were used as covariates. Results Twenty-one (49.7%) NERD patients and 18 (25.7%) non-NERD patients underwent revision ESS within a mean ± SD of 4.3 ± 2.8 and 3.7 ± 2.6 years, respectively (p = .013, by Logrank test). In Cox´s regression models, NERD, female gender, young age, asthma, AR, previous ESS, and lack of total ethmoidectomy were associated with revision-ESS. In adjusted model, only the total ethmoidectomy predicted revision-free survival. In adjusted logistic regression model, there was an insignificant trend that NERD and LM score were associated with the need for rescue/advanced therapy in the follow-up. Conclusions Patients with NERD had higher risk of uncontrolled CRSwNP than patient group without NERD, as measured by revision ESS and/or need for rescue/advanced therapy in the follow-up. In addition, baseline total ethmoidectomy was associated with revision-free survival.

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Small intestine duplication cyst with recurrent hematochezia: a case report and literature review

BMC Gastroenterology ◽

10.1186/s12876-021-01627-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhicheng Zhang ◽

Xiaowei Huang ◽

Qian Chen ◽

Demin Li ◽

Qi Zhou ◽

...

Keyword(s):

Small Intestine ◽

Case Report ◽

Literature Review ◽

Ct Scan ◽

Duplication Cyst ◽

Abdominal Ct ◽

Case Presentation ◽

Abdominal Ct Scan ◽

Capsule Endoscopes

Abstract Background Small intestine duplication cysts (SIDCs) are rare congenital anatomical abnormalities of the digestive tract and a rare cause of hematochezia. Case presentation We describe an adult female presented with recurrent hematochezia. The routine gastric endoscope and colonic endoscope showed no positive findings. Abdominal CT scan indicated intussusception due to the "doughnut" sign, but the patient had no typical symptoms. Two subsequent capsule endoscopes revealed a protruding lesion with bleeding in the distal ileum. Surgical resection was performed and revealed a case of SIDC measuring 6 * 2 cm located inside the ileum cavity. The patient remained symptom-free throughout a 7-year follow-up period. Conclusion SIDCs located inside the enteric cavity can easily be misdiagnosed as intussusception by routine radiologic examinations.

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