Colonoscopy and flexible sigmoidoscopy for follow-up of patients with left-sided diverticulitis

Introduction The prevalence of diverticular disease has been increasing in the western world over the last few decades, causing a growing burden on health care systems. This study compared the uses of flexible sigmoidoscopy with colonoscopy as a follow-up investigation for patients diagnosed with acute left-sided diverticulitis and to evaluate the need for using either procedure. Materials and methods A retrospective study of 327 patients diagnosed with acute diverticulitis was carried out. Of this total, 240 patients with left-sided diverticulitis diagnosed via computed tomography were included. These patients were categorised into two equal groups: the first 120 patients underwent colonoscopy and the second 120 patients underwent flexible sigmoidoscopy. Results All colonoscopes and flexible sigmoidoscopes confirmed the computed tomography diagnosis of sigmoid diverticular disease with no major new findings. All colonoscopes and flexible sigmoidoscopes were reported as having no complications, with nine colonoscopes reported as being difficult compared with only three flexible sigmoidoscopes. All biopsies were reported as no malignancy. Full bowel preparation was required in all colonoscopes, compared with no preparation required for flexible sigmoidoscopes. Conclusions There is no evidence to support the routine use of endoscopic evaluation after an episode of left-sided diverticulitis diagnosed on computed tomography if no worrying radiological findings have been reported. This study supports similar findings from other studies and therefore we disagree with The Royal College of Surgeons of England (Association of Coloproctology of Great Britain and Ireland recommendations) commissioning guide, which advocates routine surveillance of the colon.

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J 5 — A Data Processing System for Medical Information

Methods of Information in Medicine ◽

10.1055/s-0038-1636653 ◽

1967 ◽

Vol 06 (01) ◽

pp. 1-6

Author(s):

P. Hall ◽

Ch. Mellner ◽

T. Danielsson

Keyword(s):

Medical Records ◽

Medical Information ◽

Health Care Systems ◽

Processing System ◽

Linear Pattern ◽

Flexible Form ◽

Care Systems ◽

Pattern Recognition Analysis ◽

Numeric Information

A system for medical information has been developed. The system is a general and flexible one which without reprogramming or new programs can accept any alphabetic and/or numeric information. Coded concepts and natural language can be read, stored, decoded and written out. Medical records or parts of records (diagnosis, operations, therapy, laboratory tests, symptoms etc.) can be retrieved and selected. The system can process simple statistics but even make linear pattern recognition analysis.The system described has been used for in-patients, outpatients and individuals in health examinations.The use of computers in hospitals, health examinations or health care systems is a problem of storing information in a general and flexible form. This problem has been solved, and now it is possible to add new routines like booking and follow-up-systems.

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Assessment of Duodenal Diverticula: Computed Tomography Findings

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666180904123526 ◽

2019 ◽

Vol 15 (10) ◽

pp. 948-955

Author(s):

Erdem Yilmaz ◽

Osman Kostek ◽

Savas Hereklioglu ◽

Muhammet Goktas ◽

Nermin Tuncbilek

Keyword(s):

Computed Tomography ◽

Contrast Agent ◽

Ampulla Of Vater ◽

Common Type ◽

Radiological Features ◽

New Findings ◽

Duodenal Diverticula ◽

Median Diameter ◽

Colonic Diverticula

Aims: To demonstrate the prevalence, accompanying pathologies, imaging and follow up findings of Duodenal Diverticula (DD) with Multidetector Computed Tomography (MDCT). Materials and Methods: Consecutive 2910 abdominal MDCTs were retrospectively reviewed on axial, coronal and sagittal planes. DD were evaluated for prevalence, location, number, size, contents, diverticular neck, accompanying pancreaticobiliary pathologies, jejunal and colonic diverticula, respectively. Results: DD were diagnosed in 157 cases (5.4%) and found mostly in the second part of the duodenum. Juxta-ampullary DD was the most common type (78.3%) and mostly located ventral (n:86, 69.9%) to the ampulla of Vater. DD was solitary in 123 patients (78.3%) and more than one in 34 patients (21.7%). The median diameter of DD was 2.5 cm (range 1.5-3.6 cm) in the long-axis. The lumen of DD contains air and contrast agent (n:96, 61.1%); air, contrast agent and debris (n:42, 26.7%) in most cases. Colonic diverticula (n:36, 22.9%), cholelithiasis (n:32, 20.4%), choledocholithiasis (n:7, 4.4%), and biliary dilatation (n:8, 5.1%) were the most common additional findings. Median follow-up time was 23 months (range 11 to 41 months). In three cases, new findings (cholelithiasis, n:3, choledocholithiasis, n:1) were detected. Conclusion: Accompanying pathologies with DD diagnosis are valuable for physicians in order to manage the patients. Following clinical and radiological features of well-diagnosed DD might reduce the possible complications.

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Economic impact and cost savings of teledermatology units compared to conventional monitoring at hospitals in southern Spain

Journal of Telemedicine and Telecare ◽

10.1177/1357633x20942044 ◽

2020 ◽

pp. 1357633X2094204

Author(s):

Antonio Lopez-Villegas ◽

Rafael Jesus Bautista-Mesa ◽

Miguel Angel Baena-Lopez ◽

Maria Luisa Alvarez-Moreno ◽

Jesus E Montoro-Robles ◽

...

Keyword(s):

Cost Saving ◽

Health Care Systems ◽

Cost Savings ◽

Public Health Care ◽

Retrospective Assessment ◽

Care Systems ◽

Cost Of Time ◽

One Year ◽

The Cost

Introduction Asynchronous teledermatology (TD) has undergone exponential growth in the past decade, allowing better diagnosis. Moreover, it saves both cost and time and reduces the number of visits involving travel and opportunity cost of time spent on visits to the hospital. The present study performed a cost-saving analysis of TD units and assessed whether they offered a cheaper alternative to conventional monitoring (CM) in hospitals from the perspective of public health-care systems (PHS) and patients. Methods This study was a retrospective assessment of 7030 patients. A cost-saving analysis comparing TD units to CM for patients at the Hospital de Poniente was performed over a period of one year. The TD network covered the Hospital de Poniente reference area (Spain) linked to 37 primary care (PC) centres that belonged to the Poniente Health District of Almeria. Results We observed a significant cost saving for TD units compared to participants in the conventional follow-up group. From the perspective of a PHS, there was a cost saving of 31.68% in the TD group (€18.59 TD vs. €27.20 CM) during the follow-up period. The number of CM visits to the hospital reduced by 38.14%. From the patients’ perspective, the costs were lower, and the cost saving was 73.53% (€5.45 TD vs. €20.58 CM). Discussion The cost-saving analysis showed that the TD units appeared to be significantly cheaper compared to CM.

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P0506PATTERNS AND OUTCOMES OF GLOMERULAR DISEASES IN ADULTS PRESENTING TO MANSOURA UNIVERSITY HOSPITAL: A SINGLE-CENTER PROSPECTIVE STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0506 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Hoda M. M. Abd-Elaziz ◽

Mohammed Kamal Nassar ◽

Dina Abdallah Ibrahim ◽

Nagy Sayed-Ahmed

Keyword(s):

Health Care Systems ◽

Complete Recovery ◽

National Registry ◽

Renal Recovery ◽

University Hospital ◽

Glomerular Diseases ◽

Dialysis Unit ◽

Care Systems ◽

Stage Renal Disease

Abstract Background and Aims Glomerular diseases (GDs) impose a substantial burden on patients and health care systems, and they are considered a major cause of end-stage renal disease (ESRD) worldwide. Morbidity and mortality have shown to be substantially higher in patients with GDs than in the general population. In Egypt, there is yet no available national registry for GDs, and GDs outcome is not adequately studied. Therefore, it is of considerable interest to study patterns and outcomes of GDs in our locality. Method Patients with features suggesting GDs presenting to Mansoura nephrology and dialysis unit (MNDU) were recruited in this study between 1 July 2017 and 30 June 2018, and those with biopsy-proven GDs were prospectively followed up for a minimum of 6 months or until either death or reaching ESRD. ESRD was defined as initiation of long-term dialysis or eGFR persistently <15 ml/min per 1.73 m2 during follow up visits. Enrolled patients were subjected to through history taking and clinical examination. Biopsies were independently examined by two pathologists blinded to the clinical data. The study outcomes were to identify the GDs subtype frequencies, and to identify the frequency of those achieving either renal recovery, progression to ESRD or death from all-cause mortality. Logistic regression analysis was carried out to identify the potential predictors for renal recovery. Results Sixty-six patients (21 males and 45 females) with biopsy-proven GDs were included and completed the required period of follow up. The median age of the studied patients was 32 years (IQR 23 - 46.45). Fifty percent of the cases had hypertension and only one patient had was diabetic. The main indications for renal biopsy were unexplained kidney function decline (62%) followed by subnephrotic (23%) and nephrotic presentation (15%). Diffuse proliferative GN followed by MPGN and sclerosing GN were the most frequently encountered histopathological patterns. Primary and secondary GDs constituted 30.3% and 69.7% respectively. Lupus nephritis (LN) was the most common cause of secondary GDs and class IV LN was the most frequently encountered class accounting for 16 cases (51.6%) of patients with lupus. By the end of 6-month follow up, renal recovery was achieved in 30 patients (45.5%), 21 patients (31.8%) progressed to ESRD and 7 patients (10.6%) had died. Urban residency and total renal chronicity score were the most significant predictors of renal recovery. Conclusion Diffuse proliferative GN is the most common histopathological pattern, and secondary GDs, particularly those related to lupus, are more frequently encountered than primary GDs in our center. Unfortunately, quick complete recovery is not the rule and is possibly predictable by less chronic changes in biopsy.

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Body mass index and mortality in relation to age and follow-up of 30 years in large Austrian cohorts

European Journal of Public Health ◽

10.1093/eurpub/ckz185.147 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

G Nagel ◽

R S Peter ◽

B Föger ◽

H Concin

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Health Care Systems ◽

Generalized Additive Models ◽

Population Level ◽

Additive Models ◽

Calendar Time ◽

Care Systems ◽

Over Time

Abstract Background Obesity and its health consequences will dominate health care systems in many countries during the next decades. Prevention programs have been implemented. However, the optimum body mass index (BMI) in relation to all-cause mortality on population level is still a matter of debate. Material and Method Data 1/1989-6/2005 of the Vorarlberg Health Monitoring & Prevention Program (VHM&PP,) and 8/2005-12/2015 for Vorarlberg provided by the Main Association of Austrian Social Security Institutions were analyzed. In both cohorts, information was available on age, sex, measured height and weight as well as the date and cause of death. Generalized additive models were used to model the mortality rate as function of calendar time, age and follow-up. Results The VHM&PP cohort consisted of 85,488 men and 99,873 women and the later of 129,817 men and 152,399 women. In the second cohort, men (mean age 48 (SD16.9) vs. 45.3 (SD 15.5) and women (48.3 (SD 17.7) vs. 45.6 (SD 16.6) years) were slightly older than in the VHM&PP cohort. The average BMI was slightly higher in men (26.1 (SD4.0) vs. 25.7 (SD3.8) kg/m2) but not in women (24.6 (SD 4.8) vs. 24.7 (SD 4.9) kg/m2), respectively. In the VHM&PP cohort more ever smokers were found in both men (40.3 vs. 22.4%) and women (24.8 vs. 18.4%) than in the subsequent cohort. BMI optimum increased slightly between 1985 and 2015, from 24.9 (95%-CI: 24.0-25.9) to 26.4 (25.3-27.3) in men and from 22.4 (21.8-23.1) to 23.3 (22.5-24.5) kg/m2 in women. However, age and follow-up had major impact on the increase. In younger age the associations are quite stable, while in men over 50 years and in women over 60 years the BMI optimum decreased with length of follow-up. Conclusions Overall the BMI optimum increased slightly over time. However, age and follow-up had major impact on the association. These results suggest, that prognosis of obesity related diseases has improved over time. To detangle this further research is necessary. Key messages In Austria the BMI optimum increased slightly over time. Age and follow-up time had major impact on the association.

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Multislice Computed Tomography Imaging of Diverticultis Complication: Colovenous Fistula

Acta Chirurgica Latviensis ◽

10.2478/v10163-011-0024-y ◽

2010 ◽

Vol 10 (2) ◽

pp. 118-120

Author(s):

Maija Radzina ◽

Andris Laganovskis ◽

Mara Tirane ◽

Ligita Zvaigzne ◽

Peteris Prieditis ◽

...

Keyword(s):

Computed Tomography ◽

Diverticular Disease ◽

Multislice Computed Tomography ◽

Gastrointestinal Disease ◽

Rare Complication ◽

Acute Diverticulitis ◽

Computed Tomography Imaging ◽

Tomography Imaging ◽

Complicated Form ◽

Radiological Studies

Multislice Computed Tomography Imaging of Diverticultis Complication: Colovenous FistulaAcute colon pathology as diverticulitis is a frequent and important gastrointestinal disease, but the clinical diagnosis is often difficult to state. Several radiological studies have been used to assist in the diagnosis of acute diverticulitis (e.g. barium enema, ultrasound, and computed tomography (CT). Colovenous fistula is a rare complication of diverticulitis. We have analyzed MSCT imaging role in evaluation of such complicated form of diverticular disease.

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Naprapathy Versus Orthopaedic Standard Care for Common Musculoskeletal Disorders: An 8-year Follow-up of a Pragmatic Randomized Controlled Trial in Sweden

10.21203/rs.3.rs-641470/v1 ◽

2021 ◽

Author(s):

Stina Lilje ◽

Andreas Eklund ◽

Anders Wykman ◽

Tobias Sundberg ◽

Eva Skillgate

Keyword(s):

Health Care ◽

Musculoskeletal Disorders ◽

Health Care Systems ◽

Controlled Trial ◽

Bodily Pain ◽

Control Group ◽

National Health Care ◽

Care Systems ◽

Experimental Group

Abstract Background: Musculoskeletal pain is among the most common reasons for seeking care, specialist competence for its treatment in primary care limited and waiting lists for orthopaedics often amongst the longest. Many referrals to orthopaedics do not concern disorders that benefit from surgery. Manual therapy is effective, yet not integrated in national health care systems, and there is a lack of research on other than neck and low back pain, and a lack of long-term follow-ups. The present study evaluates the long-term effects of a complementary therapy for common orthopaedic disorders.Methods: An 8-year follow-up (96 months) of a pragmatic randomized controlled trial of naprapathy (experimental group) versus standard orthopaedic care (control group) for non-surgical patients of working age with the most common musculoskeletal disorders on the waiting lists(n=78). Bodily pain, physical function (SF36), Quality of life (QoL; SF6D), and data on health care utilization were collected.Results: N=75 participants in the original study sample completed the 8-year follow-up. The differences in bodily pain (21,7 (95% CI: 9,1-34,3)), physical function (17,6(6,7-28,4)), and QoLs (0,823 (95% CI: 0.785-0.862) compared with 0,713 (95% CI: 0.668-0.758)) were statistically significantly in favor of the experimental group (p-values<0,01). After sensitivity analysis the experimental group had altogether 260 health care visits compared with 1 161 in the control group.Conclusions:Naprapathy is a continuously effective treatment. Together with earlier research our study suggests that specialized manual therapy should be considered when triaging patients with common non-surgical musculoskeletal disorders in national health care systems.Trial registration: Not applicable, as per information given by ClinicalTrials.gov.

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Diverticulitis

Acta chirurgica iugoslavica ◽

10.2298/aci0803097p ◽

2008 ◽

Vol 55 (3) ◽

pp. 97-102 ◽

Cited By ~ 5

Author(s):

J. Pfeifer

Keyword(s):

Diverticular Disease ◽

Primary Anastomosis ◽

Acute Diverticulitis ◽

Treatment Modalities ◽

Perforated Diverticulitis ◽

Western World ◽

Common Disease ◽

Concomitant Treatment ◽

Wide Range ◽

Life Threatening

Diverticular disease produces a wide range of clinical presentations varying from minimal clinical discomfort to life-threatening complications. Often there is a considerable discrepancy between clinical, radiologic, endoscopic and pathologic findings. Diverticulosis is a quite common disease affecting about 2/3 of people in the Western world over the age 80. The exact incidence of acute diverticulitis is unclear. We distinguish between uncomplicated and complicated diverticular disease forms. The latter includes abscess formation, stricture, obstruction, and free perforation causing life-threatening peritonitis. Several classifications for perforated diverticulitis have been proposed. From the practical point of view the Hansen-Stock classification seems to be the most appropriate one as it includes all forms of diverticular disease; it can also be used preoperatively. Prophylactic resection to avoid complications is not justified in minimally symptomatic individuals. Timing of the operation depends on the clinical course and the grade of peritonitis and on concomitant treatment modalities. Emergency operations should be avoided if possible, to reduce morbidity and mortality. Elective operations should be performed best 6-8 weeks after a second diverticulitis attack. Resection plus primary anastomosis is preferred to a Hartmann?s procedure, if possible. Elective surgery should be done laparoscopically. In acute diverticulitis the goal is to treat uncomplicated forms conservatively, while complicated forms should undergo elective, laparoscopic colon resection.

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