Clinical, endoscopic and radiological assessment of patients with obstructed defecation: findings and management at a District General Hospital

Background: The aim of the study was to determine the diagnostic value of clinical, endoscopic and proctographic assessment as well as clinical outcomes in patients with obstructed defaecation (OD). The study also examined correlation between clinical/endoscopic findings and proctogram in the diagnosis of rectocele and intra-rectal intussusception (IRI).Methods: Patients presenting with symptoms of OD between January-December 2018 were assessed with manual examination, endoscopy and defecation proctogram. Patients were followed for 2-3 years for clinical outcomes.Results: There were 65 female (97.01%) and 2 male patients (2.98%), with an average age of 57.77 (34-88) years. Main indications were OD, altered bowels, faecal urgency and rectal bleeding. A total of 67 X-ray defecating proctograms and 77 endoscopies were performed. Main findings on clinico-endoscopic examination were IRI (44), rectocele (36) and haemorrhoids (21). Main findings on proctogram were rectocele (59), IRI (56) and enterocele (13). Endoscopic assessment showed sensitivity: 55.93%, specificity: 62.50% and accuracy: 56.72% in diagnosing rectocele when compared with the diagnostic confirmation on proctogram. Combining manual assessment with endoscopic findings improved sensitivity (76.27%) and accuracy (68.66%). Similar improvement was also noted in the sensitivity (61.40 to 66.67%), specificity (47 to 58%), and accuracy (53.73 to 58.21%) in diagnosing IRI when compared with the diagnostic confirmation on proctogram. Majority of the patients improved with conservative measures; however, surgical intervention was required in 13 patients.Conclusions: Although manual examination enhances endoscopic assessment in diagnosing rectocele and IRI, proctogram is still required for objective assessment. Management of OD remains mainly conservative, with surgical intervention required in some patients.

Download Full-text

Evaluation of a new diagnostic modality for distal assessment of advanced, obstructing hypopharyngeal cancer

The Journal of Laryngology & Otology ◽

10.1017/s0022215106001587 ◽

2006 ◽

Vol 121 (4) ◽

pp. 369-377

Author(s):

M H Abd El-Monem ◽

Emad A Magdy

Keyword(s):

Diagnostic Technique ◽

Extent Of Resection ◽

Hypopharyngeal Cancer ◽

Endoscopic Examination ◽

Resection Margins ◽

Diagnostic Modality ◽

Tumour Extension ◽

Skip Lesions ◽

Sensitivity Specificity ◽

Endoscopic Assessment

Introduction: Pre-operative endoscopic assessment of the distal extension of hypopharyngeal cancer is essential for proper surgical extirpation. This assessment is frequently not feasible in advanced, obstructing tumours.Aims: To study the role of a proposed new diagnostic technique: intra-operative open oesophagoscopy, in distal assessment of advanced hypopharyngeal cancer.Materials and methods: A clinicopathological study, including 35 consecutive patients with obstructing hypopharyngeal cancer.Results: Intra-operative open oesophagoscopy revealed inferior submucosal tumour extension in 19 out of 22 cases proven histopathologically, with a sensitivity, specificity and accuracy of 86, 100 and 91 per cent, respectively. Oesophageal skip lesions were detected in two cases. Intra-operative open oesophagoscopy findings surpassed data obtained from pre-operative radiological investigations and influenced the extent of resection performed. Accordingly, 19 patients had a total laryngopharyngectomy for local disease control, while 16 patients needed an additional total oesophagectomy. Histopathologically negative inferior resection margins were obtained in all cases.Conclusions: Intra-operative open oesophagoscopy was found to be a reliable diagnostic modality for distal assessment of obstructing hypopharyngeal cancer in cases in which pre-operative distal endoscopic examination was not feasible.

Download Full-text

EMERGENCY SURGERY DURING COVID 19 AT K.A.P.V GOVERNMENT MEDICAL COLLEGE AND MGMGH , TRICHY

10.36106/ijar/8200303 ◽

2021 ◽

pp. 6-9

Author(s):

Sumathi Ravikumar ◽

Yeganathan Rajappan ◽

Durairajan Vaithiyanathan ◽

Catherine Sindhuja

Keyword(s):

Surgical Intervention ◽

District General Hospital ◽

Favourable Outcome ◽

Emergency General Surgery ◽

Emergency Admissions ◽

Medical College ◽

Prolonged Duration ◽

Current Impact ◽

Emergency Surgical Intervention ◽

The Impact

COVID 19 pandemic was declared by WHO as public health emergency on January 30,2020. Health system was reorganised with the aim to cope with the new disease and maintain essential health service. Many patients suffered from ARDS which lead to the modication of clinical and surgical activity. Current impact of COVID 19 outbreak on emergency surgical practice is still not developed. Varied presentation, diagnostic uncertainity, lack of guidelines present challenges to surgeons. AIM: The aim of our study was to evaluate the impact of the COVID-19 pandemic on emergency general surgery admissions and operations in our institution METHODS: We conducted a retrospective study in K.A.P.V.G.M.C. and M.G.M.G.H., Trichy from march 2020 to December 2020. All general surgical emergency admissions to KAPVGMC and MGMGH, district general hospital were included from march to December 2020.The details of diagnosis and subsequent management were retrieved from records. CONCLUSION: It was observed thatclinical decisions were made based on urgency of each case while simultaneously evaluating their COVID 19 status. The number of surgicalcases during COVID 19 period were signicantly reduced. Recognising asymptomatic carriers and need of emergency surgical intervention were the challenges faced by the surgeons. Effective communication between microbiologist, radiologist, anaesthetist and surgeon was necessary to attain a favourable outcome. .Inspite of challenges faced 80% had postoperative uneventful period other than prolonged duration of stay and were discharged and followed up. Covid 19 pneumonia and ARDS attributed to majority of death among the 20 % of deceased , other than septicemia

Download Full-text

Validation of Simple Methods to Select a Suitable Nostril for Nasotracheal Intubation

Anesthesiology Research and Practice ◽

10.1155/2018/4910653 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Cattleya Thongrong ◽

Pattramon Thaisiam ◽

Pornthep Kasemsiri

Keyword(s):

Nasotracheal Intubation ◽

Diagnostic Value ◽

Endoscopic Examination ◽

Nasal Airflow ◽

Sitting Posture ◽

Test Sensitivity ◽

Occlusion Test ◽

In Series ◽

Increased Sensitivity ◽

Better Than

Background. Nasotracheal intubation is a blind procedure that may lead to complications; therefore, several tests were introduced to assess a suitable nostril for nasotracheal intubation. However, the value of simple tests in clinical practice was insufficient to evaluate. Method. A diagnostic prospective study was conducted in 42 patients, ASA classes I–III, undergoing surgery requiring nasotracheal intubation for general anesthesia. Two simple methods for assessing the patency of nostrils were investigated. Firstly, the occlusion test was evaluated by asking for the patient’s own assessment of nasal airflow during occlusion of each contralateral nostril while in a sitting posture. Secondly, patients breathed onto a spatula held 1 cm below the nostrils while in a sitting posture. All patients were assessed using these two simple tests. Nasal endoscopic examination of each patient was used as a gold standard. Results. The diagnostic value of the occlusion test (sensitivity of 91.7%, specificity of 61.1%, PPV of 75.9%, NPV of 84.6%, LR+ of 2.36, and LR− of 0.14) seemed better than that of the spatula test (sensitivity of 95.8%, specificity of 25.0%, PPV of 63.0%, NPV of 81.8%, LR+ of 1.28, and LR− of 0.17). When both tests were combined in series, the diagnostic value increased (sensitivity of 87.9%, specificity of 70.8%, PPV of 80.1%, NPV of 81.4%, LR+ of 3.01, and LR− of 0.17). Conclusion and Recommendations. The simple occlusion test is more useful than the spatula test. However, combining the results from both tests in series helped to improve the diagnostic value for selecting a suitable nostril for nasotracheal intubation.

Download Full-text

Association between Endoscopic Findings Vs. Serology Findings of Patients with Suspected Celiac Disease

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i56a33915 ◽

2021 ◽

pp. 301-307

Author(s):

Anwar Hussain Abbasi ◽

Khawaja Ishfaq Ahmed ◽

Nadeem Yousuf ◽

Mahjabeen Fatima Qureshi ◽

Muhammad Shahzeb Shaikh ◽

...

Keyword(s):

Celiac Disease ◽

Chronic Diarrhea ◽

Villous Atrophy ◽

Clinical Manifestations ◽

Final Analysis ◽

Normal Mucosa ◽

Diagnostic Value ◽

Endoscopic Evaluation ◽

Drug Induced ◽

Endoscopic Findings

Objective: To determine the association between endoscopic findings vs. serology findings of patients with suspected celiac disease Methods: All the suspected cases (based on their clinical manifestations) of celiac disease were initially recruited having age >14 years and <40 years of both gender. Patients who did not willing to participate, patients already taking gluten diet for more than 3 months, patients with other causes of chronic diarrhea and alternate diagnosis like thyrotoxicosis, whipple’s disease, giardiasis, patients with drug induced diarrhea, patients in whom we cannot perform endoscopy, pregnant women, and patients already diagnosed cases of celiac disease were excluded from this study. Celiac disease was confirmed based on positive anti-tTG antibodies. Endoscopic evaluation of duodenum was performed in all positive cases. Results: A total of 50 patients were recruited for final analysis. Diagnostic accuracy of endoscopy was 34.6%. Young population (31.14±6.07 years) with females predominance (72%, n=36) were more common than males. The most common symptoms were presence of chronic diarrhea (74%, n=37) followed by abdominal pain (52%, n=26), nausea & vomiting (34%, n=17), and least common was presence of constipation (2%, n=1). On endoscopic evaluation, out of 50 positive anti-tTG antibodies cases, 24 had normal mucosa while partial villous atrophy observed in 15 (30%) cases and total villous atrophy observed in 11 cases (22%). Conclusions: Celiac disease was more prevalent in young females and patients usually presents with history of chronic diarrhea. Anti-tTG antibodies have more diagnostic value than duodenal endoscopy. Villous atrophy was found in more than 50% of the patients who were diagnosed with celiac disease.

Download Full-text

Tremorography in the clinical practice

Neuromuscular Diseases ◽

10.17650/2222-8721-2019-9-4-61-72 ◽

2020 ◽

Vol 9 (4) ◽

pp. 61-72

Author(s):

T. G. Govorova ◽

T. E. Popova ◽

A. A. Tappakhov

Keyword(s):

Differential Diagnosis ◽

Clinical Practice ◽

Movement Disorders ◽

Clinical Characteristics ◽

Objective Assessment ◽

Diagnostic Value ◽

Common Type ◽

Routine Practice ◽

Pathological Tremor

Tremor is the most common type of movement disorders. In practice this differential diagnosis of hyperkinesis is diagnosed clinically and the use of additional methods of objective assessment of tremor increases the accuracy of diagnosis. The use of paraclinical methods of objective assessment of tremor improves the accuracy of diagnosis. Comparison of the neurophysiological parameters of tremor with clinical characteristics has a high diagnostic value, which justifies its use in the routine practice of neurologists. The purpose of the review is to analysis basic electrophysiological characteristics of pathological tremor, as well as the presentation of the material of its own observation.

Download Full-text

ECG in suspected pulmonary embolism

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2018-136178 ◽

2019 ◽

Vol 95 (1119) ◽

pp. 12-17 ◽

Cited By ~ 4

Author(s):

Duncan Thomson ◽

Georgios Kourounis ◽

Rebecca Trenear ◽

Claudia-Martina Messow ◽

Petr Hrobar ◽

...

Keyword(s):

Pulmonary Embolism ◽

Hospital Setting ◽

District General Hospital ◽

Diagnostic Value ◽

Suspected Pulmonary Embolism ◽

Ecg Changes ◽

Retrospective Case ◽

Strain Pattern ◽

Pulmonary Angiogram ◽

Large Clot

ObjectiveTo establish the diagnostic value of prespecified ECG changes in suspected pulmonary embolism (PE).MethodsRetrospective case–control study in a district general hospital setting. We identified 189 consecutive patients with suspected PE whose CT pulmonary angiogram (CTPA) was positive for a first PE and for whom an ECG taken at the time of presentation was available. We matched these for age±3 years with 189 controls with suspected PE whose CTPA was negative. We considered those with large (n=76) and small (n=113) clot load separately. We scored each ECG for the presence or absence of eight features that have been reported to occur more commonly in PE.Results20%–25% of patients with PE, including those with large clot load, had normal ECGs. The most common ECG abnormality in patients with PE was sinus tachycardia (28%). S1Q3T3 (3.7%), P pulmonale (0.5%) and right axis deviation (4.2%) were infrequent findings. Right bundle branch block (9.0%), atrial dysrhythmias (10.1%) and clockwise rotation (20.1%) occurred more frequently but were also common in controls. Right ventricular (RV) strain pattern was significantly more commonly in patients than controls, 11.1% vs 2.6% (sensitivity 11.1%, specificity 97.4%; OR 4.58, 95% CI 1.63 to 15.91; p=0.002), particularly in those with large clot load, 17.1% vs 2.6% (sensitivity 17.1%, specificity 97.4%; OR 7.55, 95% CI 1.62 to 71.58; p=0.005).ConclusionAn ECG showing RV strain in a breathless patient is highly suggestive of PE. Many of the other ECG changes that have been described in PE occur too infrequently to be of predictive value.

Download Full-text

Sigmoido-rectal intussusception

SAGE Open Medical Case Reports ◽

10.1177/2050313x19856242 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1985624

Author(s):

Amanda C Filiberto ◽

Tyler J Loftus ◽

Sanda A Tan ◽

Thomas E Read ◽

Atif Iqbal

Keyword(s):

Rectal Prolapse ◽

Low Anterior Resection ◽

Surgical Intervention ◽

Rectal Intussusception ◽

Lead Point ◽

High Grade ◽

Resonance Imaging ◽

Underlying Malignancy ◽

Invasive Techniques ◽

Sigmoid Cancer

Rectal prolapse is usually of benign etiology. Rarely, sigmoido-rectal intussusception results from a malignant lead-point. We report the case of a patient with a partially obstructing sigmoid cancer causing a full thickness rectal prolapse requiring surgical intervention. An 82-year-old woman presented with 1 week of rectal bleeding, fecal incontinence, and weight loss. Computed tomography identified sigmoido-rectal intussusception. Colonoscopic biopsy revealed high-grade dysplasia. Magnetic resonance imaging demonstrated a 6-cm mass forming the lead point of the intussusceptum with epiploic appendages seen within the rectal lumen. She underwent laparoscopic low anterior resection with final pathology consistent with T2N0 adenocarcinoma, and recovered well. Among adult patients with rectal prolapse, suspicion for underlying malignancy should prompt a thorough investigation to inform the decision for resection, which may be safely performed by minimally invasive techniques.

Download Full-text

Diagnostic value of Neck Lump Clinics and their clinical implication in a District General Hospital

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2018.10.233 ◽

2018 ◽

Vol 56 (10) ◽

pp. e82-e83

Author(s):

Charu Mudgal ◽

Leo Cheng ◽

Gerard Gillian ◽

Peter Boavida ◽

Enamul Ali ◽

...

Keyword(s):

General Hospital ◽

Clinical Implication ◽

District General Hospital ◽

Diagnostic Value ◽

Neck Lump

Download Full-text

PS01.110: ACUTE NECROTIZING ESOPHAGITIS WITH ESOPHAGUS PERFORATION, TREATED BY THORACOSCOPIC ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.110 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 81-81

Author(s):

Ryujiro Akaishi ◽

Yusuke Taniyama ◽

Tadashi Sakurai ◽

Takahiro Heishi ◽

Hiroshi Okamoto ◽

...

Keyword(s):

Surgical Intervention ◽

Conflicts Of Interest ◽

Esophageal Resection ◽

Endoscopic Examination ◽

Resected Specimen ◽

Thoracic Esophagus ◽

Esophageal Mucosa ◽

Acute Necrotizing ◽

Esophagus Perforation ◽

Black Pigmentation

Abstract Background Acute necrotizing esophagus is defined as the diffuse black pigmentation of the esophagus due to the necrosis of the esophageal mucosa, and so called ‘black esophagus’ from its endoscopic findings. The prevalence is only 0.001∼0.2%, although the mortality rate is up to 32%. Methods 67 years old female with medical history of diabetes mellitus, transported to the emergency room with hematemesis and conscious disorder. She had suffered from nausea and epigastralgia for two days. Her general status was in shock vitals and didn’t respond to rehydration. After intubation, emergency endoscopic examination revealed black pigmentation of the esophageal mucosa and diagnosed as acute necrotizing esophagitis. Antibiotics and blood absorption therapy had been started and the patient gradually stabilized. 1 week after the admission, esophagus perforation was suspected from the significant increase of the right pleural effusion and free air at the esophagus wall and the mediastinum on CT scan. Emergency thoracoscopy was performed and found that the esophagus was edematous and adventitia was colored into black. The esophagectomy with esophagostomy and enterostomy was performed. Results On resected specimen, mucosal necrosis was found only on squamous epithelium with three perforating areas in the middle to lower thoracic esophagus. No signs of inflammation nor ischemia was found on the gastric mucosa of the esophagogastric junction. After the operation, patient recovered generally well, except the severe stenosis of the cervical esophagus had developed. Although endoscopic dilation had been constantly performed, the reconstruction remains unsolved issue. Conclusion In acute necrotizing esophagitis, stabilization of the patient's condition by treating comorbid diseases is extremely important. Improving the nutritional status in addition to the administration of antacids and antibiotics is also required. Surgical intervention should be performed when perforating mediastinitis or abscess formation occurs. Primary closure shouldn’t be attempted, and esophageal resection with delayed reconstruction should be considered in addition to drainage. In this case, we could successfully rescued the patient with necrotic esophagitis by performing surgical intervention promptly. It is important to detect the esophagus perforation and mediastinitis early, not to miss the chance of surgical intervention for curative treatment. Disclosure All authors have declared no conflicts of interest.

Download Full-text

Reliability Assessment of the Endoscopic Examination in Patients with Allergic Rhinitis

Allergy & Rhinology ◽

10.2500/ar.2016.7.0176 ◽

2016 ◽

Vol 7 (3) ◽

pp. ar.2016.7.0176

Author(s):

Georges K. Ziade ◽

Reem A. Karami ◽

Ghina B. Fakhri ◽

Elie S. Alam ◽

Abdul Latif Hamdan ◽

...

Keyword(s):

Allergic Rhinitis ◽

Endoscopic Examination ◽

Nasal Endoscope ◽

Mild Disease ◽

Endoscopic Findings ◽

Interrater Variability ◽

Mucosal Edema ◽

Nasal Secretions ◽

A Prospective Study ◽

Bluish Discoloration

Objective To study if nasal endoscope can be a reliable tool in assessing patients with allergic rhinitis. Materials and Methods A prospective study. Patients who were diagnosed with allergic rhinitis underwent a nasal endoscopic examination performed by two physicians blinded to the scoring of each other. A correlation was made among symptom severity, endoscopic findings, and interrater variability. Results Ninety patients were included in the study: 34 patients had mild disease and 56 had moderate-to-severe allergic rhinitis according to the Allergic Rhinitis and its Impact on Asthma guidelines. Increases in mucosal edema and bluish discoloration were predictive of the severity of allergic rhinitis disease (p < 0.05). The presence of nasal secretions was not predictive of allergic rhinitis. Interrater reliability was fair for mucosal edema, moderate-to-almost perfect for the rest of the endoscopic findings. Conclusion Nasal endoscopy may reveal signs that are predictive of the severity of allergic rhinitis. A detailed checklist is needed for the nasal endoscopic examination to decrease interrater variability.

Download Full-text