Features of Various Bladder Lesions and Their Impact on Clinical Symptoms and Recurrence in Interstitial Cystitis.

PURPOSE: We aimed to investigate the impact of various bladder lesions on the clinical symptoms and recurrence of interstitial cystitis (IC). MATERIALS AND METHODS: Patients with IC who underwent transurethral resection and cauterization for Hunner lesions (HLs) were enrolled. Features of HLs-noninflamed, inflamed, and gradually inflamed-and associated cystoscopic findings, including waterfall bleeding (none, focal or extensive), submucosal hemorrhage, and mucosal streak, were analyzed to investigate their association with preoperative symptoms and recurrence. RESULTS: We included 272 procedures from 141 patients (male:female ratio 37:104) with a mean±SD age of 61.4±10.5 years. Recurrence was observed in 160 procedures after a mean of 15.6 months (range 0.7-91.7); repeat transurethral resection and cauterization was performed in 131 cases. The number of HLs observed at each procedure was variable, and sufficient bladder filling revealed hidden lesions in 10.7% of cases. Waterfall bleeding was frequently accompanied with inflamed/gradually inflamed HLs. Inflammatory HLs were associated with smaller functional bladder capacity and preoperative urgency (p=0.007). Extensive waterfall bleeding was associated with smaller functional bladder capacity (p=0.006). On multivariate analysis, initially inflamed HLs (HR: 1.675, 95% CI: 1.022-2.746, p=0.041) and gradual inflammatory changes in HLs (HR: 1.893, 95% CI: 1.050-3.410, p=0.034) were found to be risk factors for recurrence. CONCLUSIONS: Sufficient bladder filling revealed hidden HLs. The features of HLs were not associated with subjective symptoms; inflamed changes were a predictive factor for IC recurrence, and associated with frequent urgency episodes and smaller bladder capacity.

A survey of ENT undergraduate teaching in the UK.

BACKGROUND: ENT presentations are prevalent in clinical practice but feature little in undergraduate curricula. Consequently, most medical graduates are not confident managing common ENT conditions. In 2014, the first evidence-based ENT undergraduate curriculum was published to guide medical schools. OBJECTIVE: To assess the extent that current UK medical school learning outcomes correlate with the syllabus of the ENT undergraduate curriculum. METHOD: Two students from each participating medical school independently reviewed all ENT-related curriculum documents to determine whether learning outcomes from the suggested curriculum were met. RESULTS: Sixteen of 34 curricula were reviewed. Only a minority of medical schools delivered teaching on laryngectomy or tracheostomy, nasal packing or cautery, and ENT medications or surgical procedures. CONCLUSION: There is wide variability in ENT undergraduate education in UK medical schools. Careful consideration of which topics are prioritised, and the teaching modalities utilised, is essential. In addition, ENT learning opportunities for undergraduates outside of the medical school curriculum should be augmented.

Knowledge, attitude, practice and prevalence of traditional cauterization among patients in Massawa Hospital, Eritrea: a cross-sectional study.

INTRODUCTION: use of traditional cautery for the treatment of varied ailments is one of the most ancient and harmful traditional medical practices that is still in use. This study was conducted to assess the knowledge, attitude, practice and to estimate the prevalence of traditional cautery among patients visiting Massawa hospital. METHODS: a hospital-based cross-sectional study was conducted in Massawa hospital from February 20 to April 20, 2019. The study enrolled all patients aged >18 years, non-critical and willing to participate. RESULTS: a total of 900 participants were enrolled in the study. The study was dominated by Muslims (81.4%) with a median age of 42 years (IQR: 20). Self-reported prevalence of traditional cauterization was found to be 43.6% and 63% of them did their latest cautery between 2011 and 2019. Metal rods were used as cauterant in 92.3% and 47.9% reported that traditional practitioners used the same cauterant for different people. One-third of the respondents reported that it is a safe practice and 47% had the understanding that it cannot transmit communicable diseases. Moreover, 90.4% of the study participants reported that they knew someone who did cautery. Respondents with poor knowledge (AOR=6.45, 95% CI: 4.69-8.87) and attitude (AOR=8.68, 95% CI: 6.31-11.95) were more likely to practice cauterization compared to those with good knowledge and attitude. CONCLUSION: the practice of cauterization in visitors of Massawa hospital was rampant which is mainly associated with poor knowledge and attitude of the respondents, limited access to health facilities and religious/cultural conviction.

Predictors of endoscopic third ventriculostomy ostomy status in patients who experience failure of endoscopic third ventriculostomy with choroid plexus cauterization.

OBJECTIVE: At failure of endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC), the ETV ostomy may be found to be closed or open. Failure with a closed ostomy may indicate a population that could benefit from evolving techniques to keep the ostomy open and may be candidates for repeat ETV, whereas failure with an open ostomy may be due to persistently abnormal CSF dynamics. This study seeks to identify clinical and radiographic predictors of ostomy status at the time of ETV/CPC failure. METHODS: The authors conducted a multicenter, retrospective cohort study on all pediatric patients with hydrocephalus who failed initial ETV/CPC treatment between January 2013 and October 2016. Failure was defined as the need for repeat ETV or ventriculoperitoneal (VP) shunt placement. Clinical and radiographic data were collected, and ETV ostomy status was determined endoscopically at the subsequent hydrocephalus procedure. Statistical analysis included the Mann-Whitney U-test, Wilcoxon rank-sum test, t-test, and Pearson chi-square test where appropriate, as well as multivariate logistic regression. RESULTS: Of 72 ETV/CPC failures, 28 patients (39%) had open-ostomy failure and 44 (61%) had closed-ostomy failure. Patients with open-ostomy failure were older (median 5.1 weeks corrected age for gestation [interquartile range (IQR) 0.9-15.9 weeks]) than patients with closed-ostomy failure (median 0.2 weeks [IQR -1.3 to 4.5 weeks]), a significant difference by univariate and multivariate regression. Etiologies of hydrocephalus included intraventricular hemorrhage of prematurity (32%), myelomeningocele (29%), congenital communicating (11%), aqueductal stenosis (11%), cyst/tumor (4%), and other causes (12%). A wider baseline third ventricle was associated with open-ostomy failure (median 15.0 mm [IQR 10.3-18.5 mm]) compared to closed-ostomy failure (median 11.7 mm [IQR 8.9-16.5 mm], p = 0.048). Finally, at the time of failure, patients with closed-ostomy failure had enlargement of their ventricles (frontal and occipital horn ratio [FOHR], failure vs baseline, median 0.06 [IQR 0.00-0.11]), while patients with open-ostomy failure had no change in ventricle size (median 0.01 [IQR -0.04 to 0.05], p = 0.018). Previous CSF temporizing procedures, intraoperative bleeding, and time to failure were not associated with ostomy status at ETV/CPC failure. CONCLUSIONS: Older corrected age for gestation, larger baseline third ventricle width, and no change in FOHR were associated with open-ostomy ETV/CPC failure. Future studies are warranted to further define and confirm features that may be predictive of ostomy status at the time of ETV/CPC failure.

Glisson's capsule cauterisation is associated with increased postoperative pain after laparoscopic cholecystectomy: a prospective case-control study.

INTRODUCTION Postoperative pain after laparoscopic cholecystectomy has three components: parietal, visceral and referred pain felt at the shoulder. Visceral peritoneal injury on the liver (Glisson's capsule) during cauterisation sometimes occurs as an unavoidable complication of the operation. Its effect on postoperative pain has not been quantified. In this study, we aimed to evaluate the association between Glisson's capsule injury and postoperative pain following laparoscopic cholecystectomy. METHODS The study was a prospective case-control of planned standard laparoscopic cholecystectomy with standardized anaesthesia protocol in patients with benign gallbladder disease. Visual analogue scale (VAS) abdominal pain scores were noted at 2 and 24 hours after the operation. One surgical team performed the operations. Operative videos were recorded and examined later by another team to detect presence of Glisson's capsule cauterisation. Eighty-one patients were enrolled into the study. After examination of the operative videos, 46 patients with visceral peritoneal injury were included in the study group, and the remaining 35 formed the control group. RESULTS VAS pain score at postoperative 2 and 24 hours was significantly higher in the study group than control (P = 0.027 and 0.017, respectively). CONCLUSIONS Glisson's capsule cauterisation in laparoscopic cholecystectomy is associated with increased postoperative pain. Additional efforts are recommended to prevent unintentional cauterisation.

Current Role of Carnoy's Solution in Treating Keratocystic Odontogenic Tumors.

PURPOSE: To understand the frequency of use of Carnoy's solution, as a means of chemical curettage, for treating the keratocystic odontogenic tumor (KCOT). MATERIALS AND METHODS: A Web-based survey was distributed by e-mail to 6,880 members listed in the 2013 American Association of Oral and Maxillofacial Surgeons directory. RESULTS: Eight hundred nine participants across the United States responded to the survey (12% response rate). The most common procedures performed to definitively treat a KCOT were enucleation plus mechanical curettage (curette with or without peripheral ostectomy; 66%). Of the survey participants, 198 (25%) currently use Carnoy's solution, 111 (56%) of whom are using the solution with chloroform and 83 (42%) are using it without chloroform. CONCLUSION: Carnoy's solution remains a common method of chemical curettage for the definitive treatment of the KCOT. Carnoy's solution with and without chloroform is being used for chemical cautery.

Traditional Cautery for Medical Treatment Among the Bedouins of Southern Israel.

Traditional cautery for the cure of disease is an ancient and widespread mode of treatment in various cultures and is a central modality among Israeli Bedouins. To date the use of this treatment has not been assessed systematically. A personal interview was conducted among Muslim Bedouin patients who came to clinics in the Negev region in southern Israel. There were 250 participants including 128 women (51.2 %). The mean age was 45.16 ± 16.2 (range 18-86). Eighty nine (35.7 %) of the participants declared that they had personally undergone curative cautery therapy in the past. Two hundred and five (82 %) were familiar with this mode of therapy. Two thirds of those who underwent the treatment in the past said that it helped them a great deal and another 19 % said that it helped them somewhat. More men underwent the therapy than women (P = 0.034), believed in its effectiveness (P = 0.013), and declared that they were prepared to use it again in the future (P < 0.0001). Elderly patients, over the age of 61, used this therapy more than younger ones (P = 0.001). The majority of the Bedouin population in the Negev is familiar with cautery and a significant part of the population has personally undergone this therapy and believes that it is effective.

Pediatric epistaxis: epidemiology, management & impact on quality of life.

OBJECTIVE: Epistaxis in the pediatric population is a common problem for both primary care physicians (PCPs) and otolaryngologists. Although a frequent reason for referral to ENT clinics, data is lacking regarding causes, effects on quality of life and common treatment modalities. METHODS: Prospective, clinical and questionnaire based study, with ethical approval. We identified 50 cases of pediatric epistaxis (<16 years old) over a 6-month period. A thorough clinical history was taken, first aid measures and management outcome was recorded. The impact of recurring epistaxis on parental quality of life was assessed using the Parental Stress Index Short Form (PSISF). RESULTS: Thirty-three males and 17 females (2:1) were included. Mean age at presentation was 8.8 years. Initial management was inadequate, with only 30% of carers applying appropriate first aid measures. Quality of life was significantly affected in 10% of cases with primary parental concerns being fear of excessive blood loss and the stress of soiled bedclothes and night wear. Children were most affected by the negative impact on sporting activity. Otolaryngology consultation found the common causes to be iatrogenic trauma and rhinitis affecting "Littles" area. Of which 78% required silver nitrate cautery, and 22% just required reassurance and advice CONCLUSIONS: Recurrent minor nosebleeds in children can be troublesome and alarming for parents and children. We found the PSISF an easy and reliable method of assessing patient and parental stress in dealing with this problem. Raising awareness of simple management strategies among parents and PCPs could significantly reduce associated quality of life issues. Mucosal hydration, cautery and first aid advice are the fundamentals of management.

Endometrial ablation devices: review of a manufacturer and user facility device experience database.

Our objective was to evaluate complications reported to the Manufacturer and User Facility Device Experience (MAUDE) database and to look for trends of complications among various endometrial ablation devices. This database was not intended to be used either to evaluate rates of adverse events or to compare adverse event occurrence rates across devices. We performed a retrospective review of the Food and Drug Administration's MAUDE database. The database was queried for adverse events associated with the use of endometrial ablation devices. The following data were collected: event number, date reported, date of occurrence, type of ablation device, type of complication, adherence to manufacturer's protocol, brief description, disposition, who reported incident, report source, and cause of problem. The total number of adverse events reported in the United States for the time period January 1, 2003, through December 31, 2006, was 254. The largest number of major complications for cryoablation was bowel injury (n = 5), for microwave was bowel injury (n = 6), for hot water balloon was complications leading to hysterectomy (n = 7), for free circulating hot water was severe burns (n = 22), and for bipolar mesh was bowel injury (n = 19). The MAUDE database is useful to both the physician and manufacturer to look at trends and types of complications.

Treatment of basal cell carcinomas by general practitioners in Australia.

BACKGROUND: Basal cell carcinomas (BCCs) are a relatively common form of skin damage in Australians, involving approximately 1 in 200 general practice encounters per year. AIM: To determine current treatments and the associated healthcare resource costs of BCC therapy in Australia. METHODS: A retrospective survey was undertaken relating to the treatment of patients presenting to their doctor with previously untreated BCCs. Data were collected from a sample of general practitioners who were asked to randomly select two BCC patients from their medical records and complete a questionnaire. Information about treatment types, number of doctor visits, treatment complications, and specialist referrals was extracted from the patient records. RESULTS: One hundred and sixty-four patients were recruited into the study (59% male), who were treated for a total of 244 BCCs (average of 1.5 lesions per patient). Twenty-two per cent of patients were referred to a specialist, most being referred to a general surgeon (45%) or plastic surgeon (25%). Excision was the preferred therapy; second choices were cryosurgery or curettage and cautery. Few adverse events were recorded. The typical number of doctor visits varied from 3.2 to 7.4, with a range of total cost per patient of 146.60-496.20 AUS dollars, depending on complexity and the need for referral. CONCLUSION: With a reported incidence in Australia of approximately 788 per 100,000 persons, BCCs are not inexpensive to treat for such a relatively common condition.

Impact of the introduction of fee for service payments on types of minor surgical procedures undertaken by general practitioners: observational study.

The 1990 general practitioners (GPs) contract introduced item of service payment for minor surgery, payable for six categories of procedure. Early review showed no substitution of cheaper procedures for more expensive treatments. Detailed payment data from six Health Authorities for the period 1993-2000 show an 11 per cent increase in claims, largely accounted for by the rise in cautery, incorporating cryotherapy. Cryotherapy is no more effective at treating warts than cheap commercially available products, but is quite profitable for GPs. This is yet another example of item of service payment distorting treatment priorities. The new GP contract, and the initiative to develop GPs with special interests in dermatology and minor surgery, will allow primary care trusts to develop minor surgery undertaken by appropriately skilled and experienced GPs, and which reflects the needs of the population.

Prevalence of HBsAg among the non cauterized groups of blood donors.

One thousand two hundred and seventeen (1217) blood specimens from non-cauterized blood donors were tested for HBsAg by counterimmunoelectrophoresis technique: 48 specimens were positive giving an incidence of 3.95%; specimens from 99 blood donors with cautery marks were tested side by side using the same technique, 3 specimens were positive giving an incidence of 3.05%. These results show that Sudan can be considered among the countries with very high prevalence of HBsAg. This emphasizes the importance of testing every unit of blood or blood product before transfusion. This high prevalence is mainly attributable to the use of common improperly sterilized water-boiled syringes, needles and surgical instruments. The results also show that the incidence of HBsAg among cauterized donors is not higher than among non-cauterized; thus routine rejection of cauterized citizens from giving blood at the reception stage is unjustified as it adds to the problem of shortage of blood in Sudan.