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1.
Colorectal Dis ; 22(5): 562-568, 2020 05.
Article in English | MEDLINE | ID: mdl-31713965

ABSTRACT

AIM: Patients who undergo radical pelvic surgery often have problems with perineal wound healing and pelvic collections. While there is recognition of the perineal morbidity, there also remains uncertainty around the benefit of vertical rectus abdominus myocutaneous (VRAM) flaps due to the balance between primary healing and the complications associated with this form of reconstruction. This study aimed to evaluate factors associated with significant flap and donor site related complications following VRAM flap reconstruction for radical pelvic surgery. METHOD: A retrospective analysis of VRAM flap related complications was undertaken from prospectively maintained databases for all patients undergoing radical pelvic surgery (2001- 2017) in two cancer centres. RESULTS: In all, 154 patients were identified [median age 62Ā years (range 26-89Ā years), 80 (52%) men]. Thirty-three (21%) patients experienced significant donor or flap related complications. Major complications (Clavien-DindoĀ ≥Ā 3) related to the abdominal donor site occurred in nine (6%) patients, while those related to the flap or perineal site occurred in 28 (18%) patients. Only smoking (PĀ =Ā 0.003) and neoadjuvant radiotherapy (PĀ =Ā 0.047) were associated with the development of significant flap related complications on univariate analysis. Flap related complications resulted in a significantly longer hospital stay (PĀ <Ā 0.001). CONCLUSION: Careful patient selection is required to balance the risks vs the benefits of VRAM flap reconstruction. Immediate VRAM reconstruction in patients undergoing radical pelvic surgery can achieve early healing and stable perineal closure; it has a low but significant morbidity. Major flap related complications are significantly associated with smoking status and neoadjuvant radiotherapy and result in a prolonged length of hospital stay.


Subject(s)
Myocutaneous Flap , Plastic Surgery Procedures , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Morbidity , Myocutaneous Flap/transplantation , Perineum/surgery , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Plastic Surgery Procedures/adverse effects , Plastic Surgery Procedures/methods , Rectus Abdominis/transplantation , Retrospective Studies
2.
J Ultrasound Med ; 38(3): 767-773, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30121948

ABSTRACT

Protocols for the sanitation and maintenance of point-of-care ultrasound (US) equipment are lacking. This study introduces the CLEAR protocol (clean, locate, energize, augment supplies, and remove patient identifiers) as a tool to improve the readiness of US equipment, termed US equipment homeostasis. The state of US equipment homeostasis in the emergency department of a single academic center was investigated before and after implementing this protocol, with an improvement in outcomes. These findings demonstrate that the CLEAR protocol can improve US homeostasis. CLEAR can function as a teaching tool to promote homeostasis as well as a checklist to assess compliance.


Subject(s)
Checklist/methods , Point-of-Care Systems , Sanitation/methods , Ultrasonography/instrumentation , Emergency Service, Hospital , Humans , Maintenance/methods
3.
J Ultrasound Med ; 37(12): 2777-2784, 2018 Dec.
Article in English | MEDLINE | ID: mdl-29656390

ABSTRACT

OBJECTIVES: Ultrasound (US) has become an indispensable skill for emergency physicians. Growth in the use of US in emergency medicine (EM) has been characterized by practice guidelines, education requirements, and the number of EM US practitioners. Our purpose was to further document the growth of EM US by profiling the breadth, depth, and quality of US-related research presented at EM's most prominent annual research conference: the Society for Academic Emergency Medicine Annual Meeting. METHODS: We reviewed published research abstracts from the annual Society for Academic Emergency Medicine conferences from 1999 to 2015. Abstracts related to US were identified and examined for the number of authors and rigor of the research design. Designs were categorized as experimental, quasiexperimental, and nonexperimental. Abstract submissions were analyzed by the average rate of change over time. RESULTS: From 1999 to 2015, we observed a 10.2% increase in the number of accepted abstracts related to US research. This rate compared to a 3.2% average rate of change for all abstracts in general. The number of unique authors engaged in US research increased at a rate of 26.6%. Of the 602 abstracts identified as US related, only 12% could be considered experimental research. CONCLUSIONS: We observed larger increases in the number of US-related research relative to the total number of abstracts presented at a national conference. The number of investigators engaging in this research has also steadily increased. The research design of these studies was found to be primarily quasiexperimental. To improve the quality of EM's use of point-of-care US, more rigorous research with experimental designs is needed.


Subject(s)
Bibliometrics , Emergency Medical Services/methods , Ultrasonography/methods , Abstracting and Indexing , Humans , Societies, Medical , Universities
4.
Ann Emerg Med ; 65(1): 92-100.e3, 2015 Jan.
Article in English | MEDLINE | ID: mdl-24908590

ABSTRACT

STUDY OBJECTIVE: We evaluate the sensitivity of Ohio's 2009 emergency medical services (EMS) geriatric trauma triage criteria compared with the previous adult triage criteria in identifying need for trauma center care among older adults. METHODS: We studied a retrospective cohort of injured patients aged 16 years or older in the 2006 to 2011 Ohio Trauma Registry. Patients aged 70 years or older were considered geriatric. We identified whether each patient met the geriatric and the adult triage criteria. The outcome measure was need for trauma center care, defined by surrogate markers: Injury Severity Score greater than 15, operating room in fewer than 48 hours, any ICU stay, and inhospital mortality. We calculated sensitivity and specificity of both triage criteria for both age groups. RESULTS: We included 101,577 patients; 33,379 (33%) were geriatric. Overall, 57% of patients met adult criteria and 68% met geriatric criteria. Using Injury Severity Score, for older adults geriatric criteria were more sensitive for need for trauma center care (93%; 95% confidence interval [CI] 92% to 93%) than adult criteria (61%; 95% CI 60% to 62%). Geriatric criteria decreased specificity in older adults from 61% (95% CI 61% to 62%) to 49% (95% CI 48% to 49%). Geriatric criteria in older adults (93% sensitivity, 49% specificity) performed similarly to the adult criteria in younger adults (sensitivity 87% and specificity 44%). Similar patterns were observed for other outcomes. CONCLUSION: Standard adult EMS triage guidelines provide poor sensitivity in older adults. Ohio's geriatric trauma triage guidelines significantly improve sensitivity in identifying Injury Severity Score and other surrogate markers of the need for trauma center care, with modest decreases in specificity for older adults.


Subject(s)
Trauma Centers , Triage , Wounds and Injuries/diagnosis , Adolescent , Adult , Age Factors , Aged , Female , Geriatric Assessment/methods , Humans , Injury Severity Score , Male , Middle Aged , Practice Guidelines as Topic , Retrospective Studies , Sensitivity and Specificity , Trauma Centers/statistics & numerical data , Triage/standards , Wounds and Injuries/classification , Young Adult
5.
Surgeon ; 13(1): 15-8, 2015 Feb.
Article in English | MEDLINE | ID: mdl-24613184

ABSTRACT

OBJECTIVE: To assess the impact of a structured training programme in urethral catheterisation (UC) targeted at newly qualified junior doctors on rates of iatrogenic catheter morbidity within a tertiary care referral centre. SUBJECTS AND METHODS: Male UC-related morbidities were retrospectively identified from our computerised inpatient urology consultation system over a 1-year period from July 2010 to June 2011. Relevant medical records were also reviewed. Results were compared with an initial study performed between July 2006 and June 2007, prior the introduction of a structured training programme in our institution. An anonymous questionnaire was used for the subjective assessment of interns about confidence in catheterising post introduction of the programme. RESULTS: Of 725 urological consultations, 29 (4%) were related to complications arising from male UC during the 1 year period. This reflected a statistically significant decrease when compared to our 2007 figures, 51/864 (6%) (pĀ <Ā 0.05). Again, the most common indication for UC was monitoring urinary output for acute medical illness (19/29, 66%). The most common complication was urethral trauma (16/29, 55%). Of the 29 cases of UC-related morbidity, 18 (62%) resulted from interns performing UC, a decrease of 12% from our original paper. A drop of 27% was seen in the rates of UC related morbidity attributable to interns during the first 6 months of internship (July-December). Overall, 70% (vs 40% original study) of interns felt that their practical training was adequate since introduction of the programme (pĀ <Ā 0.01) with 53% considering theoretical training adequate (vs 16% original study (pĀ <Ā 0.01). When asked were they confident in performing UC, 63% said they were compared to 35% before introduction of the programme (pĀ <Ā 0.05). CONCLUSIONS: UC-related iatrogenic morbidity is not uncommon even in a tertiary-care teaching hospital. Implementation of a structured training programme in UC prior to the commencement of intern year has been shown to result in a significant decrease in the amount of iatrogenic UC related morbidity.


Subject(s)
Curriculum , Iatrogenic Disease/prevention & control , Internship and Residency/methods , Referral and Consultation , Urinary Catheterization/methods , Urology/education , Adult , Clinical Competence , Follow-Up Studies , Humans , Iatrogenic Disease/epidemiology , Ireland/epidemiology , Male , Morbidity/trends , Retrospective Studies , Time Factors
6.
Ir Med J ; 108(9): 270-2, 2015 Oct.
Article in English | MEDLINE | ID: mdl-26625650

ABSTRACT

The transobturator tape (TOT) is an effective treatment for stress urinary incontinence (SUI). Erosion of TOT mesh is a recognised complication requiring excision. A retrospective analysis of 228 females undergoing a TOT procedure over 4 years identified 16 patients (7%) that underwent excision of eroded mesh. Mean age of patients requiring excision was 48.8 years and mean weight was 72.7kg. Mean time to re-presentation was 14.5 months. Presenting symptoms included dyspareunia in 9 patients (56.2%), dysuria in 3 (18.7%), persistent incontinence in 3 (18.7%) and groin pain in one patient. Ten patients (62.5%) had a prior urogynecological procedure. After excision of eroded tape-mesh, 7 (43.7%) required a rectus fascial sling and 4 (25%) underwent repeat TOT for recurrence of SUI. Five patients (31.2%) required no further surgery. At present 10 patients (62.5%) report resolution of SUI, 4 (25%) report mild SUI and 2 (12.5%) patients have moderate/severe SUI. Resolution of symptoms occurred in the majority of patients after excision of eroded mesh and an additional anti-incontinence procedure.


Subject(s)
Suburethral Slings , Urinary Incontinence, Stress/surgery , Adult , Aged , Aged, 80 and over , Equipment Failure , Female , Humans , Middle Aged , Recurrence , Reoperation , Retrospective Studies , Risk Factors , Treatment Outcome , Young Adult
7.
J Ultrasound Med ; 33(12): 2193-6, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25425378

ABSTRACT

The Ultrasound Challenge was developed at The Ohio State University College of Medicine to introduce focused ultrasound to medical students. The goal was to develop experience in ultrasound through practice and competition. Initially this competition was held between Ohio State University College of Medicine students from years 1 through 4. The Ultrasound Challenge 2.0 was held in 2013. The event expanded on the previous structure by including students from the Wayne State University College of Medicine. The goal of this article is to describe our experiences with expansion of our interinstitutional ultrasound event. The challenge consisted of 6 stations: focused assessment with sonography for trauma, aortic ultrasound, cardiac ultrasound, pelvic ultrasound, musculoskeletal ultrasound, and vascular access. The participants were given a handbook outlining the expectations for each station ahead of time. Vascular access was graded in real time using the Brightness Mode Quality Ultrasound Imaging Examination Technique (B-QUIET) method. The remainder were timed, saved, and graded after the event by 3 independent faculty members using the B-QUIET method. The highest score with the fastest time was the winner. The Ultrasound Challenge 2.0 included 40 participants: 31 from The Ohio State University College of Medicine and 9 from the Wayne State University College of Medicine. The makeup of the winners in all categories consisted of 1 first-year medical student, 7 second-year medical students, 3 third-year medical students, and 10 fourth-year medical students. The Ultrasound Challenge 2.0 was a success for those who participated. It provided the first known interinstitutional medical student ultrasound competition. Students from both institutions were able to practice their image acquisition skills, demonstrate abilities in a competitive environment, and develop collegiality and teamwork.


Subject(s)
Curriculum , Education, Medical, Undergraduate/methods , Education, Medical, Undergraduate/organization & administration , Educational Measurement/methods , Radiology/organization & administration , Ultrasonography , Ohio
8.
J Surg Res ; 184(1): 561-6, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23764308

ABSTRACT

BACKGROUND: Traditional methods for intravascular volume status assessment are invasive and are associated significant complications. While focused bedside sonography of the inferior vena cava (IVC) has been shown to be useful in estimating intravascular volume status, it may be technically difficult and limited by patient factors such as obesity, bowel gas, or postoperative surgical dressings. The goal of this investigation is to determine the feasibility of subclavian vein (SCV) collapsibility as an adjunct to IVC collapsibility in intravascular volume status assessment. METHODS: A prospective study was conducted on a convenience sample of surgical intensive care unit patients to evaluate interchangeability of IVC collapsibility index (IVC-CI) and SCV-CI. After demographic and acuity of illness information was collected, all patients underwent serial, paired assessments of IVC-CI and SCV-CI using portable ultrasound device (M-Turbo; Sonosite, Bothell, WA). Vein collapsibility was calculated using the formula [collapsibility (%) = (max diameter - min diameter)/max diameter Ɨ 100%]. Paired measurements from each method were compared using correlation coefficient and Bland-Altman measurement bias analysis. RESULTS: Thirty-four patients (mean age 56Ā y, 38% female) underwent a total of 94 paired SCV-CI and IVC-CI sonographic measurements. Mean acute physiology and chronic health evaluation II score was 12. Paired SCV- and IVC-CI showed acceptable correlation (R(2) = 0.61, P < 0.01) with acceptable overall measurement bias [Bland-Altman mean collapsibility difference (IVC-CI minus SCV-CI) of -3.2%]. In addition, time needed to acquire and measure venous diameters was shorter for the SCV-CI (70Ā s) when compared to IVC-CI (99Ā s, P < 0.02). CONCLUSIONS: SCV collapsibility assessment appears to be a reasonable adjunct to IVC-CI in the surgical intensive care unit patient population. The correlation between the two techniques is acceptable and the overall measurement bias is low. In addition, SCV-CI measurements took less time to acquire than IVC-CI measurements, although the clinical relevance of the measured time difference is unclear.


Subject(s)
Blood Volume Determination/methods , Critical Care/methods , Postoperative Complications/diagnostic imaging , Subclavian Vein/diagnostic imaging , Ultrasonography/methods , Vena Cava, Inferior/diagnostic imaging , Adult , Aged , Aged, 80 and over , Blood Volume Determination/standards , Critical Care/standards , Female , Humans , Intensive Care Units , Male , Middle Aged , Models, Cardiovascular , Point-of-Care Systems , Postoperative Complications/physiopathology , Prospective Studies , Reproducibility of Results , Resuscitation , Subclavian Vein/physiology , Ultrasonography/standards , Vena Cava, Inferior/physiology , Young Adult
9.
Int Urogynecol J ; 24(6): 913-9, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23224022

ABSTRACT

Injectable urethral bulking agents composed of synthetic and biological biomaterials are minimally invasive treatment options for stress urinary incontinence (SUI). The development of an ideal urethral bulking agent remains challenging because of clinical concerns over biocompatibility and durability. Herein, the mechanical and biological features of injectable urethral biomaterials are investigated, with particular emphasis on their future potential as primary and secondary treatment options for SUI. A literature search for English language publications using the two online databases was performed. Keywords included "stress urinary incontinence", "urethral bulking agent" and "injectable biomaterial". A total of 98 articles were analysed, of which 45 were suitable for review based on clinical relevance and importance of content. Injectable biomaterials are associated with a lower cure rate and fewer postoperative complications than open surgery for SUI. They are frequently reserved as secondary treatment options for patients unwilling or medically unfit to undergo surgery. Glutaraldehyde cross-linked bovine collagen remains the most commonly injected biomaterial and has a cure rate of up to 53 %. Important clinical features of an injectable biomaterial are durability, biocompatibility and ease of administration, but achieving these requirements is challenging. In carefully selected patients, injectable biomaterials are feasible alternatives to open surgical procedures as primary and secondary treatment options for SUI. In future, higher cure rates may be feasible as researchers investigate alternative biomaterials and more targeted injection techniques for treating SUI.


Subject(s)
Biocompatible Materials/therapeutic use , Urethra/physiology , Urinary Incontinence, Stress/prevention & control , Biocompatible Materials/administration & dosage , Biocompatible Materials/pharmacology , Biomechanical Phenomena , Collagen/administration & dosage , Collagen/pharmacology , Collagen/therapeutic use , Humans , Injections , Treatment Outcome , Urethra/drug effects , Urinary Incontinence, Stress/physiopathology
11.
Surgeon ; 11(6): 300-3, 2013 Dec.
Article in English | MEDLINE | ID: mdl-23877024

ABSTRACT

INTRODUCTION: Our institution is a 680-bed tertiary referral centre with broad medical and surgical subspecialty services. We retrospectively audited the pattern of inpatient consultations from all specialities within our institution to the urology department over a 1-year period. METHODS: All consultations to the urology service were identified from our computerised inpatient consultation system from July 2010 to June 2011. Follow up data on investigations, interventions and subsequent outpatient appointments were also identified by review of individual patient discharge letters. RESULTS: Seven hundred and twenty five inpatient consultations were received over the period. The male to female ratio was 7:3. Mean age of patients was 66 (15-96) years. Seventy three percent of referrals were from medical sub-specialities, most commonly nephrology (17%), gastroenterology (11%) and respiratory medicine (9%). The remainder were from general surgery (16%) and other surgical sub specialities (11%). Interns (66%) and senior house officers (SHO) (28%) communicated the majority of consults. Male lower urinary tract/benign prostate related issues resulted in 25% of all consultations. Less than half of consults (47%) resulted in interventions initiated by urology, most commonly of which were catheter insertions (48%) and endoscopic procedures (35%). Only 43% of consultations were followed up in the outpatients setting. CONCLUSIONS: Inpatient consultations constitute a significant workload for urology services. The majority of these referrals did not require any urological intervention and could have been seen routinely in the outpatient setting. Providing structured referral guidelines and achieving better communication with referring teams may help to optimise this service.


Subject(s)
Inpatients , Medicine/statistics & numerical data , Referral and Consultation/statistics & numerical data , Tertiary Care Centers , Urologic Diseases/diagnosis , Urology/methods , Adolescent , Adult , Aged , Aged, 80 and over , Appointments and Schedules , Female , Humans , Ireland , Male , Middle Aged , Retrospective Studies , Workload , Young Adult
12.
Ir Med J ; 106(5): 147-8, 2013 May.
Article in English | MEDLINE | ID: mdl-23914577

ABSTRACT

Urachal carcinoma is a rare, aggressive malignancy accounting for less than 1% of bladder neoplasms. These tumours are usually adenocarcinomas and occur at the dome or anterior wall of the bladder. They often escape early clinical detection, growing for prolonged periods prior to diagnosis, resulting in local invasion and systemic spread before therapeutic intervention is initiated. We present the case of a recurrent urachal carcinoma in a young female.


Subject(s)
Adenocarcinoma/diagnosis , Adenocarcinoma/surgery , Urinary Bladder Neoplasms/diagnosis , Urinary Bladder Neoplasms/surgery , Adult , Diagnostic Imaging , Female , Humans , Neoplasm Invasiveness , Neoplasm Recurrence, Local , Pelvic Exenteration
13.
AEM Educ Train ; 6(3): e10763, 2022 Jun.
Article in English | MEDLINE | ID: mdl-35774534

ABSTRACT

Background: Women comprise 28% of faculty in academic departments of emergency medicine (EM) and 11% of academic chairs. Professional development programs for women are key to career success and to prevent pipeline attrition. Within emergency medicine, there is a paucity of outcomes-level data for such programs. Objectives: We aim to measure the impact of a novel structured professional development curriculum and mentorship group (Resident and Faculty Female Tribe, or RAFFT) within an academic department of EM. Methods: This prospective single-center curriculum implementation and evaluation was conducted in the academic year 2020-2021. A planning group identified potential curricular topics using an iterative Delphi process. We developed a 10-session longitudinal curriculum; a postcurriculum survey was conducted to assess the perceived benefit of the program in four domains. Results: A total of 76% of 51 eligible women attended at least one session; for this project we analyzed the 24 participants (47%) who attended at least one session and completed both the pre- and the postsurvey. The majority of participants reported a positive benefit, which aligned with their expectations in the following areas: professional development (79.2%), job satisfaction (83.3%), professional well-being (70.8%), and personal well-being (79.2%). Resident physicians more often reported less benefit than expected compared to fellow/faculty physicians. Median perceived impact on career choice and trajectory was positive for all respondents. Conclusions: Success of this professional development program was measured through a perceived benefit aligning with participant expectations, a positive impact on career choice and career trajectory for participants in each career stage, and a high level of engagement in this voluntary program. Recommendations for the successful implementation of professional development programs include early engagement of stakeholders, the application of data from a program-specific needs assessment, early dissemination of session dates to allow for protected time off, and structured discussions with appropriate identification of presession resources.

14.
Ultrasound J ; 13(1): 44, 2021 Oct 28.
Article in English | MEDLINE | ID: mdl-34709487

ABSTRACT

OBJECTIVES: Accurate communication is an integral component of ultrasound education. In light of the recent global pandemic, this has become even more crucial as many have moved to virtual education out of necessity. Several studies and publications have sought to establish common terminology for cardinal ultrasound probe motions. To date, no studies have been performed to determine which of these terms have been adopted by the ultrasound community at large. METHODS: A survey was developed which asked respondents to describe videos of six common probe motions in addition to providing basic demographic and training data. The survey was disseminated electronically across various academic listservs and open access resources. RESULTS: Data were collected over a 6-week period and yielded 418 unique responses. Responses demonstrated significant variation in terminology related to all 6 cardinal probe motions. While some degree of difference in response can be accounted for by discipline of training, inter-group variation still exists in terminology to describe common probe motions. Of the survey respondents, 57.5% felt that inconsistent probe motion terminology made teaching ultrasound more difficult. CONCLUSIONS: The results demonstrate that despite efforts to codify probe motions, variation still exists between ultrasound practitioners and educators in the description of cardinal probe motions. This lack of consensus can contribute to challenges in both virtual and in-person ultrasound education.

15.
AEM Educ Train ; 5(3): e10557, 2021 Jul.
Article in English | MEDLINE | ID: mdl-34124505

ABSTRACT

OBJECTIVES: Ultrasound-guided regional anesthesia (UGRA) can be a powerful tool in the treatment of painful conditions commonly encountered in emergency medicine (EM) practice. UGRA can benefit patients while avoiding the risks of procedural sedation and opioid-based systemic analgesia. Despite these advantages, many EM trainees do not receive focused education in UGRA and there is no published curriculum specifically for EM physicians. The objective of this study was to identify the components of a UGRA curriculum for EM physicians. METHODS: A list of potential curriculum elements was developed through an extensive literature review. An expert panel was convened that included 13 ultrasound faculty members from 12 institutions and from a variety of practice environments and diverse geographical regions. The panel voted on curriculum elements through two rounds of a modified Delphi process. RESULTS: The panelists voted on 178 total elements, 110 background knowledge elements, and 68 individual UGRA techniques. A high level of agreement was achieved for 65 background knowledge elements from the categories: benefits to providers and patients, indications, contraindications, risks, ultrasound skills, procedural skills, sterile technique, local anesthetics, and educational resources. Ten UGRA techniques achieved consensus: interscalene brachial plexus, supraclavicular brachial plexus, radial nerve, median nerve, ulnar nerve, serratus anterior plane, fascia iliaca, femoral nerve, popliteal sciatic nerve, and posterior tibial nerve blocks. CONCLUSIONS: The defined curriculum represents ultrasound expert opinion on a curriculum for training practicing EM physicians. This curriculum can be used to guide the development and implementation of more robust UGRA education for both residents and independent providers.

16.
Ir Med J ; 99(2): 56-7, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16548225

ABSTRACT

Emphysematous cystitis is a rare complication of lower urinary tract infections. The disease is characterized by air within the bladder wall and lumen and commonly occurs in middle-aged diabetic women. Intramural bladder gas seen on imaging is pathognomonic for this condition. The severity of the illness varies widely from cases diagnosed incidentally to patients presenting with life-threatening sepsis. We report the case of an 80-year-old non-diabetic man presenting with emphysematous cystitis after a total colectomy for ulcerative colitis.


Subject(s)
Colitis, Ulcerative/complications , Cystitis/therapy , Emphysema/therapy , Aged, 80 and over , Colectomy , Cystitis/diagnostic imaging , Cystitis/etiology , Emphysema/diagnostic imaging , Emphysema/etiology , Humans , Ireland , Male , Radiography
17.
Ann Thorac Med ; 10(1): 44-9, 2015.
Article in English | MEDLINE | ID: mdl-25593607

ABSTRACT

INTRODUCTION: Inferior vena cava collapsibility index (IVC-CI) has been shown to correlate with both clinical and invasive assessment of intravascular volume status, but has important limitations such as the requirement for advanced sonographic skills, the degree of difficulty in obtaining those skills, and often challenging visualization of the IVC in the postoperative patient. The current study aims to explore the potential for using femoral (FV) or internal jugular (IJV) vein collapsibility as alternative sonographic options in the absence of adequate IVC visualization. METHODS: A prospective, observational study comparing IVC-CI and Fem- and/or IJV-CI was performed in two intensive care units (ICU) between January 2012 and April 2014. Concurrent M-mode measurements of IVC-CI and FV- and/or IJV-CI were collected during each sonographic session. Measurements of IVC were obtained using standard technique. IJV-CI and FV-CI were measured using high-frequency, linear array ultrasound probe placed in the corresponding anatomic areas. Paired data were analyzed using coefficient of correlation/determination and Bland-Altman determination of measurement bias. RESULTS: We performed paired ultrasound examination of IVC-IJV (n = 39) and IVC-FV (n = 22), in 40 patients (mean age 54.1; 40% women). Both FV-CI and IJV-CI scans took less time to complete than IVC-CI scans (both, P < 0.02). Correlations between IVC-CI/FV-CI (R(2) = 0.41) and IVC-CI/IJV-CI (R(2) = 0.38) were weak. There was a mean -3.5% measurement bias between IVC-CI and IJV-CI, with trend toward overestimation for IJV-CI with increasing collapsibility. In contrast, FV-CI underestimated collapsibility by approximately 3.8% across the measured collapsibility range. CONCLUSION: Despite small measurement biases, correlations between IVC-CI and FV-/IJV-CI are weak. These results indicate that IJ-CI and FV-CI should not be used as a primary intravascular volume assessment tool for clinical decision support in the ICU. The authors propose that IJV-CI and FV-CI be reserved for clinical scenarios where sonographic acquisition of both IVC-CI or subclavian collapsibility are not feasible, especially when trended over time. Sonographers should be aware that IJV-CI tends to overestimate collapsibility when compared to IVC-CI, and FV-CI tends to underestimates collapsibility relative to IVC-CI.

18.
J Clin Pathol ; 41(4): 441-3, 1988 Apr.
Article in English | MEDLINE | ID: mdl-2835401

ABSTRACT

A fatal rupture of an hepatic tumour occurred in an athlete who had been taking anabolic steroids for several years as an aid to body building. The case illustrates the hazards of non-therapeutic androgen administration, and emphasises the need for athletes to be made clear of the disturbances to gonadal function, liver structure and function, and the threat to life.


Subject(s)
Anabolic Agents/adverse effects , Liver Neoplasms/chemically induced , Sports , Adult , Carcinoma, Hepatocellular/chemically induced , Humans , Liver/pathology , Liver Neoplasms/pathology , Male
19.
J Clin Pathol ; 48(1): 59-60, 1995 Jan.
Article in English | MEDLINE | ID: mdl-7706521

ABSTRACT

AIMS: To evaluate the interobserver variation in the diagnosis of cervical intraepithelial lesions, including the new category "borderline abnormalities of uncertain significance" (BAUS) which has not been tested before. METHODS: Biopsy specimens of 122 patients were reviewed by five histopathologists and the diagnoses subjected to kappa statistical analysis. RESULTS: There was poor interobserver agreement in all categories, particularly between BAUS and normal tissue. CONCLUSIONS: The current guidelines for the histological diagnosis of cervical intraepithelial neoplasia and BAUS are poorly reproducible.


Subject(s)
Cervix Uteri/pathology , Uterine Cervical Dysplasia/pathology , Uterine Cervical Neoplasms/pathology , Biopsy , Female , Humans , Observer Variation , Papillomaviridae , Papillomavirus Infections/pathology , Tumor Virus Infections/pathology , Uterine Cervical Neoplasms/classification , Uterine Cervical Dysplasia/classification
20.
J Laryngol Otol ; 109(3): 262-4, 1995 Mar.
Article in English | MEDLINE | ID: mdl-7745352

ABSTRACT

Angiolymphoid hyperplasia with eosinophilia is a rare benign condition that causes swellings in the head and neck. It is difficult to diagnose prior to biopsy and is frequently mistaken for a malignant tumour. A case involving a 21-year-old man who presented with a 2 cm diameter fibrous lesion in the subcutaneous tissue of the cheek is reported. The clinical and histological features are reviewed and the differences between this condition and the similar condition of Kimura's disease are discussed. Initial treatment with intralesional or systemic steroids is suggested as this may avoid the need for excision.


Subject(s)
Angiolymphoid Hyperplasia with Eosinophilia/diagnosis , Adult , Angiolymphoid Hyperplasia with Eosinophilia/pathology , Cheek , Diagnosis, Differential , Humans , Male
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