Does use of a colonoscopy imaging device improve performance? A cohort study.

BACKGROUND: Magnetic endoscopic imagers (MEIs) are being introduced during colonoscopy, principally for training. They aid recognition and resolution of loops. This has potential to improve technique resulting in increased completion rates and better patients' experience. OBJECTIVE: To determine whether the use of a MEI improves colonoscopists' performance. DESIGN: Cohort study. SETTINGS: Endoscopy unit in a district general hospital. PATIENTS: Consecutive patients undergoing colonoscopy during a 33 month period were studied. INTERVENTION: Patients underwent colonoscopy with or without the use of a magnetic endoscopic imager. MAIN OUTCOME MEASURES: Patient comfort and colonoscopy completion rates with and without the use of a magnetic endoscopic imager. Other data recorded included sedation and analgesia doses, patient age and gender, bowel preparation quality, antispasmodic dose, time of day, and consciousness level. RESULTS: A total of 5,879 colonoscopies were performed. A magnetic endoscopic imager was used for 4,873. A greater proportion of patients in the imager group had the lowest discomfort score (56.2 vs. 39.8%, logistic regression; p = 0.005). Doses of midazolam were similar in both groups (1.93 vs. 2.14 mg for imager and nonimager groups respectively). Completion rates were 94.5% with an imager and 91% without (logistic regression; p = 0.088). Logistic regression analysis showed that buscopan improved completion rate but detrimental factors included increasing patient age, discomfort, poor bowel preparation, and an afternoon procedure. Factors not influencing completion included gender, sedation and analgesia doses, and consciousness level. There was no correlation between documented reason for failure and use of the imager. LIMITATIONS: This was a nonrandomized trial although improved with logistic regression analysis. CONCLUSIONS: Magnetic endoscopic imager use improves patient comfort during colonoscopy but has not been shown to improve completion.

Massive traumatic abdominal hernia repair with biologic mesh.

Traumatic abdominal wall hernias (TAWHs) are rare. They can arise from either high or low impact trauma and can be associated with significant associated injury. We present the case of a 27-year-old male involved in a high-impact road traffic accident resulting in a TAWH. He sustained significant disruption to the abdominal wall and sustained injuries to the thoracic cage. Operative management was undertaken with a porcine dermal collagen mesh, using a bridge technique.

Colonic vascular anomalies and colon cancer in neurofibromatosis: report of a case.

We report a case of neurofibromatosis with synchronous adenocarcinomas in the sigmoid and transverse colon. There was widespread intimal proliferation in arteries in the region of the tumors and also in the cecum. Such vascular lesions are associated with von Recklinghausen's disease. The cecal lesion produced mural thickening visible on computed tomography. This case supports a possible genetic link between neurofibromatosis and adenocarcinoma of the colon.

Wound oozing after total hip arthroplasty.

INTRODUCTION: Total hip arthroplasty is a commonly performed operation and yet little information exists about the duration of wound oozing, the factors associated with this and the implications. The aim of this work was to identify factors influencing wound oozing by establishing their effect on the time taken for wounds to cease oozing after total hip arthroplasty. PATIENTS AND METHODS: Sixty-two consecutive patients undergoing total hip arthroplasty were included. Wounds were examined for wound oozing on a daily basis by the same observer and were then re-dressed. The time taken for each wound to become dry was recorded. Data were analysed to determine if the time-to-dryness was influenced by wound length, body mass index, estimated volume of blood in the dissected tissues, duration of surgery and ASA grade. RESULTS: Time to dryness was associated with wound length (P = 0.01), body mass index (BMI, P = 0.05), estimated volume of blood in dissected tissues (P = 0.05) and length of hospital stay (P = 0.02). No association was found with duration of surgery or ASA grade. CONCLUSIONS: A small-incision, meticulous haemostasis at surgery and a reduction in pre-operative obesity reduce the time taken for hip arthroplasty wounds to become dry. Prolonged wound oozing delays hospital discharge.