ABSTRACT
Objective:To study the clinical characteristics of patients with difficulty in decannulation after a tracheotomy in a neurological intensive care unit.Methods:A total of 122 patients undergoing tracheotomy were divided into a decannulation success group ( n=73) and a difficult decannulation group ( n=49). The Full Outline of Unresponsiveness (FOUR) and the revised version of the Coma Recovery Scale (CRS-R) were used to assess the consciousness of those in both groups. Their swallowing ability, airway anatomy, secretion retention and aspiration were documented using the Functional Oral Intake Scale (FOIS), fiberoptic endoscopic examination, Marianjoy′s 5-point secretion severity scale and the penetration-aspiration scale (PAS). Univariate analysis and multiva-riate logistic regression analysis were conducted to isolate risk factors. Results:The univariate analysis showed that age, status of consciousness, swallowing ability, secretion retention, aspiration and opening of the glottis may be indicators of difficult decannulation after a tracheotomy among those with severe neurological diseases. The logistic regression analysis found that too much retention of pharyngeal secretions and insufficient opening of the glottis should also be treated as risk factors for difficult decannulation with such patients.Conclusions:Too much retention of pharyngeal secretions and poor opening of the glottis are independent risk factors for difficult decannulation after a tracheotomy. Endoscopic examination can play an important role in the prediction and treatment of difficult decannulation.
ABSTRACT
ObjectiveTo explore the diagnostic value of fiberoptic endoscopic examination of swallowing (FEES) combined with dye test in patients with post-stroke dysphagia and silent aspiration. MethodsFrom December, 2021 to June, 2022, 50 stroke patients in the Rehabilitation Department of Xuzhou Central Hospital were selected. They were assessed with FEES and videofluoroscopic swallowing study (VFSS), and compared. ResultsThe detection rate of aspiration was higher with FEES than with VFSS (χ2 = 7.000, P < 0.05), and especially for liquid food (χ2 = 4.000, P < 0.05). There was a good consistency when consuming paste food (κ = 0.941, P < 0.001) and solid food (κ = 0.779, P < 0.001). There was a good consistency in the food residue site between two methods (κ = 0.818, P < 0.001), as well as for all the three food types (κ ≥ 0.862, P < 0.001). There was no significant difference in the scores of Penetration Aspiration Scale of three food types between two methods (Z < 0.667, P > 0.05). ConclusionFEES combined with dye test can be used for evaluating silent aspiration after stroke.
ABSTRACT
Intestinal transplantation has become the most ideal treatment for intestinal failure. Modern clinical intestinal transplantation includes three types: isolated intestinal transplantation, combined liver-intestinal transplantation and abdominal multivisceral transplantation. The immunological, anatomical and physiological characteristics of intestinal grafts significantly differ from those of other solid transplant organs. Consequently, intestinal grafts could develop specific and severe complications, such as acute rejection, chronic rejection, graft-versus-host disease (GVHD), infection and posttransplant lymphoproliferative disease (PTLD), among which acute rejection and infection are extremely challenging. Endoscopic examination and intestinal mucosal biopsy of intestinal grafts could be performed to make timely diagnosis and differentiation of these complications, then deliver targeted treatment and guarantee the long-term survival of recipients and intestinal grafts.
ABSTRACT
BACKGROUND/AIMS: Ampullary tumors come in a wide variety of malignant forms. We evaluated the diagnostic accuracy of endoscopy for ampullary tumors, and analyzed the causes of misdiagnosis. METHODS: We compared endoscopic imaging and biopsy results to final diagnoses. Types of endoscope, numbers of biopsy specimens taken, and final diagnoses were evaluated as possible factors influencing diagnostic accuracy. RESULTS: Final diagnoses were 19 adenocarcinomas, 18 normal or papillitis, 11 adenomas, two adenomyomas, one paraganglioma, and one neuroendocrine tumor. The diagnostic accuracy of endoscopic imaging or the initial biopsy was identical (67.3%). At least one test was concordant with the final diagnosis in all except two cases. Compared with the final diagnosis, endoscopic imaging tended to show more advanced tumors, whereas the initial biopsy revealed less advanced lesions. The diagnostic accuracy of the initial biopsy was influenced by the type of endoscope used and the final diagnosis, but not by the number of biopsies taken. CONCLUSIONS: Endoscopy has limited accuracy in the diagnosis of ampullary tumors. However, most cases with concordant endoscopic imaging and biopsy results are identical to the final diagnosis. Therefore, in cases where both of these tests disagree, re-evaluation with a side-viewing endoscope after resolution of papillitis is required.
Subject(s)
Adenocarcinoma , Adenoma , Adenomyoma , Biopsy , Diagnosis , Diagnostic Errors , Endoscopes , Endoscopy , Neuroendocrine Tumors , Papilledema , ParagangliomaABSTRACT
Objective To investigate the effects of lateral wall of the middle turbinate resection on the efficacy of endoscopic sinus surgery.Methods 100 patients with sinusitis were randomly divided into the study group and the control group,50 cases in each group.The control group received nasal endoscopic sinus surgery,while patients in the study group received endoscopic sinus surgery based on the implementation of the middle turbinate resection of the lateral wall.The clinical effect was observed and compared.Results The total effective rate of the study group was 94.0％,that of the control group was 90.0％,the difference between the two groups was not significant(x2 =0.36,P ＞ 0.05).The incidence rate of postoperative complications of the study group was 6.0％,which was significantly lower than 16.0％ of the control group (x2 =7.36,P ＜ 0.05).The recurrence rate of the study group was 6.0％,which was significantly lower than 18.0％ in the control group (x2 =8.19,P ＜ 0.05).The hospitalization time and local irrigation frequency in the study group were significantly lower than those of the control group (t =11.301,7:024,all P ＜ 0.05).Conclusion For clinical sinusitis patients undergoing endoscopic sinus surgery,the lateral wall of the middle turbinate resection can be implemented,it not only has better clinical efficacy and the patients' nasal anatomy has no destruction,but also can effectively guarantee the wide nasal passages,reduce postoperative adhesions,which worthy of clinical application.
ABSTRACT
La fístula de líquido cefalorraquídeo (FLCR) es la comunicación entre el espacio subaracnoídeo y la vía aérea superior. Las podemos clasificar según su etiología en quirúrgicas, traumáticas, congénitas y espontáneas. El tratamiento de las fistulas de LCR puede ser conservador o quirúrgico. OBJETIVO: Describir la experiencia en el manejo de fístulas de líquido cefalorraquídeo y analizar las técnicas quirúrgicas endoscópicas intranasales y los resultados quirúrgicos obtenidos en nuestro servicio. MATERIALES Y MÉTODOS: Estudio descriptivo, retrospectivo de corte transversal. Se incluyeron pacientes con diagnóstico de FLCR que recibieron tratamiento en el Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital de Clínicas de la Universidad Nacional de Asunción entre marzo de 2008 y diciembre de 2012. RESULTADOS: Se revisaron 17 historias clínicas de pacientescon diagnóstico de FLCR. El tratamiento fue conservador en 2 pacientes. En los 15 restantes se realizó reparación endoscópica del defecto. Sólo un paciente presentó recidiva. CONCLUSIÓN: La experiencia en nuestro servicio demuestra que el abordaje endoscópico se ha ganado su espacio en el tratamiento de las fístulas de LCR. Los resultados obtenidos para la corrección de fistulas son favorables, con buena tasa de éxito y pocas complicaciones.
The cerebrospinal fluid leak (CSF leak) is defined as the communication between the subarachnoid space and the upper airway. Can be classified according to their etiology: surgical, traumatic, congenital and spontaneous. The treatment of CSF fistulas can be conservative or surgical. OBJECTIVE: To describe the experience in the management of cerebrospinal fluid leaks and analyze intranasal endoscopic surgical techniques and surgical results obtained in our service. MATERIALS AND METHODS: A descriptive, cross-sectional, retrospective study. We included patients with a diagnosis of CSF leak who were treated at the Department of Otolarhinoryngology and Head and Neck Surgery of the Hospital de Clinicas of the Universidad Nacional de Asuncion between March 2008 and December 2012. RESULTS: We reviewed 17 medical records of patients diagnosed with CSF leak between March 2008 and December 2012. The most frequent reason for consultation was watery rhinorrhea in 16 cases. There was a case that consulted form metallic foreign body in the nasal cavity roof. Treatment was conservative in 2 patients. In the remaining 15 was performed endoscopic repair of the defect. Only one patient had recurrence. CONCLUSION: The experience in our service demonstrates that the endoscopic approach has earned its place in the treatment of CSF leakage. The results for the corrections are favorable, with good success rate and few complications.
Subject(s)
Fistula/cerebrospinal fluid , FluoresceinABSTRACT
Objective To investigate the morphologic features of gastric intestinal metaplasia (IM)using narrow band imaging(NBI)endoscopy,and its feasibility and accuracy for diagnosis of IM combined with histopathology.Methods The endoscopic examination was performed on 80 patients and suspected lesions associated with IM was further observed by NBI combined with magnifying endoscopy.The biopsy specimens were obtained from regions containing light blue crest(LBC)or non-LBC mucosa for pathological examination,and the results were analyzed.Results In 80 patients examined with NBI,IM was pathologically confirmed in 65 patients.Of which LBC was seen in 61 patients with a sensitivity of 94%and a specificity of 95%.In a total of 94 specimens obtained from LBC region,86 had histological evidence of IM with a positive predictive value of 9 1.49%.There was no evidence of IM in 79 out of 94 specimens obtained from non-LBC region of patients with or without LBC with a negative predictive value of 84.04%.The results indicated that the detective rate of IM could be increased if biopsy specimen was obtained from LBC region with help of NBI endoscopy(P＜0.05).Conclusions It has been demonstrated that NBI combined with magnifying endoscopy may improve the diagnosis of IM by clearly observing microvasculature and targeted-biopsy in LBC region,which is helpful in early diagnosis of gastric cancer.
ABSTRACT
Objective To reduce the rate of dysphagia and inhalation pneumonia by changing the food dense and evaluate the swallow function by videofluoroscopy(VF) and fiberoptic endoscopic examination of swallowing(FEES). Methods The videofluoroscopy and fiberoptic endoscopic examination of swallowing were used in 50 healthy volunteer and 35 dysphagia person. Results Aspiration was find in 14% volunteer and penetration was find in 36% volunteer. The positive rate of videofluoroscopy was higher than of fiberoptic endoscopic examination of swallowing in the two indicators. The delay of the thin barium passed the pharynx was the danger factor of aspiration. Videofluoroscopy was more sensitive in diagnosis of penetration. The time that watery barium and pudding barium flowed from pharynx to epiqlottis is longer in patients than that in volunteer. Conclusion The videofluoroscopy and fiberoptic endoscopic examination could be predicted to some extend by some clinical swallowing abnormalities, which could increase the accuracy of clinical evaluation . The viscosity changing can decrease the rate of dysphagia and inhalation pneumonia.
ABSTRACT
Swallowing syncope is thought to be induced by an abnormal esophagovagal reflex arc that leads to transient bradyarrhythmia. Bradyarrhythmia in the response to swallowing produce decreased cardiac output and cerebral perfusion which result in loss of consciousness. Dysarrhythmia are common during any procedure which involves the manipulation of upper gastrointestinal tract, such as endoscopy of the esophagus or stomach. Swallowing syncope represents an extreme form of this phenomenon. We report a patient who had bradycardia and fainting episode during endoscopic examination. High degree atrioventricular block was detected in 24 hr Holter monitoring.
Subject(s)
Humans , Atrioventricular Block , Bradycardia , Cardiac Output , Deglutition , Electrocardiography, Ambulatory , Endoscopy , Esophagus , Perfusion , Reflex , Stomach , Syncope , Unconsciousness , Upper Gastrointestinal TractABSTRACT
Objective To evaluate the applicative value of fiberoptic ductoscopy(FDS)in abnormal nipple discharge.Methods A total of 104 patients with nipple discharge were examined by fiberoptic ductoscopy(Germany Scholly Fiberoptic Gmbh 42.0500).The results were compared with postoperative pathological diagnosis.Results All the 104 cases were successfully diagnosed with FDS.The detectable rate for intraductal mass by ductoscopy is 94 %(49/52).The sensitivity and specificity of ductoscopy for mammary duct cancer is 50%(1/2)and 91%(43/47)respectively;the negative predictive value is 98%(43/44),positive predictive value is 20%(1/5),and accuracy is 90%(44/49).Five cases of papillomatosis were diagnosed by ductoscopy,in which 3 cases were consistent with postoperative pathological findings,therefore the diagnose accordance rate is 60%;the other 2 cases were proven to be multiple papilloma.Thirty-eight cases of papilloma were detected by ductoscopy and received lobectomy of bresat;55 cases of inflammatory duct disease did not receive any operation;and 3 cases(3%,3/104)were diagnosed papilloma by re-examination with ductoscopy due to persistent nipple discharge,and were confirmed after operation.Conclusions Fiberoptic ductoscopy is the first choice for examination of nipple discharge for its accuracy in finding pathogenic cause and locating lesion,and surgery can thereby be avoided for galactophoritis and mammarv duct ectasia patients.
ABSTRACT
Anisakiasis is a accidental parasitic infection caused by nematode larvae belonging to the subfamily Anisakinae when a raw or inadequately cooked fish is ingested. The common clinical symptoms are severe colicky abdominal pain or epigastric full sensation, nausea, vomiting and fever, but hematemesis or melena is very rare. We report a case of a 11-year-old female child who developed severe epigastric pain recurrently for 2 months, and recalled that she had eaten the raw flesh of an Astroconger myriaster. Endoscopic examination showed the whitish worm invading the stomach wall. Clinical symptoms disappeared after endoscopic removal. This study may be the first pediatric case of gastric anisakiasis in korea.