Comparison of prediction of outcomes in upper GI bleed using non-endoscopic scoring systems

Background: Several scoring systems have been designed for risk stratification and prediction of outcomes in upper GI bleed. Endoscopy plays a major role in the diagnostic and therapeutic management of UGIB patients. However not all patients with UGIB need endoscopy. The objective of the present study was compared the prediction of mortality using different scoring systems in patients with upper GI bleed. A decision tool with a high sensitivity would be able to identify high and low risk patients and for judicious utilization of available resources.Methods: 100 patients were assessed with respect to their clinical parameters, organ dysfunction, pertinent laboratory parameters and five risk assessment scores i.e. clinical Rockall, Glasgow Blatchford, ALBI, PALBI and AIMS65 were calculated.Results: For prediction of outcomes, AIMS65 was superior to the others (AUROC of 0.889), followed by the GBS (AUROC of 0.869), followed by clinical Rockall score (AUROC 0.815), followed by ALBI score (AUROC of 0.765), followed by PALBI score (AUROC of 0.714) all values being statistically significant.Conclusions: The AIMS65 score is best in predicting the mortality in patients with upper GI bleed. The optimum cut off being >2. Though GBS may be better in predicting the need for intervention, it is inferior in predicting the mortality. The newer scores like ALBI and PALBI are inferior to AIMS65 and GBS in predicting mortality.

Nonendoscopic endonasal dacryocystorhinostomy: Outcome in 134 eyes.

Aims: To evaluate the outcome of nonendoscopic endonasal dacryocystorhinostomy (NEN‑DCR) in patients with nasolacrimal duct obstruction (NLDO) in India. Methods: Retrospective case series of NEN‑DCR between July 2012 and October 2014. All patients had follow‑up >3 months. Success was defined anatomically as patency on irrigation and functionally as relief from epiphora. Statistical Analysis Used: Fischer’s exact test and Chi‑square test. Results: A total of 122 patients (134 eyes; 81 female; mean age 37 ± 18 years) were included. Indications were primary acquired NLDO in 92 (68%) eyes of adults (>18 years), NLDO in children (<18 years) in 22 eyes (16%), acute dacryocystitis in 13 eyes, failed prior DCR in six eyes, and secondary acquired NLDO in one eye. Mean duration of surgery was 36 min (range: 16–92). At a median follow‑up of 6 months (range: 3–15), 86% eyes had functional success and 85% had anatomical success. Revision NEN‑DCR was successful in 13/16 eyes. All patients with acute dacryocystitis were completely symptom‑free at final visit. In children, (17/22) 77% achieved functional success after primary NEN‑DCR which improved to 100% after one revision. Tube‑related epiphora and granuloma in ten eyes resolved after removal. Conclusion: NEN‑DCR gives good outcome in primary NLDO and is also effective in those with acute dacryocystitis and in children with NLDO. The technique obviates the need for an endoscope and has an acceptable safety profile and thus may be particularly suited for the developing nations.

Non-endoscopic Predictors of Large Esophageal Varices in Patients with Liver Cirrhosis / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to identify non-endoscopic predictors for the presence of large esophageal varices in Korean patients with liver cirrhosis. METHODS: Among 736 patients with liver cirrhosis newly diagnosed between the year 2001 and 2005, 245 patients (171 men and 74 women, mean age of 51.9 years) fulfilled the inclusion criteria and underwent EGD as screening tests for esophageal varices. Fifteen variables were analysed to identify the presence of large esophageal varices. RESULTS: Esophageal varices were noted in 186 patients (75.9%) and large varices in 55 patients (22.4%), while 59 patients (24.1%) had no varices at the time of initial diagnosis of cirrhosis. The causes of liver cirrhosis were viral hepatitis (41.2%), chronic alcoholism (42.4%), viral hepatitis/alcoholism (9.8%), and others (6.6%). Fifty-one percent, 35.1% and 13.9% of the patients belonged to Child-Pugh class A, B, and C, respectively. Variables associated with the presence of large esophageal varices on univariate analysis were the presence of ascites, splenomegaly (long-axis > or =12 cm by ultrasound measure), alcoholism, Child-Pugh class, platelet count, prothrombin time, and albumin. On multivariate analysis, alcohol, splenomegaly, and ascites were significantly associated with the presence of large esophageal varices. If the patients have two of them, sensitivity and negative predictive value were 80% and 91.7%, respectively. Patients without all three factors had no large esophageal varices. CONCLUSIONS: These results suggest that patients who have at least two among ascites, splenomegaly, and alcoholism would have an increased risk of having large esophageal varices.

Endoscopic and Non-endoscopic Epidural Adhesiolysis in FBSS Patient / 대한마취과학회지

BACKGROUND: The pathophysiologies of Failed Back Surgery Syndrome (FBSS) are epidural adhesion& fibrosis; arachnoiditis, neural encroachment, mechanical instability. Epidural adhesiolysis alleviate back pain through blocking the neural activity of scar area and decreasing the inflammation & edema. There are two methods of adhesiolysis, endoscopic & non-endoscopic adhesiolysis. Present study was aimed to compare the pain relief & side effects between two methods. METHODS: We investigated 86 post-laminectomy patients with low back pain and radiculopathy, who do not relieved with any kinds of conservative treatment. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with MRI examination. Group I was consisted with non-endoscopic 41 patients, and Group II was endoscopic 45 patients. Evaluation included assessment of pain relief (visual analogue scale, VAS), rate of reprocedures and duration of pain relief (VAS < 5) at post-epidural adhesiolysis 2 week, and 1, 2, 6 months. We also looked for complication of adhesiolysis. RESULTS: Statistical analysis (t-test, chisquared test) demonstrated VAS & reprocedure rate was significantly low (P < 0.05) in group II at 6 month and duration of pain relief (VAS < 5) was more prolonged in group II. One patient in each groups complained skin eruption and pruritus, and one patient of group II was proved epidural abscess and one patient of group I complained headache. CONCLUSIONS: Endoscopic and non-endoscopic epidural adhesiolysis are effective and safe in patients, who was not relieved the symptoms with conservative treatment, but endoscopic epidural adhesiolysis is more recommendable because its more prolonged effect.