ABSTRACT
AIMS: To assess the factors contributing to the technical and clinical success of colorectal stenting for large bowel obstruction. METHODOLOGY: 268 cases of colonic stenting for large bowel obstruction were performed in 249 patients of mean age of 72 years (28-98) between 2006 and 2013. The majority of strictures were due to malignant disease, 244/268 (91 %). Diverticular strictures accounted for 24/268 (9 %). RESULTS: Overall technical success rate was 81 % (217/268), with a clinical success rate of 65 % (174/268). Duration of symptoms ranged from 0 to 180 days (mean 8 days). Technical success rate was seen to decrease with increasing symptom duration. For symptom duration of less than 1 week, technical success was 85.4 % (181/212) versus 69.6 % (39/56) for those with symptoms of greater than a week (p < 0.05). Clinical success rates fell from 71.3 % (107/150) to 59.3 % (70/118) (p < 0.05) when attempting to stent lesions of greater than 5 cm. There was also a significant reduction in clinical success when stenting lesions on a bend rather than a straight segment of colon 75.7 % (109/144) versus 59.7 % (74/124) (p < 0.05). A total of 20 (7.46 %) perforations were identified during the study. Stent migration occurred in 6.6 % of cases. In-stent stenosis occurred in 3.3 %. The overall 30-day all cause mortality rate was 9 %. CONCLUSION: Lesion size, location and duration of obstructive symptoms are statistically significant determinants of patient outcome. These factors could be used to advise patient selection for colonic stenting or direct progression to surgical intervention.
Subject(s)
Colonic Diseases/therapy , Colorectal Neoplasms/therapy , Diverticulosis, Colonic/therapy , Intestinal Obstruction/therapy , Stents , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Stents/adverse effects , Treatment OutcomeABSTRACT
Chronic paronychia is a common occupational disease. It is multifactorial and affects a number of different groups of workers. However, the condition is not described as affecting hairdressers although hairdressing is associated with a range of other occupation-related hand conditions. We report an unusual case of chronic paronychia in a female hairdresser which occurred as a consequence of a hair shaft penetrating beneath the nail fold. Personal hygiene with thorough removal of any hairs that have penetrated the epidermis and wearing clean gloves can prevent the condition. We suggest that clinicians should be aware of the types of occupation and mechanisms involved in patients developing chronic paronychia.
Subject(s)
Barbering , Foreign Bodies/complications , Hair , Nails/pathology , Occupational Diseases/pathology , Paronychia/pathology , Aged , Chronic Disease , Female , Foreign Bodies/microbiology , Humans , Nails/microbiology , Occupational Diseases/etiology , Occupational Diseases/microbiology , Paronychia/etiology , Paronychia/microbiology , Treatment OutcomeABSTRACT
Radiologists frequently encounter studies demonstrating spinal instrumentation, either as part of the patient's postoperative evaluation, or as incidental to a study performed for another purpose. It is important for the reporting radiologist to identify potential complications of commonly used spinal implants. Part 1 of this review examined both the surgical approaches used and the normal appearances of these spinal implants and bone grafting techniques. This second part of the review will focus on the multimodal imaging strategy adopted in the assessment of the instrumented spine and the demonstration of imaging findings of common postoperative complications.
Subject(s)
Orthopedic Fixation Devices/adverse effects , Prostheses and Implants/adverse effects , Spinal Diseases/diagnosis , Spinal Fusion/adverse effects , Foreign-Body Migration/diagnosis , Humans , Magnetic Resonance Imaging , Medical Errors , Postoperative Complications/diagnosis , Prosthesis Failure , Prosthesis-Related Infections/diagnosis , Spinal Diseases/surgery , Spinal Fusion/instrumentation , Tomography, X-Ray Computed , Treatment FailureABSTRACT
The general radiologist frequently encounters studies demonstrating spinal instrumentation, either as part of the patient's postoperative evaluation or as incidental to a study performed for another purpose. There are various surgical approaches and devices used in spinal surgery with an increased understanding of spinal and spinal implant biomechanics drives development of modern fixation devices. It is, therefore, important that the radiologist can recognize commonly used devices and identify their potential complications demonstrated on imaging. The aim of part 1 of this review is to familiarize the reader with terms used to describe surgical approaches to the spine, review the function and normal appearances of commonly used instrumentations, and understand the importance of the different fixation techniques. The second part of this review will concentrate on the roles that the different imaging techniques play in assessing the instrumented spine and the recognition of complications that can potentially occur.
