ABSTRACT
Internal hernias are an infrequent cause of small bowel obstruction with transmesosigmoid herniation being very rare, especially in patients with no history of abdominal surgery or trauma. Early surgical intervention is important in acute presentation to reduce the high morbidity and mortality rates associated with this disease.
ABSTRACT
AIMS: We intended to define volume-normalized flow rates (cQ; VQI) and to construct and validate uroflow (Q)-volume (V) nomograms in our Indian (non-Caucasian) population. METHODS: Prospective observational study. PARTICIPANTS: Group A, male healthy volunteers 18-45 years without LUTS. Group B, men >18 years with LUTS (IPSS > 7; global QOL > 2). The participants voided in standing on normal-to-strong desire into digital gravimetric uroflowmeter. Data of <50 ml void and intermittent flow was discarded. Reference cQ calculated using (i) Von Garrelts equations (=Q/VV(2)), (ii) cubic equations (=Q/VV(3)). Bladder volume (BV) rather than voided volume (VV) was considered for Q-V relation (BV = VV + PVR). VQI derived from present data were compared with the reference-VQI in terms of differences in area-under-curve of receiver operating characteristics. For comparing sensitivity, specificity and predictive values of study nomograms with Caucasian nomograms (Liverpool and Siroky), data of group-A and -B were plotted on each nomogram and no. of observations above and below the cutoffs (defined as equivalent to -1 SD) manually counted. RESULTS: Total 542 voids of group-A and 465 of group-B included for final analysis. Q-V relation was best described as [Q â BV(2.4) â BV(2)]. The derived VQI (=Q/BV(2.4) â Q/BV(2)) fared significantly superior to reference VQI with VV as denominator. Nomograms, constructed on Q â BV(2) , were less sensitive but had higher specificity and positive predictive values compared to Caucasian nomograms. CONCLUSIONS: Volume-normalized flow-rate index with BV as denominator (Q/BV(2)) is has highly discriminative value in screening for voiding dysfunction. Population-specific Q-BV nomograms are more specific and predictive than Caucasian Q-VV nomograms.
Subject(s)
Asian People , Lower Urinary Tract Symptoms/diagnosis , Models, Biological , Urinary Bladder Diseases/diagnosis , Urinary Bladder/physiopathology , Urodynamics , Adult , Aged , Humans , India , Lower Urinary Tract Symptoms/ethnology , Lower Urinary Tract Symptoms/physiopathology , Male , Middle Aged , Nomograms , Predictive Value of Tests , Prospective Studies , Reference Values , Reproducibility of Results , Time Factors , Urinary Bladder Diseases/ethnology , Urinary Bladder Diseases/physiopathology , White People , Young AdultABSTRACT
Peripheral vascular disease is a rare feature of pheochromocytoma. This potentially catastrophic but curable tumor should be suspected in combination of distal necrosis with hypertension and palpable pulses. We report such an unusual case of pheochromocytoma presenting as toe necrosis.
