Meta-analysis: Intestinal ultrasound to evaluate colonic contents and constipation.

BACKGROUND: Constipation can be diagnosed clinically using the Rome criteria. Ultrasound (US), which lacks the radiation exposure of conventional X-ray, holds promise as a non-invasive tool to evaluate colonic contents and constipation. AIM: To examine the role of US in the assessment of constipation. METHODS: We performed a systematic search of Embase (OVID, 1984), Medline (Ovid, 1946), Cochrane Central, ClinicalTrials.gov and Australia New Zealand Clinical Trials Registry from database inception to 26 January 2024 according to PRISMA guidelines and prospectively registered with PROSPERO. All studies using US to assess constipation or colonic contents in either adults or children were included. Rectal diameter measurements were pooled in meta-analysis. Risk of bias was assessed using the Newcastle Ottawa Scales and Joanna Briggs Institute checklists. RESULTS: Of 12,232 studies screened, 51 articles (6084 patients; 3422 children) describing US to assess symptoms in patients with constipation were included. Most studies used Rome criteria to diagnose constipation. Rectal diameter was associated with clinical constipation in 29 paediatric studies (3331 patients). Meta-analysis showed the mean rectal diameter of constipated patients was significantly higher than controls (mean difference 12 mm, 95% confidence intervals (CI): 6.48, 17.93, p < 0.0001, n = 16 studies). Other features of constipation on US included posterior acoustic shadowing and echogenicity of luminal contents. CONCLUSION: US is an appealing imaging modality to assess luminal contents and constipation. Further well-designed studies are required to validate US metrics that accurately identify constipation.

Paroxysmal stabbing headache in the multiple dermatomes of the head and neck: a variant of primary stabbing headache or occipital neuralgia?

A paroxysmal stabbing or icepick-like headache in the multiple nerve dermatomes, especially involving both trigeminal and cervical nerves, has not been fully explained or classified by the International Classification of Headache Disorder, 2(nd) Edition (ICHD-II). Of patients with acute-onset paroxysmal stabbing headache who had visited the Hallym University Medical Center during the last four years, 28 subjects with a repeated stabbing headache involving multiple dermatomes at the initial presentation or during the course were prospectively enrolled. All patients were neurologically and otologically symptom free. A coincidental involvement of both trigeminal and cervical nerve dermatomes included seven cases. Six cases involved initially the trigeminal and then cervical nerve dermatomes. Five cases showed an involvement of the cervical and then trigeminal nerve dermatomes. The remaining patients involved multiple cervical nerve branches (the lesser occipital, greater occipital and greater auricular). Pain lasted very shortly and a previous history of headache with the same nature was reported in 13 cases. Preceding symptom of an infection and physical and/or mental stress were manifested in seven and six subjects, respectively. All patients showed a self-limited benign course and completely recovered within a few hours to 30 days. Interestingly, a seasonal gradient in occurrence of a stabbing headache was found in this study. A paroxysmal stabbing headache manifested on multiple dermatomes can be explained by the characteristics of pain referral, and may be considered to be a variant of primary stabbing headache or occipital neuralgia.

Moyamoya disease initially presenting visual field defect.

Progressive narrowing of distal carotid arteries and the development of compensatory fine networks are the characteristic findings of moyamoya disease. Cerebral infarction in moyamoya disease is due to a decreased blood flow and shows an uneven distribution in the distal bed of the anterior and middle cerebral arteries. The progression of disease in the posterior circulation follows that in the anterior circulation. Posterior circulation symptoms due to cerebral infarction usually occur in the advanced stage of the disease and follow the anterior circulation symptoms. We encountered an unusual case of moyamoya disease which initially presented with a transient visual field defect. One month later our patient developed blindness and her cerebral angiography showed advanced moyamoya disease.

Single-layer continuous anastomosis in gastrointestinal surgery: a prospective audit.

BACKGROUND: Single-layer intestinal anastomoses have been constructed conventionally using an interrupted suture technique. It is however, increasingly popular to perform such anastomosis using a continuous suture. METHODS: One hundred and eighty consecutive patients with 254 continuous single-layer anastomoses performed over a 4 year period were included in the study. Sixty-one patients underwent oesophagectomy, oesophageal bypass or gastrectomy, 32 underwent biliary bypass, hepatic, biliary or pancreatic resection and 88 had colorectal operations. The median age was 67 years. RESULTS: There were 254 anastomoses of which four leaked (1.6%). Fifteen patients (8.3%) died in hospital. CONCLUSION: These results show that the single-layer continuous suture technique is safe in gastrointestinal anastomoses.

Blood coagulation monitoring and anticoagulant therapy after liver resection: brief report.

In this sample of 140 patients undergoing hepatic resection to remove cancerous tissue, hypercoagulation was the most common postoperative BCD; in ten patients, this complication led to hepatic failure and hepatic coma. These findings differ from those previously reported in the literature, possibly because our patients had advanced hepatomas which had already infiltrated the great vessels of the liver, and/or the remaining liver was seriously cirrhotic. We found that blood-coagulation monitoring and anticoagulation therapy yielded encouraging results, and it is our hope that this treatment in combination with immunotherapy will prolong the survival of these patients.