Adenoidectomy performed without vision may be one of the reasons for recurrence of symptoms. Residual adenoids are acknowledged in the literature as one of the complications of the traditional technique. We highlight the fact that the need for revision adenoidectomy is not uncommon and suggest that we should improve our surgical technique in the UK by visualization of the postnasal space either by a mirror or an endoscope.
Background
Our study validated the low anterior resection syndrome (LARS) score questionnaire, the colorectal functional outcome (COREFO) questionnaire, and the Memorial Sloan-Kettering Cancer Center bowel function instrument (MSKCC-BFI) in Greek rectal cancer patients.
Methods
Internal consistency, repeatability, construct and discriminant validity were evaluated for LARS, COREFO, and MSKCC-BFI questionnaires. The convergent validity was assessed by correlations with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR29 domains.
Results
The internal consistency of the questionnaire’s subscales was satisfactory (Cronbach’s a>0.6). The repeatability test showed extremely high reproducibility (intraclass correlation coefficient >0.9). High positive correlation was detected between the 3 questionnaires’ total scores and each of their questions (rho>0.5), indicating their valid construction. All questionnaires demonstrated a good convergent validity through correlations with comparable domains of the EORTC QLQ-C30 and CR29. Statistically significant associations were detected between LARS, COREFO, MSKCC-BFI scores and tumor distance and temporary stoma (P<0.001 and P=0.009, P<0.001 and P=0.005, P<0.001 and P=0.002 respectively). In addition, COREFO and MSKCC-BFI scores were significantly associated with radiation therapy. LARS score was significantly correlated to all COREFO and MSKCC-BFI subscales.
Conclusions
The Greek versions of the LARS score, COREFO and MSKCC-BFI questionnaires were proven to have good psychometric properties and can be used as specific and valid instruments for measuring LARS. Since the COREFO and MSKCC-BFI questionnaires, which are more extensive and possibly less applicable in routine clinical practice, showed no advantages in relation to the LARS score, the latter may be established as the simplest, fastest to complete and most targeted tool for assessing LARS.
The most commonly used adenoidectomy technique in the UK is digital palpation followed by blind curettage, according to this postal questionnaire survey. Few respondents reported performing adenoidectomy under direct vision: only 10 per cent used a mirror during the procedure and only 8 per cent used an endoscope.
HighlightsLumbar-peritoneal (LP) and ventriculo-peritoneal (VP) shunt placement is the treatment of choice for diversion of cerebrospinal fluid (CSF) from the subarachnoid space into the peritoneal cavity.Perforation of the bowel by lumbar-peritoneal or ventriculo-peritoneal shunt is an extremely rare complication.We report a case of a 72 old female patient with LP shunt for raised intracranial pressure, who presented with LP shunt catheter protruding from anus.She was surgically treated with removal of the distal part of the shunt, external drainage of the proximal part and primary closure of the perforation.
Primary extra-nodal non-Hodgkin's lymphoma (NHL) of the skeletal muscles is a well recognized entity although such occurrences are not very common. Presentation in the muscles of the face has only rarely been described. We present a case of primary extra-nodal NHL in a non-immunocompromised patient involving only the muscles of facial expression and not extending to the oral cavity or sinonasal tract. The patient was subsequently treated with chemotherapy and at the time of writing remained in remission. We suggest that lymphoma should be considered among the causes for malignant infiltration of the muscles of the face.
Key Clinical MessagePatients with postradiation therapy for malignancies and/or extensive colorectal surgery are prone to the development of enteroperineal fistulas. Application of biological meshes may prove beneficial in treating complicated enteroperineal fistulas as they provide a stable ground for closing pelvic defects even in contaminated fields.
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