HighlightsGastro-splenic fistula is rare condition that develops as complication of gastric or splenic pathologies.Delayed diagnosis of splenic abscess predisposes to the formation of gastro-splenic fistula.Gastro-splenic fistula could develop in patients with sickle cell disease.CT scan is the diagnostic modality of choice and upper GI endoscopy findings are often misinterpreted.Splenectomy and proximal gastrectomy is the treatment of choice for the gastro-splenic fistula.
Background
Chronic rhinosinusitis (CRS) is a common inflammation of the nose and the paranasal sinuses. Intractable CRS cases are generally treated with endoscopic sinus surgery (ESS). Although the effect of ESS on CRS symptoms has been studied, the pattern of symptom improvement after ESS for CRS is yet to be investigated. The aim of this study was to determine the magnitude and sequence of symptom improvement after ESS for CRS, and to assess the possible preoperative factors that predict surgical outcomes in CRS patients.
Methods
This was a longitudinal prospective study of 68 patients who had CRS (with or without nasal polyps). The patients underwent ESS at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The Sino-nasal Outcome Test-22 (SNOT-22) questionnaire was used for assessment at four time points during the study: pre-ESS, 1-week post-ESS, 4 weeks post-ESS, and 6 months post-ESS.
Results
The difference between the mean scores recorded for the five SNOT-22 domains pre-ESS and 6 months post-ESS were as follows: rhinologic symptoms (t-test = 7.22, p-value = < 0.001); extra-nasal rhinologic symptoms (t-test = 4.87, p-value = < 0.001); ear/facial symptoms (t-test = 6.34, p-value = < 0.001); psychological dysfunction (t-test = 1.99, p-value = 0.049); and sleep dysfunction (t-test = 5.58, p-value = < 0.001). There was a significant difference between the mean scores recorded for the five domains pre-ESS and 6 months post-ESS. Rhinologic symptoms had the largest effect size (d = 1.12), whereas psychological dysfunction had the least effect size (d = 0.24). The only statistically significant difference in the SNOT-22 mean scores recorded 4 weeks post-ESS was observed between allergic and non-allergic patients (t = − 2.16, df = 66, p = 0.035).
Conclusion
Understanding the pattern of symptom improvement following ESS for CRS will facilitate patient counselling and aid the optimization of the current treatment protocols to maximize surgical outcomes and quality of life.
Level of evidence
Prospective observational.
Typhlitis (neutropenicenterocolitis) is a life-threatening condition with 50% mortality occurring in 3.5% of adult neutropenic patients. With no definitive physical findings, diagnosis is usually made with contrast-enhanced computerised tomography (CECT). We present the first-ever case of this diagnosis being made with 18F-FDG PET/CT.
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