Background:Current dogma suggests that the diagnosis of rectal injury can be made after physical examination and proctoscopy (PR). However,anecdotal evidence suggests that these modalities lack specificity when applie...Background:Current dogma suggests that the diagnosis of rectal injury can be made after physical examination and proctoscopy (PR). However,anecdotal evidence suggests that these modalities lack specificity when applied to children and that computed tomography (CT) scanning may be superior. A direct comparison between CT scanning and PR has not been performed. We therefore sought to compare CT with PR in the diagnosis of rectal injury by analyzing our large institutional experience. Methods:To assess institutional outcome,the charts of all children younger than 18 years admitted to our level I trauma center (1999-2004) were prospectively collected and retrospectively assessed. Demographics,diagnostic accuracy (PR vs CT),and outcome (length of stay,days in the intensive care unit [ICU],Injury Severity Score,and missed injury) were assessed. Results:There were 24 injuries (63% boys,71% blunt,100% survival),and diagnostic modality included the following:PR,37.5% ; CT,37.5% ; laparotomy alone,8% . Length of stay (PR 5.7 ± 6.2 vs CT 13.7 ± 22.2,NS) were similar between groups. Of the missed rectal injuries,66% of patients undergoing PR hadmissed injuries that were ultimately detected by CT whereas 33% of the patients undergoing CT scan had a missed injury. Conclusion:CT is at least as accurate as PR in diagnosing pediatric rectal injury. Consideration of early scanning as opposed to PR may improve diagnosis and outcome in these patients.展开更多
评价在开展老年直肠镜检查时辅以个体化健康教育,分析此方法的的应用效果。方法:选择来我院做直肠镜检查的受检者中选出病情适合本研究的老年人70例,患者来院检查的时间段为2019年1月份到2019年12月份,按照检查顺序将其平均分为对照组(...评价在开展老年直肠镜检查时辅以个体化健康教育,分析此方法的的应用效果。方法:选择来我院做直肠镜检查的受检者中选出病情适合本研究的老年人70例,患者来院检查的时间段为2019年1月份到2019年12月份,按照检查顺序将其平均分为对照组(前6个月)和观察组(后6个月),每组例数各为35例。前者仅依靠以往的常规护理,后者辅以个性化健康教育,对比两组受检者的肠道清洁程度、治疗依从性;对比两组受检者检查前后的心率、舒张压、收缩压水平。结果:观察组的肠道清洁优良率比对照组高增加较多(100.00% VS 77.14%)(P<0.05)。观察组配合检查的依从性也比对照组上升较多(100.00% VS 77.14%)(P<0.05)。两组受检者的心率、舒张压、收缩压数据在检查前差别不大(P>0.05);干预后,观察组以上指标数据与检查前变化不大(P>0.05),但是对照组的以上指标却上升很过,且明显高于同时间点观察组水平(P<0.05)。结论:个体化健康教育可提高老年直肠镜检查的检查效果,值得临床推广应用。展开更多
PURPOSE: This study was designed to compare routine clinical examination and d efecography in the diagnosis of rectal intussusception in constipated patients a nd study relationships between rectal intussusception and...PURPOSE: This study was designed to compare routine clinical examination and d efecography in the diagnosis of rectal intussusception in constipated patients a nd study relationships between rectal intussusception and symptoms. METHODS: A t otal of 127 consecutive patients with functional constipation were examined in t he left-lateral position with rectal palpation and rectoscopy according to a pr otocol. An overall clinical judgment was made if the patient had intussusception , unclear finding, or no intussusception. Defecography was performed without kno wledge of the results of the clinical evaluation. Symptomduration varied between 0.5 to 60 (median, 10) years. All patients fulfilled a bowel questionnaire and all had a full physiologic workup. RESULTS: A diagnosis by digital examination ( P = 0.002) and by rectoscopy (P = 0.002) as well as the overall judgment (P = 0. 0002) was clearly related to a longer intussusception as measured by defecograph y. Five of six intraanal intussusceptions were correctly assessed by clinical examinat ion,whereas the correlation to defecographywas poor in the group with short intu ssusceptions. Neither clinical nor defecographic diagnosis of rectal intussuscep tion were related to the main symptoms of constipation but both were associated with a tendency toward lower anal resting pressures (P = 0.04 and P = 0.06) and an obtuse anorectal angle (during evacuation, P = 0.01 and P = 0.01). CONCLUSION S: There is no clear relationship between rectal intussusception and constipatio n. However, intussusception is related to sphincter function and may be of clini cal relevance. A normal clinical examination will exclude most long intussuscept ions, whereas a positive finding needs further evaluation with defecography.展开更多
文摘Background:Current dogma suggests that the diagnosis of rectal injury can be made after physical examination and proctoscopy (PR). However,anecdotal evidence suggests that these modalities lack specificity when applied to children and that computed tomography (CT) scanning may be superior. A direct comparison between CT scanning and PR has not been performed. We therefore sought to compare CT with PR in the diagnosis of rectal injury by analyzing our large institutional experience. Methods:To assess institutional outcome,the charts of all children younger than 18 years admitted to our level I trauma center (1999-2004) were prospectively collected and retrospectively assessed. Demographics,diagnostic accuracy (PR vs CT),and outcome (length of stay,days in the intensive care unit [ICU],Injury Severity Score,and missed injury) were assessed. Results:There were 24 injuries (63% boys,71% blunt,100% survival),and diagnostic modality included the following:PR,37.5% ; CT,37.5% ; laparotomy alone,8% . Length of stay (PR 5.7 ± 6.2 vs CT 13.7 ± 22.2,NS) were similar between groups. Of the missed rectal injuries,66% of patients undergoing PR hadmissed injuries that were ultimately detected by CT whereas 33% of the patients undergoing CT scan had a missed injury. Conclusion:CT is at least as accurate as PR in diagnosing pediatric rectal injury. Consideration of early scanning as opposed to PR may improve diagnosis and outcome in these patients.
文摘评价在开展老年直肠镜检查时辅以个体化健康教育,分析此方法的的应用效果。方法:选择来我院做直肠镜检查的受检者中选出病情适合本研究的老年人70例,患者来院检查的时间段为2019年1月份到2019年12月份,按照检查顺序将其平均分为对照组(前6个月)和观察组(后6个月),每组例数各为35例。前者仅依靠以往的常规护理,后者辅以个性化健康教育,对比两组受检者的肠道清洁程度、治疗依从性;对比两组受检者检查前后的心率、舒张压、收缩压水平。结果:观察组的肠道清洁优良率比对照组高增加较多(100.00% VS 77.14%)(P<0.05)。观察组配合检查的依从性也比对照组上升较多(100.00% VS 77.14%)(P<0.05)。两组受检者的心率、舒张压、收缩压数据在检查前差别不大(P>0.05);干预后,观察组以上指标数据与检查前变化不大(P>0.05),但是对照组的以上指标却上升很过,且明显高于同时间点观察组水平(P<0.05)。结论:个体化健康教育可提高老年直肠镜检查的检查效果,值得临床推广应用。
文摘PURPOSE: This study was designed to compare routine clinical examination and d efecography in the diagnosis of rectal intussusception in constipated patients a nd study relationships between rectal intussusception and symptoms. METHODS: A t otal of 127 consecutive patients with functional constipation were examined in t he left-lateral position with rectal palpation and rectoscopy according to a pr otocol. An overall clinical judgment was made if the patient had intussusception , unclear finding, or no intussusception. Defecography was performed without kno wledge of the results of the clinical evaluation. Symptomduration varied between 0.5 to 60 (median, 10) years. All patients fulfilled a bowel questionnaire and all had a full physiologic workup. RESULTS: A diagnosis by digital examination ( P = 0.002) and by rectoscopy (P = 0.002) as well as the overall judgment (P = 0. 0002) was clearly related to a longer intussusception as measured by defecograph y. Five of six intraanal intussusceptions were correctly assessed by clinical examinat ion,whereas the correlation to defecographywas poor in the group with short intu ssusceptions. Neither clinical nor defecographic diagnosis of rectal intussuscep tion were related to the main symptoms of constipation but both were associated with a tendency toward lower anal resting pressures (P = 0.04 and P = 0.06) and an obtuse anorectal angle (during evacuation, P = 0.01 and P = 0.01). CONCLUSION S: There is no clear relationship between rectal intussusception and constipatio n. However, intussusception is related to sphincter function and may be of clini cal relevance. A normal clinical examination will exclude most long intussuscept ions, whereas a positive finding needs further evaluation with defecography.
