Oral preparations for flexible sigmoidoscopy.
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Administration, Oral↗
Biomedical subjects
R K Fincher
Publications and source records attributed to R K Fincher.
Resident participation in flexible sigmoidoscopy does not affect patient satisfaction.
OBJECTIVE: We sought to assess the effect of resident involvement in flexible sigmoidoscopy on patient satisfaction and comfort. METHODS: Adults undergoing flexible sigmoidoscopy completed a previsit questionnaire on indication for procedure, GI-related history, and functional status. Immediately after the procedure, satisfaction and procedure comfort were assessed. Additional information collected included procedure duration, depth of sigmoidoscope penetration, and visualization of diverticuli or polyps. RESULTS: Among 408 endoscopies, patient characteristics and procedure indications were similar between sigmoidoscopies done by residents (n = 111) or staff. There were no differences in patient satisfaction, procedure comfort, or willingness to undergo the procedure again in the future. Sigmoidoscopies involving residents averaged 5.6 min longer, even after adjusting for preparation quality, depth of insertion, specific endoscopist, and the presence of polyps or diverticuli. CONCLUSIONS: Patient satisfaction and comfort with flexible sigmoidoscopy was not reduced by resident involvement, though the procedure duration was slightly longer.
Female↗
Ampullary somatostatinoma in a patient with Merkel cell carcinoma.
A 59-yr-old white man with Merkel cell carcinoma of his right leg status post extensive skin resection and chemotherapy had dilated hepatic and common bile ducts on a routine follow-up abdominal CT scan. A 1.9-cm ampullary mass was appreciated on endoscopy. Histology showed psammoma bodies and positive immunoperoxidase staining consistent with a somatostatinoma. Merkel cell tumors and somatostatinomas are extremely rare neuroendocrine tumors derived from neural crest cells. Associations have been found between somatostatinomas and other islet cell tumors with multiple endocrine neoplasia syndromes, but no reported association has been published between islet cell tumors and Merkel cell tumors. This patient represents the first documented case of Merkel cell carcinoma and somatostatinoma in a single patient. Such an occurrence may represent a previously undescribed neuroendocrine tumor syndrome, and this possibility should be considered when either tumor is diagnosed.
Carcinoma, Merkel Cell↗
A comparison of bowel preparations for flexible sigmoidoscopy: oral magnesium citrate combined with oral bisacodyl, one hypertonic phosphate enema, or two hypertonic phosphate enemas.
OBJECTIVE: Magnesium citrate with hypertonic enemas or oral bisacodyl provides superior preparation quality for sigmoidoscopy over enemas alone. We compared three magnesium citrate sigmoidoscopy preparations in a randomized, single-blind, controlled trial. METHODS: Two hundred and ninety-one adults scheduled for routine sigmoidoscopy were randomly assigned to receive one of three preparations containing oral magnesium citrate (296 cc) taken the night before the procedure in combination with the following: 1) oral bisacodyl (10 mg), given with the magnesium citrate the night before the procedure; 2) one hypertonic phosphate enema 1 h before the procedure; or 3) two hypertonic phosphate enemas, given singly at 2 and 1 h before the procedure. Endoscopists rated preparation quality, procedure duration, and depth of endoscopic insertion. Patients assessed preparation comfort and overall satisfaction. RESULTS: Preparation quality was rated as excellent or good for 80.6% in the bisacodyl group, 88.7% in the one-enema group, and 85.1% in the two-enema group (p = 0.30). Patients reported the oral bisacodyl regimen was better tolerated (p = 0.032). Although the three regimens were comparable in most side effects, the bisacodyl preparation was associated with more diarrhea (p = 0.0003). Mean procedure duration, mean insertion depth, and prevalence of diverticula and polyps were similar in all groups. Fewer than 4% of patients required repeat procedures due to poor preparation quality. CONCLUSIONS: There was no statistical difference between the quality of the three bowel preparations. Patients considered an oral bisacodyl and magnesium citrate regimen more easily tolerated, though it was associated with more diarrhea.
Administration, Oral↗
Eosinophilia in Wegener's granulomatosis.
Significant eosinophilia is a prominent feature in Churg-Strauss syndrome but has only rarely been described in Wegener's granulomatosis (WG). We describe two Wegener's granulomatosis patients with > 30% eosinophilia on their initial presentations. Other etiologies that could account for their eosinophilia were excluded. Both patients had pulmonary alveolar hemorrhage, sinusitis, arthritis, high-titer cytoplasmic antineutrophil cytoplasmic antibodies (cANCA), and proteinase-3 antibodies, but no evidence of renal disease. Herein we discuss eosinophilia, the differential diagnosis of pulmonary infiltrates and eosinophilia, the role of cANCA in vasculitis and autoimmune disease, compare Wegener's granulomatosis and Churg-Strauss syndrome, and review possible pathogenic mechanisms.
Adult↗
Accuracy of measurements of hemoglobin and potassium in blood samples from peripheral catheters.
OBJECTIVE: To compare measurements of hemoglobin and potassium in blood samples obtained from peripheral venous catheters with measurements in samples obtained via venipuncture. SUBJECTS: 53 adult volunteer patients admitted to a medical ward. METHODS: For each patient, a 10-mL blood sample was obtained from a 20-gauge or larger peripheral venous catheter after a 3-mL volume of fluid was discarded. Immediately afterward, additional samples were obtained by venipuncture, and all samples were sent to the laboratory for measurement of hemoglobin and potassium levels. Separate venipuncture samples were obtained from both extremities in another 10 subjects to assess intratechnique variation. Results were analyzed by using limits-of-agreement analysis. RESULTS: Blood samples were successfully obtained from a peripheral catheter in 32 (60%) of the 53 patients. The success rate was 78% with 18-gauge catheters and 42% with 20-gauge catheters (P = .021). The 95% agreement interval in the set of differences between values for samples obtained via catheter and samples obtained via venipuncture was +/- 0.37 mmol/L for potassium and +/- 7.6 g/L for hemoglobin. The 95% agreement interval for the venipuncture control group was +/- 0.21 mmol/L for potassium and +/- 7.3 g/L for hemoglobin. The preset acceptable interval for potassium measurements was +/- 0.3 mmol/L, and that for hemoglobin measurements was +/- 10 g/L. CONCLUSIONS: Obtaining blood samples from peripheral catheters is an acceptable alternative to venipuncture for hemoglobin measurements but not for potassium measurements. Larger gauge catheters are better than small-gauge catheters for obtaining blood samples.
Adult↗