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W M Rodney

Publications and source records attributed to W M Rodney.

At least 37 records · Page 2Linked to original sources
PubMed1994

Maternal gallbladder assessment during obstetric ultrasound: results, significance, and technique.

BACKGROUND: Gallbladder disease is four times as common in women as in men, and pregnancy appears to contribute to the development of gallstones. During pregnancy, most women receive ultrasound scans, which are highly sensitive to the detection of gallstones. The purpose of this study was to examine the additional time and effort required to scan the gallbladder during obstetric ultrasound scanning. METHODS: The maternal gallbladder was examined in 228 consecutive obstetric ultrasound scans performed for medical indications at any time during pregnancy. Scanning was conducted by family physician faculty located in two university settings and one rural private practice. Patients were not required to fast prior to the scan. RESULTS: Gallstones were found in 5.3% of the patients, and an additional 3.1% had undergone prior cholecystectomy, for an overall incidence of current or previous gallbladder disease among 8.4% of the patients. The gallbladder was visualized in 97.4% of patients without a previous cholecystectomy. In 95.7% of cases, obtaining this additional information required less than 2 minutes. CONCLUSIONS: This study suggests that an evaluation of the maternal gallbladder at the time of obstetric ultrasound scans can be performed rapidly without special patient preparation. The study further suggests that obstetric ultrasound skills may allow family physicians to expand their diagnostic use of ultrasound to include gallbladder evaluation. Scanning techniques and the clinical significance of having this information in the patient's medical record are discussed.

Adolescent↗
PubMed1994

Cervicography.

Explore the source record for details and available documents.

Cervix Uteri↗
PubMed1994

Esophagogastroduodenoscopy for the family physician.

Esophagogastroduodenoscopy is most commonly performed for evaluation of epigastric pain, severe heartburn, chronic nausea and other dyspepsia syndromes that are not relieved by medical therapy. It should not be performed as an in-office procedure in patients with unstable angina, respiratory failure, active upper gastrointestinal bleeding or hemodynamic instability. Although office esophagogastroduodenoscopy is safe for low-risk patients, the risks associated with anesthesia and the need for postprocedure observation may require other patients to undergo the procedure in a hospital setting. Use of a local anesthetic throat spray reduces the gag response that occurs when the endoscope is swallowed. Sedation is commonly achieved with intravenous administration of a benzodiazepine plus a narcotic, and the effects of these drugs can be rapidly reversed. Complications are rare and most frequently result from medications rather than from the procedure itself.

Endoscopy, Digestive System↗
PubMed1993

Sedation associated with a more complete colonoscopy.

BACKGROUND: This study examined the effect of sedation on the rate of complete colonoscopic examinations by a family physician performing colonoscopy at an urban family practice residency. The outcomes of biopsies and polypectomies performed during the period of the study were also evaluated. METHODS: Data were prospectively collected on 164 consecutive colonoscopies. Seventy-three percent (124/164) of the examinations were training experiences supervised by the first author. The outcomes of examinations of 126 sedated patients were compared with those of 38 nonsedated patients. Patients were not randomly selected. RESULTS: Examinations of 126 sedated patients were carried out with an 85% reach-the-cecum rate compared with a 31% reach-the-cecum rate for 38 nonsedated patients (P < .05). A higher percentage of examinations done without sedation (16%) were terminated because of pain than were terminated in sedated patients (5%) (P < .05). An electrolyte purge solution was found to be the most effective colonoscopy preparation; only 7% (7/100) of examinations on patients prepared by this method were terminated because of inadequate bowel preparation. Adenomas were found in 11% (14/126) of sedated patients and in 8% (3/38) of nonsedated patients. Cancer was detected in 4 sedated patients. CONCLUSIONS: These findings suggest that sedation in colonoscopy is associated with a higher percentage of complete examinations. Also, patients prepared with an electrolyte purge solution tend to have fewer examinations terminated because of inadequate preparation.

Adenoma↗
PubMed1993

Management of suspected perforation following colonoscopy: a case report.

Early detection of colon cancer is imperative for a good prognosis. Family physicians are therefore becoming the front line of defense in the fight against colorectal malignancy. Many family physicians are incorporating colonoscopy into their practices in an attempt to avoid costly referrals and loss of continuity of care. While the complication rate for colonoscopy is extremely low, any physician who performs colonoscopy must be fully aware of all possible complications and their management.

Abdominal Pain↗
PubMed1993

Evolving colonoscopy skills in a rural family practice: the first 293 cases.

During the 1980s, many family physicians acquired flexible sigmoidoscopy skills for the early detection and secondary prevention of colorectal cancer. As these skills have matured, some family physicians have advanced from flexible sigmoidoscopy to the performance of colonoscopy. This is a descriptive report of this phenomenon from the private practice of one family physician. The first five years of total colonoscopy experience (293 procedures) were analyzed. No complications were encountered. A learning effect (measured in terms of scope depth and anatomical depth) was present during the first 50 procedures; an improvement in examination depth between the 25th and 50th procedure was present. Previous abdominal surgery had an effect on limiting scope-insertion depths. There were no complications, and among sedated patients, 137/253 (54%) of procedures reached the cecum. Important findings included cancer, polyps, and colitis. Twenty-seven percent (9/34) of important pathological findings were located beyond the reach of the 60 cm sigmoidoscope. This study of full colonoscopy in private family practice suggests it is safe, and the diagnostic yield is substantial. Additional studies by family physicians are needed regarding technique, quality assurance, and patient satisfaction.

Adolescent↗
PubMed1993

Esophagogastroduodenoscopy by family physicians phase II: a national multisite study of 2,500 procedures.

We have prospectively studied 1,783 upper gastrointestinal tract endoscopy procedures as performed by family physicians from thirteen separate office practices. Phase I of the study previously reported on 717 procedures in which patient management was enhanced, diagnostic yields were high, and biopsies were performed where appropriate. In Phase II, the data totaled 2,500 procedures representing 51.1 years of cumulative practice experience by the entire group. All cases were gathered prospectively and biopsies were confirmed by a pathologist's independent tissue analysis. In this series, family physicians were asked to record all complications, and to specify the exact manner in which performance of the procedure enhanced patient management. There have been biopsies in 1,230 (69% biopsy rate) Phase II cases with biopsy reports available in 1,194 (97% reporting rate) cases. There is pathological confirmation of the family physicians' visual diagnosis in 1,104 of 1,194 (93%) available biopsy reports for a 92% accuracy rate. There have been no complications, and the complication rate for the total series (1/2, 500) is now 0.0004.

Biopsy↗
PubMed1992

Flexible sigmoidoscopy and the despecialization of gastrointestinal endoscopy. An environmental impact report.

BACKGROUND: Gastrointestinal endoscopy is a diagnostic and therapeutic tool for the prevention of premature death from cancer. Flexible equipment innovations during the 1970s increased the power of this technique dramatically. For family physicians and general internists, dissemination of these techniques started around 1979 and continued during the 1980s. METHODS: In this report, data describing the gradual reformation of primary-care cancer screening are discussed. RESULTS: For example, one longitudinal study revealed a sustained improvement in physician compliance with American Cancer Society guidelines associated with the advent of flexible sigmoidoscopy and short colonoscopy skills. For symptomatic patients, compliance increased from 2% to 79% over 5 years. CONCLUSIONS: Flexible sigmoidoscopy is now well accepted. Endoscopic biopsy, full colonoscopy, and polypectomy skills are now available to many primary-care physicians. This represents a technical advance, and it is a small part of a larger medical-care revolution in which technology is decentralized. This holds great promise for the eradication of premature death from colorectal cancer.

Colonoscopy↗