Defecating proctography: A pictorial essay

OBJECTIVES

To provide an illustrative description of the technique and spectrum of findings in defecating proctography.

KEY FINDINGS

Important findings on defecating proctography include rectocoele, enterocoele, sigmoidocoele, cystocoele, intussusception, rectal prolapse, descending perineum, incomplete emptying, anismus, and faecal incontinence. This review article illustrates these key findings with examples.

CONCLUSION

Defecating proctography is a well-established and cost-effective method of assessing disordered defecation. In conjunction with clinical information and other diagnostic tests, findings on defecating proctography can guide appropriate multidisciplinary management and may lead to improvement in embarrassing and debilitating symptoms in many patients.

IMPLICATIONS FOR PRACTICE

This review article provides a suggested technique and covers the spectrum of findings on defecating proctography.

CLiP, catheter and line position dataset

Correct catheter position is crucial to ensuring appropriate function of the catheter and avoid complications. This paper describes a dataset consisting of 50,612 image level and 17,999 manually labelled annotations from 30,083 chest radiographs from the publicly available NIH ChestXRay14 dataset with manually annotated and segmented endotracheal tubes (ETT), nasoenteric tubes (NET) and central venous catheters (CVCs).

[Thyroid gland function after therapy of the laryngeal cancer: prospective examinations]

The paper presents the results of the study concerning thyroid gland function of the patients suffering from larynx cancer treated with: a) surgery only (n = 31), b) surgery with further radiotherapy with radical doses 5400-7000 cGy (n = 44), c) radiotherapy along with radical doses 6400-7000 cGy (n = 7). 82 patients (M-73, F-9) were examined. Average age was 58 (min. 30, max. 80). Thyroid gland function was evaluated by measurement of: a) hTSH, fT3, fT4, b) serum lipids concentration. The examinations mentioned above were performed before as well as after the treatment at: a) 1, b) 1-6, c) 6-12, d) 12-24, e) longer than 24 months after completion of treatment. The longest period of observation involved 8 years. Our results show that hypothyroidism (mostly subclinical) occurs seldom (6% of all the cases) in the early phase (up to 1 month) after surgical treatment. After radiotherapy only--no subclinical hypothyroidism was observed. The combined treatment seems to be the most frequent cause of subclinical hypothyroidism. Its frequency increases (up to 27%) with the length of time since the conclusion of treatment. We also tried to explain the pathogenesis of subclinical hypothyroidism on the basis of histopathologic examination of thyroid tissue (n = 13) derived from the patients after various ways of treatment. The studies were compared to the results of histological examinations of the thyroid sections obtained during autopsy (n = 20) from the control group (not suffered from thyroid diseases).

[The influence of treatment of progressive edematous infiltrative ophthalmopathy on intraocular pressure]

PURPOSE

To evaluate the influence of systemic steroid therapy and retrobulbar irradiation on intraocular pressure (IOP) in patients with infiltrative--oedematous Graves' ophthalmopathy.

MATERIAL AND METHODS

We examined 76 patients divided into 3 groups: I--treated by irradiation only (15 patients), II--treated by irradiation and oral prednisone therapy (26 patients), III--treated by irradiation and intravenous methylprednisolone pulse therapy (35 cases). All patients underwent full ophthalmological examination (including IOP measurement, perimetry and gonioscopy) before, during, immediately after and 2-20 months after treatment.

RESULTS

Increased IOP (21-31 mm Hg) was observed in 54 patients (71%) before treatment. The iridocorneal angle was open in all eyes. Changes in perimetry were not characteristic for glaucoma. IOP was higher in patients with more severe ophthalmopathy. We recorded transient increase of IOP during treatment in only 3 patients. Increased IOP immediately after therapy was observed in 16 patients with severe symptoms and signs of ophthalmopathy: in group I--4/15 (27%), in group II--4/26 (15%), in group III--8/35 (23%). Higher IOP was recorded in 10 patients two to twenty months after completion of treatment: from group I--4/15 (27%), from group II--1/26 (4%) and from group III--5/35 (14%). In 6 of these 10 persons we observed recurrence of ophthalmopathy, in 4 patients higher IOP was the only deviation, they needed local therapy. The mean values of IOP were lower in patients treated by steroid therapy in comparison to patients treated by irradiation only. The most rapid improvement of clinical status was observed in patients treated by methylprednisolone pulse therapy.

CONCLUSIONS

The increase of IOP in patients with Graves' ophthalmopathy correlates with severity and duration of eye disease. Systemic steroid therapy is more efficient in reduction of IOP than irradiation of the retrobulbar tissue. Our results suggest that combined therapy is a preferable method of treatment of progressive ophthalmopathy, including cases with increased intraocular pressure.

[Hormonal function of the thyroid gland after therapy for laryngeal cancer]

The paper presents the results of the study concerning thyroid gland function of the patients suffering from larynx cancer treated with: a) surgery only, b) surgery with further radiotherapy with radical doses 5000-6500 cGy, c) radiotherapy along with radical doses 6500-7200 cGy. Thyroid gland function was evaluated by measurement of: a) hTSH, FT3, FT4, b) serum lipids concentration. The hTSH concentration was evaluated by immunoradiometric method whereas FT3 and FT4 by DELFIA techniques (deleted fluorescence). 162 patients (M-148, F-14) were examined. Average age was 57 (min.-30, max.-80). The patients were divided into two groups. The first group (n = 90) involved those who had been examined once at different time since the end of treatment (retrospective examinations). The patients who had been examined before as well as after treatment were established as the second group (n = 72) (prospective examinations). In this case the examinations are still being continued and they are carried out at: a) 1, b) 1-6, c) 6-12, d) 12-24, e) longer than 24 months after completion of treatment. Our preliminary data show that hypothyroidism (mostly subclinical) occurs seldom (7% of all the cases) in the early phase (up to 1 month) after surgical treatment and gets normal spontaneously (up to 6 months). After radiotherapy only--no subclinical hypothyroidism was observed. Interestingly, the combined treatment seems to be the most frequent cause of subclinical hypothyroidism. Its frequency increases (up to 47%) with the length of time since the conclusion of treatment (2 years and longer). Because of continuation of our examinations the presented data are still preliminary and they will be verified in the next paper. We also tried to explain the pathogenesis of subclinical hypothyroidism on the basis of histopathologic examination of thyroid tissue derived from the patients (after combined treatment and after radiotherapy) during further total laryngectomy performed because of neoplasm renewal.

A controlled study of postoperative radiotherapy for patients with completely resected nonsmall cell lung carcinoma. Groupe d'Etude et de Traitement des Cancers Bronchiques

BACKGROUND

Postoperative radiotherapy is commonly used to treat patients with completely resected nonsmall cell lung carcinoma, but its effect on overall survival has not been established.

METHODS

After undergoing complete surgical resection, 728 patients with non-small cell lung carcinoma (221 Stage I, 180 Stage II, and 327 Stage III) were randomized to receive either postoperative radiotherapy at a total dose of 60 gray or observation only . The main end point was overall survival.

RESULTS

At the reference date, 218 of 355 patients in the control group had died and 262 of 373 in the radiotherapy group had died. Five-year overall survival was 43% for the control group and 30% for the radiotherapy group (P = 0.002, log rank test; relative risk [RR]: 1.33; 95% confidence interval [CI]: 1.11-1.59). This result was not modified by adjustment for potential prognostic factors. The excess mortality rate for the radiotherapy group was due to an excess of intercurrent deaths (P = 0.0001; RR: 3.47; the 5-year intercurrent death rate was 8% for the control group and 31% for the radiotherapy group). Radiotherapy had no significant effect on local recurrence (RR: 0.85; 95% CI: 0.64-1.14) and no effect on metastasis (RR: 1.06; 95% CI: 0.85-1.31). The rate of non-cancer-related death increased with the dose per fraction delivered.

[Results of nasopharynx cancer treatment: some prognostic factors]

42 cases of nasopharynx cancer treated between 1985 and 1995 in ENT and Radiotherapeutic Clinic of the Pomeranian Medical Academy were analyzed. In 15 patients (34.5%) planoepithelial carcinoma was found, in 9 (20.9%)--anaplastic carcinoma, in 6 (13.9%)--lymphoepithelial, and in individual cases--spindle-shaped and mucoepidermal carcinoma solidum. 34 patients were treated by radical irradiation (60-70 Gy doses) and 8--by palliative (20-35 Gy). In 7 patients neck dissection was carried out. Better results were achieved in older patients (over 60 years old) than in younger ones. Prognosis in women was better than in men. 5 years' survival rate for T1-2 group was achieved in 77% of cases. For T3-4 group it amounted to 48%; in N0-1--69% and in N2-3 group--52%. 71% patients with planoepithelial carcinoma, whereas only 48% with undifferentiated carcinoma survived 5 years. The rate of 56% of 5 years' survival time is comparable with good results of other authors.

[The results of radiation and surgical treatment of early vocal cord carcinoma (T1a, T1b)]

Results of surgery treatment from the external access and radiotherapy in early, stage of vocal cords carcinoma were presented. Clinical material consisted of 94 cases with squamous cell carcinoma of vocal cords with stage T1a and T1b treated in Szczecin University Department of Otorhinolaryngology from 1987 to 1996. 51 cases were operated on (26 by chordectomy and 25 by frontolateral laryngectomy). Radiotherapy was applied in 43 patients. The 3 and 5 years' survival rate in the surgery group was 97% and after radiotherapy 88 to 80%. The functional results were also presented. It was concluded that the mode of treatment in early stages of vocal cord carcinoma should be individualized.

[Neoplasm metastasis to the eye--diagnosis and therapy]

PURPOSE

The increasing occurrence of neoplastic metastases to the eye encouraged us to present our own observation on this topic.

MATERIAL AND METHODS

We have examined 17 patients with metastatic tumors of the eye (in 6 cases there was bilateral involvement). The group included 11 females and 6 males, aged 43 to 69 years. The most common primary tumor was breast carcinoma (9 women-13 eyes); then cancers of lung (4 men), gastrointestinal tract (2 women-3 eyes), maxillary sinus (1 case); and malignant lymphoma (1 case). In 5 patients the eye was enucleated because of secondary glaucoma.

RESULTS

Improvement or stopping the progression of the disease was achieved in 1 of 2 patients treated with argon laser, 3 of 6 patients treated with xenon lamp photocoagulation, and in all 8 eyes treated with gamma-therapy. In one case of metastatic tumor of the iris a partial iridectomy was performed. A case of systemic malignant lymphoma was treated pharmacologically.

CONCLUSIONS

It seems that the best option of treatment of eye metastases is gamma-therapy, particularly effective in small lesions. Authors emphasize that it is necessary to perform routine ophthalmologic examinations in patients with breast cancer, lung cancer, and other neoplasms associated with high risk of metastases to the eye. This can allow to early detect eye metastases and start the appropriate treatment.

[Evaluation of quality of life in patients with cancer]

Subjective evaluation of health related quality of life was studied in 53 cancer patients. The Polish version of quality of life questionnaire SF-36 was distributed among the patients before radiotherapy and repeated after one year. Significantly higher quality of life was found in the control measurement after one year in comparison to the evaluation before radiotherapy started. The quality of life estimated by the patients was not correlated with physician's evaluation of patients made with the use of the Zubrod scale. Patients in more advanced disability due to the cancer (Zubrod scale) evaluated their social activity better than did subjects less severely disabled and bed-bound. Patients' sex as well as the localization of the cancer did not influence their opinion regarding their quality of life. The severity of pain and discomfort the patients experienced before radiotherapy correlated with the evaluation of quality of life. The severity of pain and discomfort the patients experienced before radiotherapy correlated with the evaluation of quality of life. After one year the intensity of pain and discomfort correlated only with the patients' general health evaluation and with physical fitness but not with their social and daily activity.