Common Cause Of Referral Research Articles

Nonalcoholic Fatty Liver Disease: Identifying the Disease Burden in Sri Lanka.

Nonalcoholic fatty liver disease (NAFLD) is becoming one of the most important causes for chronic liver disease and also hepatocellular carcinoma (HCC) in Sri Lanka. This tendency is also recognized worldwide. More than half of the middle-aged and elderly adults in urban Sri Lanka have ultrasonic evidence of NAFLD. The NAFLD is also identified in population from rural areas of Sri Lanka and also in children. Nonalcoholic steatohepatitis (NASH) cirrhosis is the most common cause of referral for liver transplantation in Sri Lankans. The NASH is also the most common cause for rejecting potential donors for liver transplantation in Sri Lanka. Patients who underwent liver transplantation for cryptogenic cirrhosis developed evidence of NASH following liver transplantation. Recent evidence suggests that there is a genetic component to NAFLD. PNPLA3, a single gene polymorphism linked to the short arm of chromosome 22, is associated with the severity of NAFLD. The presence of this genetic polymorphism appears to carry higher risk of patients with NAFLD developing NASH with fibrosis cirrhosis and hepatocellular carcinoma. In a large population-based study from Sri Lanka, there was a tendency to develop NAFLD associated with this genetic polymorphism. In a population-based study, NAFLD was identified as an independent risk factor for development of diabetes. This association is recognized worldwide now. Most patients with HHC in Sri Lanka developed it on a back ground of cryptogenic cirrhosis. At the same time, the prevalence of the markers for hepatitis B and C was rare in Sri Lankan patients with HCC.How to cite this article: Dassanayake AS. Nonalcoholic Fatty Liver Disease: Identifying the Disease Burden in Sri Lanka. Euroasian J Hepato-Gastroenterol 2018;8(1):69-72.

Study of Delirium on Psychiatric Referrals at Helping Hands Community Hospital, Kathmandu, Nepal

Background and Objectives: Delirium is one of the most important neuro-psychiatric disorders in Consultation liaison psychiatry. There is a dearth of studies in this subject in Nepalese context. The objective of this study was to find out the demographic profile, source of referral, reason for referral and possible risk factors for delirium and association between risk factors and subtypes of delirium.Material and Methods: This is a descriptive cross-sectional study carried out in a tertiary care center over a period of six months. Delirium was diagnosed by psychiatrist based on International Classification of Disease, 10th revision, Diagnostic Criteria for Research (ICD-10 DCR) and was classified into subtypes using the Liptzin and Levkoff criteria. Data analysis was done using SPSS version 16 and chi- square test was applied to find the association between risk factors and subtypes of delirium.Results: A total of 52 cases of delirium were included in the study. Majority of cases were aged 65 years and above with male preponderance. The most common cause for referral was disturbed behavior and disorientation. Hyperactive delirium was the most common subtype of delirium. Most of the referred cases of delirium were from Medical ward and Intensive Care Unit/Critical Care Unit (ICU/CCU). Infection / Inflammation, Drug/alcohol intoxication or withdrawal and those with multiple etiologies were the most common possible causes of delirium. There was no significant difference in terms of associated risk factors between the clinical subtype (p = 0.8023).Conclusion: The presence of delirium warrants prompt intervention to identify and treat the underlying causes and consultation liaison psychiatric services should be enhanced to achieve this goal.Janaki Medical College Journal of Medical Sciences (2017) Vol. 5(2): 19-26

Study of Patient Satisfaction with Persian Medicine in Referrals to Behesht Persian Medicine Clinic of Iran University of Medical Sciences in 2016

Background: Today, complementary and alternative medicine and a variety of traditional medicine, along with conventional medicine, are used to prevent and treat diseases. In Iran, Persian medicine is taught academically and its services are being provided to patients. The aim of this study is to evaluate the patient satisfaction with Persian medicine and the reasons for follow up or non-follow-up of treatment by patients referred to Behesht Persian medicine clinic of Iran university of Medical Sciences. Methods: 394 cases were selected among patients who were treated by Persian medicine in the Behesht clinic in 2016. After extracting the data, a semi structured questionnaire regarding the degree of satisfaction with the treatment and the reasons for follow up or non-follow up of the patients was completed by making phone calls with participants. Data were then analyzed using software (Microsoft Excel 2016). Results: Women were referred to the Persian medicine clinic more than men (72.5% versus 27.5%). The most common causes of referral were gastrointestinal diseases (15.1%) and musculoskeletal disorders (13.5%). 35% of the patients referred only once and did not follow the treatment. The most common causes of non-referral were the patient’s own lack of attention to taking medication and follow-up (24.2%), disease recovery (23%), lack of appropriate response to treatment (20.8%) and relocation of the therapist (11.6%). 91.4% of participants did not mention any complications and 95.84% were satisfied with the behavior of doctors. Overall, 82.6% of patients had a tendency to recurrent referral to the clinic. Conclusion: Despite the problems with referral of patients to the Persian medicine clinic, there is a high inclining rate that reflects the satisfaction of the treatment. Therefore, planning to solve existing problems and facilitating the referral of patients can increase the satisfaction rate of Persian medicine. More studies are needed in other Persian medicine centers to evaluate patients’ satisfaction.

Satisfaction Level among Nephrologists towards Chronic Kidney Disease Patients Referred from Primary Health Care System

Background: chronic kidney disease (CKD) risk factors have been increased in the Saudi population. Therefore, primary health care physicians play a major role in controlling these risk factors, and prevent further kidney damage. Sometimes, Nephrology consultation is needed to provide them with an ideal medical care as soon as the diagnosis is made. Purpose: The aim of the study was to assess the level of satisfaction among nephrologists towards primary health care referral system. Methods: a cross-sectional study was carried out in Riyadh city, Saudi Arabia. Participants were nephrologists who work in major hospitals. A designed questionnaire was used for data collection consisted of demographic data of the participant, causes of referral, quality of referral forms, and patients’ care prior referral. Results: a total of 89 nephrologists were recruited in the study, most of them were males and non-Saudi physicians. Confirming the diagnosis and providing recommended treatment for the patients are the most common causes for referral. Most of the participants were satisfied about quality of referral and prior referral care. There was no difference in the satisfaction level among consultants compared to specialists. Whereas, private sector nephrologists were more satisfied. Conclusion: Governmental hospitals have to work harder to improve their health system, as they are the main source for most of Saudi citizens’ health problems. Providing a nephrologist with good referral letter, and good communication between primary care physicians and other medical specialties provides a better health care to the patients.

Quality of referral to the pediatric emergency of a tertiary care hospital in a developing country before and after introduction of an educational interventional module E

Background : Since there is no standard referral and feedback system available in India, we decided to study the quality of referral coming to our Pediatric Emergency before and after the introduction of an educational module with respect to demography of referral, association with severity of illness, mortality and feasibility issues. Using this data we plan to develop a standard referral format and feedback system that will help in streamlining the emergency referrals Methods : Methodology: Our study was completed in three phases in the Paediatric Emergency Unit viz the Pre intervention data collection, Intervention Phase, Post intervention data collection Quality of referral were done using structured referral proforma and comparative statistics were done for various parameters Results : A total of 1249 patients attended emergency during the pre and post intervention phases of which 4864 patients were admitted, 2359(48%) were paediatric and 2472(51%) were neonatal referrals. Thus our major chunks of inpatient admissions were ‘referred’ patients (99.3%). The two neighbouring states of Punjab (48.2%) and Haryana(22.4%) were topping the list. 80.9% referrals were from public sector hospitals of which the medical college hospitals topped the list (53.6%). 86.4% used Government ambulance services. Most common cause of referral was PICU/NICU/Mechanical ventilation (50.4%) The quality of referral had an association in terms o physiological status at the time of arrival. The proportion of patients arriving in the decompensated status in relation to poor referrals had significantly decreased in comparison of pre and post intervention period [580(79.8%) vs 1025(93.7%); p=0.0001]. The proportion of poor referrals had significantly reduced to 78% and there was a corresponding significant increase in proportion of fair (18%) and good referrals (4%). Conclusion : Referral education interventional module had significantly improved the quality of referrals coming to our Pediatric emergency in terms of better apre referral documentation of investigations, examination findings, and reasons for referral. The proportion of patients presenting in a decompensated state had significantly reduced after introduction of interventional module. Continuing education will be required for sustained and increasing benefits. There is a need for structured referral proforma and referral network among the healthcare facilities in the particular geographic area.

Selected data from the Polish National Prenatal Cardiac Pathology Registry from the year 2016

Abstract Introduction: Analysis have been subjected to evaluate standard data reports from the Polish National Prenatal Cardiac Pathology Registry from the year 2016, compared to previous years. Material and methods: The methodology of this work was comparison of the data from previous years that have been published in the Prenatal Cardiology and records generated in www. orpkp.pl from the year 2016. The total number of records entered in the Registry in the year 2016 was n=774. Results: Top 10 most common prenatal CHD in 2016 were such as follow: HLHS, AVSD, VSD, d-TGA, TOF, AvS, muscular VSD, Aberrant origin R subclavian artery, RAA, CoA. In the centers Lodz and Krakow the most common prenatal congenital heart defects were severe CHD requiring surgery in 1 st month of life. In the contrast, in Warsaw the first place was taken by a “critical heart defects” regardless whether cardiac surgery was planned in first week (contemporary definition of prenatal critical heart defects) or first month - contemporary definition of severe planned heart defects of postnatal life. Conclusion: The fact that in 2016 most common cause of referrals to targeted the fetal chocardiography was abnormal, large vessels view and not the abnormal 4 chamber view of the heart, suggests more and better training of hysicians performing the screening or basic study of fetal heart in Poland.

An analysis of occupation related mental health referrals of paramillitary forces to a tertiary care hospital

Background: The security personnel of our country including Army Personnel, C.I.S.F., Police and other security personnel bear a large amount of physical and psychological stress to maintain law and order situations at different corners of the country at different situations. To assess the Psychiatric Morbidity in C.I.S.F., the course of referrals of Para-military persons to a tertiary care hospital and to evaluate the Mental Health burden in the Para-military set up by virtue of their occupation. Methods: The study sample included all the consecutive patients referred by CISF Headquarters Hospital to the Mental Health Institute (MHI), S.C.B. Medical College, Cuttack, Odisha, from April 2015 to March 2016. The clinical information is collected from the patient and accompanying personnel from CISF or family members who accompanied the patient. The diagnosis is based on ICD-10 and the final opinion is given by the consultants of Psychiatry after final evaluation of all the reports. Results: Psychiatric assessment for job fitness (48%) was the dominant cause for referral of PMF staff to MHI. Substance abuse (alcohol) related disorders were the next common cause of referral (20%).Conclusions: Mental health burden in Para-military bases are substantial which should be taken care of in urgency basis. There is urgent need of posting of Psychiatrists with Clinical Psychologists and Psychiatric Social Worker or a team of the Mental Health Professionals should visit the paramilitary set ups regularly to look into improper diagnosis and review cases.

Interdepartmental Dermatology: Characteristics and Impact of Dermatology Inpatient Referrals at a Teaching Hospital in Eastern India.

Background:Dermatology is primarily considered to be an outpatient-centered specialty. However, several inpatient admissions to other specialties require dermatologic consultation for optimum management.Aims:To analyze the causes of inpatient dermatology referrals, departments sending referrals, and impact of dermatology consultation on patient management.Materials and Methods:We conducted a cross-sectional study by analyzing the records of 486 patient referrals over a 4-year period. The demographic details, specialties requesting consultation, cause of referral, and dermatological advice have been recorded and analyzed.Results:Dermatology consultation changed the dermatologic diagnosis and treatment of almost two-thirds of patients. General medicine requested the maximum number of referrals, “skin rash” being the most common cause for referral. Accurate diagnosis on referrals was provided by only 30.2% of nondermatologists. Common dermatological disorders were often misdiagnosed by these physicians, and dermatology referrals had significant impact on the diagnosis and subsequent management of these patients.Conclusion:While dermatologic referral leads to improved patient care, there is a need for better training of nondermatologists enabling them to recognize and treat common dermatoses.

Socio-Demographic Characteristics of Patients Presenting to the Vascular Emergency Department of National Institute of Cardiovascular Diseases (NICVD)

Emergency department of vascular surgery of National Institute of Cardiovascular Diseases (NICVD) is rendering service for the patients suffering from vascular trauma since 2001. Data regarding this practice of emergency services is rarely published. This paper aims to provide the epidemiological characteristics of patients presenting the vascular emergency department of NICVD between 01/9/14 to 30/09/14. This study is intended to benefit the policy makers, healthcare providers in Bangladesh to promote and define the specialty of emergency vascular department and to allocate resources more effectively to address country’s acute care needs. In total sixty four (64) patients was attended in this 1 month. The male to female ratio was 60:4 with age range from nine to sixty four years (mean age 30.8years). Among them thirty nine percent patients belong to low socioeconomic class, thirty one percent from middle class and others from affluent family. Forty patients (62.5%) were referred from various institute of Dhaka city and rest from outside Dhaka. Seventy five percent patients came by ambulance, eight percent by private vehicles and rest by other means. Fifty eight patients (90.62%) came with referral papers from other health institutes, where there is no vascular surgery department. Most common cause of referral was vascular trauma (78.12%), other causes of referral were complicate vascular aneurysm (7.8%) and vascular thrombosis (14.06%). The time since injury and seeking treatment for vascular surgery ranged two hours to six days. Mean time was 10.3 hours. Forty cases (62.5%) sustained vascular trauma by accident with sharp cutting objects during occupational and house hold activities, assault (stab injury, blunt injury and gunshot) ten cases (15.62%), road traffic accident seven cases (10.93%), intravenous drug abusers three cases (4.68%), accidentally fall from height three cases (4.68%) and post operative complication one cases (1.56%). This study demonstrates that eighty eight percent study populations presented with arterial injuries and only twelve percent with venous injuries. Associated injuries (tendon, nerve, muscle, fracture of bones and joints dislocation) were present in fifty six patients (87.5%). Most common artery that was injured was radial artery. Vascular Injuries were treated with end to end anastomosis in twenty five patients (36.6%), ligation of vessels in twenty three patients (35.9%), fasciotomy was done in eight patients (12.5%) , embolectomy (fogerty) was done in four patients (6.25%) ,. aneurysmectomy was needed in two patients (3.1%) and interposition venous graft was used in two cases (3%). The emergency department of vascular surgery of National Institute of Cardiovascular Diseases (NICVD) is taking the entire burden with their small resources to ensure the best quality care for the management of the patients with vascular injuries. The data can inform and guide the allocation of national resources towards emergency care, injury prevention campaigns, emergency service evaluation and clinical guideline development.University Heart Journal Vol. 11, No. 1, January 2015; 3-6

Study of referred cases in Obstetric and Gynecological practise at a tertiary care hospital in Central India

Background: Referral services for identification & referral of high risk pregnancies are an integral part of maternal and child health services. This study was aimed to incidence of referral cases of obstetrics/gynaecology analyze and to analyse the availability of adequate essential care for obstetric and gynaecological emergencies at health centers at periphery level. Methods: 156 consecutively referred cases at Sri Aurobindo Medical College and PGI, Indore from various peripheral and private hospitals were included in the study and prospectively analysed for the cause of obstetric/gynaecological treatment referral, treatment obtained before arrival, delays during various points of treatment. Results: Out of 156 cases studied, 118 cases (75.64%) were of obstetrics and 38 cases (24.35 %) were of gynaecology. Neonatal ICU care post delivery (n=28, 23.7%) was the most common cause of referral, followed by cases due to obstructed labour (n=27, 22.8 %). Out of 38 cases of gynaecology, maximum cases were of Ca Ovary (n=15, 39.4%), followed by those of uterire prolapsed (n= 14, 36%). Neonatal mortality in referred cases was observed in 8 cases, while obstetrics deaths were observed in 3 cases. Lack of facilities at peripheral health centre and lack of blood bank facilities were dominant reasons for referring the cases. Conclusion: In view of the above findings, there is need for social and clinical interventions to fill the gaps in the current referring practices, to strengthen and improve quality of services, infrastructure and availability of trained manpower at peripheral health centres. Key words: Referral cases, Obstetrics, Gynaecology, Obstructed labour

MD1 - Economic Evaluation Of Bst-Cargel As An Adjunct To Microfracture Versus Microfracture Alone In Knee Cartilage Surgery

Objectives:Knee cartilage damage is a common cause of referral for orthopedic surgery. Treatment aims to reduce pain and symptoms by repairing cartilage. Microfracture, the current standard of care...

Rupture of a Superior Mesenteric Artery Pseudoaneurysm Presenting with Asymptomatic Anemia

Anemia is a common cause of referrals to gastroenterologists. Only a small number of anemia cases result from vascular abnormalities. Visceral artery aneurysms and pseudoaneurysms are rare forms of vascular disease that have significant potential for rupture, resulting in potentially life-threatening hemorrhaging. We present the case of a 70-year-old female patient with a pseudoaneurysm of the superior mesenteric artery complicated with rupture, who had no abdominal pain and only anemia. (Korean J Med 2015;88:560-563)

Study of Referral Pattern of Women for Safe Confinement to a Tertiary Care, Government Teaching Hospital in Karnataka

Introduction: The focus of NRHM is to reduce maternal and child morbidity and mortality with emphasis on rural health care. The major strategies under RCH-II are: Essential Obstetric care, Institutional delivery, skilled attendant at a delivery place, Emergency Obstetric care, Operationalising FRUs and Operationalising PHCs and CHCs for 24- hour delivery services (2). With the above background, we tried to determine the criteria for referral of obstetric cases to our hospital. The study will help reviewing the structure and pattern of referrals. 1. Objectives: To study the obstetric and socio-economic profiles of study subjects. 2. To study the referral criteria adopted by peripheral institutions and doctors. 3. To study the maternal and perinatal outcome of referrals. Materials and methods: Cross sectional study was conducted in a tertiary care teaching hospital among 30 pregnant women referred from periphery for safe confinement. Criteria for referral, mode of delivery and immediate outcome was studied. Results: Absence of doctors in the periphery was the most common cause for referral. Among the cases referred 46% belonged to low risk group Conclusion: 24/7 emergency obstetric care as envisaged in yet to be achieved.

Economic evaluation of BST-CarGel as an adjunct to microfracture vs microfracture alone in knee cartilage surgery

Objectives:Knee cartilage damage is a common cause of referral for orthopedic surgery. Treatment aims to reduce pain and symptoms by repairing cartilage. Microfracture, the current standard of care, yields good short-term clinical outcomes; however, treatment might fail after 2–3 years. A Chitosan-Beta glycerolphosphate-based medical device (BST-CarGel) is used as an adjunct to microfracture and demonstrates improvements in quantity and quality of repaired tissue, potentially reducing the risk of treatment failure. This study aimed to establish the economic value of BST-CarGel vs microfracture alone in knee cartilage repair from the societal perspective, using Germany as the reference market.Methods:A decision tree with a 20-year time-horizon was constructed, in which undesirable clinical events were inferred following initial surgery. These events consisted of pain management, surgery, and total knee replacement. Clinical outcomes were taken from the pivotal clinical trial, supplemented by other literature. Data and assumptions were validated by a Delphi panel. All relevant resource use and costs for procedures and events were considered.Results:In a group of patients with all lesion sizes, the model inferred that BST-CarGel yields a positive return on investment at year 4 (with 20-year cumulative cost savings of €6448). Reducing the incremental risk of treatment failure gap between the device and microfracture by 25–50% does not alter this conclusion. Cost savings are greatest for patients with large lesions; results for patients with small lesions are more modest.Limitations:Clinical evidence for microfracture and other interventions varies in quality. Comparative long-term data are lacking. The comparison is limited to microfracture and looks only at costs without considering quality-of-life.Conclusion:BST-CarGel potentially represents a cost-saving alternative for patients with knee cartilage injury by reducing the risk of clinical events through regeneration of chondral tissue with hyaline characteristics. Since the burden of this condition is high, both to the patient and society, an effective and economically viable alternative is of importance.

Fifteen-minute consultation: The infant with a tongue tie

Tongue tie is an increasingly common cause for referral of infants to our general paediatric surgery service. In this article, we will explore the indications for tongue tie division in...

SP0099 Ultrasound in Trauma - What the Rheumatologist Needs to Know

Posttraumatic pain of the ankle and foot can result from either acute trauma or disorders related to chronic microtrauma.The latter are common causes of referral in everyday rheumatologic clinical practice....

Different causes of referral to ophthalmology emergency room

Background:Eye-related complaints compose approximately 1–6% of complaints of patients referring to general emergency ward around the world. Eye injuries are the most common cause of referral to eye emergency ward. To understand the impact of eye injuries in Iran and to plan preventive strategies, it is important to understand the complete magnitude of the problem with regard to true population-based data and standard reproducible definitions.Aim:The main goal of this study was to identify the major causes of referrals to eye emergency ward in patients with eye-related complaints in an eye referral Hospital in Iran.Settings and Design:In a cross-sectional study, 3150 patients who referred to Farabi Hospital emergency ward, Tehran, Iran, from January to December 2007 were included in the study and their detailed information were recorded.Materials and Methods:The patients’ demographic data, medical history and final diagnosis were recorded in a questionnaire.Results:The mean age of patients was 33.2±16.8 years and 2380 patients (75.6%) were males. While 299 patients (9.5%) were referred for non-urgent reasons, work-related injuries were the most common cause of referral (955 patients; 30.3%). In patients referred due to trauma (1950 patients), work-related injuries occurred in 955 patients (49%) and occurred accidentally (by chance) in 819 patients (42%). The majority of patients referred with traumatic injuries were males (1708 patients; 87.6% versus 242 patients; 12.4%). The most common etiologies of eye trauma (1950 patients) were metal filings (814 patients; 41.8%), blunt trauma (338 patients; 17.3%), fireworks (236 patients; 12.1%) and sharp objects (222 patients; 11.4%). Globe injury was diagnosed in 1865 patients (95.7%) of trauma cases. In patients referred due to non-traumatic reason (1200 patients), eye infection occurred in 482 patients (40.2%) and 299 patients (24.9%) were referred for non-urgent reasons. There was little difference between the frequency of non-trauma-related problems among genders (672 male patients; 56% versus 528 female patients; 44%).Conclusions:This study identified multiple risk factors whose presence significantly increases severity of an eye injury. Male gender, youth and unprotected eyes during high-risk activities such as sports and certain jobs are risk factors for eye injuries. In patients referred due to non-traumatic reasons, males and females are similar. Considerable proportion of non-trauma-related problems was due to eye infection, that one of the most important reasons may be connected to the increasing use of contact lenses in our target population. Thereupon, we need for further educative and preventive interventions at the level of general population.

Serum Iron, Zinc, and Copper Concentration in Premature Graying of Hair

Premature graying of hair with unclear etiology, which is known as premature canities, is a common cause of referrals to the dermatologists. We assessed the relationship between serum iron, copper, and zinc concentrations with premature canities. This study was conducted on patients under 20years old suffering from premature canities, having a minimum of ten gray hair fibers, and referring to university hospitals of Isfahan (Iran). The results were compared with age-sex-matched controls. Demographic data and disease characteristics were recorded for two groups. We studied serum iron, copper, and zinc concentrations of 66 patients and 66 controls using atomic absorption and Ferrozine methods. The mean age of studied cases was 17.8 ± 2.0years, and the mean age of the onset of canities was 15.5 ± 3.2years with no significant difference between males and females (P > 0.05). Serum copper concentration was significantly lower in patients compared with controls (90.7 ± 37.4 vs. 105.3 ± 50.2μg/dL, P = 0.048), but serum iron concentration was significantly lower in controls compared to patients (88.8 ± 39.5 vs. 108.3 ± 48.4μg/dL, P = 0.008). Also, there was no significant difference between patients and controls in serum zinc concentration (114.8 ± 67.8 vs. 108.2 ± 49.9μg/dL, P = 0.285). According to these results, among copper, zinc, and iron, a low serum copper concentration may play a role in premature graying of hairs in our society. Further studies are needed to find the underlying mechanism of this relationship.

Dermal sinus tract of the spine

Spinal dermal sinus tract (DST) is a rare entity which usually comes to clinical attention by cutaneous abnormalities, neurologic deficit, and/or infection. We performed this study to assess presentation patterns, associated anomalies, radiologic, urologic, and surgical findings in children afflicted with spinal DST. Medical records of 35 children treated for spinal DST in Children's Medical Center from January 2001 to December 2008 were reviewed. Patients' age ranged from 3 days to 8.44 years. Dermal sinuses were located most frequently in the lumbar and lumbosacral regions. The most common causes for referral were abnormal skin findings (57.1%) and infection (31.4%). Notably eight patients presented with meningitis. The overall rate of neurologic abnormalities was 37.1%, four of whom presented acutely with rapidly progressive paraplegia and meningitis. The most common magnetic resonance imaging finding was tethered cord (63%). At least one urological evaluation was performed in 30 patients, which revealed abnormal results in 77% of them. All patients underwent complete resection of the tract and repair of associated abnormalities. Most tracts terminated within the intradural space. Fifteen patients (42.8%) had inclusion tumor with the dermoid tumor being the most common. None of the patients demonstrated neurological deterioration postoperatively. Dermal sinus tract is an innocuous-appearing spinal dysraphism that may contribute to devastating morbidities if not timely addressed. In order to prevent complications, timely surgical intervention including complete resection of sinus tract with intradural exploration and correction of associated abnormalities is of utmost importance.

Gender Differences in Patients Presenting with Dysphagia

Background: Dysphagia is a common cause of referral for upper endoscopy. Gender differences within such a cohort have not been previously described in the literature. We hypothesized that the etiology of dysphagia would differ by gender. Aim: To determine if gender differences exist among the etiology of dysphagia in patients presenting for upper endoscopy. Methods: A prospective analysis was performed on all patients undergoing upper endoscopy for the indication of dysphagia between 1/1/2006 and 6/1/2007 at the University Hospital. All patients completed dysphagia symptom assessment along with validated gastroesophageal reflux questionnaires. Endoscopic findings and demographics were also recorded. Results: A total of 190 patients were enrolled (92 males, 98 females). Males and females were similar in age of presentation (49.7 ± 15.0 vs. 52.8, ± 16.3), duration of symptoms (8.2 ± 9.0 vs. 6.0 ± 8.7), and severity of dysphagia scores (median 1.9 ± 1.4 vs. 2.1 ± 1.5). A significant difference in the distribution of endoscopic findings exist between males and females (p < 0.004). Multiple esophageal rings are more prevalent in males than females (28.6% vs. 13.9%, p < 0.02). Schatzki's Rings (SR) are described more in females than males (20.8% vs. 6.1%, p < 0.01) [see table]. A history of esophageal food impaction (EFI) occurred more frequently in males (30.4% vs. 17.3%, p < 0.04). A high prevalence of multiple esophageal rings was found in both genders who described prior EFI (males 55.6%, females 46.7%). Prior food impaction increased the likelihood of finding multiple esophageal rings in females (OR 7.7, p < 0.03), but not in males (OR 1.8, p = NS). Conclusion: The endoscopic findings and history of esophageal food impaction in patients presenting with dysphagia differ significantly by gender. History of esophageal food impaction greatly increases the likelihood of finding multiple esophageal rings in females. Suspicion of multiple esophageal rings should be high not only in men, but also in women who present with EFI and dysphagia.