Site Of Obstruction Research Articles

Ultrasonography (USG) Evaluation among Patients with Biliary Obstruction in a Tertiary Care Center

Background: Biliary obstruction is a blockage in the bile ducts that prevents bile from flowing from the liver to the small intestine. Objectives: This study aimed to assess the efficacy of ultrasonography (USG) among patients with a blockage in the bile ducts as known as biliary obstruction. Methods: This was a prospective observational study conducted at the Department of Radiology and Imaging at Sir Salimulliah Medical College Hospital, Dhaka, Bangladesh. This study included patients with clinical suspicion of biliary obstruction who underwent USG. Characteristics of the obstruction were evaluated for both benign and malignant lesions through USG. The findings were then correlated with ERCP, histopathology, or surgery to calculate the diagnostic performance of the former two modalities. Results: Out of 145 patients, 63 were in the malignant group and 82 were in the benign group. The sensitivity, specificity, and accuracy of detecting the nature of obstruction by USG were 33%, 84%, and 48.9%, respectively. The overall diagnostic accuracy of USG in predicting the site of obstruction was 64.3%. Hydatid Cyst and the Main Pancreatic Duct Stricture were the most accurate findings of USG. Conclusions: USG should be the initial screening modality of choice for predicting the level and nature of obstruction in patients with a clinical suspicion of obstructive jaundice.

Age-group-specific associations between adenoid/tonsillar hypertrophy and craniofacial features

BackgroundAge plays an important role in the association between adenotonsillar hypertrophy and craniofacial morphology. This study aimed to analyse the association of adenoid and tonsillar hypertrophy with craniofacial features in different age groups.MethodsLateral cephalograms were obtained from 942 patients aged 6–15 years (433 boys, 509 girls). They were divided into three age groups: 6–9 years (n = 189), 9–12 years (n = 383), and 12–15 years (n = 370). According to the different sites of pharyngeal obstruction, they were classified as control group (CG), adenoid hypertrophy group (AG), tonsillar hypertrophy group (TG) and adenotonsillar hypertrophy group (ATG). Cephalometric measurements were performed on each enrolled participant. Comparisons between groups and correlations between these cephalometric variables and obstruction sites were evaluated.ResultsAt 6–9 years of age, ATG and TG correlated with increased mandibular height (B = 2.2, p = 0.029; B = 2.6, p = 0.042, respectively). At the age of 9–12 years, AG showed a steep growth direction (B = 1.5, p = 0.002), TG showed a higher probability of Class III skeletal pattern (smaller SNB, ANB and SGn/FH, larger Go-Me) and ATG manifested a higher proportion of Class III skeletal pattern. At 12–15 years of age, there was no significant association between cephalometric measurements and pharyngeal lymphoid tissue enlargement.ConclusionsChildren with isolated adenoid hypertrophy have a vertical growth direction at 9–12 years of age. Isolated adenoid hypertrophy correlated with longer mandibular body, more anterior mandible and horizontal skeletal Class III pattern at 6–12 years. Combination of obstructive adenoids and tonsils manifested similarly to children with isolated tonsil hypertrophy.

Oral Gastrografin: A Safe Alternative in Meconium Obstruction of Prematurity

Meconium obstruction of prematurity is primarily seen among very low birthweight or extremely low birthweight premature babies, causing low intestinal obstruction. It may delay the establishment of early full enteral feeding and compromise nutrition or cause obstruction requiring surgery or intestinal perforation. Currently, the management is mainly based on expert opinion and low-quality evidence. Conventional hyperosmolar contrast enema and gastrografin enema may not reach the site of obstruction because of the proximal nature of the meconium obstruction. Oral gastrografin is an effective and safe alternative for relieving meconium obstruction in a 28-week preterm baby. This avoids the need for surgery. This article highlights the use of oral route of gastrografin as a good nonsurgical alternative in extreme preterm babies in resource-limited circumstances.

Iliac vein obstruction: accuracy of Direct Multidetector Computed Tomographic Venography and duplex ultrasound.

To evaluate the accuracy of direct computed tomographic venography (DCTV) and duplex ultrasound (DUS) in the identification of iliac vein obstruction in highly symptomatic patients with severe chronic venous disease (CVD) compared with intravascular ultrasound (IVUS). this study involved patients who had advanced CVD (CEAP C3-6). All patients underwent DCTV, venous duplex scanning, and IVUS. The presence of iliac vein obstruction was detected, and degree of obstruction was classified into 3 grades (grade I, 0% to 49%; grade II, 50% to 79%; and grade III, 80% or greater). The sensitivity, specificity, PPV, NPV, and accuracy were calculated for each modality compared with IVUS. Inter-observer agreement was assessed using the κ coefficient. of 94 patients with CVD, IVUS identified iliac vein obstruction in 55 (58.5%) patients (25.5% was grade 1, 27.3% was grade 2, 47.3% was grade 3). The sensitivity, specificity of DCTV in diagnosing obstruction was (96%, 95% in grade 1; 100%, 100% grade 2; 100%, 100% in grade 3, respectively). The sensitivity, specificity of DUS was (63.9%, 65% in grade 1; 68%, 82% in grade 2, and 70%, 85% in grade 3, respectively). The overall agreement of DUS was 0.73 (95% CI, 0.70-0.79), and DCTV was 0.96 (95% CI, 0.91- 0.97). DUS is a reasonable initial imaging modality for the identification of significant iliac vein obstruction. DCTV provides an accurate reproducible imaging for accurate estimation needed for treatment planning. Direct CT Venography provides accurate reproducible radiological information required for treatment planning of patients with Iliac vein obstruction including accurate assessment of site of obstruction, its morphology, and degree of obstruction and it can replace the use of indirect CT venography using smaller amount of contrast media with accurate diagnosis.

Predictors of nasolacrimal duct intubation failure for primary acquired nasolacrimal duct obstruction: a computed tomography-dacryocystography (CT-DCG) study.

Making a choice between nasolacrimal duct intubation and dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (PANDO) is an important issue in clinical practice. This study aimed to determine the potential lacrimal sac characteristics that could be used as predictors of unsuccessful intubation for PANDO based on computed tomography-dacryocystography (CT-DCG). In this retrospective comparative observational study, we included PANDO patients with a history of failed intubation for nasolacrimal duct obstruction as the intubation failure group and PANDO patients without a history of intubation as the control group. We analyzed the lacrimal sac height, lacrimal sac width, and obstruction site based on CT-DCG, all measured based on several reference levels on axial sections (upper, intermediate, lower level, common canaliculus level, and lowermost contrast level), which were defined according to the contrast and the bony structure. A total of 114 sides of the PANDO were studied, including 36 in the intubation failure group and 78 in the control group. The intubation failure group showed a smaller lacrimal sac height (11.69±4.59 mm) and width (2.28±1.97 mm, intermediate level) than the control group (14.13±2.92, 3.32±2.02 mm, P=0.005 and 0.012, respectively). The intubation failure group had a higher obstruction site than the control group (P=0.009). A small lacrimal sac and high obstruction site are predictors of nasolacrimal duct intubation failure in PANDO. For PANDO patients with a small lacrimal sac or a high obstruction position, DCR is recommended as opposed to intubation.

Role of Multidetector Computed Tomography Urography in Evaluating Obstructive Uropathy in a Tertiary Hospital in Rural India.

This study aims to evaluate the role of multidetector computed tomography (MDCT) urography in cases of obstructive uropathy to determine the cause, side, site, and level of obstruction and to differentiate between acute and chronic cases of obstructive uropathy based on imaging features. Using Cochran's formula, a sample sizeof 121 patients was calculated. The patients underwent computed tomography (CT) urography to assess the obstructing agents causing obstructive uropathy. The conducted scan had four phases: the non-contrast phase, corticomedullary phase, nephrographic phase, and excretory phase. We assessed the obstructive agents and the changes they caused in the urinary tract. A total of 74 patients (61.16%) had calculus as their obstructive agent, followed by stricture (14.88%). The obstructive agents were intraluminal in 102 patients (84.3%) and extraluminal in 19 patients (15.7%). The ureter was the most common site of obstruction, accounting for 41.32%. The acute cases were 66 (54.55%), and the chronic cases were 55 (45.45%). A statistically significant (p<0.05) association was found using the chi-square test in the comparison of the enhancement and excretion of the kidneys and the type of case (acute or chronic). A statistically significant (p<0.05) association was found using the chi-square test in the comparison of the distribution of the secondary findings, such as perinephric fat stranding and perinephric fluid collection, and thetype of case (acute or chronic). MDCT urography is a highly reliable method of imaging the cause of obstructing agents in cases of obstructive uropathy and the damage caused by them. The type of enhancement and excretion and the secondary findings play an important role in determining the acuteness or the chronicity of the obstructive agent.

Clinical study on diverse surgical affections of oesophagus in buffaloes

This Article presents the detailed study of oesophageal affections of buffaloes recorded in the clinic of Department of Veterinary Surgery and Radiology VCC CVAS, RAJUVAS, Bikaner Rajasthan India. Different clinical symptoms, types of affections, etiology and postoperative complications were recorded, plane and contrast radiographic study was carried out and affections were categorized based on their diagnosis. Complete obstruction was present in the highest number followed by diverticulum. The site of obstruction in most of the animal was distal cervical regional close to the thoracic inlet and impacted plastic and tarpaulin was the most impacted material retrieved in the oesophagotomy procedures. Conservative and surgico-therapeutic treatment was carried out. Rupture of oesophagus was noticed as a consequence of complete obstruction at proximal site in delayed presented cases. Narrowing of oesophagus noticed at mid cervical region because of the fibrosis of the oesophgaus. Dilation of oesophagus was present in consequences of chronic obstruction and chronic history of ailments. Penetrating foreign bodies mostly sharp needles were present at proximal oesophagus. Early presented cases having healthy mucosa showed the successful outcome and chronicity of the condition resultant in complications and poor prognosis.

Developing a virtual Endoscopic Surgery Planning system to optimize surgical outcomes.

Planning and predicting functional outcomes of endoscopic sinus surgeries (e.g., nasal airflow) based solely on visualizing Computerized Tomography (CT) or endoscopy poses a challenge to produce optimal clinical outcomes. Technology development, retrospective case report. A virtual surgery planning (VSP) tool is developed that can load any patient's CT data and allow surgeons to remove obstructive tissue using both visual and haptic feedback endoscopically. Pre-calculated airflow resistance, wall shear stress, pressure drop are displayed on the anatomy to identify potential sites of obstruction. After each virtual surgery, changes in nasal airflow can be computed, and the process is reiterated until an optimal result is reached. As proof-of-concept, a series of isolated or combined procedures were performed on CT of one patient, who had olfactory losses that may involve obstructions blocking the air/odor flow to the olfactory fossa (OF). For this patient, an isolated medial partial middle turbinectomy (PMT) demonstrated the best outcome, better than traditionally performed lateral PMT, while septal body reduction worsened air/odor flow to OF. This proof of concept case report demonstrates the potential usefulness of VSP in preoperative planning based on objective benchmarks and could be a valuable tool for optimizing future surgical outcomes.

Differences in salivary microbiome among children with tonsillar hypertrophy and/or adenoid hypertrophy.

Children diagnosed with severe tonsillar hypertrophy display discernible craniofacial features distinct from those with adenoid hypertrophy, prompting illuminating considerations regarding microbiota regulation in this non-inflammatory condition. The present study aimed to characterize the salivary microbial profile in children with tonsillar hypertrophy and explore the potential functionality therein. A total of 112 children, with a mean age of 7.79 ± 2.41 years, were enrolled and divided into the tonsillar hypertrophy (TH) group (n = 46, 8.4 ± 2.5 years old), adenoid hypertrophy (AH) group (n = 21, 7.6 ± 2.8 years old), adenotonsillar hypertrophy (ATH) group (n = 23, 7.2 ± 2.1 years old), and control group (n = 22, 8.6 ± 2.1 years old). Unstimulated saliva samples were collected, and microbial profiles were analyzed by 16S rRNA sequencing of V3-V4 regions. Diversity and composition of salivary microbiome and the correlation with parameters of overnight polysomnography and complete blood count were investigated. As a result, children with tonsillar hypertrophy had significantly higher α-diversity indices (P＜0.05). β-diversity based on Bray-Curtis distance revealed that the salivary microbiome of the tonsillar hypertrophy group had a slight separation from the other three groups (P＜0.05). The linear discriminant analysis effect size (LEfSe) analysis indicated that Gemella was most closely related to tonsillar hypertrophy, and higher abundance of Gemella, Parvimonas, Dialister, and Lactobacillus may reflect an active state of immune regulation. Meanwhile, children with different degrees of tonsillar hypertrophy shared similar salivary microbiome diversity. This study demonstrated that the salivary microbiome in pediatric tonsillar hypertrophy patients had different signatures, highlighting that the site of upper airway obstruction primarily influences the salivary microbiome rather than hypertrophy severity.IMPORTANCETonsillar hypertrophy is the most frequent cause of upper airway obstruction and one of the primary risk factors for pediatric obstructive sleep apnea (OSA). Studies have discovered that children with isolated tonsillar hypertrophy exhibit different craniofacial morphology features compared with those with isolated adenoid hypertrophy or adenotonsillar hypertrophy. Furthermore, characteristic salivary microbiota from children with OSA compared with healthy children has been identified in our previous research. However, few studies provided insight into the relationship between the different sites of upper airway obstruction resulting from the enlargement of pharyngeal lymphoid tissue at different sites and the alterations in the microbiome. Here, to investigate the differences in the salivary microbiome of children with tonsillar hypertrophy and/or adenoid hypertrophy, we conducted a cross-sectional study and depicted the unique microbiome profile of pediatric tonsillar hypertrophy, which was mainly characterized by a significantly higher abundance of genera belonging to phyla Firmicutes and certain bacteria involving in the immune response in tonsillar hypertrophy, offering novel perspectives for future related research.

WP4.16 - Gallstone ileus as an infrequent cause of bowel obstruction- a review of small cohort

Abstract Introduction It is uncommon cause of small bowel obstruction, presents 1 – 5% of adult population. It is a rare complication of chronic cholecystitis which lead to cholecysto-enteric fistula and impaction of gall stone in GI tract leading to mechanical bowel obstruction. Our aim is to report the natural history and management of this condition in District Hospital. Method Retrospective 10 years of data was collected with CT findings of intestinal obstruction with gall stone ileus. It included 10 patients over 10 years whose medical records were evaluated retrospectively. Results Majority of patients were female (90%, n:9) with mean age of 81.6 years (range 61-96) although 90% of population were above 70 years. Presenting complaints were mostly pain and vomiting. Onset of symptoms between 2- 7 days. The site of obstruction was mostly ileum (n=9) with exception of one case in sigmoid proximal to stricture and size of stone was ranging ffrom2.5 to 4 cm, moreover most of the patients had previous history of gall stone (n=7) with one post cholecystectomy status. During routine investigations 50 % of patients had deranged LFT &amp;AKI and 50-60% had raised inflammatory markers (WBC,CRP).Intervention as Enterolithotomy was the preferred approach (n=8,2 lap ,7 open) and non operative management was performed in two cases.The mean post op length of stay were 10 days in open and 5 days in Lap respectively. Conclusions Elderly female patients are more prone to have gallstone ileus particularly with a past medical history of gall stone and the preferred management option is Enterolithotomy which could be open or laparoscopic depending on expertise of the Surgeon.

Predictive Factors for the Successful Outcome of Urethral Sphincter Injections of Botulinum Toxin A for Non-Neurogenic Dysfunctional Voiding in Women.

Dysfunctional voiding (DV) is not uncommon in women with non-neurogenic voiding dysfunction. Because of its unknown pathophysiology, effective and durable treatment is lacking. This study aimed to analyze the results of treatment and predictive factors for a successful outcome of botulinum toxin A (BoNT-A) treatment in female patients with DV. In total, 66 women with DV confirmed by a videourodynamic study (VUDS) were treated with a BoNT-A injection into the urethral sphincter once (n = 33) or several times (n = 33). VUDS was performed before (baseline) and after the BoNT-A treatment. Patients with a global response assessment of the voiding condition of 2 or 3 and a voiding efficiency (VE) of >20% than baseline were considered to have a successful outcome. The baseline demographics, VUDS parameters, and VUDS DV subtypes were compared between the successful and failed groups. Predictive factors for a successful outcome were investigated by logistic regression analyses. Successful and failed outcomes were achieved in 27 (40.9%) and 39 (59.1%) women, respectively. After BoNT-A injections, the maximum flow rate (Qmax), voided volume, and VE all significantly increased, and the postvoid residual (PVR) was slightly improved. No significant difference in the number of injections and medical comorbidity was found between the groups. However, the successful group had a higher incidence of previous pelvic surgery. No significant difference in the treatment outcome was found among patients with different urethral obstruction sites. Significant improvements in Qmax, voided volume, PVR, VE, and the bladder outlet obstruction (BOO) index were noted in the successful group. A lower VE at baseline and a history of surgery were identified as predictive factors for a successful outcome of BoNT-A injections for treating DV. BoNT-A injections into the urethral sphincter can effectively improve VE in 40.9% of women with DV. Women with higher BOO grades and previous pelvic surgery are predicted to have a successful treatment outcome.

Cola Saves My Life: The Successful Treatment of Oesophageal Food Bolus Impaction with Cola Ingestion

Oesophageal food bolus impaction, a serious emergency, requires immediate intervention to prevent complications, such as perforation or aspiration leading to respiratory distress. Severity varies based on factors such as the size of the ingested object, obstruction site, individual health, and the promptness of medical attention. In this report, we present the case of a middle-aged gentleman who presented to the emergency department with oesophageal food obstruction caused by a piece of lamb meat. Despite the initial unsuccessful attempts with first aid treatment, the patient experienced immediate relief of obstruction upon ingesting cola. This case highlights the potential use of cola in managing selected cases of oesophageal food impaction, offering a non-invasive alternative to oesophago-duodenoscopy. While cola emerged as a promising intervention in this case, its broader applicability and safety warrant further investigation through controlled trials. Establishing judicious cola use guidelines alongside traditional interventions can enhance patient care and safety.

Development and validation of deep learning models for bowel obstruction on plain abdominal radiograph.

Artificial intelligence (AI) could help medical practitioners in analyzing radiological images to determine the presence and site of bowel obstruction. This retrospective diagnostic study proposed a series of deep learning (DL) models for diagnosing bowel obstruction on abdominal radiograph. A total of 2082 upright plain abdominal radiographs were retrospectively collected from four hospitals. The images were labeled as normal, small bowel obstruction and large bowel obstruction by three senior radiologists based on comprehensive examinations and interventions within 48 hours after admission. Gradient-weighted class activation mapping was used to visualize the inferential explanation. In the validation set, the Xception-backboned model achieved the highest accuracy (0.863), surpassing the VGG16 (0.847) and ResNet models (0.836). In the test set, the Xception model (accuracy: 0.807) outperformed other models and a junior radiologist (0.780) but not a senior radiologist (0.840). In the AI-aided diagnostic framework, the junior and senior radiologists made their judgements while aware of the Xception model predictions. Their accuracy significantly improved to 0.887 and 0.913, respectively. We developed and validated DL-based computer vision models for diagnosing bowel obstruction on plain abdominal radiograph. DL-based computer-aided diagnostic systems could reduce medical practitioners' workloads and improve diagnostic accuracy.

Sulfonic Acid-Functionalized Graphdiyne for Effective Li-S Battery Separators.

Lithium-sulfur (Li-S) batteries enable a promising high-energy-storage system while facing practical challenges regarding lithium dendrites and lithium polysulfides (LiPSs) shuttling. Herein, a fascinating SO3H-functionalized graphdiyne (SOGDY) was developed by grafting SO3H onto GDY to modify the separator in Li-S batteries. It realizes structure-retained material transformation, that is, SOGDY retains the crystalline all-carbon network and uniform subnanopores from the initial GDY. The abundant SO3H and uniform pores create a rapid Li+ transport relay station, benefit rapid Li+ transport and even lithium deposition, and prevent lithium dendrite growth. The spatial obstruction and strong polar adsorption sites from SO3H effectively inhibit LiPS shuttling. Additionally, SOGDY establishes a fast electron-transfer pathway to facilitate the LiPS conversion. The SOGDY/PP separator exhibited steady cycling at 1 mA cm-2 over 3500 h in the Li∥Li symmetric battery and achieved outstanding low-temperature and high-rate performance in the Li-S battery with a high initial specific capacity of 804.5 mA h g-1 and a final capacity of 504.9 mA h g-1 after 500 cycles at 3 C and -10 °C. This work demonstrates that introducing a stable all-carbon network and uniform functionalized nanopores is an effective strategy to modify the Li-S battery separator.

Drug-Induced Sleep Endoscopy Predicts Subjective Outcomes of Adenotonsillectomy.

Persistent obstructive sleep apnea (OSA) after adenotonsillectomy (AT) has been reported in 20%-30% of children. The aim of this study was to determine the predictive value of drug-induced sleep endoscopy (DISE) at the time of AT on subjective AT outcomes. This was a prospective cohort study of children aged 2-18 years being treated with AT for sleep disordered breathing (SDB) with one or more risk factors for AT failure: age >7 years, obesity, severe baseline OSA, Black race. All underwent DISE at the time of AT. Potential predictors of subjective AT outcome included age, sex, obesity, and DISE patterns. Multivariable linear regression was used to model predictors of post-AT Pediatric Sleep Questionnaire (PSQ) and OSA-18 outcomes. Pre- and post-AT PSQ/OSA-18 responses were available from 194 children. Mean age was 9.3 ± 3.5 years, with 59% obese, 50% female, and 67% White. After AT, mean PSQ score decreased from 0.60 ± 0.19 to 0.28 ± 0.22, p < 0.001 and mean OSA-18 score decreased from 66 ± 21 to 37 ± 18, p < 0.001. The most frequent sites of obstruction were the tonsils (92%), nasal airway (77%), adenoids (64%), and velopharynx (65%). Multivariable regression modeling demonstrated worse outcomes with obesity, male gender, and multilevel obstruction that included the nasal airway and tongue base in addition to adenotonsillar obstruction. Persistent OSA and symptom burden after AT was common in this population. Obesity, male gender, and multilevel obstruction during DISE were all associated with worse subjective outcomes. 3 Laryngoscope, 2024.

Efficacy and safety of self-expandable metallic stents for management of benign gastric outlet obstruction-A prospective study.

We aimed at evaluating the safety and efficacy of self-expandable metallic stent (SEMS) insertion for managing patients with benign gastric outlet obstruction (GOO). This prospective interventional study included 23 patients. All consecutive treatment-naïve symptomatic patients with benign GOO were recruited. Fully covered SEMS were deployed across the stricture under fluoroscopic and endoscopic guidance. Technical success, clinical success and sustained treatment response (STR) were assessed. Technical success was defined as the successful deployment of SEMS at the desired anatomic location. Clinical success was defined as the resolution of symptoms and an increase in Gastric Outlet Obstruction Scoring System (GOOSS) of at least 1 point from the baseline score on Day 7. STR was assessed at four and eightweeks post stent removal in patients who had a response at week four. Factors associated with stent migration and non-response at week four were also assessed. The median age of the study population was 30years (range 19-65years). Males constituted 65.22%. Most patients presented with vomiting (100%) and abdominal pain (95.65%). Peptic stricture was most common etiology for GOO (60.9%) followed by tubercular (26.1%) and corrosive (13%). Most common site of obstruction was junction of first and second part of duodenum (69.57%) followed by pyloric (30.43%). Median length of stricture was 2cm (range 1.5-4). Technical success was achieved in all 23 patients (100%). Clinical success was achieved in 21 patients (91.3%). Response at Day 28 was seen in 20 patients (86.95%). Eighteen of 20 (90%) patients who had a response at week four had STR at week four and week eight after stent removal. Stent migration occurred in five (21.7%) patients. On univariate analysis, stricture length, calibre and stent length were found to predict migration. Fully covered SEMS was an effective and safe management modality in patients with benign GOO. Stent migration remains a troublesome disadvantage.

Lingual Tonsillectomy as Part of a DISE-Directed Multilevel Upper Airway Surgery to Treat Complex Pediatric OSA: A Safe and Appropriate Procedure.

To study the efficiency of lingual tonsillectomy (LT) as part of multilevel surgery in children with complex obstructive sleep apnea (OSA). To evaluate the safety and the outcomes of LT. Retrospective case series. Pediatric tertiary care academic center. We included all children operated for LT to treat complex OSA, from January 2018 to June 2022. All patients underwent a protocolized drug-induced sleep endoscopy (DISE) followed by a coblation LT, associated with the treatment of all other obstructive sites. Patient demographics, medical history, surgery, and outcomes were reviewed. The efficiency of LT was analyzed exclusively in patients with a preoperative and postoperative sleep study. One hundred twenty-three patients were included. Median age was 8 years (interquartile range, IQR [3-12]). Sixty-five (53%) patients had Down syndrome, 22 (18%) had a craniofacial malformation, and 8 (7%) were obese. LT was associated with adenoidectomy (n = 78, 63%), partial tonsillectomy (n = 70, 57%), inferior turbinoplasty/turbinectomy (n = 59, 48%), epiglottoplasty (n = 92, 75%), and/or expansion pharyngoplasty (n = 2, 2%). Eighty-nine patients underwent a sleep study before and after surgery. The median apnea-hypopnea index (AHI) decreased from 18 events/h (IQR [9-36]) before surgery to 3 events/h (IQR [1-5]) after surgery (P < .001) (patients with a postoperative AHI <1.5 events/h, n = 31, 35%, and an AHI <5 events/h, n = 32, 36%). Seventeen out of 30 (57%) patients could be weaned from continuous positive airway pressure after surgery. Two patients had a postoperative hemorrhage and 2 patients required a transient postoperative reintubation. In children with complex OSA, LT as part of a DISE-directed multilevel upper airway surgery, was a very efficient and safe procedure.

Correlation and Diagnostic Agreement Between Ultrasonography and MRCP in Evaluating Obstructive Jaundice: A Prospective Study

Background: Obstructive jaundice is a clinical condition characterized by the yellow discoloration of the skin, sclera, and mucous membranes due to elevated bilirubin levels caused by bile flow obstruction. Accurate diagnosis of the obstruction's cause and site is essential for effective management. Ultrasonography (USG) is commonly used for initial screening, but it has limitations, especially in visualizing the distal common bile duct (CBD). Magnetic resonance cholangiopancreatography (MRCP) has emerged as a superior, non-invasive imaging modality with higher accuracy in evaluating biliary obstructions. Objective: To evaluate the correlation and agreement between USG and MRCP findings in patients with obstructive jaundice and to determine the diagnostic accuracy of each modality in detecting the level and cause of biliary obstruction. Methods: This prospective cohort study was conducted over six months at a tertiary care hospital in Rawalpindi. A total of 32 patients with clinical suspicion of obstructive jaundice were included. Each patient underwent both USG and MRCP. USG was performed using a GE Logiq-e machine, followed by MRCP on a Philips Achieva 1.5 Tesla MRI scanner. Data were analyzed using SPSS version 25. Pearson's correlation coefficient and kappa statistics were used to assess the correlation and agreement between the two modalities. The diagnostic accuracy of USG and MRCP was compared based on the detection of the level of obstruction and the identification of benign and malignant etiologies. Results: The mean age of the patients was 59.53 ± 13.41 years, with 65.6% being male. MRCP showed a diagnostic accuracy of 97.2% compared to 78.1% for USG. MRCP detected distal CBD calculi with 100% accuracy, while USG missed these in 11 cases. A positive correlation was found between USG and MRCP in detecting the site of obstruction (r = 0.48, p = 0.005), the porta hepatis as the site of obstruction (r = 0.47, p = 0.006), and the ampulla as the site of obstruction (r = 0.47, p = 0.006). However, the correlation for benign etiologies was weak (r = 0.094, p = 0.607), and for malignant etiologies, it was moderate (r = 0.31, p = 0.08). Conclusion: MRCP demonstrated superior diagnostic accuracy compared to USG in evaluating patients with obstructive jaundice, particularly in detecting distal CBD calculi and malignant lesions. While USG remains useful as an initial screening tool, MRCP should be considered the preferred imaging modality when detailed evaluation is required.

Airway and Airway Obstruction Site Segmentation Study Using U-Net with Drug-Induced Sleep Endoscopy Images.

Obstructive sleep apnea is characterized by a decrease or cessation of breathing due to repetitive closure of the upper airway during sleep, leading to a decrease in blood oxygen saturation. In this study, employing a U-Net model, we utilized drug-induced sleep endoscopy images to segment the major causes of airway obstruction, including the epiglottis, oropharynx lateral walls, and tongue base. The evaluation metrics included sensitivity, specificity, accuracy, and Dice score, with airway sensitivity at 0.93 (± 0.06), specificity at 0.96 (± 0.01), accuracy at 0.95 (± 0.01), and Dice score at 0.84 (± 0.03), indicating overall high performance. The results indicate the potential for artificial intelligence (AI)-driven automatic interpretation of sleep disorder diagnosis, with implications for standardizing medical procedures and improving healthcare services. The study suggests that advancements in AI technology hold promise for enhancing diagnostic accuracy and treatment efficacy in sleep and respiratory disorders, fostering competitiveness in the medical AI market.

Surgical outcomes and prognosis of intracorporeal versus extracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer: a propensity score-matching study

This study compared the surgical outcomes and long-term prognosis of intracorporeal and extracorporeal esophagojejunostomy after laparoscopic total gastrectomy (LTG) for gastric cancer patients. In total 228 clinical stage I gastric cancer patients undergoing LTG were enrolled from January 2012 and December 2022. Each case in the totally laparoscopic total gastrectomy (TLTG) group was 1:1 propensity score-matched to control cases in the laparoscopy-assisted total gastrectomy (LATG) group. In total, 95 and 93 LATG and TLTG patients were included after propensity score matching (PSM). Clinicopathological features, surgical outcomes, and survival variables were compared, and risk factors for postoperative complications were analyzed. Patient characteristics were well balanced between the LATG and TLTG groups after PSM. The TLTG group showed less blood loss, decreased frequency of analgesic use, and shorter duration of analgesic use. The TLTG group had significantly lower rates of intestinal obstruction and surgical site infection. Larger tumor size and advanced pTNM stage were independent risk factors for postoperative complications. There was no significant difference in overall survival (OS). Compared with LATG, TLTG was associated with better surgical outcomes and fewer postoperative surgical complications in gastric cancer patients although there was no significant difference in OS.