Publications Authored By Renae Kavlock
We reviewed the electronic charts of 210 patients with non-melanoma skin malignant tumours and calculated the positive predictive value of the initial clinical diagnosis. Histological confirmation for each lesion was compared with the provisional clinical diagnosis made in the clinic.
Of the 147 lesions provisionally diagnosed as basal cell carcinomas, 133 lesions were histologically confirmed to be basal cell carcinomas (BCC) (PPV 90.4 %). Of the 63 lesions provisionally thought to be squamous cell carcinomas, 47 lesions were histologically confirmed as squamous cell carcinomas (SCC) (PPV 74.6 %). The difference between the PPVs for the two types of malignancy in our study was not significant (p = 0.39). Statistics between our results for BCC and SCC and those reported from two other cancer institutes revealed no significant difference (p = 0.58 and 0.07).
The present study supports that relying on clinical diagnosis with the purpose to formalise a treatment plan for head and neck non-melanoma skin cancer is safe and efficient. This is more reliable in cases of basal cell carcinoma in comparison to suspected squamous cell carcinomas. Although positive predictive value represents a reliable measure of diagnostic accuracy, it is increased when populations with higher prevalence of the disease are studied.
A total of 105 cases were reviewed. Compliance varied. Documentation of altered sensation was consistently poor and too many unnecessary radiographs were taken. There may be a need to circulate the guidelines again to increase awareness and reduce variability between centres.
We present a review of presentation of spinal epidural abscesses and indications for surgical intervention.
Subjects also expelled a water-filled (50 cc) balloon or silicone-stool (FECOM) either lying or sitting and rated their stooling sensation.
When attempting to defecate in the lying position, a dyssynergic pattern was seen in 36% of subjects with empty rectum and 24% with distended rectum. When sitting, 20% showed dyssynergia with empty rectum and 8% with distended rectum. More subjects (p < 0.05) showed dyssynergia in lying position. When lying, 60% could not expel balloon and 44% FECOM. When sitting, fewer (p < 0.05) failed to expel balloon (16%) or FECOM (4%). FECOM expulsion time was quicker (p < 0.02). Stool-like sensation was more commonly (p < 0.005) evoked by FECOM than balloon.
In the lying position, one-third showed dyssynergia and one-half could not expel artificial stool. Whereas when sitting with distended rectum, most showed normal defecation pattern and ability to expel stool. Thus, body position, sensation of stooling and stool characteristics may each influence defecation. Defecation is best evaluated in the sitting position with artificial stool.
Quantitative and qualitative manometric analysis was performed in 8-h epochs. Patients were followed up for 1 yr.
Constipated patients showed fewer pressure waves and lower area under the curve (p < 0.05) than controls during daytime, but not at night. Colonic motility induced by waking or meal was decreased (p < 0.05) in patients. High-amplitude propagating contractions (HAPCs) occurred in 43% of patients compared to 100% of controls and with lower incidence (1.7 vs 10.1, p < 0.001) and propagation velocity (p < 0.04). Manometric features suggestive of colonic neuropathy were seen in 10, myopathy in 5, and normal profiles in 4 patients. Seven patients with colonic neuropathy underwent colectomy with improvement. The rest were managed conservatively with 50% improvement at 1 yr.
Patients with slow-transit constipation exhibited either normal or decreased pressure activity with manometric features suggestive of colonic neuropathy or myopathy as evidenced by absent HAPC or attenuated colonic responses to meals and waking. In refractory patients, colonic manometry may be useful in characterizing the underlying pathophysiology and in guiding therapy.
While attempting to place an epidural, the patient failed to achieve adequate skin analgesia despite multiple attempts at local infiltration. When a spinal was ultimately placed, sensory or motor blockade was not obtained despite no evidence of technical problems with technique. Further questioning revealed multiple prior episodes of local anesthetic failure in this patient. CONCLUSIONS: While the failure rate of spinal anesthesia has been shown range from 4-13% and is often attributed to technical failure, elements of this particular case suggest a true resistance to local anesthetics.