SciCombinator

Discover the most talked about and latest scientific content & concepts.

Concept: Fecal impaction

168

BACKGROUND: PEG-based laxatives are considered today the gold standard for the treatment of constipation in children. PEG formulations differ in terms of composition of inactive ingredients which may have an impact on acceptance, compliance and adherence to treatment. We therefore compared the efficacy, tolerability, acceptance and compliance of a new PEG-only formulation compared to a reference PEG-electrolyte (PEG-EL) formulation in resolving faecal impaction and in the treatment of chronic constipation. METHODS: Children aged 2–16 years with functional chronic constipation for at least 2 months were randomized to receive PEG-only 0.7 g/kg/day in 2 divided doses or 6.9 g PEG-EL 1–4 sachets according to age for 4 weeks. Children with faecal impaction were randomized to receive PEG-only 1.5/g/kg in 2 divided doses until resolution or for 6 days or PEG-EL with an initial dose of 4 sachets and increasing 2 sachets a day until resolution or for 7 days. RESULTS: Ninety-six children were randomized into the study. Five patients withdrew consent before starting treatment. Three children discontinued treatment for refusal due to bad taste of the product (1 PEG-only, 2 PEG-EL); 1 (PEG-EL) for an adverse effect (abdominal pain). Intent-to-treat analysis was carried out in 49 children in the PEG-only group and 42 in the PEG-EL group.No significant differences were observed between the two treatment groups at baseline.Adequate relief of constipation in terms of normalized frequency and painless defecation of soft stools was achieved in all patients in both groups. The number of stools/week was 9.2 +/- 3.2 (mean +/- SD) in the PEG-only group and 7.8 +/- 2.4 in the PEG-EL group (p = 0.025); the number of days with stool was 22.4 +/- 5.1 in the PEG-only group and 19.6 +/- 7.2 in the PEG-EL group (p = 0.034).In the PEG-only group faecaloma resolution was observed in 5 children on the second day and in 2 children on the third day, while in the PEG-EL group it was observed in 2 children on the second day, in 3 children on the third day and in 1 child on the fifth day.Only 2 patients reported mild treatment-related adverse events: 1 child in the PEG-only group had diarrhoea and vomiting and 1 child in the PEG-EL group had abdominal pain requiring treatment discontinuation. The PEG-only preparation was better tolerated as shown by the lower frequency of nausea than in the PEG-EL group.In the PEG-only group, 96% of patients did not demonstrate any difficulties associated with treatment, as compared with 52% of patients in the PEG-EL group (p < 0.001). Also, the PEG-only formulation taste was better than that of PEG-EL (p < 0.001). The difference between the percentage of subjects who took > 80% of the prescribed dose was in favour of the PEG-only group (98% vs. 88%), though it did not reach a conventional statistical level (p = 0.062). CONCLUSION: PEG-only was better tolerated and accepted than PEG-EL in children with chronic constipation. At the higher PEG doses recommended by the manufactures children in the PEG-only group had higher and more regular soft stool frequency than PEG-EL.Trial registrationClinicalTrials.gov: NCT01592734.

Concepts: Randomized controlled trial, Constipation, Gastroenterology, Irritable bowel syndrome, Feces, Polyethylene glycol, Fecal impaction, Enema

26

Purpose: To describe a patient with nasolacrimal duct obstruction (NLDO) caused by dental impaction.

Methods: This is an interventional case report of an 18-year-old man presenting epiphora of the right eye. Previous surgical management was unsuccessful. Computed tomography (CT) of the orbits and sinuses was performed. Dacryocystorhinostomy (DCR) on the right lacrimal sac resulted in complete remission of symptoms. The DCR surgical outcome at last follow-up was recorded.

Results: The CT imaging showed ankylosis of deciduous canines and impaction of persistent canines. The root of the right impacted dental element was involved with the nasolacrimal duct, leading to NLDO. Endoscopic DCR resulted in complete remission of symptoms. The patient was symptom-free at last follow-up.

Conclusions: Our case adds NLDO to the long list of complications arising from dental impactions, highlighting the importance of correct early management of the latter condition. This case also shows that dental impaction can be included among the secondary mechanical causes of NLDO.

Concepts: Medical terms, Tears, Lacrimal sac, Lacrimal apparatus, Nasolacrimal duct, Fecal impaction, Impaction, Nasolacrimal canal

0

Compound odontomas are common odontogenic tumors associated with permanent tooth impaction in the premaxilla. This report describes the case of a 14-year-old girl with an odontoma-associated impaction over the premaxilla that was treated using autotransplantation to satisfy an immediate esthetic demand. At postoperative follow-up conducted in the 14th month, a satisfactory cosmetic appearance with a healthy periodontal status was observed. In addition, the authors discuss the possible complications of autotransplantation and different treatment strategies for odontoma-associated impaction and for correcting bone defects in this case report. Autotransplantation for treating odontoma-associated impaction can be an alternative solution for satisfying an immediate cosmetic demand and providing a favorable outcome.

Concepts: Game theory, Strategy, Fecal impaction, Strategy pattern, Odontogenic

0

Freeze-dried and irradiated allograft bone (FIAB) is more easily impacted than fresh-frozen allograft bone (FAB) but has weaker incorporation efficiency. We combined FIAB with fresh autologous coagula to enhance donor-host incorporation after impaction during hip revision.

Concepts: Bone grafting, Fecal impaction

0

Treatment of palatally impacted and transposed canines is challenging for both orthodontists and oral surgeons. To treat a maxillary canine impaction without risking damage to adjacent teeth, it is necessary to use cone-beam computed tomography for proper localization and treatment planning. In this case report, a palatally impacted canine was initially retracted distally with a microimplant inserted in the palatal slope and then was moved buccally into its ideal position. The patient’s occlusion and smile esthetics were significantly improved after orthodontic treatment.

Concepts: Patient, Teeth, Orthodontics, Canine tooth, Fecal impaction, Maxillary canine

0

To describe stone-free rates and complications of ureteroscopic treatment for impacted compared with non-impacted ureteral stones and evaluate predictive variables for impaction.

Concepts: Fecal impaction

0

Stercoral colitis is an inflammatory process involving the colonic wall related to fecal impaction. This rare condition is associated with high morbidity-mortality.

Concepts: Inflammation, Inflammations, Colon, Anti-inflammatory, Feces, Fecal impaction

0

Colonic obstruction is a relatively common condition in emergency care, with a mortality rate of up to 20%. In 90% of cases it results from colonic or rectal adenocarcinoma, volvulus, or stenosis secondary to diverticular disease. When fecal impaction is the underlying cause, the condition is usually managed conservatively, but may on occasion become complicated and even require surgical intervention. Based on the proven efficacy of Coca-Cola® to dissolve gastric phytobezoars, we report a case of colonic obstruction secondary to sigmoid fecaloma.

Concepts: Surgery, Actuarial science, Colon, Colonoscopy, Gastroenterology, Feces, Rectum, Fecal impaction

0

Stercoral perforation is a rare cause of bowel perforation. It is caused by faecal impaction, which generates pressure against the colon wall, leading to ischaemic necrosis and subsequent perforation. Since diagnosis is often delayed, stercoral perforation is usually mistreated as constipation or faecal impaction, leading to high mortality. This report presents a case of stercoral perforation in a woman aged 34 years who was promptly diagnosed and successfully treated.

Concepts: Death, Abdominal pain, Constipation, Gastroenterology, Bowel obstruction, Feces, Defecation, Fecal impaction

0

Odontoma is considered to be the most common odontogenic tumor of the oral cavity. Most odontomas are asymptomatic and are discovered during routine radiographic investigations and can cause disturbances in the eruption of the teeth, most commonly delayed eruption or deflection. By a retrospective study design, demographic and clinical data regarding patients who presented odontomas from year 1995 to 2015 were obtained in order and the influence of active therapy on the dentition and on the treatment of impacted teeth was analyzed. Forty-five patients (mean age 14.2 years) with 29 complex and 16 compound odontomas were included in this retrospective study. Initial symptoms were delayed eruption of permanent teeth (n = 25), pain (n = 6), swellings (n = 4), and no symptoms (n = 10); 31 patients were discovered by incidence, all of them via panoramic radiographs. The mandible/maxilla ratio was about 2:1 (31/15). Thirty-two out of 45 odontomas were in close proximity of at least 1 tooth (n = 21 at incisive). A total of 12 teeth were extracted (complex: n = 8; compound: n = 4). Of the nonextracted teeth, 33 teeth were displaced and retained. Of those, 29 teeth were aligned through orthodontic-surgical approach and 4 teeth erupted spontaneously after surgery during the follow-up period. An early detection of odontoma is more likely an accidental radiological finding, hence the need for routine radiographic analysis should be emphasized. Early diagnosis of odontomas in primary dentition is crucial in order to prevent later complications, such as impaction or failure of eruption of teeth.

Concepts: Medical imaging, Radiography, Retrospective, Teeth, Tooth, Fecal impaction