The utilization of flexible sigmoidoscopy by family practitioners after residency training

BACKGROUND

Flexible sigmoidoscopy is routinely performed by family practice physicians, most of whom receive training in postgraduate education programs. The aim of this study was to assess the utilization of flexible sigmoidoscopy by family practitioners who received training during residency.

METHODS

Family practitioners who underwent training in flexible sigmoidoscopy during their residency were contacted by phone or mail and polled regarding their current use of flexible sigmoidoscopy and assessment of their previous training.

RESULTS

Forty-two graduates were contacted; 76% were certified (according to our predefined criteria) during training and 74% were currently performing flexible sigmoidoscopy. Of those who were certified, 87% were currently using flexible sigmoidoscopy compared with 45% of those who did not receive certification (p = 0.02). Training during the last year of residency was more likely to be associated with current use of flexible sigmoidoscopy than earlier training (69% vs. 30%, p = 0.03). Certification was associated with more procedures during training (24.3 +/- 1.7 vs. 16.6 +/- 3.1, p < 0.05). Current users performed a mean of 4.3 +/- 0.75 procedures/month; most reached 40 cm in depth of insertion and completed the procedure in 17.2 +/- 1.2 minutes. Of patients undergoing flexible sigmoidoscopy, 13% were ultimately referred for colonoscopy. Most practitioners considered their training useful and only 9.6% had obtained additional training outside residency.

CONCLUSIONS

Most family practitioners certified in flexible sigmoidoscopy during residency performed the procedure in their practices. Depth of insertion and time for completion of the procedure seem to be adequate.

Diagnostic and therapeutic endoscopy through the gastrostomy site

We report a successful diagnostic and therapeutic endoscopy through the gastrostomy site in two patients in whom conventional antegrade upper endoscopy was not possible. In one, the endoscopic and histologic diagnosis of a completely obstructing malignant lesion in the upper esophagus was possible by retrograde intubation using a bronchoscope. In the other, the gastrostomy site was used to gain access and assist in the placement of a jejunostomy tube. We describe a technique to help circumvent the lack of air insufflation with the bronchoscope. Both endoscopies were carried out without the need for drugs for conscious sedation. This percutaneous route, through a gastrostomy site, in the technique described by us uses a readily available endoscope in any hospital setting, does not need conscious sedation, and does not need dilation of the stoma site, allowing access to the gastrointestinal tract for diagnostic and therapeutic purposes.

Herpes zoster induced urinary retention in Hodgkin's disease

A patient with Hodgkin's disease with acute urinary retention caused by herpes zoster is presented. Two other similar cases previously reported in the literature are reviewed along with a review of English literature on herpes zoster causing urinary retention and on other genitourinary problems in Hodgkin's disease. Because of increased incidence of herpes zoster in Hodgkin's disease, recognition of this complication is stressed since other causes of actue urinary retention in Hodgkin's disease have serious implications.