1/24. Laparoscopic removal of an Angelchik prosthesis.The use of Angelchik prosthetic rings for the surgical treatment of gastroesophageal reflux disease has been associated with frequent complications, including dysphagia and migration, erosion, or disruption of the ring. Although reports of the laparoscopic insertion of Angelchik rings have been published, there have been no descriptions of the laparoscopic removal of rings inserted at open laparotomy. Our group recently removed an Angelchik ring laparoscopically in an 80-year-old woman with progressive, refractory dysphagia and esophageal narrowing due to an Angelchik ring originally placed in 1981 via an upper midline incision at open operation. Upper endoscopy and dilatation had failed to provide symptom relief. An extensive adhesiolysis was performed laparoscopically, and the Angelchik ring was dissected free from the proximal stomach, diaphragm, and liver. The fibrous pseudocapsule enclosing the ring was divided, and the prosthesis was removed from around the esophagus and abdominal cavity. Intraoperative upper endoscopy confirmed resolution of the esophageal stricture. There were no intraoperative complications, and the patient was discharged home on the 3rd postoperative day tolerating a regular diet. Postoperatively, she experienced resolution of her dysphagia and complained only of mild reflux symptoms, which were easily controlled with famotidine and antireflux precautions. This case suggests that laparoscopic removal of Angelchik prosthetic rings is feasible for surgeons familiar with advanced laparoscopic procedures of the esophageal hiatus and should be considered for symptomatic patients, even if the ring was inserted via an open operation.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/24. Congenital short-bowel; a case study and review of the literature.A congenital short bowel (CSB) is a rare entity in pediatric surgery. We present the case of a newborn boy with a total small intestinal length of 47 cm, malrotation and gastroesophageal reflux, who is 19 months old at the time of this report. Main treatment steps were Ladd's procedure, a fundoplication and long-term parenteral nutrition. We suggest that missing physiological herniation of the gut into the coelomic cavity may impair normal intestinal growth and rotation and lead to congenital short bowel. review of all cases reported in the literature shows a considerable mortality of 88%. The limiting factor seems to be reduced motility of the short small bowel causing functional obstruction and liver failure.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
3/24. Supraesophageal complications of gastroesophageal reflux.Supraesophageal complications of GERD have become more commonly recognized or suspected by physicians. However, the direct association between these complications and GERD has often been difficult, if not impossible, to establish. Furthermore, the majority of patients with suspected supraesophageal complications of GERD do not have either the characteristic symptoms of heartburn and regurgitation or the definitive findings of esophageal inflammation, which would help reinforce the suspicion of a connection between the supraesophageal complications and GERD. Frequent acid reflux has been shown in patients with various bron-chopulmonary, laryngopharyngeal, or oral cavity disorders. GERD is one of the most common gastrointestinal complaints in the population. It is possible that the supraesophageal problems and acid reflux are mutually independent disorders that occur in the same person. The suspected mechanisms of GERD-related supraesophageal complications appear to be directed through two pathways: by a vagal reflex between the esophagus and tracheobronchial tree triggered by acid reflux or by microaspiration that causes contact damage to mucosal surfaces. The most useful diagnostic modality available to the clinician to aid in the diagnosis of supraesophageal GERD complications is the ambulatory pH recording technique. However, the sensitivity and specificity of this test for recording esophageal or pharyngeal acid reflux events has been critically challenged. Despite the many clinical studies that support the theory that GER has a role in suspected supraesophageal complications, only 1 long-term prospective controlled study of a large group of patients with asthma has shown the positive effects of the elimination of acid reflux. With the focus now on "outcomes medicine," there is a serious need for appropriately designed, controlled studies to answer the many questions surrounding a cause-and-effect association between acid reflux and supraesophageal disorders. Because of the lack of convincing proof between acid reflux and suspected supraesophageal complications, the physician must resort to an intent-to-treat strategy as both a primary therapy and a diagnostic trial. High-dose PPI therapy for prolonged periods is the recognized conservative therapy. Operative therapy (i.e., fundoplication operation) is the procedure of choice when overt regurgitation occurs or when medical therapy, although successful, is not practical for long periods. Controlled, well-designed clinical trials and more sophisticated techniques to measure and quantify acid reflux are crucial in the future to help determine which patients with suspected supraesophageal complications actually have acid reflux as a primary cause. The medical community needs to be alerted to the possibility of an association between GERD and supra-esophageal complications so that patients with a GERD-related complication will be recognized and effectively treated.- - - - - - - - - - ranking = 9.8428957865189keywords = oral cavity, cavity (Clic here for more details about this article) |
4/24. Successful laparoscopic removal of a migrated Angelchik prosthesis.Implantation of an Angelchik prosthesis has been considered a quick and safe procedure for the surgical treatment of gastroesophageal reflux disease. Since its introduction in 1979 more than 25,000 have been inserted worldwide. However, the use of this device has been largely abandoned because of frequent complications and high costs. One of the more serious complications is migration of the prosthesis, which usually requires open correction. We recently operated on a 49-year-old man with a migrated Angelchik prosthesis. The device, placed 17 years earlier, had now migrated to the free abdominal cavity causing recurrent urinary tract infections and fecal incontinence. The prosthesis was removed laparoscopically via three ports in a simple procedure without any blood loss. Recovery was uneventful. At this writing, complaints have resolved, and reflux is being controlled medically. This case supports the suggestion that Angelchik prosthesis-related problems may be solved laparoscopically, even if the device was inserted via an open procedure.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
5/24. Restoration of enamel and dentin erosion due to gastroesophageal reflux disease: a case report.gastroesophageal reflux disease (GERD) is a condition where acid contents of the stomach are regurgitated into the oral cavity, which results in continual exposure of the teeth to these acids. knowledge of the relationship between GERD and dental erosion enables the appropriate diagnosis and treatment of the underlying medical condition as well as the affected teeth. This article details a case report where severe dental erosion was present due to GERD. After management of the disease, treatment (i.e., diagnosis, treatment planning, and restoration) of the eroded dentition is described.- - - - - - - - - - ranking = 9.8428957865189keywords = oral cavity, cavity (Clic here for more details about this article) |
6/24. Failure of mouth-to-mouth resuscitation in cases of sudden infant death.We describe two cases of sudden infant death syndrome (SIDS) and one case of apparent life threatening apnoea where resuscitation was attempted by the mouth-to-mouth route. This was associated with evidence of gastric distension, including reflux of milk into the airway in the first two cases. In the second case the mother used mouth-to-mouth breathing after finding that she could not cover her baby's nose-and-open-mouth with her mouth. In the last case, the mother went on to try the mouth-to-nose route, with a good outcome. Systematic documentation of the route of resuscitation and its outcome in all cases of SIDS and near-miss SIDS may provide valuable insights into the optimal route for infant resuscitation.- - - - - - - - - - ranking = 27.82274333254keywords = mouth (Clic here for more details about this article) |
7/24. Irritability in Krabbe's disease: dramatic response to low-dose morphine.Krabbe's disease is characterized by normal neonatal development with subsequent regression and profound, medically intractable irritability. Two female infants presented at 5 months of age with increasing irritability, abnormal motor control, and developmental regression. Investigations confirmed the diagnosis of Krabbe's disease. Maximal treatment of gastroesophageal reflux and nitrazepam 0.1 mg/kg by mouth three times daily were unsuccessful in controlling irritability. morphine was initiated and titrated to 0.06 mg/kg by mouth every 6 hours in Patient 1 and 0.1 mg/kg by mouth every 8 hours in Patient 2, resulting in remarkably successful control of irritability. The diagnosis of Krabbe's disease is devastating for families and is compounded by the marked irritability. Management is difficult, but in these two infants, irritability was successfully controlled with low-dose morphine.- - - - - - - - - - ranking = 5.564548666508keywords = mouth (Clic here for more details about this article) |
8/24. Breath alcohol analysis in one subject with gastroesophageal reflux disease.A large number of people suffer from the heartburn symptoms associated with gastroesophageal reflux disease (GERD). Relatively little has been published on its potential for biasing a breath alcohol measurement. The present case describes an individual (white male, aged 23) who experimentally consumed 1.0 g/kg of an alcohol beverage and subsequently provided breath and blood samples for analysis. Breath expirograms were also collected following several different preexhalation breathing maneuvers. Shortly after the end of drinking the mean of replicate breath alcohol results exceeded that of the corresponding venous blood alcohol. A later paired comparison (during the postabsorptive phase) showed the blood alcohol to exceed the breath. None of the expirograms provided evidence that "mouth alcohol" due to gastroesophageal reflux had biased any test results. People with GERD can provide biased-free end-expiratory breath alcohol results where sound forensic practice is followed, which includes: 15-min. preexhalation observation, duplicate testing, instrumental detection systems, and trained alert operators who ask appropriate questions and watch for associated signs.- - - - - - - - - - ranking = 1.8548495555027keywords = mouth (Clic here for more details about this article) |
9/24. The efficacy of laparoscopy in detecting and treating associated congenital malformations in children.One of the main advantages of laparoscopy in children is the fact that it enables a magnified view and the possibility to explore the whole abdominal cavity. This case report clearly shows these advantages. We report the case of a 3-yr-old girl, suffering from severe GERD and right inguinal inguinal hernia, who had already been operated at birth for esophageal atresia. We performed a laparoscopic fundoplication according to Nissen and, at the end of procedure, we decided to turn the optic down to control the right inguinal region to confirm the presence of an inguinal hernia. To our great surprise we found a right oblique external hernia as well as a direct inguinal hernia on the same side. Both hernias was treated successfully in laparoscopy. At a 1-year follow-up, the patient presented no reflux and no recurrence of the inguinal hernias. The laparoscopy in this case permitted operation on two different pathologies involving the upper and lower parts of the abdominal cavity using the same ports and without enlarging the incision, as would happen in laparotomy. The main relevance of this case is that laparoscopy allowed the detection of an associated pathology like a direct inguinal hernia that would have been certainly overlooked in open surgery and could have caused a recurrent hernia if operated via open surgery.- - - - - - - - - - ranking = 2keywords = cavity (Clic here for more details about this article) |
10/24. Dental erosion caused by silent gastroesophageal reflux disease.BACKGROUND: gastroesophageal reflux disease, or GERD, is a relatively common condition, in which stomach acid may be refluxed up through the esophagus and into the oral cavity, resulting in enamel erosion. Symptoms such as belching, unexplained sour taste and heartburn usually alert the patient to the condition. In silent GERD, however, these symptoms do not occur, and enamel erosion of the posterior dentition may be the first indication of GERD. CASE DESCRIPTION: A 30-year-old man came to a dental clinic with enamel erosion on the occlusal surfaces of his posterior teeth and the palatal surfaces of his maxillary anterior teeth. He reported no history of gastrointestinal disease or heartburn. CLINICAL IMPLICATIONS: Enamel erosion may be a clinical sign of silent GERD that allows the dentist to make the initial diagnosis. Referral to a physician or gastroenterologist is necessary to define the diagnosis; however, dental expertise may be essential in distinguishing between differential diagnoses such as bulimia, attrition and abrasion. Successful treatment of this medical condition is necessary before dental rehabilitation can be initiated successfully.- - - - - - - - - - ranking = 9.8428957865189keywords = oral cavity, cavity (Clic here for more details about this article) |
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