scholarly journals State of Play: Eight Decades of Surgery for Esophageal Atresia

2018 ◽  
Vol 29 (01) ◽  
pp. 039-048 ◽  
Author(s):  
Julia Zimmer ◽  
Simon Eaton ◽  
Louise Murchison ◽  
Paolo De Coppi ◽  
Benno Ure ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Esophageal Atresia ◽  
Literature Search ◽  
Oesophageal Atresia ◽  
Case Reports ◽  
Full Range ◽  
Technical Equipment ◽  
Recurrent Fistula ◽  
Stricture Rate

Aim Surgical expertise and advances in technical equipment and perioperative management have led to enormous progress in survival and morbidity of patients with esophageal atresia (EA) in the last decades. We aimed to analyze the available literature on surgical outcome of EA for the past 80 years. Materials and Methods A PubMed literature search was conducted for the years 1944 to 2017 using the keywords “esophageal/oesophageal atresia,” “outcome,” “experience,” “management,” and “follow-up/follow up.” Reports on long-gap EA only, non-English articles, case reports, and reviews without original patient data were excluded. We focused on mortality and rates of recurrent fistula, leakage, and stricture. Results Literature search identified 747 articles, 118 manuscripts met the inclusion criteria. The first open end-to-end anastomosis and fistula ligation was reported in 1941. Thoracoscopic fistula ligation and primary anastomosis was performed first in 2000. Reported mortality rate decreased from 100% before 1941 to 54% in 1950 to 1959, 28% in 1970 to 1979, 16% in 1990 to 1999, and 9% nowadays. Rates of recurrent fistula varied over time between 4 and 9%. Leakage rate remained stable between 11 and 16%. However, stricture rate increased from 25 to 38%. Conclusion Including a full range of articles reflecting the heterogeneity of EA, mortality rate significantly decreased during the course of 80 years. Along with the decrease in mortality, there is a shift to the importance of major postoperative complications and long-term morbidity regardless of surgical technique.

scholarly journals Multiple Doses of Icatibant used during Pregnancy

2017 ◽  
Vol 8 (3) ◽  
pp. ar.2017.8.0210 ◽  
Author(s):  
Lauren W. Kaminsky ◽  
Theodore Kelbel ◽  
Fay Ansary ◽  
Timothy Craig
Keyword(s):  
Adverse Events ◽  
Literature Search ◽  
Medical Literature ◽  
Case Reports ◽  
Treatment Options ◽  
Multiple Treatment ◽  
Multiple Doses ◽  
Healthy Infants

Background Hereditary angioedema (HAE) is a life-long disease that often manifests by puberty. Treatment of attacks is essential to improve quality of life and to decrease morbidity and mortality. During pregnancy, treatment is limited because multiple treatment options, including icatibant, are not approved for use during pregnancy. Objective We report the outcomes of three pregnancies during which icatibant was used by a patient with HAE with normal C1-inhibitor for treatment of attacks. We also reviewed the literature for reports of icatibant use during pregnancy for outcomes and adverse events. Methods We report on a patient who treated herself with icatibant during three separate pregnancies. Postpartum follow-up verified the health of the mother and children. We also performed a complete literature search of medical literature data bases on icatibant use during pregnancy. Results The patient in our report administered multiple doses of icatibant during three pregnancies. The child born from the first pregnancy and the child from the third pregnancy were born at term and without congenital anomalies. The child from the second pregnancy was 1-month preterm. All three children were developmentally normal. The literature search identified two case reports and one abstract of limited icatibant use without adverse events during pregnancy in patients with HAE. These pregnancies resulted in the births of healthy infants. Conclusion From a search of the literature, three cases of icatibant use during pregnancy resulted in healthy infants. In addition, we report that from icatibant use in three separate pregnancies, one infant was born prematurely, but there were no birth defects. From follow-up, the children continued meeting developmental milestones. This report adds to the acquisition of knowledge for drug adverse events during postmarketing surveillance for icatibant use during pregnancy.

scholarly journals COVID-19 Tedavisinde Favipiravir Kullanımı

2021 ◽  
Vol 26 (1) ◽  
pp. 1-11
Author(s):  
Emre Kara ◽  
Ahmet Çağkan İnkaya ◽  
Kutay Demirkan ◽  
Serhat Ünal
Keyword(s):  
Adverse Effects ◽  
Drug Interactions ◽  
Literature Search ◽  
Case Reports ◽  
Treatment Options ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
The World

There are treatment options with partially shown efficacy against SARS-CoV-2. A drug with proven effect on survival has not yet been developed for the new coronavirus disease (COVID-19) defined in December 2019. Many chemicals that are being used or developed for different indications have been used for COVID-19 treatment, based on their effects observed in in vitro studies. Favipiravir, one of these drugs, was first used in Wuhan, the starting center of the pandemic. Since the spread of the infection to the world, it has been used in our country as well as countries such as Italy, Japan, Russia, Ukraine, Uzbekistan, Moldova and Kazakhstan, Bangladesh, Egypt, India. There are few studies conducted and published to evaluate the effectiveness of favipiravir, but many studies are ongoing. In this review, it was aimed to review and evaluate the studies and case reports reporting the efficacy of favipiravir in the treatment of COVID-19. With the literature search, 223 results were reached, 210 articles were fully accessed, and a total of 34 articles were included in the analysis. In the scope of the review, under the title of pharmacology of favipiravir, adverse effects and drug interactions in addition to pharmacokinetic and pharmacodynamic properties are mentioned. Favipiravir is one of the options for the treatment of COVID-19 patients, but randomized, controlled trials involving much more patients and longer follow-up periods need to be planned and the results of ongoing trials evaluated.

scholarly journals Odontogenic Keratocyst in Children: A Review

2016 ◽  
Vol 10 (1) ◽  
pp. 117-123 ◽  
Author(s):  
Ahmed H. Kamil ◽  
Bassel Tarakji
Keyword(s):  
Literature Search ◽  
Case Reports ◽  
Case Series ◽  
Late Presentation ◽  
Odontogenic Keratocyst ◽  
High Recurrence Rate ◽  
Gorlin Syndrome ◽  
English Only ◽  
Goltz Syndrome

Objective: Is to highlight the characteristics and management of odontogenic keratocyst in children only Material and Method: Computerized search in pubmed between (2005-2015) using specific words such as odontogenic keratocyst in children, odontogenic keratocyst association with Gorlin-Goltz syndrome with abstract written in English only. Result: During computerized literature search 77 articles in the years (2005-2015) were found. All these publications were miscellaneous studies including case series and case reports. Only 35 papers were selected which conform to our criteria. Most of the papers indicate that the histological type of keratocyst prevalent in children was parakeratinized variant, and most of the cases occurred in maxilla rather than mandible. Conclusion: We recommend that the surgeons who treat keratocysts in children take into consideration the late presentation in addition to the destructive nature and high recurrence rate. General practitioners face difficulty in early detection and referral of children with keratocysts or Gorlin syndrome. Treatment by multidiscplinary team is important if associated with Gorlin's syndrome Postoperative follow up is advised every 6 months.

scholarly journals Endoscopic Stenting and Clipping for Anastomotic Stricture and Persistent Tracheoesophageal Fistula after Surgical Repair of Esophageal Atresia in an Infant

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Mohammed Amine Benatta ◽  
Amine Benaired ◽  
Ahmed Khelifaoui
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Surgical Repair ◽  
Anastomotic Stricture ◽  
Balloon Dilation ◽  
Endoscopic Stenting ◽  
Recurrent Fistula ◽  
Metal Type ◽  
Esophageal Strictures

Anastomotic stricture (AS) and recurrent tracheoesophageal fistula (TEF) are two complications of surgical repair of esophageal atresia (EA). Therapeutic endoscopic modalities include stenting, tissue glue, and clipping for TEF and endoscopic balloon dilation bougienage and stenting for esophageal strictures. We report herein a two-month infant with both EA and TEF who benefited from a surgical repair for EA, at the third day of life. Two months later he experienced deglutition disorders and recurrent chest infections. The esophagogram showed an AS and a TEF confirmed with blue methylene test at bronchoscopy. A partially covered self-expanding metal type biliary was endoscopically placed. Ten weeks later the stent was removed. This allows for easy passage of the endoscope in the gastric cavity but a persistent recurrent fistula was noted. Instillation of contrast demonstrated a fully dilated stricture but with a persistent TEF. Then we proceeded to placement of several endoclips at the fistula site. The esophagogram confirmed the TEF was obliterated. At 12 months of follow-up, he was asymptomatic. Stenting was effective to alleviate the stricture but failed to treat the TEF. At our knowledge this is the second case of successful use of endoclips placement to obliterate recurrent TEF after surgical repair of EA in children.

scholarly journals Acquired digital fibrokeratoma: A case report and review of the literature

2017 ◽  
Vol 2 (2) ◽  
Author(s):  
Su Li ◽  
Xin Li ◽  
Fu-lun Li ◽  
Bin Li
Keyword(s):  
Case Report ◽  
Literature Search ◽  
Case Reports ◽  
Ring Finger ◽  
Differential Diagnoses ◽  
Review Of The Literature ◽  
Patient Demographics ◽  
History Of ◽  
Slow Growing

<p>Acquired digital fibrokeratoma (ADFK) has typical characteristics and occurs most frequently on the fingers. The size of the tumor is usually less than 1 cm in diameter. We report a case of a typical ADFK, along with a review of the literature. A 76-year-old man presented with a two-year history of a slow-growing keratotic tumor on the edge aspect of his right hand ring finger. A literature search was conducted to identify published case reports of ADFK. Data on patient demographics, size and location of the lump, treatment, and follow-up were collected from each case report. This case is of interest because of the rarity of ADFK. Additionally, we have emphasized the importance of ruling out other causes of abnormal growths and considering fibrokeratoma during differential diagnoses.</p>

scholarly journals Myotomy in sigmoid megaesophagus: is it applicable? A systematic review and meta-analysis

2021 ◽  
Author(s):  
Marina Feliciano Orlandini ◽  
Maria Carolina Andrade Serafim ◽  
Letícia Nogueira Datrino ◽  
Guilherme Tavares ◽  
Luca Schiliró Tristão ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Postoperative Mortality ◽  
Perioperative Outcomes ◽  
Manual Search ◽  
The Mean

Summary Introduction: Achalasia may evolve to sigmoid megaesophagus in 10–15% of patients and is usually treated with esophagectomy, which has high morbi-mortality. Many surgeons debate the applicability of the Heller myotomy for treating sigmoid megaesophagus. This study intents to analyze the effectiveness of myotomy for treating patients with sigmoid megaesophagus. Methods: A systematic review and meta-analysis was conducted in PubMed, Cochrane, Lilacs and Embase alongside manual search of references. The inclusion criteria were clinical trials, cohort, case-series; patients with sigmoid megaesophagus and esophageal diameter ≥ 6 cm; and patients undergoing primary myotomy. The exclusion criteria were reviews, case reports, cross-sectional studies, editorials, letters, congress abstracts, full-text unavailability; previous surgical treatment for achalasia; and pediatric or animal model studies. No restrictions on language and date of publication, and no filters were applied. Subgroups analyses were performed to assess the laparoscopic myotomy perioperative outcomes. Besides, subgroup analyses were performed to assess the long-term outcomes of the studies with a follow-up time &gt; 24 months. To verify heterogeneity, the I2 test was used. The random effects were applied, and the fixed model was evaluated as sensitivity analysis. To assess risk of bias and certainty of evidence, the tools ROBINS-I and GRADE were used, respectively. Registration number: CRD42020199667. Results: Sixteen articles were selected, encompassing 350 patients. The mean age ranged from 36 to 61 years old, and the mean follow-up ranged from 16 to 109 months. Complications rate was 0.08 (CI: 0.040–0.153; P = 0.01). Need for retreatment rate was 0.128 (CI: 0.031–0.409; P = 0.01). The probability of good or excellent outcomes after myotomy was 0.762 (CI: 0.703–0.812; P &lt; 0.01). Postoperative mortality rate was 0.008 (CI: 0.004–0.015; P &lt; 0.01). Conclusion: Surgical myotomy is an option for avoiding esophagectomy in achalasia, with a low morbi-mortality rate and good results. It is effective for most patients and only a minority will demand retreatment.

DOZ047.63: Closing the gap: transitioning adolescents with esophageal atresia to adult care

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
A D Hawley ◽  
J-A E Brooks ◽  
M G Nightingale ◽  
W J Teague ◽  
J Crameri ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Services ◽  
Esophageal Atresia ◽  
Health Knowledge ◽  
Oesophageal Atresia ◽  
Transition Process ◽  
Poor Compliance ◽  
Adult Health ◽  
Adult Services

Abstract Introduction Evidence supports engaging adolescents and carers in an individualized transition process to improve health outcomes through increased patient knowledge, skills, adherence, quality of life and ultimately, engagement with adult services. Further, a comprehensive transition process promotes confidence in navigating adult health services. While transition for chronic medical cohorts has received considerable attention over decades, there is increasing recognition of the importance of transition for adolescents with surgical conditions. Background It is widely held that the transition of adolescents born with esophageal atresia (OA) from pediatric to adult services is important, and if not managed well, may compromise outcomes. We designed and implemented a transition process for adolescent OA patients at our hospital (with establishment of a transfer pathway in partnership with adult health services) in 2017. Methods Following implementation of a transition process a retrospective review was undertaken in 2019 to identify themes from the dedicated Transition Support Service (TSS) Clinics (October, 2017–December, 2018) for OA patients aged 15–19 years. Patients were identified from an institutional database (Nate Myers Oesophageal Atresia Database, Royal Children's Hospital, Melbourne). These patients had previously been invited to: Attend TSS Clinics as part of routine clinical care.Re-engage in multidisciplinary follow-up (if necessary) including with a consultant surgeon, OA nurse and respiratory physician. Institutional ethics approval was obtained prior to commencement of the study (HREC #QA/51265/RCHM-2019). Results A total of 18 adolescent OA patients and their parents attended RCH TSS and associated follow-up clinics. We observed three key themes in attendees reports and experiences: Poor health knowledge: 56% of adolescents had poor knowledge about their OA, including previous surgery, possible complications and their symptoms;Poor compliance: 54% of adolescents reported poor compliance with prescribed regular medications (e.g. anti-reflux therapy);Mental health issues: 39% of adolescents identified as having mental health concerns, e.g. low mood or clinical depression, anxiety, anger or had engaged in self-harm. Anxiety about transfer to adult services was moderate to high in the majority (61%) of adolescents and their parents. Conclusions The themes identified in this study support the need for, and importance of, a structured process to transition adolescents born with OA to adult services.

scholarly journals Eosinophilic pancreatitis: a review of the pathophysiology, diagnosis, and treatment

2020 ◽  
Author(s):  
Yue Sun ◽  
Dan Pan ◽  
Kai Kang ◽  
Ming-Jun Sun ◽  
Yi-Ling Li ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Literature Search ◽  
Web Of Science ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Diagnostic Algorithm ◽  
Diagnosis And Treatment ◽  
Ultrasound Computed Tomography ◽  
Key Terms

Abstract Eosinophilic pancreatitis (EP) is an extremely rare disease caused by purely eosinophilic infiltration of the pancreas. EP is prone to being misdiagnosed as pancreatic cancer, causing unnecessary economic and physical harm to the patient. We report three cases of EP that were cured by steroids without relapse from 2017 to now. The clinical data of the three patients, including clinical manifestations, serological manifestations, imaging (ultrasound, computed tomography, and MRI), pathological diagnosis and treatment, and telephone follow-up of all patients, were retrospectively analysed. In addition, a literature search was conducted on the Web of Science and PubMed databases using key terms related to EP, considering case reports with no restrictions on the date of publication or language. In conclusion, we analysed 19 cases and determined the diagnostic criteria for EP. The diagnostic algorithm for EP can be used to diagnose EP easily. We hope that our standards and algorithm can reduce the rate of misdiagnosis and contribute to clinical diagnosis and treatment. In addition, we expect to evaluate more EP cases to test our diagnostic criteria and design a systematic diagnostic flow chart.

scholarly journals Thoracoscopic oesophageal atresia/tracheo-oesophageal fistula (OA/TOF) repair is associated with a higher stricture rate: a single institution’s experience

2021 ◽  
Vol 37 (3) ◽  
pp. 397-401
Author(s):  
H. Thakkar ◽  
D. M. Mullassery ◽  
S. Giuliani ◽  
S. Blackburn ◽  
K. Cross ◽  
...  
Keyword(s):  
Anastomotic Leak ◽  
Open Surgery ◽  
Oesophageal Atresia ◽  
Median Number ◽  
Open Approach ◽  
Recurrent Fistula ◽  
Stricture Rate ◽  
Anastomotic Strictures ◽  
Thoracoscopic Repair ◽  
Clinically Significant

Abstract Purpose Thoracoscopic OA/TOF repair was first described in 1999. Currently, less than 10% of surgeons routinely employ minimally access surgery. Our primary aim was to review our immediate-, early- and long-term outcomes with this technique compared with the open approach. Methods A retrospective review of all patients undergoing primary OA/TOF (Type C) repair at our institution from 2009 was conducted. Outcome measures included length of surgery, conversion rate from thoracoscopy, early complications such as anastomotic leak and post-operative complications such as anastomotic strictures needing dilatations. Fisher’s exact and Kruskal–Wallis tests were used for statistical analysis. Results 95 patients in total underwent OA/TOF repair during the study period of which 61 (64%) were completed via an open approach. 34 were attempted thoracoscopically of which 11 (33%) were converted. There was only one clinically significant anastomotic leak in our series that took place in the thoracoscopic group. We identified a significantly higher stricture rate in our thoracoscopic cohort (72%) versus open surgery (43%, P < 0.05). However, the median number of dilations (3) performed was not significantly different between the groups. There was one recurrent fistula in the thoracoscopic converted to open group. Our median follow-up was 60 months across the groups. Conclusion In our experience, the clinically significant leak rate for both open and thoracoscopic repair as well as recurrent fistula is much lower than has been reported in the literature. We do not routinely perform contrast studies and are, thus, reporting clinically significant leaks only. The use of post-operative neck flexion, ventilation and paralysis is likely to be protective towards a leak. Thoracoscopic OA/TOF repair is associated with a higher stricture rate compared with open surgery; however, these strictures respond to a similar number of dilatations and are no more refractory. Larger, multicentre studies may be useful to investigate these finding further.

Severe Head Injury linked to Subsequent Development of Malignant Brain Tumour within a Short Period- A Case Report

2018 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Head Injury ◽  
Brain Tumour ◽  
Severe Head Injury ◽  
Case Reports ◽  
Subsequent Development ◽  
Malignant Brain Tumour ◽  
Tumour Development ◽  
Short Period ◽  
The Brain

There have been a few case reports of head injury leading to brain tumour development in the same region as the brain injury. Here we report a case where the patient suffered a severe head injury with contusion. He recovered clinically with conservative management. Follow up Computed Tomography scan of the brain a month later showed complete resolution of the lesion. He subsequently developed malignant brain tumour in the same region as the original contusion within a very short period of 15 months. Head injury patients need close follow up especially when severe. The link between severity of head injury and malignant brain tumour development needs further evaluation. Role of anti-inflammatory agents for prevention of post traumatic brain tumours needs further exploration.

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