scholarly journals Kluth type I3 and intra-abdominal variants of esophageal atresia: A case series

2020 ◽  
Vol 9 ◽  
pp. 18
Author(s):  
Rahul Gupta ◽  
Rozy Paul ◽  
Manika Boipai ◽  
Priya Mathew ◽  
Ankit Singh ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Gastroesophageal Junction ◽  
Case Series ◽  
Feeding Tube ◽  
First Case ◽  
Infant Feeding Tube ◽  
Low Threshold ◽  
Rubber Catheter ◽  
Esophageal Pouch

Background: Esophageal atresia (EA) encompasses a group of congenital anomalies (one in 2500 live births) comprising an interruption in the continuity of the esophagus combined with or without a persistent communication with the trachea. It is confirmed by passing no. 10 sterile, blunt‑tipped red rubber catheter into the esophagus, which gets failed to pass beyond 10 cm. Case Series: We describe two male neonates in whom the infant feeding tube could be passed to 18-20 cm in the upper esophageal pouch. A babygram with a blunt-tipped soft red rubber catheter in situ confirmed the esophageal atresia (EA) with the long upper pouch in the first case and EA with obstruction at the gastroesophageal junction in the second one. Conclusion: The importance of recognizing rare Kluth variants of EA is stressed. A low threshold for performing a red rubber catheter test is stressed.

scholarly journals Spontaneous intravesical knotting of infant feeding tube: a rare case report

2018 ◽  
Vol 6 (9) ◽  
pp. 3179
Author(s):  
Ashvin S. Gadhvi ◽  
Udit I. Gadhvi ◽  
Nimesh B. Thakkar ◽  
Nidhi D. Shah ◽  
Ranjit Zapadiya
Keyword(s):  
Case Report ◽  
Infant Feeding ◽  
Rare Case ◽  
Foley Catheter ◽  
Feeding Tube ◽  
Feeding Tubes ◽  
First Case ◽  
Infant Feeding Tube ◽  
Rare Case Report ◽  
Urological Emergency

Infant Feeding tube is universally used in Paediatric Patients for many diagnostic as well as therapeutic purposes. Intravesical knotting of IFT is rare but having significant morbidity. We here present such a rare case report in 6 month old patient treated endoscopically. Sometimes it is very difficult to remove knotting with various techniques discussed later, but it may cause more trauma to urethra. There are only few reported cases worldwide about it in few journals. But Endoscopic removal being safe among all. In such Urological Emergency, always early Identification is most important to prevent further complications. As neonate and infant’s urethra is small compared to the available smallest Foley catheter (8Fr), a 5 Fr and 8 Fr feeding tubes are practical alternatives to drain urine from the bladder. Intravesical catheter knotting of small feeding tubes placed as urinary diversion from the bladder is rare. The first case of catheter knotting in a pediatric patient was reported in 1976.

scholarly journals Long Upper Pouch in Esophageal Atresia: A Rare Variant

2015 ◽  
Vol 5 (1) ◽  
pp. 6 ◽  
Author(s):  
Enono Yhoshu ◽  
Jai Kumar Mahajan ◽  
Vedarth Dash
Keyword(s):  
Infant Feeding ◽  
Clinical Sign ◽  
Rare Variant ◽  
Esophageal Atresia ◽  
Relevant Literature ◽  
Diagnostic Errors ◽  
Feeding Tube ◽  
Excessive Salivation ◽  
Infant Feeding Tube

The earliest clinical sign of esophageal atresia (EA) is excessive salivation and the diagnosis is made by failure to pass an infant feeding tube (IFT) into the stomach. The diagnostic errors may occur due to presence of an unusually long upper pouch, when the IFT seems to pass into the stomach. We describe one such case and review the relevant literature.

CORRELATION BETWEEN POSITION OF RED RUBBER CATHETER ON X RAY AND GAP LENGTH IN TYPE C ESOPHAGEAL ATRESIA (EA)

2021 ◽  
pp. 1-3
Author(s):  
Ankit Singh ◽  
Neeraj Tuteja ◽  
Vinita Chaturvedi
Keyword(s):  
Primary Repair ◽  
Plain Radiograph ◽  
Clinical History ◽  
Additional Risk ◽  
Type C ◽  
Rubber Catheter ◽  
Esophageal Pouch ◽  
Systemic Examination ◽  
Gap Width

BACKGROUND AND AIM: Gap length is important determinant for feasibility of primary repair in atresia and also for the preparedness and prognosis of delayed or staged operative procedures. A diagnostic plain radiograph with a red rubber catheter in situ might provide reliable information regarding the gap length without involving additional risk and cost. The present study was conducted to assess the gap length between the two esophageal pouches by preoperative plain radiography with in situ red rubber catheter in upper esophageal pouch and to know the correlation between position of red rubber catheter and measured gap length between upper and lower pouch. METHODOLOGY: Out of all patients admitted and diagnosed as gross's type C EA during September 2018 to November 2019 were included in the present study. The data regarding clinical history, general and systemic examination, pre-operative investigations including plain radiograph with in situ red rubber catheter and intraoperative measured gap length were recorded. Statistically correlation assessed between position of red rubber catheter and intraoperatively measured gap length among patients with type c EA. RESULTS: Total 283 patients were included in the present study. Radiologically position of red rubber catheter was found at level of T2, T3 and T4 in 18.7%, 55.5% and 25.8% respectively. A correlation was found between the preoperative radiological assessments of position of red rubber catheter with intra operatively measured gap length in this study and association between these two variable were found statistically signicant (r=-0.66, P=0). CONCLUSION: The preoperatively radiographic position of upper pouch should be assessed carefully to predict the gap width and it helps in preparedness of surgical management of the patients.

scholarly journals 512 The Management of Aural Foreign Bodies During the COVID-19 Pandemic - MKUH ENT Department Experience

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G C Ho ◽  
R Thind ◽  
D Yap ◽  
A Hunt
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
Case Series ◽  
Success Rates ◽  
First Case ◽  
Prolonged Duration ◽  
Successful Removal ◽  
The Impact ◽  
The Relationship

Abstract Aim During the initial wave of the COVID-19 pandemic, ENT UK published a clinical guide on surgical prioritisation which suggested that aural foreign bodies can be removed between one and three months from initial presentation. This case series aims to investigate the impact of leaving aural foreign bodies in situ for a prolonged period of time, including the risk of complications, success rates of subsequent removal attempts and whether foreign bodies can clear themselves without intervention. Method Retrospective study of all aural foreign body referrals to the ENT emergency clinic over a 6-month period. Results Thirty-four patients were identified. The duration of foreign bodies left in-situ ranged from 1 to 78 days. Four patients suffered from traumatic removal upon initial attempts, however there were no other significant complications. First attempts made by non-ENT specialists (68.8%) all failed and were associated with a high risk of trauma (36.4%). The chances of successful removal on second attempt (28.6%) reduced dramatically when compared to the first attempt (52.9%). Two patients had no foreign body visualised upon second attempt, suggesting it has cleared itself. A total of 7 patients (20.6%) required removal under general anaesthesia. Conclusions Due to the unique circumstances of the COVID-19 pandemic, this is the first case series to look specifically at the relationship between duration of aural foreign bodies left in situ for over 30 days from presentation and the risk of complications. Our data suggests that prolonged duration did not increase the incidence of complications.

Esophageal Atresia and Associated Duodenal Atresia: A Cohort Study and Review of the Literature

2020 ◽  
Author(s):  
Maria Enrica Miscia ◽  
Giuseppe Lauriti ◽  
Dacia Di Renzo ◽  
Angela Riccio ◽  
Gabriele Lisi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Esophageal Atresia ◽  
Primary Repair ◽  
English Literature ◽  
Delayed Diagnosis ◽  
Case Series ◽  
Primary Treatment ◽  
Duodenal Atresia ◽  
Staged Approach ◽  
Missed Diagnosis

Abstract Introduction Esophageal atresia (EA) is associated with duodenal atresia (DA) in 3 to 6% of cases. The management of this association is controversial and literature is scarce on the topic. Materials and Methods We aimed to (1) review the patients with EA + DA treated at our institution and (2) systematically review the English literature, including case series of three or more patients. Results Cohort study: Five of seventy-four patients with EA had an associated DA (6.8%). Four of five cases (80%) underwent primary repair of both atresia, one of them with gastrostomy placement (25%). One of five cases (20%) had a delayed diagnosis of DA. No mortality has occurred. Systematic Review: Six of six-hundred forty-five abstract screened were included (78 patients). Twenty-four of sixty-eight (35.3%) underwent primary correction of EA + DA, and 36/68 (52.9%) underwent staged correction. Nine of thirty-six (25%) had a missed diagnosis of DA. Thirty-six of sixty-eight underwent gastrostomy placement. Complications were observed in 14/36 patients (38.9 ± 8.2%). Overall mortality reported was 41.0 ± 30.1% (32/78 patients), in particular its incidence was 41.7 ± 27.0% after a primary treatment and 37.0 ± 44.1% following a staged approach. Conclusion The management of associated EA and DA remains controversial. It seems that the staged or primary correction does not affect the mortality. Surgeons should not overlook DA when correcting an EA.

scholarly journals Sodium-Glucose Cotransporter-2 Inhibitors in Patients with Hereditary Podocytopathies, Alport Syndrome, and FSGS: A Case Series to Better Plan a Large-Scale Study

Cells ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 1815
Author(s):  
Jan Boeckhaus ◽  
Oliver Gross
Keyword(s):  
Glomerular Filtration ◽  
Alport Syndrome ◽  
Large Scale ◽  
Case Series ◽  
Hereditary Diseases ◽  
Glomerular Filtration Barrier ◽  
Early Effect ◽  
Filtration Barrier ◽  
First Case ◽  
Sodium Glucose Cotransporter

Hereditary diseases of the glomerular filtration barrier are characterized by a more vulnerable glomerular basement membrane and dysfunctional podocytes. Recent clinical trials have demonstrated the nephroprotective effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in chronic kidney disease (CKD). SGLT2-mediated afferent arteriole vasoconstriction is hypothesized to correct the hemodynamic overload of the glomerular filtration barrier in hereditary podocytopathies. To test this hypothesis, we report data in a case series of patients with Alport syndrome and focal segmental glomerulosclerosis (FSGS) with respect of the early effect of SGLT2i on the kidney function. Mean duration of treatment was 4.5 (±2.9) months. Mean serum creatinine before and after SGLT-2i initiation was 1.46 (±0.42) and 1.58 (±0.55) mg/dL, respectively, with a median estimated glomerular filtration rate of 64 (±27) before and 64 (±32) mL/min/1.73 m2 after initiation of SGLT2i. Mean urinary albumin-creatinine ratio in mg/g creatinine before SGLT-2i initiation was 1827 (±1560) and decreased by almost 40% to 1127 (±854) after SGLT2i initiation. To our knowledge, this is the first case series on the effect and safety of SGLT2i in patients with hereditary podocytopathies. Specific large-scale trials in podocytopathies are needed to confirm our findings in this population with a tremendous unmet medical need for more effective, early on, and safe nephroprotective therapies.

Fluorescent in situ hybridization (FISH): A useful diagnostic tool for childhood conjunctival melanoma

2021 ◽  
pp. 112067212110307
Author(s):  
Raquel María Moral ◽  
Carlos Monteagudo ◽  
Javier Muriel ◽  
Lucía Moreno ◽  
Ana María Peiró
Keyword(s):  
In Situ Hybridization ◽  
Fluorescent In Situ Hybridization ◽  
Pediatric Population ◽  
Diagnostic Technique ◽  
Histopathological Diagnosis ◽  
Fish Analysis ◽  
Conjunctival Melanoma ◽  
Adequate Treatment ◽  
First Case

Introduction: Conjunctival melanoma is extremely rare in children and has low rates of resolution. Definitive histopathological diagnosis based exclusively on microscopic findings is sometimes difficult. Thus, early diagnosis and adequate treatment are essential to improve clinical outcomes. Clinical case: We present the first case in which the fluorescent in situ hybridization (FISH) diagnostic technique was applied to a 10-year-old boy initially suspected of having amelanotic nevi in his right eye. Based on the 65% of tumor cells with 11q13 (CCND1) copy number gain and 33% with 6p25 (RREB1) gain as measured by the FISH analysis, and on supporting histopathological findings, the diagnosis of conjunctival melanoma could be made. Following a larger re-excision, adjuvant therapy with Mitomycin C (MMC), cryotherapy and an amniotic membrane graft, the patient has remained disease-free during 9 years of long-term follow-up. Case discussion: Every ophthalmologist should remember to consider and not forget the possibility of using FISH analyses during the differential diagnosis of any suspicious conjunctival lesions. Genetic techniques, such as FISH, have led to great advances in the classification of ambiguous lesions. Evidence-based guidelines for diagnosing conjunctival melanoma in the pediatric population are needed to determine the most appropriate strategy for this age group.

scholarly journals Clinical, Laboratory and Histological Features of Dipeptidyl Peptidase-4 Inhibitor Related Noninflammatory Bullous Pemphigoid

2021 ◽  
Vol 10 (9) ◽  
pp. 1916
Author(s):  
Ágnes Kinyó ◽  
Anita Hanyecz ◽  
Zsuzsanna Lengyel ◽  
Dalma Várszegi ◽  
Péter Oláh ◽  
...  
Keyword(s):  
Bullous Pemphigoid ◽  
Clinical Laboratory ◽  
Case Series ◽  
Dipeptidyl Peptidase ◽  
Area Index ◽  
Histological Features ◽  
Dipeptidyl Peptidase 4 ◽  
First Case ◽  
Dipeptidyl Peptidase 4 Inhibitor ◽  
The Mean

Bullous pemphigoid (BP) is an autoimmune blistering disease of elderly patients that has shown increasing incidence in the last decades. Higher prevalence of BP may be due to more frequent use of provoking agents, such as antidiabetic dipeptidyl peptidase-4 inhibitor (DPP4i) drugs. Our aim was to assess DPP4i-induced bullous pemphigoid among our BP patients and characterize the clinical, laboratory and histological features of this drug-induced disease form. In our patient cohort, out of 127 BP patients (79 females (62.2%), 48 males (37.7%)), 14 (9 females and 5 males) were treated with DPP4i at the time of BP diagnosis. The Bullous Pemphigoid Disease Area Index (BPDAI) urticaria/erythema score was significantly lower, and the BPDAI damage score was significantly higher in DPP4i-BP patients compared to the nonDPP4i group. Both the mean absolute eosinophil number and the mean periblister eosinophil number was significantly lower in DPP4i-BP patients than in nonDPP4i cases (317.7 ± 0.204 vs. 894.0 ± 1.171 cells/μL, p < 0.0001; 6.75 ± 1.72 vs. 19.09 ± 3.1, p = 0.0012, respectively). Our results provide further evidence that DPP4i-associated BP differs significantly from classical BP, and presents with less distributed skin symptoms, mild erythema, normal or slightly elevated peripheral eosinophil count, and lower titers of BP180 autoantibodies. To our knowledge, this is the first case series of DPP4i-related BP with a non-inflammatory phenotype in European patients.

scholarly journals Incidence, Risk, and Visual Outcomes after Repositioning of Acute Non-Traumatic Flap Dislocations Following Femtosecond-Assisted LASIK

2021 ◽  
Vol 10 (11) ◽  
pp. 2478
Author(s):  
Majid Moshirfar ◽  
David G. West ◽  
Chase M Miller ◽  
William B. West ◽  
Shannon E. McCabe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
High Myopia ◽  
Case Series ◽  
Retrospective Case ◽  
Visual Outcomes ◽  
Uncorrected Distance Visual Acuity ◽  
Incidence Risk ◽  
Mechanical Devices

Although the use of femtosecond lasers instead of mechanical devices has decreased the incidence of flap complications following laser-assisted in situ keratomileusis (LASIK), dislocations and striae still occur. Flap repositioning is an effective intervention to improve visual outcomes after acute flap complications in both microkeratome-assisted and femtosecond-assisted LASIK. This retrospective case series included patients undergoing flap repositioning secondary to acute flap dislocation and/or visually significant striae within the first two weeks following femtosecond LASIK (FS-LASIK) from 2015 to 2020 at a single institution. Preoperative, intraoperative, and postoperative de-identified data were analyzed for incidence, risk factors, and visual acuity outcomes. The incidence of flap repositioning was 0.35% in 21,536 eyes (n = 70). Indications for repositioning included acute flap dislocation (35.7%) and visually significant striae (64.3%). High myopia (OR = 3.04, p = 0.001) and patient age over 50 years (OR = 3.69, p = 0.001) were the strongest risk factors for these complications. Prior to flap repositioning, uncorrected distance visual acuity (UDVA) of 20/20 or better and 20/40 or better occurred in 19% and 57% of eyes, respectively. After repositioning, a final UDVA of 20/20 or better and 20/40 or better occurred in 78% and 98% of eyes, respectively. After repositioning, one line of UDVA was lost in two eyes (2.8%) and two lines were lost in one eye (1.4%). Risk factors for acute flap dislocation included high myopia and age over 50 years. Flap repositioning was effective in salvaging visual outcomes.

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