Challenges in Evaluation and Management of Children with Myocardial Bridging

Myocardial bridging (MB) is a congenital anomaly where a coronary artery branch or group of branches extends inside a tunnel consisting of myocardium. Although it is mostly considered “benign,” it is reported that MB may lead to significant cardiac problems and sudden cardiac deaths. While it is a congenital anomaly, its symptoms usually arise at further ages rather than childhood. The literature on MB in children is in the form of case reports or small case series. This is why pediatric cases are assessed in the light of information obtained from adults. This review compiled the literature on MB in adults and children and compared it, as well as discussing questions arising regarding the clinic, diagnosis, and treatment of MB.

Gastrostomy as a Preemptive Measure after Pancreatoduodenectomy against Delayed Gastric Emptying: A Small Case Series and a Review of the Literature

Delayed gastric emptying (DGE) is a common (20–30%) postoperative complication following pancreatoduodenectomy (PD) (Parmar et al., 2013). Various causes and preemptive measures have been suggested to decrease the occurrence of DGE. We added a simple step in the procedure of 26 consecutive pancreatic head resections, which seems to alleviate DGE and has never been highlighted before.

The Safety, Tolerability, and Impact of Respiratory–Swallow Coordination Training and Expiratory Muscle Strength Training on Pulmonary, Cough, and Swallow Function Surrogates in Amyotrophic Lateral Sclerosis

Purpose This feasibility study examined the safety, tolerability, and impact of expiratory muscle strength training (EMST) combined with respiratory–swallow coordination training (RST) in comparison to EMST alone, and no treatment on pulmonary function, cough function, surrogates of swallow function, and diaphragm thickness in a pre–post small case series of people with amyotrophic lateral sclerosis (ALS). Method This prospective, nonrandomized, delayed intervention case series consisted of six people with ALS: three patients assigned to EMST + RST, two patients assigned to EMST only, and one patient who received no intervention. Patients undergoing treatment underwent a 5-week no-treatment lead-in period before undergoing their respective 5 weeks of treatment with an optional maintenance period for an additional 5 weeks ( n = 4). Primary outcome measures included pulmonary function measurements, scores on the Eating Assessment Tool-10 and Swallowing Related Quality of Life, and diaphragm thickness. Results Descriptive statistics were used to describe outcome measures and individual patient performance. Results revealed that EMST + RST was a safe and well-tolerated intervention, and that both respiratory interventions led to maintenance and improvement of some outcome measures in most patients within this small case series. Conclusion This exploratory study provides preliminary support regarding the tolerability and efficacy of a combined respiratory intervention in a small case series of people with ALS.