Gastroparesis, Thymoma, and Asymptomatic Myasthenia: A Rare Clinical Scenario

Background: Paraneoplastic gastroparesis is a gastrointestinal syndrome that rarely precedes a tumor diagnosis. To increase awareness of this rare clinical entity, we present a case of severe gastroparesis, which was later proven to be associated with a thymoma. Case report: A 55-year old man had the sudden onset of severe abdominal cramps and abdominal distension, early satiety with postprandial nausea, acid regurgitation, belching, and flatulence. He lost about 20 pounds. The physical and imaging examination revealed stomach distension, gastroparesis, and the presence of a solid mass in the anterior mediastinum. Radical surgery was performed to remove the thymoma and, given the high value of Mib-1, the patient was submitted to postoperative chest radiation therapy. After thymectomy, a diagnosis of paraneoplastic myasthenia gravis with subacute autonomic failure was made. Conclusion: Autoimmune gastroparesis should be considered as a potential paraneoplastic syndrome in patients with thymoma, myasthenia gravis, and delayed gastric emptying in the absence of mechanical obstruction.

Not Everything Is Cordless Today—Case Report of Acute Intestinal Obstruction in a Neonate Due to Cord Clamping

We report a case of a 2-day-old neonate with bilious vomiting and abdominal distension. A small bowel obstruction with ileal perforation due to a misplaced clamping of the umbilical cord was apparent before laparotomy. This complication was a sequala after clamping the cord too close to the abdominal wall in a case where there was a hernia into the cord with intestinal content. A herniation of abdominal contents due to an omphalocele minor or a hernia must be taken into consideration during the inspection of the umbilical cord before clamping.

A Study of Early Parenteral Nutritional Support and Factors Associated with Clinical Outcomes in Major Pediatric Burn Patients

Objectives: Adequate nutritional support is one of the challenging treatments of major pediatric burns. Parenteral nutrition (PN) is one of the options to achieve daily caloric goal. Latest nutritional guidelines recommend late PN initiation due to unclear benefit over risk based on the limited data. Our study provides the data of parenteral nutrition within 7 days post admission (early PN) and factors affecting clinical outcomes in major pediatric burn patients. Methods: A retrospective study was conducted regarding pediatric burn patients who had over 15% of their total body surface area (TBSA) with second- or third-degree burns. All the patients were classified as requiring early PN support or non-early PN support. Results: 124 major pediatric burns were reviewed. Eighty-six patients (65.2%) were male, and the median age was three years (0.3-15 years). Early PN showed no association with length of hospital stay (LOS) (p=0.480) or a 30-day mortality (p=0.529). The children’s age, wound infections, and abdominal distension were the independent associated factors of LOS (p=0.025, 0.001, and 0.003 respectively). Pneumonia and urinary tract infection were independent factors associated with 30-day mortality (p=0.025). Conclusions: Early PN in acute pediatric burns was not associated with LOS or 30-day mortality. It can be considered as options of nutritional support in acute, major pediatric burns. Effective management of wound infections and abdominal distension may reduce LOS.

Evaluation of early feeding through nasogastric tube in patients after cardiovascular surgery at the Hanoi Heart Hospital

Objectives: The goal of the study was to describle and understand the factors related to the nasogastric tube feeding in patients after cardio-vascular surgery. Methods: The study involved 100 consecutive patients who underwent cardio-vascular surgery at Hanoi Heart Hospital from April 1 to August 3, 2019..All subjects underwent assessed with the early feeding through nasogastric tube after 6 hours operation. Main results: The mean age of the patients was 54.4 ± 14.5 years old. The percentage of men were 48%, BMI <18.5 were 25%, used inotropic drug were 46% and sedative were 27%. The incidence of patients with abdominal distension and vomiting were 13%. No complications related to early feeding. Factors related to the residual index were sedation and duration of mechanical ventilation. Conclusion: Early nasogastric tube feeding in patients after cardiac and vascular surgery is safe, feasible and feasible.

Demographic Profile and Clinical Spectrum of Alcoholic Liver Disease among Males in Pakistan

Introduction: Alcohol is the most common substance abused in western world. Males tend to have more severe liver disease because of heavy and regular drinking. Methods: Adult patients, 16 years of age and older, diagnosed with ALD within 1 year, were included in the study. Liver disease from other causes was excluded. Demographic profiles, clinical features, laboratory and endoscopic findings of the patients, Child-Turcotte-Pugh (CTP), Model End Stage Liver Disease (MELD) were recorded. Results: A total of 104 patients with ALD who met the inclusion criteria were enrolled in the study. The mean age of the patients enrolled in the study was 49.2 years (SD = 13.1). Most of the patients were in the 30-65 age group. The four most common clinical symptoms in patients were abdominal distension (n = 89, 85.6%), bilateral lower limb edema (n = 78, 75%), jaundice (n = 39, 37.5%) and anorexia (n = 41, 39.4%). Of 104 patients, 96 (92.3%) had cirrhosis, 9 (8.7%) had fatty liver and alcoholic hepatitis. Of 94 patients with ALD, 49(52.1%) had CTP grade C and 83 (88.3%) had MELD score ≥ 16. Conclusions: ALD was mainly observed in young patients. The most common clinical symptoms were abdominal distension, bilateral oedema of the lower limbs, jaundice and anorexia. Among patients with cirrhosis of the liver, the majority of patients were CTP class C and obtained a MELD score ≥16. Keywords: Alcoholic liver disease, clinical profile, demographic profile

Prenatal and Postnatal Manifestations of Congenital Chloride Diarrhea Due to a Heterozygote Variant of the SLC26A3 Gene: A Case Report

Congenital chloride diarrhea (CCD) is caused by a recessive mutation in the SLC26A3 gene and characterized mainly by watery diarrhea, hypochloremia and metabolic alkalosis. Various different mutations in SLC26A3 are responsible for the disease. In the prenatal period, the symptoms of CCD may include polyhydramnios, preterm labor and abdominal distension. The main feature of CCD is chloride-rich diarrhea, which leads to excessive loss of fluid and salt immediately after birth and is followed by weight loss and dehydration. Hyponatremia and hypochloremia are soon accompanied by hypokalemia and metabolic alkalosis. Untreated CCD is fatal even in the first weeks of life. Diagnosis is made by high fecal chloride concentrations in patients with serum electrolytes corrected by salt substitution and confirmed using genetic testing of peripheral blood samples. Here, we detail prenatal and postnatal manifestations of a preterm infant, born via Caesarian section, who was suspected to suffer intrauterine bowel obstruction. Upper median laparotomy was performed and no intestinal abnormalities found. The course of the neonatal period was complicated by severe diarrhea with hypochloremia, hyponatremia and metabolic alkalosis. Based on the patient's clinical picture and stool examination, a diagnosis of CCD was established. Mutation of the SLC26A3 gene was confirmed using genetic testing.

To feed, or not to feed? Evaluating enteral nutrition practices in surgical neonates

Background: Early enteral feeding initiation following surgical procedures in neonates has demonstrated several benefits. In high income countries, where parenteral nutrition is readily available, enteral feeding initiation is often delayed. This study seeks to examine clinical factors and decision-making processes that guide nutrition practices in surgical neonates in the United States (US) and Kenya. Methods: A REDCap survey was developed and distributed to pediatric surgery attendings and fellows at Riley and Peyton Manning Children’s Hospitals in Indiana (US) and Shoe4Africa Children’s and AIC Kijabe Hospitals in Kenya. Nine responses were collected during the initial two-week long pilot, then analyzed using REDCap and SPSS 25. Results: Responses were collected from eight pediatric surgery attendings and a fellow practicing in Indianapolis, IN. The three most highly ranked clinical factors important for initiation of enteral feeds were stability of the patient, nasogastric or orogastric output color, and gastric output volume. Factors most highly ranked for advancement of feeds included frequency and volume of emesis and abdominal distension. These factors were similarly ranked for foregut and hindgut procedures. Protocols for pyloric stenosis (n=6) include initiation of enteral nutrition within 24-48 hours. Four of nine respondents felt that surgeons at their institution are not aggressive enough in feeding surgical neonates. The primary perceived barrier to achieving full enteral nutrition was patient gut dysmotility (n=8). All respondents felt that they were similarly (n=4) or more (n=5) proactive in feeding surgical neonates compared to their peers. Conclusions and Impact: Feeding practices in surgical neonates are dependent on individual clinician decision-making processes and patient factors. Once the data from the Kenyan surgeons is collected, comparisons between practice patterns will be analyzed. Real-world enteral feeding practices will be evaluated in an adjunct observational study, which we hope will inform protocols with earlier enteral feeding initiation in the future.

Giant Ovarian Cysts Treated by Single-Port Laparoscopic Surgery: A Case Series

BackgroundOvarian cysts are very common diseases of the female reproductive system. Giant ovarian cysts refer to the tumors with diameters greater than 10 cm. In recent years, due to the development of clinical diagnosis, imaging modalities, and the improvement of patients’ cognition of the diseases, the occurrence of giant ovarian cysts has become rare. The purpose of this study was to show a new operation method of single-port laparoscopy to treat giant ovarian cysts.MethodsWe report a case series of five patients with giant ovarian cysts who underwent single-port laparoscopic surgery in the gynecology department of the Shengjing Hospital of China Medical University between June 2020 and March 2021. The inclusion criteria were ovarian cysts at least 20 cm in diameter, and cases when the tumor might be malignant were excluded.ResultsThe patients’ mean age was 26.2years. The most common clinical presentation was progressive abdominal distension. Median size of the cysts at imaging was 39.2 cm (range 21–63 cm). All patients underwent single-port laparoscopic surgery, and none of them converted to laparotomy. On final pathological reports, two cysts were serous cystadenomas, and three were mucinous cystadenomas. All patients recovered well and were discharged on time.ConclusionGiant ovarian cysts can be treated by single-port laparoscopic surgery. In addition to the well-known advantages of laparoscopic surgery (e.g., small pelvic interference, fast postoperative recovery), it can also play the role of perfect cosmetic results, which has more advantages for young women.

Application Effect of Acupoint Massage on Zusanli on Premature Infants with Feeding Intolerance and Their Clinical Symptoms

FI is mainly caused by functional disturbance in premature infants, which greatly poses a threat to their growth and development, so a large number of studies on the clinical features of FI should be conducted to provide theoretical support for treatment. The purpose of the study was to investigate the therapeutic effect of acupoint massage on Zusanli on premature infants with feeding intolerance (FI) and their clinical symptoms. A total of 60 premature infants with FI admitted to our hospital over the past two years were selected as the FI group, and another 60 premature infants without FI were selected as the control group. The birthweight and gestational age of the premature infants in the FI group were significantly lower than those in the control group ( P < 0.001 ), whereas there were no significant differences in general information of the premature infants between the two groups ( P > 0.05 ). Vomiting, abdominal distension, and gastric retention are the main clinical symptoms of premature infants with FI, and acupoint massage on Zusanli combined with routine treatment can effectively improve digestive function, relieve clinical symptoms, and shorten treatment time of premature infants with FI, which is worthy of application and promotion in clinical practice.