Potentialities of computed tomography in the diagnosis of hiatal hernia

An analysis of the results of 98 studies has demonstrated the potentialities of X-ray computed tomography in the diagnosis of hiatal hernia (HH), provided the X-ray computed tomography (XCT) semiotics of HH. It has found that XCT may directly visualize and objectively evaluate anatomic structures, such as diagraphmatic crus and esophageal foremen. It has emphasized that when XCT of abdominal and thoracic organs is performed, it is necessary to include the areas of diagragmatic curs and esophageal foramen into the list of anatomic structures binding for visual assessment and characterization, which in combination with other studies will assist in the early diagnosis of hiatal hernia and eventually expand the potentialities of XCT to a greater extent.     

A new syndrome with prenatally diagnosed thoracoschisis, hiatal hernia and extremities' agenesis: case report

Thoracoschisis is a very rare congenital anomaly and is usually associated with limb and abdominal wall defects forming part of limb-body wall complex. We here present a case of a 29-week-4-day pregnancy ended with intrauterine demise. Postmortem examination revealed hiatal hernia, thoracoschisis and protrusion of some part of liver from this defect, left forearm agenesis and right arm and right hand agenesis. The findings accompanying thoracoschisis in this presented case exclude any previously reported related syndrome and we believe that this is a new syndrome.     

Full incorporation of Strattice(TM) Reconstructive Tissue Matrix in a reinforced hiatal hernia repair: a case report

ABSTRACT: INTRODUCTION: A non-cross-linked porcine acellular dermal matrix was used to reinforce an esophageal hiatal hernia repair. A second surgery was required 11 months later to repair a slipped Nissen; this allowed for examination of the hiatal hernia repair and showed the graft to be well vascularized and fully incorporated. CASE PRESENTATION: A 71-year-old Caucasian woman presented with substernal burning and significant dysphagia. An upper GI series revealed a type III complex paraesophageal hiatal hernia. She underwent laparoscopic surgery to repair a hiatal hernia that was reinforced with a xenograft (StratticeTM Reconstructive Tissue Matrix, LifeCell, Branchburg, NJ, USA) along with a Nissen fundoplication. A second surgery was required to repair a slipped Nissen; this allowed for examination of the hiatal repair and graft incorporation 11 months after the initial surgery. CONCLUSION: In this case, a porcine acellular dermal matrix was an effective tool to reinforce the crural hiatal hernia repair. The placement of the mesh and method of fixation are believed to be crucial to the success of the graft. It was found to be well vascularized 11 months after the original placement with no signs of erosion, stricture, or infection. Further studies and longterm follow-up are required to support the findings of this case report.     

Induction of parturition in conjunction with antibiotic treatments

Parturicion was induced in pregnant beef cows and heifers with 15 mg of flumethasone to test: 1) the effects of an orally active antibiotic on flumethasone induction of parturition success rate and incidence of retained placenta and 2) the effects of injectable long acting and orally active antibiotics on subsequent fertility and offspring performance. Gestation length and birth weight were not significantly changed. There were no significant differences among calving ease scores even though induction significantly improved vigor. Induction caused a significant increase in the incidence of retained placental membranes. Pregnancy rate (P<.01) and conceptions per service (P<.05) were lower for those animals affected with retained placentas. There were no significant differences among actual weaning weights for the three treatment groups or between adjusted weaning weights for the control and the orally active antibiotic groups, however, the adjusted weaning weights of calves from cows receiving an orally active antibiotic were significantly greater than those receiving an injectable long acting antibiotic (P<.10).     

Mutagenic activity of antibiotics alone and in conjunction with alkanesulfonates

Differential and combined effects of 0.25 and 0.50% antibiotics (ampicillin, neomycin, furadentine) and alkylating agents (ethyl methanesulfonate, methyl ethanesulfonate, methyl methanesulfonate) were assayed on Phaseolus vulgaris L. (2 n = 22) at the M₂ generation for chlorophyll mutations. The general types scored were Albino, Xantha, Virescens and Maculata. Yellowish-green leaves having red mid-veins and veinlets were observed only amongst the progeny raised after treatment with 0.25% ethyl methanesulfonate or 0.25% methyl ethanesulfonate + 0.25% ampicillin. The frequency of chlorophyll mutation after combined treatments in general was higher than after differential treatments. Methyl methanesulfonate among alkanesulfonates and neomycin among antibiotics induced higher frequencies of chlorophyll mutations. No chlorophyll mutant was produced by ampicillin.Although antibiotics induced a lower frequency of chlorophyll mutation than alkylating agents, the frequency and pattern of spectra of chlorophyll mutants showed an action of antibiotics in inducing mutation similar to that of alkylating agents. Therefore, it is considered that antibiotics are potential mutagens.     

Estrus and pregnancy after synchrony with lutalyse in conjunction with Syncro-Mate-B.

Estrous response and pregnancy rates are decreased for cows given Syncro-Mate-B (SMB) during metestrus (Day 1 to 5 of an estrous cycle). Data indicate these decreases are due, in part, to retention of a functional corpus luteum (CL). Our objective was to determine whether PGF2alpha administered in conjunction with SMB would improve estrous response and pregnancy rates in metestrous cows with no detrimental effects to cows in other stages of the estrous cycle. Three hundred seventy-three suckled beef cows were observed for estrus for 21 d before SMB administration to determine stage of an estrous cycle. Blood samples were collected 14 and 7 d before treatment and at SMB administration. Serum was assayed for concentration of progesterone to verify stage of estrous cycle or noncyclicity. All cows received the standard SMB regime and were allotted by age and stage of cycle to one of two groups. Cows denoted SMB + L received 25 mg of PGF2alpha 8 d after implantation, whereas cows denoted SMB served as controls. On Day 10, SMB implants were removed and females were observed for subsequent estrus. At this time, calves were removed from their dams for 48 h. Artificial insemination was performed 12 hr after observation of a standing estrus. Timed insemination was performed at 48 hr after implant removal for cows not inseminated at 24 or 36 hr after implant removal. Interval to synchronized estrus (within 5 d of implant removal) was lengthened for metestrous cows compared to cows in other stages of the cycle irrespective of treatment (P < 0.001). Cows receiving PGF2alpha had a greater pregnancy rate at 5 d compared to controls (P = .0672). Interval to estrus, estrous response, and pregnancy rate to A1 at d 28 or end of breeding season were not affected by administration of PGF2alpha in conjunction with SMB when compared to the standard SMB protocol.     

Characteristics and management of congenital esophageal stenosis: findings from a multicenter study

Background

Congenital esophageal stenosis (CES) is a rare condition frequently associated with esophageal atresia (EA). There are limited data from small series about the presentation, treatment, and outcomes of CES.

Methods

Medical records of all patients with CES included in the French Network on Esophageal Malformations and Congenital Diseases were reviewed retrospectively with regard to diagnosis, treatment, and outcome.

Results

Over 18 years, 61 patients (30 boys) had CES, and 29 (47%) of these patients also had EA. The mean age at diagnosis was 24 months (1 day to 14 years) and was younger in patients with CES and EA than in those with isolated CES (7 vs. 126 months, p?<?0.05). Twenty-one of the 61 patients with CES had no clinical symptoms: in three patients, the findings were incidental, and in 18 of the 29 patients with associated EA, CES was diagnosed at the time of surgical repair of EA or during a postoperative systematic esophageal barium study. In the 40 other patients, at diagnosis, 50% presented with dysphasia, 40% with vomiting, 50% with food impaction, and 42% with respiratory symptoms. Diagnosis of CES was confirmed by esophageal barium study (56/61) and/or esophageal endoscopy (50/61). Sixteen patients had tracheobronchial remnants (TBR), 40 had fibromuscular stenosis (FMS), and five had membrane stenosis (MS). Thirty-four patients (56%) were treated by dilation only (13/34 remained asymptomatic at follow-up); 15 patients were treated by dilation but required later surgery because of failure (4/15 remained asymptomatic at follow-up); and nine patients had a primary surgical intervention (4/9 were asymptomatic at follow-up). Dilation was complicated by esophageal perforation in two patients (3.4%). At follow-up, dysphagia remained in 36% (21/58) of patients, but the incidence did not differ between the EA and the isolated CS groups (10/29 vs. 7/32, p?=?0.27).

Conclusions

CS diagnosis can be delayed when associated with EA. Dilation may be effective for treating patients with FMS and MS, but surgical repair is often required for those with TBR. Our results show clearly that, regardless of the therapeutic option, dysphagia occurs frequently, and patients with CES should be followed over the long term.