Eosinophilic esophagitis after esophageal atresia: is there an association? Case presentation and literature review

Eosinophilic esophagitis (EoE) is a relatively new condition resulting in dysphagia or symptoms resembling gastroesophageal reflux disease, symptoms that also are common in patients with a history of esophageal atresia. We present 2 patients with persistent dysphagia after repair of esophageal atresia that was caused by EoE. Although the exact etiology and pathogenesis of EoE remain unclear, it is now generally accepted that it is the result of a T-helper cell 2-type immune response with a crucial role for the eosinophil-specific chemotaxis factor eotaxin 3 and eosinophils. Because there are genetic similarities between esophageal atresia and EoE, we speculate that patients with esophageal atresia are at increased risk for developing EoE.     

Elderly recipients of hepatitis C positive renal allografts can quickly develop liver disease

Our institution explored using allografts from donors with Hepatitis C virus (HCV) for elderly renal transplantation (RT). Thirteen HCV- elderly recipients were transplanted with HCV+ allografts (eD+/R-) between January 2003 and April 2009. Ninety HCV- elderly recipients of HCV- allografts (eD-/R-), eight HCV+ recipients of HCV+ allografts (D+/R+) and thirteen HCV+ recipients of HCV- allografts (D-/R+) were also transplanted. Median follow-up was 1.5 (range 0.8-5) years. Seven eD+/R- developed a positive HCV viral load and six had elevated liver transaminases with evidence of hepatitis on biopsy. Overall, eD+/R- survival was 46% while the eD-/R- survival was 85% (P = 0.003). Seven eD+/R- died during follow-up. Causes included multi-organ failure and sepsis (n = 4), cancer (n = 1), failure-to-thrive (n = 1) and surgical complications (n = 1). One eD+/R- died from causes directly related to HCV infection. In conclusion, multiple eD+/R- quickly developed HCV-related liver disease and infections were a frequent cause of morbidity and mortality.     

Sympathetic chain clipping for hyperhidrosis is not a reversible procedure

Background  

Many techniques have been used to treat palmar hyperhidrosis. Compensatory sweating is a difficult adverse effect. Clipping has been proposed because of its supposed reversibility when clips are removed at a later date. The primary aims of this article are to investigate the neuronal lesion of the sympathetic chain caused by clipping and to study the possibility of regeneration after removal of the clips.     

Angioplasty and stenting of a jugular-carotid fistula resulting from the inadvertent placement of a hemodialysis catheter: case report and review of literature

Hemodialysis catheterization through the right internal jugular vein (IJV) is widely used for mid- to long-term hemodialysis for patients with renal failure. The purpose of this report is to address a serious complication in conjunction with this procedure. This is a case report of an iatrogenic jugular-carotid fistula (JCF) and a method for rectifying such a vascular conundrum, using endovascular techniques. We describe the technique used to achieve closure of the fistula as well a review of the literature. An 82-year-old woman with history of congestive heart failure, chronic renal failure, and diabetes mellitus developed an iatrogenic arteriovenous fistula, following an attempt of canalizing the right IJV. The patient was treated using three different stents, which achieved closure of the fistula. Venous catheter misplacement into an artery is a serious complication. Early endovascular treatment should be considered for a JCF.     

Robotic-assisted Heller myotomy versus laparoscopic Heller myotomy for the treatment of esophageal achalasia: a case–control study

Minimally invasive surgery has become the gold standard for the treatment of achalasia. The incorporation of robotic technology can improve many limitations of laparoscopic surgery, through, for example, the availability of three-dimensional vision, increasing the degrees of movement, avoiding the fulcrum effect and optimizing ergonomics. The aim of this study was to compare robotic-assisted laparoscopic Heller myotomy (RAHM) with laparoscopic Heller myotomy (LHM) in terms of efficacy and safety. Thirty-one patients with diagnosis of achalasia confirmed by esophagogram and manometry were included. Dysphagia and weight loss were the main complaints in both groups. 18 patients were treated with LHM and 13 patients with RAHM. There was no difference in mean operative time (76?±?13 vs. 79?±?20?min; P?=?0.73). Intraoperative complications were less frequent in the robotic-assisted procedures (5.5% vs. 0%); however, this was a non-significant difference. 94.5?C100% of patients had relief of their symptoms. We conclude that RAHM is a safe and effective procedure. The operative time is no longer than in LHM, but it is necessary to evaluate the technique in randomized clinical trials to determine its advantages in terms of intraoperative complications.     

Comparative Analysis Electroencephalographic of Alpha,Beta and Gamma Bands of a Healthy Individual and One with Hemiparesis

[Purpose] The study analyzed the electroencephalographic (EEG) data of the central cortical areas, during execution of the motor gestures of feeding, activation of the system of mirror neurons, and imagery between a right hemiparetic volunteer (RHV) and a healthy volunteer (HV). [Subjects and Methods] The volunteers’ EEG data were recorded with their eyes open for 4 minutes while they performed five experimental tasks. [Results] The alpha band, absolute power value of HV was lower than that of RHV. In the beta band, during the practice condition, there was an increase in the magnitude of the absolute power value of HV at T3, possibly because T3 is representative of secondary motor areas that work with cortical neurons related to planning and organizing sequence of movements performed by the hands. The gamma band is related to the state of preparation for movement and memory. The results of this study indicate that there was increased activation of the gamma frequency band of HV. [Conclusion] The findings of this study have revealed the changes in pattern characteristics of each band which may be associated with the brain injury of the hemiparetic patient.Key words: Electroencephalography, Hemiparetic, Rehabilitation