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Journal of Clinical Rheumatology :... Apr 2023
Topics: Humans; Striae Distensae; Skin
PubMed: 36870082
DOI: 10.1097/RHU.0000000000001950 -
Journal of Clinical Gastroenterology Jul 2021Gastroesophageal reflux disease (GERD) is steadily increasing in incidence and now affects 18% to 28% of the population in the United States. A thorough understanding of...
Gastroesophageal reflux disease (GERD) is steadily increasing in incidence and now affects 18% to 28% of the population in the United States. A thorough understanding of the pathophysiology underlying this disease is necessary to improve the current standard of care. Most GERD pathophysiology models focus on the lower esophageal sphincter (LES) as the key element which prevents esophageal reflux. More recent research has highlighted the crural diaphragm (CD) as an additional critical component of the GERD barrier. We now know that the CD actively relaxes when the distal esophagus is distended and contracts when the stomach is distended. Crural myotomy in animal models increases esophageal acid exposure, highlighting the CD's vital role. There are also multiple physiological studies in patients with symptomatic hiatal hernia that demonstrate CD dysfunction is associated with GERD. Finally, computer models integrating physiological data predict that the CD and the LES each contribute roughly 50% to the GERD barrier. This more robust understanding has implications for future procedural management of GERD. Specifically, effective GERD management mandates repair of the CD and reinforcement of the LES. Given the high rate of hiatal hernia recurrences, it seems that novel antireflux procedures should target this essential component of the GERD barrier. Future research should focus on methods to maintain crural integrity, decrease hiatal hernia recurrence, and improve long-term competency of the GERD barrier.
Topics: Esophageal Sphincter, Lower; Esophagitis, Peptic; Esophagogastric Junction; Gastroesophageal Reflux; Hernia, Hiatal; Humans
PubMed: 33883513
DOI: 10.1097/MCG.0000000000001547 -
The Open Orthopaedics Journal 2018SLAP lesions of the shoulder are challenging to diagnose by clinical means alone. Interpretation of MR images requires knowledge of the normal appearance of the labrum,... (Review)
Review
BACKGROUND
SLAP lesions of the shoulder are challenging to diagnose by clinical means alone. Interpretation of MR images requires knowledge of the normal appearance of the labrum, its anatomical variants, and the characteristic patterns of SLAP lesions. In general, high signal extending anterior and posterior to the biceps anchor is the hallmark of SLAP lesions. Common diagnostic criteria for a SLAP lesion by MR or MR arthrography include the following: presence of a laterally curved, high signal intensity in the labrum on a coronal image, multiple or branching lines of high signal intensity in the superior labrum on a coronal image, full-thickness detachment with irregularly marginated high signal intensity and/or separation >2 mm on conventional MRI or 3 mm on MR arthrography between the labrum and glenoid on a coronal image, and a paralabral cyst extending from the superior labrum.
METHODS
MR diagnosis of SLAP tears may be improved with provocative maneuvers, such as longitudinal traction of the arm or positioning of the shoulder in abduction and external rotation during imaging. The use of intra-articular contrast distends the joint similar to what occurs during arthroscopy and forced diffusion under the labrum may improve the ability to detect SLAP lesions that might not be seen with standard MR. Improved diagnostic accuracy for SLAP tears is seen with 3-T compared with 1.5-T MR imaging, with or without intra-articular contrast material.
CONCLUSION
Regardless of MR findings, however, physicians should be cautious when recommending surgery in the patient with a vague clinical picture. The patient's history, physical exam, and imaging evaluation all should be considered together in making the decision to proceed with surgery.
PubMed: 30197713
DOI: 10.2174/1874325001812010314 -
Harefuah Dec 2021Distended fetal bladder, also known as fetal megacystis, usually points to lower urinary tract obstruction (LUTO) which is most commonly caused by posterior urethral...
Distended fetal bladder, also known as fetal megacystis, usually points to lower urinary tract obstruction (LUTO) which is most commonly caused by posterior urethral valves (PUV) in the male fetus. We present a short case-series of fetal megacystis without oligohydramnion where primary vesicoureteral reflux (VUR) was the leading aetiology. These cases also displayed a high rate of kidney dysplasia with early-onset renal dysfunction. By contrast, late-onset diagnosis of isolated megacystis, i.e without significant renal parenchymal or upper urinary tract abnormalities, had a surprisingly benign postnatal course with spontaneous resolution after birth. Our case series also display the associated risk for extra-renal malformations and specifically neuro-cognitive developmental abnormalities which should be sought on genetic and imaging evaluation.
Topics: Female; Fetal Diseases; Fetus; Humans; Male; Pregnancy; Ultrasonography, Prenatal; Urethral Obstruction; Urinary Bladder
PubMed: 34957714
DOI: No ID Found -
Der Ophthalmologe : Zeitschrift Der... Apr 2015Trabeculectomy provides an excellent reduction of intraocular pressure (IOP) and is the reference technique in the treatment of glaucoma patients. Canaloplasty is a... (Comparative Study)
Comparative Study Review
BACKGROUND
Trabeculectomy provides an excellent reduction of intraocular pressure (IOP) and is the reference technique in the treatment of glaucoma patients. Canaloplasty is a relatively new surgical non-penetrating procedure for restoring the natural outflow pathway of aqueous humour. The aim of canaloplasty is to permanently distend the collapsed Schlemm's canal with the placement of a 360° intracanalicular tension suture.
OBJECTIVES
This review article describes the comparison between trabeculectomy and canaloplasty with and without cataract surgery.
MATERIAL AND METHODS
Original studies, case reports and reviews are described and the results are discussed.
RESULTS
Although canaloplasty may not be as effective in reducing IOP, trabeculectomy can be associated with severe vision-threatening complications however, the combination of canaloplasty with cataract surgery achieves a higher IOP reduction than canaloplasty alone. In contrast, trabeculectomy alone provides better IOP control than phacotrabeculectomy due to a higher risk of early bleb scarring induced by an increased intraocular inflammatory reaction.
CONCLUSION
If a higher postoperative IOP is acceptable and additional topical glaucoma medication tolerable, canaloplasty can be considered as an alternative to trabeculectomy as the incidence of complications is low and postoperative care less intensive. Canaloplasty may also be suitable for patients with high risk of bleb failure and early glaucoma with a target IOP not necessarily requiring a filtering procedure. Therefore, canaloplasty offers a treatment option for the management of open-angle glaucoma, especially in combination with cataract surgery.
Topics: Aqueous Humor; Glaucoma; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Ophthalmic Solutions; Trabeculectomy
PubMed: 25712418
DOI: 10.1007/s00347-014-3160-7 -
Abdominal Radiology (New York) Mar 2018CT colonography (CTC) has demonstrated equivalent accuracy to optical colonoscopy in the detection of clinically relevant polyps and tumors but this is only possible... (Review)
Review
CT colonography (CTC) has demonstrated equivalent accuracy to optical colonoscopy in the detection of clinically relevant polyps and tumors but this is only possible when technique is optimized. The two most important features of a high-quality CTC are a well-prepared colon and a distended colon. This article will discuss the dietary, bowel preparation, and fecal/fluid tagging options to best prepare the colon. Strategies to optimally distend the colon will also be discussed. CT scan techniques including patient positioning and radiation dose optimization will be reviewed. With proper technique which includes sufficient bowel preparation, fecal/fluid tagging, bowel distension, and optimized scan technique, high-quality CTC examinations should become more feasible, easier to interpret, and more consistently reproducible leading to increased utilization and increased referrals.
Topics: Artifacts; Cathartics; Colonography, Computed Tomographic; Colonoscopy; Colorectal Neoplasms; Contrast Media; Early Detection of Cancer; Humans; Imaging, Three-Dimensional; Radiation Dosage; Radiographic Image Interpretation, Computer-Assisted; Subtraction Technique
PubMed: 29450610
DOI: 10.1007/s00261-018-1499-y -
Journal of Veterinary Diagnostic... Nov 2022A 7-y-old, captive, intact female meerkat () was presented with lethargy, decreased appetite, dyspnea, and distended abdomen. At autopsy, the right atrium was markedly...
A 7-y-old, captive, intact female meerkat () was presented with lethargy, decreased appetite, dyspnea, and distended abdomen. At autopsy, the right atrium was markedly dilated, and the right atrioventricular valve (RAV) was dysplastic with shortened or absent chordae tendineae and direct attachment of the valve to the papillary muscles, which, in turn, were fused and abnormally positioned. The right ventricle was considered to be hypertrophied. Also present were hydrothorax, ascites, atelectasis, and hepatic congestion. A diagnosis of RAV dysplasia was made. Histologic findings included hypertrophy of cardiomyocytes and marked centrilobular hepatic congestion and hemorrhage, which were consistent with right-sided heart failure.
Topics: Female; Animals; Chordae Tendineae; Tricuspid Valve; Heart Failure; Autopsy
PubMed: 36184940
DOI: 10.1177/10406387221128208 -
Clinical Endoscopy Sep 2016During colonoscopy, air insufflation to distend the lumen and facilitate careful inspection and scope insertion can induce pain and cause discomfort. Carbon dioxide (CO)... (Review)
Review
During colonoscopy, air insufflation to distend the lumen and facilitate careful inspection and scope insertion can induce pain and cause discomfort. Carbon dioxide (CO) insufflation can decrease abdominal pain and discomfort during and after colonoscopy. The advantage of CO insufflation is the rapid absorption of the gas across the intestine. Another painless option is water-assisted colonoscopy. Two methods for water-assisted colonoscopy are available: water immersion and water exchange. In a recent direct comparison, the water exchange method was superior to water immersion, CO insufflation, and air insufflation with respect to pain during colonoscopy, although it still had the disadvantage of being a time-consuming procedure. Cap-assisted colonoscopy is a simple technique involving the use of a small transparent cap attached to the tip of the scope. Three studies showed an advantage of this technique in terms of reduced patient discomfort compared with the conventional method. Three robotic colonoscopy systems (Endotics System [Era Endoscopy], NeoGuide [NeoGuide Systems Inc.], and Invendoscope [Invendo Medical]) have been introduced to evaluate pain reduction during colonoscopy, but none has been widely adopted and used in practice. In this review, clinical trials of several techniques and new devices for painless colonoscopy are described and summarized.
PubMed: 27744665
DOI: 10.5946/ce.2016.132 -
Progress in Retinal and Eye Research Jul 2021We propose an integrated model of aqueous outflow control that employs a pump-conduit system in this article. Our model exploits accepted physiologic regulatory... (Review)
Review
We propose an integrated model of aqueous outflow control that employs a pump-conduit system in this article. Our model exploits accepted physiologic regulatory mechanisms such as those of the arterial, venous, and lymphatic systems. Here, we also provide a framework for developing novel diagnostic and therapeutic strategies to improve glaucoma patient care. In the model, the trabecular meshwork distends and recoils in response to continuous physiologic IOP transients like the ocular pulse, blinking, and eye movement. The elasticity of the trabecular meshwork determines cyclic volume changes in Schlemm's canal (SC). Tube-like SC inlet valves provide aqueous entry into the canal, and outlet valve leaflets at collector channels control aqueous exit from SC. Connections between the pressure-sensing trabecular meshwork and the outlet valve leaflets dynamically control flow from SC. Normal function requires regulation of the trabecular meshwork properties that determine distention and recoil. The aqueous pump-conduit provides short-term pressure control by varying stroke volume in response to pressure changes. Modulating TM constituents that regulate stroke volume provides long-term control. The aqueous outflow pump fails in glaucoma due to the loss of trabecular tissue elastance, as well as alterations in ciliary body tension. These processes lead to SC wall apposition and loss of motion. Visible evidence of pump failure includes a lack of pulsatile aqueous discharge into aqueous veins and reduced ability to reflux blood into SC. These alterations in the functional properties are challenging to monitor clinically. Phase-sensitive OCT now permits noninvasive, quantitative measurement of pulse-dependent TM motion in humans. This proposed conceptual model and related techniques offer a novel framework for understanding mechanisms, improving management, and development of therapeutic options for glaucoma.
Topics: Aqueous Humor; Glaucoma; Humans; Intraocular Pressure; Sclera; Trabecular Meshwork
PubMed: 33217556
DOI: 10.1016/j.preteyeres.2020.100917 -
Journal of Thoracic Disease Aug 2018Lung volume reduction surgery (LVRS) for symptomatic patients with advanced emphysema was proven to be successful in a large randomized multi-center trial (NETT) and in... (Review)
Review
Lung volume reduction surgery (LVRS) for symptomatic patients with advanced emphysema was proven to be successful in a large randomized multi-center trial (NETT) and in several smaller randomized single center trials. This evidence primarily concerns patients with heterogeneous, upper-lobe predominant emphysema and low exercise tolerance within certain selection criteria regarding lung function values. As the most important effect of LVRS is generated by reducing the hyperinflation, even patients with homogeneous emphysema morphology profit from the procedure. Simultaneously, by removing distended and functionless areas in heterogeneous emphysema, also patients with seriously impaired diffusion capacity, moderate pulmonary arterial hypertension, a history of previous LVRS and alpha-1-antitrypsin-deficiency (AATD) can be considered as candidates for (re-)-LVRS. This article summarizes indications for LVRS in these various subtypes of emphysema patients.
PubMed: 30210828
DOI: 10.21037/jtd.2018.08.93