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Diseases of the Esophagus : Official... May 2017In patients with gastroesophageal reflux disease (GERD) and erosive esophagitis, treatment with proton pump inhibitors (PPIs) is highly effective. However, in some... (Meta-Analysis)
Meta-Analysis Review
In patients with gastroesophageal reflux disease (GERD) and erosive esophagitis, treatment with proton pump inhibitors (PPIs) is highly effective. However, in some patients, especially those with nonerosive reflux disease or atypical GERD symptoms, acid-suppressive therapy with PPIs is not as successful. Alginates are medications that work through an alternative mechanism by displacing the postprandial gastric acid pocket. This study performed a systematic review and meta-analysis to examine the benefit of alginate-containing compounds in the treatment of patients with symptoms of GERD. PubMed/MEDLINE, Embase, and the Cochrane library electronic databases were searched through October 2015 for randomized controlled trials comparing alginate-containing compounds to placebo, antacids, histamine-2 receptor antagonists (H2RAs), or PPIs for the treatment of GERD symptoms. Additional studies were identified through a bibliography review. Non-English studies and those with pediatric patients were excluded. Meta-analyses were performed using random-effect models to calculate odds ratios (OR). Heterogeneity between studies was estimated using the I2 statistic. Analyses were stratified by type of comparator. The search strategy yielded 665 studies and 15 (2.3%) met inclusion criteria. Fourteen were included in the meta-analysis (N = 2095 subjects). Alginate-based therapies increased the odds of resolution of GERD symptoms when compared to placebo or antacids (OR: 4.42; 95% CI 2.45-7.97) with a moderate degree of heterogeneity between studies (I2 = 71%, P = .001). Compared to PPIs or H2RAs, alginates appear less effective but the pooled estimate was not statistically significant (OR: 0.58; 95% CI 0.27-1.22). Alginates are more effective than placebo or antacids for treating GERD symptoms.
Topics: Adult; Alginates; Antacids; Female; Gastroesophageal Reflux; Glucuronic Acid; Hexuronic Acids; Histamine H2 Antagonists; Humans; Male; Proton Pump Inhibitors; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 28375448
DOI: 10.1093/dote/dow020 -
Journal of Clinical Orthopaedics and... Sep 2022Textilomas, gossypibomas, muslinomas and gauzomas, otherwise collectively known as Retained Non-absorbable Hemostatic Material (RNHM), are surgical materials such as... (Review)
Review
UNLABELLED
Textilomas, gossypibomas, muslinomas and gauzomas, otherwise collectively known as Retained Non-absorbable Hemostatic Material (RNHM), are surgical materials such as cotton or gauze pads that are accidentally retained in the surgical bed post-operatively. They may present acutely with signs of infection or may rarely remain chronic and asymptomatic; the latter posing a significant challenge to clinical and imaging diagnosis. Textilomas are not routinely reported due to their medicolegal implications and are usually encountered fortuitously. Here, we report a case of an individual who presented with a non-specific lower backache, had a remote history of lumbar discectomy and in whom a textiloma at the postoperative site was seen to mimic a soft-tissue mass on imaging. In addition, we review current, up-to-date literature on delayed presentations of such retained materials after surgery of the lumbar spine.
CASE REPORT
A 43-year-old male presented with pain in his right lower back and gluteal region. He had undergone an L4-L5 discectomy 11 years ago, remained asymptomatic since, and noticed an insidious, worsening pain a week before presentation. Mild tenderness was elicited over the region of pain. A clinical diagnosis of L4-L5 extraforaminal disc prolapse with deep surgical site infection was made. Ultrasound showed an iso-to-hyperechogenic lesion in the right lower paraspinal region. MRI showed a very well-defined, ovoid T1-hypointense and T2-iso-hypointense lesion in the deep posterior paraspinal region of the L4/5 level adjacent to right laminar process of L4 vertebra. The lesion caused scalloping and chronic erosion of the laminar process. No obvious air pockets were present. The features of infection, like soft tissue oedema and collection, were absent. Based on imaging, differentials of nerve sheath tumour and gossipybomas was made. Open wound exploration was performed, which showed a wad of gauze within the right L4-L5 interlaminar space, with thin surrounding granulation tissue The L4-L5 disc and exiting nerve root were normal. The mass was removed, local washing was done and wound was closed.
CONCLUSION
Though unfortunate and relatively rare, the possibility of a textiloma must be considered among the differential diagnoses of a mass in the spinal region in the event of prior surgery, no matter how remote the history. Clinical presentation may vary, but the imaging appearance is largely consistent and can be relied upon to prevent unnecessary investigation and facilitate early surgical removal of the offending retained material.
PubMed: 36051862
DOI: 10.1016/j.jcot.2022.101967