scholarly journals Long-term outcome of a modified balloon dilatation in the treatment of patients with achalasia

2013 ◽  
Vol 70 (10) ◽  
pp. 915-922 ◽  
Author(s):  
Radoje Doder ◽  
Nenad Perisic ◽  
Ratko Tomasevic ◽  
Darko Mirkovic ◽  
Zoran Jankovic ◽  
...  
Keyword(s):  
Body Weight ◽  
Balloon Dilatation ◽  
Body Weight Loss ◽  
Term Outcome ◽  
Duration Of Symptoms ◽  
Long Term Outcome ◽  
Esophageal Lumen ◽  
Esophageal Scintigraphy ◽  
Clinically Significant ◽  
The One

Background/Aim. Balloon dilatation is a standard approach to the initial achalasia treatment. Modified dilatation is also applied to rise efficacy and to lower complications. Methods. A total of 57 patients were analysed within a median follow-up of 8.2 years. No premedication was used, dilatation was performed up to the pain treshold, while introduction and positioning of a dilatator was done in combination of endoscopic and radiological control. Dilatation effect was estimated by both Kim Symptom Scoring and objective parameters: body weight rise and radiological scintigraphic findings. Results. Excellent and good results were obtained in 50 (88%) of the patients, while in 7 (12%) of the patients surgery was performed. There was no difference in dilatation efficacy regarding sex of the patients, but the results were better in the patients above 40 years. Duration of symptoms, body weight loss, esophageal lumen width do not indicate the definitive dilatation outcome. Esophageal scintigraphy and body weight increase were in a direct correlation with the effect of dilatation measured with the Kim Symptom Scoring. After the one to two repeated dilatations the efficacy increased from 74% to 88% justifying the repetition of dilatation. In 2 (3.57%) of the patients, that is in 2.65% of the totally dilated patients, perforation was recorded. There was no lethal outcome of dilatation, and the other complications were not clinically significant. Conclusion. Modified balloon dilatation can be recommended for initial method in achalasia treatment due to high efficacy, easy performance in daily hospital while complications are in standard range.

Leptin causes body weight loss in the absence of in vivo activities typical of cytokines of the IL-6 family

1998 ◽  
Vol 275 (3) ◽  
pp. R913-R919 ◽  
Author(s):  
Davide Agnello ◽  
Cristina Meazza ◽  
Christopher G. Rowan ◽  
Pia Villa ◽  
Pietro Ghezzi ◽  
...  
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Body Weight Loss ◽  
Peripheral Blood Cell ◽  
Serum Corticosterone ◽  
Amyloid A ◽  
Cell Counts ◽  
Control Body ◽  
The One

To investigate if leptin shares in vivo activities with interleukin (IL)-6 family cytokines, it was tested in normal mice for the ability, after a single injection, to induce the acute-phase protein serum amyloid A, to potentiate the induction by IL-1 of serum corticosterone and IL-6, and to inhibit the induction by lipopolysaccharide of serum tumor necrosis factor and, after seven daily injections, to cause body weight loss and to change peripheral blood cell counts. At a 0.5 mg/kg dose, leptin caused body weight loss but did not show any of the other activities above. At a dose of 5 mg/kg, which also caused body weight loss, leptin potentiated the induction by IL-1 of serum corticosterone and IL-6 but did not show any other activity. In addition to causing body weight loss, leptin shows only some of the in vivo activities typical of IL-6 family cytokines and only if used at a dose that exceeds the one sufficient to affect body weight. In vivo, leptin seems to chiefly control body weight and not inflammatory or hematopoietic processes.

scholarly journals Long-term neurodevelopment in children born with esophageal atresia: a systematic review

2021 ◽  
Author(s):  
Camille E van Hoorn ◽  
Chantal A ten Kate ◽  
Andre B Rietman ◽  
Leontien C C Toussaint-Duyster ◽  
Robert Jan Stolker ◽  
...  
Keyword(s):  
Cognitive Development ◽  
Motor Function ◽  
Esophageal Atresia ◽  
Current Knowledge ◽  
Neurodevelopmental Outcome ◽  
Cognitive Outcome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
The One

Summary Background Although the survival rate of esophageal atresia (EA) has increased to over 90%, the risk of functional long-term neurodevelopmental deficits is uncertain. Studies on long-term outcomes of children with EA show conflicting results. Therefore, we provide an overview of the current knowledge on the long-term neurodevelopmental outcome of children with EA. Methods We performed a structured literature search in Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google scholar on November 8, 2020 with the keywords ‘esophageal atresia’, ‘long-term outcome’, ‘motor development’, ‘cognitive development’, and ‘neurodevelopment’. Results The initial search identified 945 studies, of which 15 were included. Five of these published outcomes of multiple tests or tested at multiple ages. Regarding infants, one of six studies found impaired neurodevelopment at 1 year of age. Regarding preschoolers, two of five studies found impaired neurodevelopment; the one study assessing cognitive development found normal cognitive outcome. Both studies on motor function reported impairment. Regarding school-agers, the one study on neurodevelopmental outcome reported impairment. Cognitive impairment was found in two out of four studies, and motor function was impaired in both studies studying motor function. Conclusions Long-term neurodevelopment of children born with EA has been assessed with various instruments, with contrasting results. Impairments were mostly found in motor function, but also in cognitive performance. Generally, the long-term outcome of these children is reason for concern. Structured, multidisciplinary long-term follow-up programs for children born with EA would allow to timely detect neurodevelopmental impairments and to intervene, if necessary.

scholarly journals Psychosis in youth in Singapore: a case series

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S117-S117
Author(s):  
Pei Ling Lim ◽  
Roselyne Shirley ◽  
Pat Fong
Keyword(s):  
Adult Population ◽  
Psychiatric Service ◽  
Case Series ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Term Outcome ◽  
Duration Of Symptoms ◽  
Long Term Outcome ◽  
Paediatric Hospital ◽  
Seeking Help

ObjectiveIn this report, we present a case series of children with psychotic symptoms referred to a child consultation liaison psychiatric service within a tertiary paediatric hospital in Singapore. The purpose of this case series is to identify common symptoms at presentation, review the current practices in our hospital for investigation and treatment of first episode psychosis and short-term outcomes.Case reportWe identified 9 cases over a 1 year period, for which 7 were seen whilst admitted to hospital and 2 in the outpatient clinic. There were 6 females and 5 males ranging in age from 11 to 16 years old. The commonest symptoms on presentation were perceptual disturbance (88%) most commonly auditory hallucinations and altered behaviour (55%). Of the 7 children admitted to hospital, all were seen by the neurology team prior to the request for a psychiatric opinion. All admitted patients had blood and radiological investigations carried out. Most of the children were started on a short course of antipsychotic medication with the majority continuing to attend follow-up outpatient.DiscussionOnly 9 cases were identified in this case series over a 1 year period highlighting that psychosis is not a common presentation in the paediatric population. From the history alone, it can be challenging to distinguish between primary and secondary causes of psychosis. Acute onset of symptoms and the presence of other neurological signs should raise the suspicion of an underlying organic cause. Out of 9 cases, only 1 case was treated for a presumed organic aetiology, which is consistent with findings from other authors who only found underlying organic factors in 12.5% of cases.In this case series, we also noted that 45% of cases reported having symptoms for over 1 year before seeking help. This is also seen in the adult population in Singapore. Stigma, denial and lack of information about psychosis may all contribute to delay in seeking help. Although prolonged duration of untreated psychosis has been shown to be associated with poor long-term outcome, we found in our case series that even patients who reported a long duration of symptoms still responded well to medication.ConclusionThere is room for collaboration with our neurology colleagues in the approach towards children with first presentation of psychosis, both in terms of investigations and management. Identifying reasons for disengagement from psychiatric care is an area for further investigations to improve outcomes in our patients.

Adjustment Disorder and Its Clinical Management

2017 ◽  
Author(s):  
Mauro Giovanni Carta ◽  
Antonio Preti
Keyword(s):  
Adjustment Disorder ◽  
Operational Definition ◽  
Clinical Settings ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Key Words Adaptation ◽  
The One ◽  
Definition Of ◽  
Anxiety Depression

Adjustment disorder is a condition of subjective emotional distress triggered as a consequence of a meaningful change in life. The diagnosis of adjustment disorder is hindered by the difficult operational definition of stress and of its related concept of “vulnerability,” by the problem of disentangling symptoms of adjustment disorder from those attributable to comorbid anxiety and mood disorders, and by the poor boundaries of the disorder with other stress-related conditions on the one hand and with common adaptation to life events on the other. Despite the high frequency of its diagnosis in clinical settings, there has been relatively little research on the adjustment disorder and, consequently, very few hints about its treatments. Several psychotherapies have been developed to deal with patients diagnosed with adjustment disorder, with inconclusive evidence on their effectiveness. Antidepressants may abate the symptoms and help patients reacquire occupational and social functioning. The medium-term outcome of adjustment disorder is good, with 70 to 80% of those diagnosed with it showing no evidence of psychopathology when reassessed 5 years from the episode. However, when comorbid with a personality disorder or a substance use disorder, the short-term risk of suicide may be increased. The long-term outcome of adjustment disorder seems to be worse in children and adolescents than in adults. In particular, adolescents diagnosed with adjustment disorder were more likely than adults to have received a diagnosis of a severe mental disorder at the 5-year follow-up, including schizophrenia, schizoaffective disorder, and bipolar disorder. This review contains 1 figure, 6 tables, and 52 references. Key words: adaptation, adjustment disorder, anxiety, depression, stress, trauma, treatment, vulnerability

Management of Ureteropelvic Junction Obstruction With High-pressure Balloon Dilatation: Long-term Outcome in 50 Children Under 18 Months of Age

Urology ◽  
2013 ◽  
Vol 82 (5) ◽  
pp. 1138-1144 ◽  
Author(s):  
Alberto Parente ◽  
José-María Angulo ◽  
Rosa Maria Romero ◽  
Susana Rivas ◽  
Laura Burgos ◽  
...  
Keyword(s):  
High Pressure ◽  
Balloon Dilatation ◽  
Ureteropelvic Junction Obstruction ◽  
Ureteropelvic Junction ◽  
Term Outcome ◽  
Long Term Outcome

Psychogenic Tremor: Long-Term Outcome

CNS Spectrums ◽  
2006 ◽  
Vol 11 (7) ◽  
pp. 501-508 ◽  
Author(s):  
Joseph Jankovic ◽  
Kevin Dat Vuong ◽  
Madhavi Thomas
Keyword(s):  
Movement Disorders ◽  
Clinical Information ◽  
Baylor College ◽  
Term Outcome ◽  
Duration Of Symptoms ◽  
Long Term Outcome ◽  
Clinical Criteria ◽  
Psychogenic Movement Disorders ◽  
The Mean

ABSTRACTIntroduction: Psychogenic disorders, also referred to as somatoform, conversion, somatization, hysteria, and medically unexplained symptoms, are among the most challenging disorders to diagnose and treat. Psychogenic movement disorders are increasingly encountered in specialized clinics, and represent ~15% of all patients evaluated in the Baylor College of Medicine Movement Disorders Clinic.Objective: To characterize psychogenic tremor and provide data on prognosis and long-term outcome in a large group of patients with psychogenic tremor followed in a movement disorders clinic.Methods: Patients evaluated at the Baylor College of Medicine Movement Disorders Clinic in Houston, Texas, between 1990 and 2003 with the diagnosis of psychogenic movement disorder (PMD), who consented to be interviewed, were administered a structured questionnaire designed to assess current motor and psychological function.Results: psychogenic tremor is the most common PMD, accounting for 4.1 % of all patients evaluated in our clinic. We were able to obtain clinical information on a total of 228 of 517 (44.1%) patients with PMD, followed for a mean of 3.4±2.8 years. Among the 127 patients diagnosed with psychogenic tremor, 92 (72.4%) were female, the mean age at initial evaluation was 43.7±14.1 years, and the mean duration of symptoms was 4.6±7.6 years. The following clinical features were considered to be characteristic of psychogenic tremor: abrupt onset (78.7%), distractibility (72.4%), variable amplitude and frequency (62.2%), intermittent occurrence (35.4%), inconsistent movement (29.9%), and variable direction (17.3%). Assessment of long-term outcome showed that 56.6% of patients reported improvement in their tremor. Factors predictable of a favorable outcome were elimination of stressors and patient's perception of effective treatment by the physician.Conclusion: This largest longitudinal study of patients with psychogenic tremor provides data on the clinical characteristics and natural history of this most common PMD. The accurate diagnosis of psychogenic tremor is based not only on exclusion of other causes but is also dependent on positive clinical criteria, the presence of which should avoid unnecessary investigation. The prognosis of psychogenic tremor may be improved with appropriate behavioral and pharmacologic management.

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