Quality-of-life impact of diaphragm plication in patients with diaphragmatic paralysis: A retrospective study.

OBJECTIVES: While the overall incidence and prevalence of diaphragmatic paralysis are unknown due to a wide variety of underlying causes, symptomatic patients experience a marked decline in their quality of life. The goal of this study was to measure the impact of diaphragm plication surgery on the quality of life in patients who were diagnosed with diaphragmatic paralysis. METHODS: A retrospective review of the medical records of 46 patients who underwent diaphragmatic plication surgery was performed. The review included patients who experienced unilateral and bilateral diaphragmatic paralysis. Patients who underwent repeat diaphragm plication surgery were also included in the study. Patients from the retrospective cohort were then contacted by telephone to answer the Dyspnea-12 (D-12) questionnaire. Patients were asked to recall the severity of their symptoms and quality of life preplication, 1-month postplication, and 6-month postplication. Severity of symptoms was ranked as either none, mild, moderate, or severe. Values were then assigned to each rank as follows: none = 0, mild = 1, moderate = 2, and severe = 3. Relative change and statistical significance were calculated with preplication measurements used as the baseline. Scores between preplication versus 1-month postplication and 6-month postplication were then compared by Student's paired t-test. All tests were two-sided and statistical significance was set at P < 0.05. RESULTS: Forty-six patients were included in the study, from which 21 answered the D-12 questionnaire. Average scores from each component of the D-12 questionnaire showed improvement in the severity of symptoms from preplication to 1-month postplication. The latter period was then followed by continued improvement in all areas when symptoms 6-month postplication were assessed. CONCLUSION: In patients with diaphragmatic paralysis, diaphragm plication was effective in reducing patients' symptoms while improving overall quality of life.

Health Inequities in Pediatric Trauma.

This review article highlights the disparities evident in pediatric trauma care in the United States. Social determinants of health play a significant role in key aspects of trauma care including access to care, gun violence, child abuse, head trauma, burn injuries, and orthopedic trauma. We review the recent literature as it relates to these topics. The findings from these recent studies emphasize the important principle that trauma care for children should be designed with a focus on equity for all children.

A novel presentation of alcohol-induced gastric necrosis: a case report.

Acute gastric necrosis is a rare condition with unknown pathogenesis. Existing literature describes acute esophageal necrosis as a result of excessive alcohol use; however, it is more difficult to find literature on alcohol-induced gastric necrosis. This condition may present with epigastric tenderness, vomiting or diarrhea with findings of pneumoperitoneum, gastric pneumatosis and portal venous gas on computed tomography. These patients can have complications such as septic shock, peritonitis and death. In this case report, we discuss a patient with a history of alcohol abuse who presented with acute gastric necrosis. On endoscopy, this patient was found to have a black necrotic gastric fundus and unusual erythematous changes to the mucosa. Prior research has identified other findings of patchy or diffuse circumferential black pigmentation of esophageal mucosa in patients with alcohol-induced esophageal necrosis, otherwise known as black esophagus. This case report aims to describe this novel presentation of alcohol-induced gastric necrosis.