Durability of pneumatic dilation monotherapy in treatment-naive achalasia patients.

BACKGROUND: Pneumatic dilation (PD) is often billed as a "short term" treatment for achalasia but anecdotally can last years. This study sought to explore how long a single pneumatic dilation may induce symptom remission in a treatment-naïve achalasia patient. METHODS: A single center, retrospective chart review of patients with an ICD-9 or - 10 code of achalasia between 2005 and 2017 was performed. Treatment naïve patients with manometric diagnosis of primary achalasia were included. Outcomes (success or failure); single vs multiple PD; age; and estimated duration of effect were evaluated. Each patient underwent a single PD unless re-intervention was required for relapse. RESULTS: 83 patients (52% female, median 51.6 ± 3.6 years) were included. 43% underwent 2 PD and 13% underwent 3 PD. There was no significant relation between age, gender, and number of PDs. After 1 PD, 87.5% of patients reported > 1 year of symptom remission. 80.5% of relapsed patients reported success after a 2nd dilation. 1 PD was more likely to result in success than multiple PDs (p < 0.001). The measured median duration of remission after 1 PD was 4.23 years, and for 2 PDs, 3.71 years. The median estimated remission time after 1 PD was 8.5 years (CI 7.3-9.7, p = 0.03). CONCLUSIONS: PD is a safe, durable treatment for achalasia. A single PD is likely to last years. A second PD, if required, also has a high likelihood of success.

EUS-guided gastroenterostomy for proximal jejunal obstruction: technique modification for more distal upper GI tract obstruction.

Video 1Demonstration of the EUS guided gastroenterostomy.

Effects of Ketorolac, Xylazine, and Bupivacaine Multimodal Analgesia on Goats.

The current study aimed to investigate the effect of some of the analgesic drugs, such as Xylazine, Ketorolac, and Bupivacaine alone/mixed, on analgesia scores in the local breed goats. This research was performed on 35 male and female local breed goats within the age range of 6-8 months with an average weight of 17±3 Kg. The animals were divided into seven groups (n=5). The first group received Xylazine at a dose of 0.1 mg/kg BW through intramuscular injection (IM), while the second group was administered Ketorolac at a dose of 2 mg/kg BW through IM. The third group was administered Bupivacaine at a dose of 2 mg/kg BW through subcutaneous injection (SC). The fourth group was administered ketorolac at a dose of 2 mg/kg BW through IM and after 1 h was administered xylazine at a dose of 0.1 mg/kg BW through IM. The fifth group was administered Bupivacaine at a dose of 2 mg/kg BW through SC and after 1 h was administered xylazine at a dose of 0.1 mg/kg BW through IM. The sixth group was administered a mixture of Bupivacaine and ketorolac at the dose of 2 mg/kg BW through SC and 2 mg/kg BW through IM, respectively. The seventh group was administered Bupivacaine at a dose of 2 mg/kg BW through SC and ketorolac at the dose of 2 mg/kg BW through IM simultaneously. After 1 h, the seventh group was administered xylazine at the dose of 0.1 mg/kg BW through IM. Analgesia scores were evaluated every 10 min from the starting point for 180 min to determine values, such as respiratory and heart rate as well as rectal temperature. Moreover, the analgesic degree was examined for the head, flanks, hind limb, forelimb, and tail every 10 min. The recorded data in the current study revealed that the seventh group had a higher analgesic effect, compared to the other groups depending on the analgesia of the head, tail, flank, forelimb, and hindlimb. In the end, the group that received the mixture or combination of Bupivacaine (2 mg/kg BW-SC) and ketorolac (2 mg/kg BW-IM) followed by the administration of xylazine at a dose of 0.1 mg/kg BW after 1 h had a short period of onset of analgesia and showed long analgesia time and more depth, compared to other groups and without ataxia.

[An anterior mediastinal mass of rare etiology]. / Masse médiastinale antérieure d'étiologie rare.

Hydatid cyst of the mediastinum is very uncommon. The diagnosis, usually evident in endemic regions in the case of a typical clinical-radiological presentation, is rather more difficult in certain atypical forms. We report a case of a 19-year-old man who presented with a mass of tumour like appearance in the anterior mediastinum. The diagnosis of mediastinal hydatid cyst was established by transthoracic needle biopsy and endoscopic bronchial aspiration revealed hydatid membranous debris. The diagnosis was confirmed when the mediastinal cyst ruptured into a bronchus. Thoracotomy was carried out with an uneventful post-operative recovery. This observation illustrates the diagnostic difficulties when a mediastinal hydatid cyst presents the appearances of a tumour. This possibility must be included in the differential diagnosis of every mediastinal mass, particularly in endemic regions.

[Determinants of quality of life in chronic obstructive pulmonary disease]. / Déterminants de la qualité de vie dans la bronchopneumopathie chronique obstructive.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is considered as a systemic disease with pulmonary starting point. The use of spirometry alone is certainly not the best way to reflect the impact of disease on quality of life for patients. PATIENTS AND METHODS: Prospective study concerning 70 patients treated for COPD. Quality of life was assessed using the French version of the Saint-George questionnaire. RESULTS: Our population was predominantly male (97%) with a mean age of 63 years. All patients were smokers with an average of 46 pack-years. The total score of the Saint-Georges respiratory questionnaire was 50.7%. The mean scores of different fields were 68% for the field activities, 49% for impact and 26% for the item of symptoms. The multidimensional BODE index was correlated with the quality of life and its various fields were more powerfully than the forced expiratory volume per second, the number of exacerbations, the six-minute walking test and dyspnea score. CONCLUSION: It is important to integrate the multidimensional classification indices in assessing the severity of the disease because only these indices can reflect the systemic aspect of the disease.

[Pulmonary fibrosis as a presentation of Wegener's granulomatosis]. / Une fibrose pulmonaire révélant une granulomatose de Wegener.

INTRODUCTION: Pulmonary fibrosis secondary to antineutrophil cytoplasmic antibodypositive vasculitis is rarely reported. Most cases have occurred in association with microscopic polyangiitis. CASE REPORT: We report the case of an 82-year-old man presenting with pulmonary fibrosis. The CT scan showed honeycombing and traction bronchiectasis with peripheral and basal predominance. The diagnosis of Wegener's granulomatosis was based on the association of positive antineutrophil cytoplasmic antibodies, urinary sediment abnormalities and renal biopsy findings. CONCLUSION: We emphasize, through this case, the rarity of interstitial fibrosis as a pulmonary manifestation of vasculitis and we discuss the pathogenesis of this association.