PubMed · 13526272
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1958-04-12. BLEEDING varices.. https://pubmed.ncbi.nlm.nih.gov/13526272/
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BACKGROUND: Scarce information is available on the effects of body's positioning in the number and the duration of gastroesophageal reflux episodes in very low birth weight infants. AIM: To evaluate the influence of prone compared to supine positions on the frequency and duration of acid gastroesophageal reflux episodes in very low birth weight infants and study the role of body position in the occurrence of exams with reflux index > or = 5% and > or = 10%. METHODS: Sixty one prolonged esophageal pH monitoring exams were retrospectively analyzed. The difference between the prone and supine position exam duration was not longer than 3 hours. The reflux index was evaluated for the total period of the exam (reflux index total) and for each period in the two positions. The total number of reflux episodes, the number of reflux episodes > 5 minutes and the longest reflux episode were evaluated for each period in the two positions. These parameters were compared in accordance with body positioning, for each one of the three reflux index total categories: reflux index total < 5%, > or = 5% and > or = 10%. The frequencies of exams with reflux index total > or = 5% and reflux index total > or = 10% were compared for both positions. RESULTS: The number of hours in prone (11.2 +/- 1.0) and in supine (11.2 +/- 1.1) position were not different. All the prone positions monitoring parameters were significantly lower than the supine ones, in the three reflux index total categories. In the supine position, 32.7% (20/61) and 27.8% (17/61) of the exams, which were normal in prone, became abnormal, taking into account reflux index > or = 5% and > or = 10%, respectively, obtained for each position. CONCLUSIONS: In prone position, there is a significant decrease in number and duration of acid reflux episodes in very low birth weight infants. Supine position promotes a significant increase in the number of esophageal pH monitoring exams with reflux index > or = 5% and > or = 10%, making easier the diagnose of the gastroesophageal reflux disease.
OBJECTIVE: To study the sonographic anatomy and physiology of the human fetal esophagus during the mid-trimester of pregnancy using a high-resolution linear transducer. METHODS: This was a prospective observational study of the fetal esophagus between 19 and 25 weeks' gestation. The study was performed in 60 consecutive fetuses, after a normal anatomy scan, using a 5-13-MHz matrix array wide-band transducer. During the examination the collapsed esophagus was first visualized, and followed by a 5-min video recording in order to demonstrate luminal patency and peristaltic waves. RESULTS: Complete anatomical visualization of the esophagus was possible in 52 (86.7%) patients and at least partial visualization in 58 (96.7%) patients. Three different patterns of esophageal motility were observed: a simultaneous and short opening of the whole esophagus was found in 35 (58.3%) fetuses; a segmental, peristalsis-like movement from the pharynx, through the mediastinum, and into the stomach was found in 18 (30%) fetuses; and in one fetus reflux-like passage of solid contents from the stomach was observed. The mean time required for demonstration of esophageal patency was 96.1 (range, 10-300) s. CONCLUSIONS: Demonstration of normal anatomy and physiological activity of the fetal esophagus is feasible using appropriate transducers. The most commonly observed pattern of esophageal motility in the mid-trimester of pregnancy is the simultaneous relaxation of the upper and lower esophageal sphincters with concurrent opening of the esophageal lumen from the upper thorax to the stomach. Demonstration of a patent esophagus may be helpful in fetuses with suspected esophageal atresia.
Surgical use of robotics, or computer-assisted surgical systems (CAS), has evolved over the last 10 years; for the treatment of chest diseases, however, the development has really occurred in the last 3 to 4 years. This brief history means that there have been few publications in the medical literature, and those that exist are mostly case reports. Moreover, because of this modest experience, robotic thoracic procedures currently take more time than nonrobotic cases and, thus, are more expensive. The surgical learning curve appears to be steep, especially for the more complex procedures. As surgeons gain greater experience and the complexity and cost of the equipment are reduced, we should expect to see greater utility of CAS in thoracic surgery.