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At least 343 records · Page 19Linked to original sources
PubMed1994

Effects of new fish oil derivative on fatty acid phospholipid-membrane pattern in a group of Crohn's disease patients.

Fish oil has been recently proposed as a possible effective treatment in inflammatory bowel disease (IBD); however, a lot of annoying side effects (ie, belching, halitosis, diarrhea, etc) affect patient compliance. We carried out a study of patient tolerance in a group of Crohn's disease (CD) patients with a new fish oil derivative consisting of 500-mg capsules of eicosapentaenoic-docosahexaenoic (EPA 40%-DHA 20%), a free fatty acid mixture (Purepa), and we also evaluated its incorporation into phospholipids, both in plasma and in red cell membranes. Five groups of 10 CD patients in remission received nine Purepa capsules daily in four different preparations (A: uncoated, B: coated, pH 5.5; C: coated, pH 5.5, 60 min time release; D: coated, pH 6.9) and 12 x 1-g capsules daily of a triglyceride preparation (Max-EPA, EPA 18%-DHA 10%), respectively. We coated three of the four Purepa preparations in order to delay the release of contents in an attempt to minimize the side effects. After six weeks of treatment, the group taking Purepa capsules, coated, pH 5.5, 60 min time release (group C) showed the best incorporation of EPA and DHA in red blood cell phospholipid membranes (EPA from 0.2 to 4.4%, DHA from 3.7 to 6.3%), and no side effects were registered, whereas in all other groups side effects were experienced in 50% or more of subjects. This new preparation will make it possible to treat patients for long periods.

Adult↗
PubMed1987

The management of Crohn's colitis with colonogastric fistula. Report of a case.

Colonogastric fistula, more commonly called "gastrocolic," is a rare complication of Crohn's colitis. The 17th incidence of this fistula is reported. Fecal halitosis is a prominent symptom. Barium enema is the most accurate diagnostic tool. Colonoscopy plays a role in delineating surgical therapy. The stomach resection is described. Because of its pathogenesis, the authors prefer to call this "colonogastric" fistula, rather than gastrocolic fistula.

Adult↗
PubMed2003

Transmural migration of gastrostomy tube retention discs.

BACKGROUND: Accidental dislodgment is one of the most frequent causes of avoidable cost and consternation related to gastrostomy tubes. The Sacks-Vine gastrostomy tube, inserted in an antegrade fashion by a percutaneous technique, is extremely stable due to the construction of its disc retention device. However, transmural migration of the retention disc is a known severe delayed complication associated with this tube. OBJECTIVE: To review the presentation, diagnosis, and treatment of transmural migration of gastrostomy retention discs, to propose a mechanism for the progressive development of this complication, and to recommend a method for preventing its occurrence. MATERIALS AND METHODS: From January 1991 to October 1999, pediatric interventional radiologists at two children's hospitals performed 300 antegrade gastrostomy and gastrojejunostomy primary insertion procedures. A "push-pull" variation of the antegrade approach used for 44 of these insertions is excluded from further analysis. Of the remaining 256 procedures, 5 boys and 3 girls with a mean age of 5.1 years (range 0.8-19 years) were identified from review of the prospectively gathered procedural database with significant complications related to the disc retention component of their gastrostomy tubes. A retrospective analysis was conducted of their medical records, diagnostic imaging, and interventional and surgical findings. RESULTS: Transmural migration was diagnosed on average 36 months after insertion (16-48 months). The diagnosis was made incidentally during endoscopy (n=1) or fluoroscopy (n=5) in six asymptomatic patients, and during barium enema to explore feculent vomiting and halitosis in two symptomatic patients. Migration of the retention disc fell along a continuum from intramural (n=4) to transmural and intracolonic (n=4), with gastric mucosal erosion, extensive granulation and inflammation in all eight patients. Although there was no evidence of free air in any patient, a gastrocolic fistula was demonstrated in four patients and a gastrocolocutaneous fistula in two of four patients with complete transmural migration. Surgical resection of the disc, gastrostomy, and fistula repair if needed was successfully performed in all patients. CONCLUSIONS: Gastrostomy tubes with an internal retention disc are at risk for progressive disc migration into and through the gastric wall, resulting in irretrievable fixation and potential fistula formation. This severe delayed complication results from prolonged traction on the retention disc. Transmural migration may be avoided through improved tube care education, daily disc mobilization, and earlier disc retrieval.

Adolescent↗
PubMed2007

[On quality of life after surgical therapy of oral cancer - a retrospective multi-center study: the connection between dedentition, denture, quality of life, and dysphagia, and the resulting rehabilitation schemes].

PURPOSE: The surgical treatment of oral cancer results in functional and aesthetical impairments. Patients' quality of life is considerably impaired by oral symptoms resulting from therapy of oral cancer. In many cases the inevitable resection of the tumor, as well as the adjuvant radiochemotherapy will cause the destruction of physiologically and anatomically important structures. One focus of research was the specific rehabilitation of dental loss by functional dentures. Another was the course of 19 impairments (comprehension of speech for unknown others, comprehension of speech for familiar others, eating/swallowing, mobility of the tongue, opening range of the mouth, mobility of lower jaw, mobility of neck, mobility of arms and shoulders, sense of taste, sense of smell, appearance, strength, appetite, respiration, pain, swelling, xerostomia, halitosis). METHODS: Commissioned by the German, Austrian and Swiss cooperative group on tumors of the maxillofacial region (DOSAK), data were collected in 3.894 questionnaires at 43 hospitals in Germany, Austria and Switzerland. The catalogue comprised 147 items in 9 chapters. At the end of the enquiry, 1.761 anonymous questionnaires were returned by 38 hospitals. 1.652 of these could be evaluated regarding the question. RESULTS: The sum score of the 19 impairments was highly increased immediately after the operation and recovered over the next 6 months, without, however, reaching the pre-surgery level. Of 1.652 patients, only 35% did not lose any teeth during therapy. 23% lost up to 5, 17% up to 10 teeth. A quarter of the patients lost more than 10 teeth. The more teeth were lost, the greater the decline of quality of life (p < or = 0.001), although this could be allayed by the functionality of the dentures (p < or = 0.001). There is a reciprocal dependence between the functionality of dental prosthetics and impairment by eating/swallowing (p < or = 0.001). CONCLUSIONS: Patients' quality of life after radical surgery of a carcinoma of the oral cavity depends not only on the functionality of dentures and the specificity of rehabilitation, but also from the initial findings, the extent and location of the resection, the chosen therapy, the general circumstances of the patient's life as well as their strategies of coping. These factors, however, unlike those of functionality of dental prosthesis and rehabilitation, are not modifiable.

Austria↗
PubMed2005

Diffuse gingival enlargement.

Diffuse gingival enlargement is defined as an excessive growth of periodontal tissue. It can be considered a relatively common finding, as thousands of patients have been described in the literature. Patients may seek medical attention because of pain, tenderness, interference with speech and/or mastication, halitosis, or unsightly appearance, or gingival enlargement may be an unexpected finding on routine physical examination. Diffuse gingival enlargement has numerous causes, including poor dental hygiene, medications, serious systemic illnesses, genetic conditions, other specific physiologic states, or it may be idiopathic. Given the large number of possible underlying conditions, the work-up of a patient presenting with diffuse gingival enlargement may seem daunting. We present a systemic review of diffuse gingival enlargement, including an algorithm that can be used to direct the work-up of patients presenting with this condition.

Algorithms↗
PubMed2005

Awareness of general practitioners towards treatment of laryngopharyngeal reflux: a British survey.

OBJECTIVE: Patients with acid reflux can occasionally present with atypical symptoms such as globus pharyngeus, constant throat clearing, chronic cough, hoarseness, catarrh, choking episodes or asthma-like symptoms. The aim of this survey was to determine whether general practitioners are aware of the atypical manifestations of reflux and the differences in treatment between laryngopharyngeal reflux and gastroesophageal reflux. DESIGN: Questionnaire Survey. SETTING: Primary Care RESULTS: One hundred and sixty general practitioners who routinely refer patients to our Department of Otolaryngology were selected and a postal survey was conducted. One hundred and fifty of these responded (94% response rate). The commonest symptoms for which proton pump inhibitors are prescribed are heartburn (65%), followed by a combination of heartburn and other symptoms (15%), chronic cough (4%), choking episodes (4%), asthma-like symptoms (3%), hoarseness (2%), globus (2%), catarrh (1%), dysphagia (1.5%), frequent throat clearing (1.5%), halitosis and/or bitter taste (1%). CONCLUSIONS: Our results suggest that the majority of the general practitioners surveyed are unaware of the entity laryngopharyngeal reflux or reflux symptom index. More awareness is required in the primary care setting for early recognition of patients with suspected laryngopharyngeal reflux.

Anti-Ulcer Agents↗
PubMedDate not supplied

["Usual" morbidity of pediatric tonsillectomy: a study of 126 cases].

Pediatric tonsillectomy is a common procedure in the ENT practice, usually in a Day-surgery basis. The aim of the present work is to further investigate postoperative morbidity to improve both treatment and quality of assistance. 126 children operated in our Day-surgery unit were included in the study, and a questionnaire with items related to postoperative pain, otalgia, halitosis, vomitig, fever and other aspects was filled by their parents or relatives in charge. Significative pain lasting until the third or fourth day was recorded in half of the cases. At the end of the first week most of the children are improved, although only 55% are eating normally. Vomitting, usually the day of the surgery, is described by one third of cases. In our experience, ambulatory tonsillectomy is a safe procedure with low incidence of complications, which are mild. However, the delay in returning to a normal diet and the relative high incidence of vomiting bring into question the inclusion of tonsillectomy in a Day-Surgery program, making necessary to implement treatment protocols to avoid such problems.

Adolescent↗
PubMed2002

Experience with Ultraflex expandable metallic stents in the management of endobronchial pathology.

BACKGROUND: Experience with Ultraflex expandable metallic stents (Micro-invasive, Boston Scientific, Watertown, MA) in the management of endobronchial pathologies leading to airway compromise is reported. METHODS: Between January 1999 and August 2000, twenty-eight expandable metallic stents were inserted into 25 patients (7 men and 18 women; median age, 65 years) who presented with respiratory distress. Each patient had comorbid medical conditions or end-stage malignancy that precluded formal surgical repair. Seventeen patients had intrinsic airway obstruction, 5 had extrinsic compression, 2 had a tracheal tear, and 1 had a tracheoesophageal fistula. Stents were inserted through a bronchoscope under direct vision. Eighteen patients received tracheal stents alone (1 of these patients received two tracheal stents), and 5 patients received bronchial stents only. Two patients received a tracheal and a bronchial stent. Twenty-one stents were covered and seven were uncovered. RESULTS: All patients had successful stents with restoration of airway patency and closure of tracheal defects. One patient developed a respiratory infection early after the operation. Follow-up bronchoscopy confirmed satisfactory stent position in each patient. Late complications included sputum retention, halitosis, and granulation tissue formation. CONCLUSIONS: Ultraflex expandable metallic stents should be considered in the management of airway compromise in selected patients for whom formal surgical repair is inappropriate or contraindicated.

Aged↗
PubMedDate not supplied

Symptoms, gastritis, and Helicobacter pylori in patients referred for endoscopy.

Acute Helicobacter pylori infection is associated with dyspeptic symptoms but chronic infection has not clearly been shown to cause symptoms. To define further the role of H. pylori infection and gastritis in dyspepsia, we interviewed all patients about to undergo upper endoscopy, recorded the primary indication for endoscopy, noted the endoscopic findings, and obtained antral biopsies. Among non-ulcer patients there was a strong correlation of acute gastritis with H. pylori. Gastritis and H. pylori increased with age, and non-steroidal anti-inflammatory drug use correlated with normal histology. Neither H. pylori concentration nor gastritis grade correlated with gender, use of alcohol and tobacco, indication for endoscopy, or symptoms (epigastric pain, nausea, vomiting, bloating, belching, heartburn, halitosis, and flatulence).

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2003

Randomized, open-label preference study of two cyclosporine capsule formulations (usp modified) in stable solid-organ transplant recipients.

BACKGROUND: Prior research has indicated patient dissatisfaction with the odor, size, and taste of cyclosporine capsules, as well as the halitosis and body odor the capsules can cause. OBJECTIVES: The purposes of this investigation were to (1) compare the overall cyclosporine capsule preference (Gengraf vs Neoral) in stable, solid-organ transplant recipients, (2) assess patient preference based on specific capsule attributes, and (3) determine the reliability of the Cyclosporine Capsule SatiSfaCtion Survey (original to this study). METHODS: In this multicenter, randomized, open-label, parallel-group, preference study, patients were recruited from 144 centers in North America with established transplant programs. Solid-organ transplant recipients who had taken stable doses of cyclosporine (Neoral) for >/=2 consecutive months were randomized in a 9:1 ratio to receive another cyclosporine formulation (Gengraf) or to remain on Neoral therapy. Patients completed the Cyclosporine Capsule Satisfaction Survey prior to randomization (baseline survey) and after taking the study drug for 4 weeks (final survey). The survey consisted of multiple attribute items with high face validity in assessing patients' perceptions and preferences with regard to their overall experience, as well as specific attributes of cyclosporine capsules known to affect patient acceptance. RESULTS: The intent-to-treat population included 1906 patients (1211 men, 693 women [sex unknown in 2 patients]; mean [SD] age, 50.2 [12.4] years). A total of 1708 patients were switched to Gengraf; 198 continued on Neoral. Based on their overall experience with both capsule formulations, the majority of patients switched to Gengraf (61.9%) responded that they preferred the Gengraf capsule, compared with 13.7% who preferred the Neoral capsule and 24.4% who indicated no preference (P < 0.001). A similar preference for Gengraf was observed based on capsule odor (66.3%), ease of swallowing (51.5%), taste (57.1%), and impact on breath odor (52.5%) and body odor (48.4%) (P < 0.001 for each test). The results of internal consistency and reproducibility calculations were high for the Cyclosporine Capsule Satisfaction Survey. Internal consistency ranged from alpha = 0.84 to 0.95 for the subscales and was alpha = 0.95 for the overall score. Ranges for reproducibility in the subscales were r = 0.75 to 0.79, with an overall reproducibility of r = 0.85. Guyatt's responsiveness statistics for the subscale and overall scores were moderately high to very high, indicating that the survey is capable of measuring change in response to treatment. CONCLUSIONS: Of the transplant recipients receiving Gengraf in this study, most preferred Gengraf to Neoral based on overall experience, capsule odor, difficulty swallowing, taste, breath odor, and body odor. Among all study patients, fewer patients receiving Gengraf were bothered by capsule odor, difficulty in swallowing, taste, or the impact on breath or body odor compared with patients who continued to receive Neoral. Internal consistency, reproducibility, and responsiveness results show that the Cyclosporine Capsule Satisfaction Survey is a psychometrically valid instrument that is appropriate for use in clinical trials.

Adolescent↗
PubMed2000

Lingual tonsillectomy for refractory paroxysmal cough.

Historically, the lingual tonsils are the most neglected members of Waldeyer's ring. They are often overlooked even in a thorough head and neck exam because of their anatomic location and the ambiguous constellation of symptoms which they produce when they are diseased or enlarged. The lingual tonsils have been reported to be associated with a variety of upper aerodigestive tract symptoms including odynophagia, dysphagia, otalgia, globus, halitosis, chronic cough, and dyspnea. Many patients with lingual tonsillar pathology may undergo extensive work-up for some of these non-specific upper airway complaints by their primary physician before referral to an otolaryngologist. Consequently, the diagnosis of lingual tonsillar disease requires a high index of suspicion and a thorough physical exam including evaluation of the tongue base and hypophaynx with indirect mirror or fiberoptic exam. In order to draw attention to this frequently unrecognized entity, we present a case report of a child with chronic cough resulting from lingual tonsillar hypertrophy.

Airway Obstruction↗
PubMed2000

Clinical presentation as a guide to the identification of GERD in children.

OBJECTIVE: to determine if there is a correlation between common otolaryngologic symptoms and presence of gastroesophageal reflux disease (GERD) in children. METHODS: charts of 295 children presenting with suspicion of GERD were reviewed for presenting symptoms including: (1) airway symptoms: stertor, stridor, frequent cough, recurrent croup, wheezing, nasal congestion, obstructive apnea, blue spells, hoarseness, throat clearing; (2) feeding symptoms: wet burps, globus sensation, frequent emesis, dysphagia, choking/gagging, sore throat, halitosis, food refusal, stomach aches, arching, drooling, chest pain, irritability, and failure to thrive. At least one positive test of barium esophagram, gastric scintiscan, pH probe or esophageal biopsy resulted in inclusion in the GERD positive group. RESULTS: 214 children had GERD diagnosed while 81 had no positive tests for GERD. Between the GERD positive and GERD negative groups, the significantly different symptoms were stertor (P=0.040), cyanotic spells (P=0.043), frequent emesis (P=0.007), failure to thrive (P=0.006), and choking/gagging (P=0.044). Three pooled variables were created: airway flow (stertor, stridor, cyanotic spells), airway irritation (frequent cough, recurrent croup, throat clearing), and feeding (dysphagia, failure to thrive, frequent emesis). GERD patients who were 2 years or less were compared to those older than 2 years and all three of these pooled variables were significantly different between these groups (P<0. 001). CONCLUSION: children who present with a certain constellation of airway or feeding symptoms are more likely to have a positive GERD test. Children 2 years old or less are more likely to present with airway symptoms or feeding difficulties while children older than 2 years are more likely to present with airway irritation.

Airway Obstruction↗
PubMed2001

Paranasal sinus computed tomographic findings of children with chronic cough.

OBJECTIVE: Chronic cough is a frequent problem in the practice of clinical pediatrics, and sinusitis is a common etiologic factor. In this study, our aim was to determine the prevalence of sinus abnormalities in pediatric patients presenting with chronic cough. METHODS: Forty-two patients, ranging from 3 to 16 years of age from both sexes completed the study. Paranasal sinuses were examined by coronal paranasal sinus limited computed tomographic scan. The CT scan findings were categorized as no disease, minimal, moderate and severe sinusitis. RESULTS: The most frequent symptoms after cough were rhinorrhea, sniffling, and halitosis. We found sinus abnormalities in 66.6% and no abnormality in 33.3% of the children. Age and sex were not important factors in sinus disease. There was no correlation between sinus findings and any of symptoms. The most common anatomical abnormalities were concha bullosa, paradoxical middle turbinate, Haller's cells, and deviated nasal septum. These abnormalities were not correlated with sinus disease. CONCLUSION: Paranasal sinus abnormalities are common among pediatric patients with chronic cough and imaging studies of the sinuses should be considered in these children.

Adolescent↗
PubMed1998

Interpreting and using clinical trials.

In 1754, aboard HMS Salisbury, James Lind conducted a simple, controlled clinical trial. He took 12 patients with "pale and bloated skin, listlessness, an aversion to exercise, swollen gums, halitosis, ecchymotic mucous membranes, and limb edema" and allocated them to receive treatment with one of six different therapies. Since the patients receiving two of his six chosen interventions had such a dramatic recovery, he felt ethically obligated to end his trial and administer these treatments to all the remaining sailors. Today we fully recognize the impact that the controlled clinical trial can have on the development of new interventions. Unfortunately, very few of these interventions are likely to have as dramatic an impact on outcomes as lemons and oranges did on scurvy. Because the interventions we study tend to have relatively small treatment effects, and because the design and reporting of published RCTs has consistently been documented to be less than perfect, there is a real need for us to develop critical appraisal skills. This article is by no means the only approach to critical appraisal, but hopefully it serves as an adequate starting point for the journey.

Algorithms↗
PubMed1998

Oral manifestations of hereditary sensory and autonomic neuropathy type IV. Congenital insensitivity to pain with anhidrosis.

OBJECTIVE: Hereditary sensory and autonomic neuropathy type IV (congenital insensitivity to pain with anhidrosis) is a rare disorder. In this study, we investigated the oral and dental manifestations associated with hereditary sensory and autonomic neuropathy type IV. STUDY DESIGN: Eighteen patients with hereditary sensory and autonomic neuropathy type IV whose ages ranged from 1 year 0 months to 22 years 3 months were examined for oral signs and symptoms of tooth abnormalities, malocclusions, soft tissue disorders, tongue papilla atrophy, and morphologic abnormalities of hands and fingers. RESULTS: All 18 patients showed congenital insensitivity to pain and anhidrosis. Oral self-mutilations, such as autoextraction of teeth and severe biting injuries (with resultant scarring) of the finger tips and oral soft tissues (tongue, lip, and buccal mucosa), were found in most patients. In infant patients the condition was typically characterized by decubital ulcers on the ventral surface of the tongue, resulting from trauma of the incisal edge of erupting mandibular primary incisors during sucking or nursing. These ulcers led to several local and systemic problems, such as tongue bleeding, infection, malnutrition, and halitosis. A large number of missing teeth and a high incidence of dental caries were additional characteristic findings. Such oral self-mutilations were found to decrease with age and with the intellectual, social, and/or emotional development of the patients. However, not all of the mutilations were completely eliminated. Two patients had partial dentures to replace missing teeth. CONCLUSIONS: Our study suggests that early diagnosis and specific dental management for patients with hereditary sensory and autonomic neuropathy type IV are important for prevention of the characteristic oral and dental problems accompanying this disorder.

Adolescent↗
PubMed2006

Antibiotic use in tonsillectomies: therapeutic or prophylactic? Required or excessive?

Adenotonsillectomy is one of the most commonly performed surgeries in the pediatric and young adult populations. The postoperative morbidity of this surgical procedure is often significant, including odynophagia, dysphagia, fever, halitosis, loss of weight and reduced oral intake. After tonsillectomy, with or without adenoidectomy, the colonization of the open tonsillar fossae by the bacterial population of the oral cavity would cause an exacerbation of the local inflammatory response worsening postoperative pain. The hypothesis that a reduction of the bacterial population of an open surgical wound could minimize the local inflammation, stimulate the healing process and hasten recovery triggered a considerable number of studies addressing the relation between the use of perioperative antibiotics and postoperative morbidity of adenotonsillectomy. In spite of the fact that those studies claim to perform an assessment of the surgical prophylactic use of antibiotics, their outline is not in compliance with the worldwide-accepted principles of surgical antibiotic prophylaxis. By performing a critical review of the literature, the authors discuss the advantages and disadvantages of using antibiotics in tonsillectomies or adenotonsillectomies, as well as the most appropriate definition for its utilization.

Adenoidectomy↗
PubMed1996

An audit of prophylactic antibiotic treatment following tonsillectomy in children.

A prospective audit study was undertaken to assess the effect of two different management policies following tonsillectomy in children in this hospital, one of which requires a prophylactic five-day course of oral antibiotics and the other doses not. A total of 95 children were entered into the trial: 54 received post-operative antibiotics and 41 did not. The post-operative recovery was assessed by completion of a parent questionnaire which included the following parameters: degree of patient distress, nausea and vomiting, otalgia, halitosis, pharyngeal bleeding, analgesic requirement, day of return to a regular diet and General Practitioner consultation. There was no significant reduction in any of the morbidity measures in patients treated with antibiotics. I fact, the analgesic requirement and the incidence of otalgia and irritability on Days 6 and 7 and secondary haemorrhage were significantly higher in the antibiotic-treated patients. Although the number of patients included in this study are small, the result suggest that post-operative antibiotics do not improve the outcome of uncomplicated tonsillectomy. Our previous practice of routinely administering antibiotics to post-tonsillectomy children has been discontinued as the consequence of this audit.

Adolescent↗
PubMed2006

Measurement of ammonia in human breath with a liquid-film conductivity sensor.

Measurement of breath NH3 is of interest in clinical applications as it can be used as a measure of kidney/liver functions as well as halitosis. We have developed a liquid-film conductivity sensor to measure NH3 in human breath. A film of dilute H2SO4 is formed on the top of two metal capillary tubes placed in a concentric annular arrangement. The tube exterior has been specially treated to render it hydrophilic. As breath passes over the sensor tip, the film collects NH3 and the solution conductivity (measured by the concentric capillaries functioning as electrodes) decreases accordingly. This initial rate of conductivity decrease was determined to be the best metric (most rapid and least dependent on breath pCO2) for ammonia, relative to time to attain complete neutralization (conductivity minimum) or the final rate of conductivity increase as more ammonia dissolves after neutralization. The absorbing solution composition was optimized so that CO2 does not interfere. Both dynamic measurement using mask sampling and offline balloon sampling were performed. Ammonia readily absorbs on surfaces when significant concentrations of water vapor are present. As such, memory effects are common when analyzing human breath for ammonia. This problem was successfully eliminated. The results from this sensor agreed well with data obtained by a solution-phase fluorometric technique using a porous membrane diffusion scrubber and o-phthalaldehyde derivatization chemistry. For breath CO2 measurement, the applicability of a similar sensor that relies on a NaOH film was also demonstrated.

Ammonia↗