Esophageal Motility Patterns in Paraesophageal Hernia Patients Compared to Sliding Hiatal Hernia: Bigger Is Not Better

BACKGROUND

In patients with paraesophageal hernias (PEH), the course of the esophagus is often altered, which may affect esophageal motility. High-resolution manometry (HRM) is frequently used to evaluate esophageal motor function prior to PEH repair. This study was performed to characterize esophageal motility disorders in patients with PEH as compared to sliding hiatal hernia and to determine how these findings affect operative decision-making.

METHODS

Patients referred for HRM to a single institution from 2015 to 2019 were included in a prospectively maintained database. HRM studies were analyzed for the appearance of any esophageal motility disorder using the Chicago classification. PEH patients had confirmation of their diagnosis at the time of surgery, and the type of fundoplication performed was recorded. They were case-matched based on sex, age, and BMI to patients with sliding hiatal hernia who were referred for HRM in the same period.

RESULTS

There were 306 patients diagnosed with a PEH who underwent repair. When compared to case-matched sliding hiatal hernia patients, PEH patients had higher rates of ineffective esophageal motility (IEM) (p<.001) and lower rates of absent peristalsis (p=.048). Of those with ineffective motility (n=70), 41 (59%) had a partial or no fundoplication performed during PEH repair.

CONCLUSION

PEH patients had higher rates of IEM compared to controls, possibly due to a chronically distorted esophageal lumen. Offering the appropriate operation hinges on understanding the involved anatomy and esophageal function of each individual. HRM is important to obtain preoperatively for optimizing patient and procedure selection in PEH repair.

A comparative study of some hydroxyanthraquinones as acid-base indicators

Alizarin, Alizarin S, quinizarin and quinalizarin have been compared as acid-base indicators with Bromocresol Green and Methyl Orange as reference indicators. The chromaticity co-ordinates, complementary chromaticity co-ordinates, pK(a) values, transition pH-range, pH of maximum colour change, optimum concentration for titrations and the quality of colour change were determined. The results show all four to be good indicators with a colour change quality similar to that of Bromocresol Green.

Role of average speed in N₂O exhaust emissions as greenhouse gas in a huge urban zone (MVMZ): would we need a cold sun?

Nowadays, the drastic pollution problems, some of them related with greenhouse gas emissions, have promoted important attempts to face and diminish the global warming effects on the Mexico Valley Metropolitan Zone (MVMZ) as well as on the huge urban zones around the world. To reduce the exhaust gas emissions, many efforts have been carried out to reformulate fuels and design new catalytic converters; however, it is well known that other variables such as socio-economic and transport structure factors also play an important role around this problem. The present study analyzes the roles played by several commonly-used three-way catalytic converters (TWC) and the average traffic speed in the emission of N(2)O as greenhouse gas. According to this study, by increasing the average traffic flow and avoiding constant decelerations (frequent stops) during common trips, remarkable environmental and economic benefits could be obtained due to the diminution of N(2)O and other contaminant emissions such as ammonia (NH(3)) and even CO(2) with the concomitant reduced fossil fuel consumption. The actions mentioned above could be highly viable to diminish, in general, the global warming effects and contamination problems.

[Hospital mortality in an Internal Medicine service]

The Internal Medicine service of the Hospital General de Vic (Barcelona) takes part in the mortality committee by revising and discussing in-hospital mortality.

BACKGROUND

to establish the characteristics of the deceased, death causes and to revise possible changes in the last six-years time or problems related to the exitus, to evaluate and improve hospitalized patientś assistance.

METHODOLOGY

Every case was revised following a specific register: demographical data, diagnosis and death cause, hospital death, documentation data, terminal or agonic situation when hospitalized, autopsies and death quality data. Exitus due to hospital problems were analyzed and classified in different groups. The statistical analysis was performed with measures of central tendency and of standard deviation.

RESULTS

During the revised six years, there were 819 exitus (5.1%). Global average death age was 79 +/- 1.8 years: 52.5% were men and 47.4% were women; 22.8% died in less than forty-eight hours after hospitalization. The most frequent death causes were cerebrovascular accident (24%), chronic obstructive pulmonary disease (14.4%) and pneumonia (9.6%). There were a small number of autopsies (4.8%). Ratio of exitus due to hospital problems was stable during the six years (0.5%), in which nosocomial infection was the severest problem.

CONCLUSIONS

The total percentage of exitus was 5.1%, higher than the common standards. Mortality causes coincide with other series. Ratio of exitus due to hospital problems was according to recommended objectives. The number of autopsies was very small. A correct completing and revision of the clinical recording is indispensable to spot a shortage in the hospitalized patientś assistance.