Influence of everyday bolus consistencies in different body positions on high-resolution esophageal pressure topography (HREPT) parameters.

The standard protocol for esophageal manometry involves placing the patient in the supine position with head turned to left (supine head left [SHL]) while evaluating liquid bolus swallows. Routinely, semisolid or solid boluses are not evaluated. Currently, the daily American diet includes up to 40% solid or semisolid texture. Thus far, the data on the effect of different bolus on high-resolution esophageal pressure topography (HREPT) parameters are scarce. This study aims to evaluate the effect of every day bolus consistencies in different body positions on HREPT variables. HREPT was performed on healthy volunteers with a modified protocol including liquid swallows in the SHL position followed by applesauce (semisolid), cracker (solid), and marshmallow (soft solid) in three different positions (SHL, sitting, and standing). A total of 38 healthy adult subjects (22 males and 16 females, median age = 27, and mean body mass index = 25) were evaluated. The resting upper esophageal sphincter pressure was significantly different while subjects swallowed crackers, applesauce, and marshmallows in most positions compared with liquid SHL (P < 0.05). The lower esophageal sphincter, contractile front velocity, and distal contractile integral pressures did not differ in all different consistencies compared with SHL. The integrated relaxation period was significantly higher with solid bolus compared with liquid bolus only in SHL position. The intrabolus pressure was significantly different with solid and soft solid boluses in all postures compared to liquid SHL. The American diet consistency affects upper esophageal sphincter pressure and partially integrated relaxation period and intrabolus pressure in various positions. Semisolid bolus swallows do not cause substantial pressure changes and are safe for evaluation and maintaining adequate caloric intake in patients with dysphagia who cannot tolerate solids.

Management of retrosternal goitres: results of early surgical intervention to prevent airway morbidity, and a review of the English literature.

We present our experience and also review the world literature on the management of retrosternal goitres (RSGs). There is now irrefutable evidence that almost all RSGs will continue to grow and eventually cause airway compression. We describe the diagnosis, investigation and surgical approach to the management of this condition.

An unusual presentation of sphenoid sinusitis with septicaemia in a healthy young adult.

Streptococcus pneumonia and Haemophilus influenzae account for more than 50% of bacterial acute sinusitis. Isolated sphenoid sinusitis is a rare disease with potentially devastating complications such as cranial nerve involvement, brain abscess, and meningitis. It occurs at an incidence of about 2.7% of all sinus infections. There have been no previous reported cases of unilateral sphenoid sinusitis presenting as septicaemia in an otherwise healthy young immunocompetent adult.

Tetrahedral calcite crystals facilitate self-assembly at the air-water interface.

Calcite crystals often nucleate and grow in solutions of calcium carbonate, and these crystallites can become trapped at the air water interface, where they form unusual structures. The most common is a fractal structure, which can extend over a large fraction of the interface, and whose origin is understood in terms of the aggregation of the particles. Much more rarely, a different and entirely unexpected structure is observed: the particles remain well separated on the interface, forming an ordered phase reminiscent of a two-dimensional colloidal crystal. The structure of the crystallites that form this ordered phase is always observed to be tetrahedral, in contrast to the much more common rhombohedral structure of the crystallites that form the fractal phase. We show that the interparticle interaction potential that leads to this ordered phase is a balance between a long-range attractive interaction and a long-range repulsive interaction. The attraction results from gravity-induced capillary forces, while the repulsion results from a dipole-dipole interaction due to the charged surface of the tetrahedral crystals. The interaction potential is estimated from the thermal motion of the particles, and fits to the theoretically expected values suggest that the effective surface charge on the tetrahedral crystals is sigma approximately 0.01 charges/nm2.

The myth of tracheomalacia and difficult intubation in cases of retrosternal goitre.

Although it is widely believed that management of the airway is difficult in surgery for retrosternal goitre, a review of the literature, revealing management of 1969 patients with retrosternal goitre, provided scant evidence of difficult intubation or post-operative tracheomalacia resulting in tracheal collapse. This was reflected in our own series of 18 thyroidectomies for retrosternal goitre performed at our hospitals.

Swallowed nasal pack: a rare but serious complication of the management of epistaxis.

Packing of the nose with a suitable material remains a popular method of treating epistaxis. The authors report a serious complication of a new design of nasal pack; Rapid Rhino, which was swallowed during the treatment of a patient with epistaxis, resulting in bowel perforation.

Reidel's thyroiditis and Tolosa-Hunt syndrome, a rare association.

A previously undescribed association of Reidel's thyroiditis with Tolosa-Hunt syndrome is reported. A 33 year-old Caucasian female presented with a two-year history of painful progressive goitre, histologically a Reidel's thyroiditis. She underwent left partial thyroidectomy. Post-operatively she developed severe right retro-orbital pain, right temporal headache and a partial right occulomotor nerve palsy. A diagnosis of Tolosa-Hunt syndrome was made. Some important aspects of this case are discussed.

Pneumopericardium: an unusual manifestation of blunt tracheal trauma.

A case of pneumopericardium in a child following blunt injury to his trachea is described. Such a case has not been previously described in the literature. A probable anatomical explanation for this rare event is offered.