Gastropharyngeal and gastroesophageal reflux in globus and hoarseness.

BACKGROUND: The role of gastropharyngeal reflux in patients with globus pharyngeus and hoarseness remains unclear. OBJECTIVE: To evaluate patients with complaints of globus, hoarseness, or globus and hoarseness combined for the presence of gastropharyngeal and gastroesophageal reflux. DESIGN: Prospective clinical cohort study of 3 groups of patients undergoing ambulatory 24-hour double-probe pH monitoring. In patients with pathologic gastroesophageal reflux, an upper gastrointestinal endoscopy was also performed. SETTING: Tertiary care, outpatient clinic. PATIENTS: Twenty-seven patients with globus alone, 20 patients with hoarseness alone, and 25 patients with globus and hoarseness combined. RESULTS: Patients with well-defined pathologic reflux (ie, gastroesophageal reflux with or without gastropharyngeal reflux) were present mainly in the group of patients with globus combined with hoarseness: 18 (72%) of 25 patients, compared with 7 (35%) of 20 patients with hoarseness alone and 8 (30%) of 27 with globus alone. Seven (10%) of all 72 patients had prolonged acid exposure at the laryngopharyngeal junction in the presence of a normal gastroesophageal pH registration. Abnormal findings in the esophagus were found at endoscopy in 17 (65%) of 26 patients with pathologic gastroesophageal reflux (with or without gastropharyngeal reflux). CONCLUSIONS: We found a high prevalence of pathologic reflux in patients with both globus and hoarseness. Based on these findings, we strongly advise upper gastrointestinal endoscopy for symptomatic otolaryngological patients with pathologic gastroesophageal reflux.

[Anatomo-clinical aspects of traumatic spinal cord lesions]. / Anatomo-klinicheskie aspekty travmaticheskikh povrezhdenii spinnogo mozga.

A comprehensive clinical (150 patients), pathological (6 autopsied spinal cords) and experimental (17 animals) investigation of the spinal cord posttraumatic affections was conducted. The afferent and efferent spinal nerve fibers degeneration was compared and its spatial distribution assessed. Transsynaptic and immediate connections between spinal structures and cranial nerve nuclei are shown to be the major determinants of the intercentral integration and CNS plasticity.

[Colonoscopic follow up of rectocolonic cancer surgeries. Assessment of 64 examinations]. / Le suivi coloscopique des cancers rectocoliques opérés. Bilan de 64 examens.

A collation of 64 colonoscopic examinations performed on 41 patients operated on for cancer of the colon or rectum is reported. Eleven patients (26.8 percent) had positive follow-up endoscopic findings. In 13 enumerated tumoral proliferations. 8 benign polyps and 5 malignant growths were found, one of the latter on the anastomosis, and the other 4 on the remaining colon. 80 percent of these tumoral growths and all malignant tumors were discovered in the two years following surgery. When colonic strictures present before operation prevent total colonoscopic exploration, such an endoscopic examination of the colon in its entirety must be made immediately following passage of three post-operative months. It is prudent not to wait for attendant alarming signs but rather to integrate total colonoscopy including excision of "overlooked" or newly-formed polyps into the follow-up protocol of all colon surgery cancer patients who have become high-risks for either a relapse or recurrence of polyps. In the initial two post-operative years, when there is a maximal risk. Colonoscopy should be performed every six months and thereafter at longer but regular intervals throughout survival.

[Multiple endocrine neoplasms associated with Zollinger-Ellison syndrome and hyperparathyroidism]. / Néoplasie endocrine multiple avec association syndrome de Zollinger-Ellison-hyperparathyroïdie.

We report the case of a 43 year old man with multiple endocrine neoplasia (Zollinger-Ellison syndrome-hyperparathyroidism) diagnosed during investigations for a severe ulcer with diarrhoea. The history suggested Zollinger-Ellison syndrome, especially as basal acid production and blood gastrin levels were high. Hypercalcaemia and low blood phosphate levels suggested hyperparathyroidism, which was confirmed by ultra-sound of the neck, showing two parathyroid adenomas. The aim of treatment was two-fold: suppress the hyperparathyroidism and treat the Zollinger-Ellison syndrome. The approach is surgical in most cases, but the tumour is often impossible to remove and total gastrectomy has become rare with the progress in anti-secretory therapy. When the tumour behind a case of Zollinger-Ellison syndrome cannot be found, complementary chemotherapy is indicated. Other endocrine lesions must always be sought and the family investigated to exclude Wermer syndrome.

[Various anatomic and clinical features of traumatic lesions of the spinal cord]. / Nekotorye anatomicheskie i klinicheskie osobennosti travmaticheskikh povrezhdenii spinnogo mozga.

Results of a pathomorphological, experimental and clinical study designed to ascertain morphological changes associated with impairment of vital visceral functions following spinal cord trauma are presented. Clinical manifestations of such disorders were studied in 127 patients with complicated vertebral fractures. Further investigations involved postmortem examination of the brain of four patients with complete anatomical rupture of the spinal cord at the level of CV, CVI, and LI segments as well as the brain of 18 mature cats with various types of spinal cord resection which were treated by silver impregnation according to Bilshovsky, Naute with the final staining of the nuclear structures according to Kawamura-Niimy. Widespread degenerative changes in the ascending conduction tracts of the spinal cord leading to the structures of the cerebral trunk were revealed. Disruptions of respiratory and cardiovascular activities secondary to complete traumatic rupture of the lower cervical segments of the spinal cord appear to be caused by impaired conduction along the ascending tracts of the spinal cord leading to the nuclei of the reticular formation of the cerebral trunk, mainly those of giant and small cells, nuclei of the vagus nerve (dorsal one and that of the solitary tract), locus coeruleus, mesencephalic nuclei of the trigeminal nerve and a number of other structures of the cerebral trunk.

[Histomorphologic changes following plastic repair of defects in spinal dura mater with a capron strip in complicated experimental fractures of the spine]. / Gistomorfologicheskie izmeneniia pri plastike defektov tverdoi mozgovoi obolochki spinnogo mozga kapronovoi lentoi pri oslozhnennykh perelomakh pozvonochnika v éksperimente.

A wide incision of the dura mater of the spinal cord helps to inspect the subdural space in detail. If there is a defect in the dura mater, or if it is impossible to suture it due to edema and swelling of the spinal cord, it is rational to resort to plastic replacement with a band of capron mesh which resolves completely by the end of the third year after the surgical intervention.

[Prevention of postural reactions in patients with spinal cord lesions]. / Preduprezhdenie postural'nykh reaktsii u bol'nykh s porazheniiami spinnogo mozga.

Changes in the cardiovascular system in 83 patients with spinal cord affections were studied before operation and during the anesthesia period. Disorders in the cardiovascular system up to cardiac arrest occur during operation in patients who have been, bed-ridden for more than 3--4 weeks. The authors suggest that training on a table-bed should be included into the complex of preoperative preparation of the patients; this prevents different coarse disorders and cardiac arrest during operation.

[System of programmed control of an in- and outflow device for long-term irrigation of the bladder]. / Sistema programmnogo kontrolia pritochno-ottochnogo ustroistva dlia dlitel'nogo promyvaniia mochevogo puzyria

A unique apparatus for programmed monitoring of Monro's system in patients with affections and lesions of the spinal cord is described. The apparatus assembly includes a 2-mode time relay, retention device, electric magnet with a core and two half-rings. The compactness and ruggedness of the unit enables its use under any conditions. The reliability of its construction has stood the test of its long-term continuous operation. Thanks to the presence of the program time relay the cyclic recurrence of the urinary bladder lavage is strictly adhered to.