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Esophageal Web Complicating an Isolated Esophageal Lichen Planus
Bahrain Medical Bulletin, Vol. 40, No. 4, December 2018 Esophageal Web Complicating an Isolated Esophageal Lichen Planus Sara Al-Saad, MB BCh BAO* Abdulla Darwish, FRCPath** Veena Nagaraj, FRCPath*** Zuhal Ghandoor, FRCP**** Lichen planus (LP) is a chronic, idiopathic disorder affecting the mucosal surfaces, skin and nails. Esophageal involvement in this disease is rare and only few cases were found in literature, thus making its diagnosis challenging as it can be easily misdiagnosed as gastroesophageal reflux disease. Currently, little is known about its pathogenesis and management. We report a case of a previously healthy 32-year-old female who presented with the complaint of dysphagia, which was later diagnosed endoscopically as an esophageal web. Biopsy of the lesion revealed a histological diagnosis of an esophageal lichen planus (ELP). This was treated with multiple Esophagogastro Duodenoscopy (OGD) dilatation sessions and local steroids. We also reviewed similar reported cases in the literature, stressing on the importance of the successful management of such a disease and its complications. Bahrain Med Bull 2018; 40(4): 254 - 256 Lichen Planus (LP) is a mucocutaneous disease of the stratified The treatment of esophageal webs includes endoscopic squamous epithelium, which affects the mucous membranes, dilatation, steroids and surgical myomectomy3. skin, nails, and scalp. LP is estimated to affect 0.5% to 2.0% of the general population. It is mostly reported in middle- The relationship between ELP and esophageal webs is not clear aged patients (between 30-60 years of age) and is seen more and rarely reported in the literature. evidently in females1. The aim of this presentation is to report a case of esophageal It is one of the chronic disorders where oral involvement may web complicating an ELP. -
Hypertrophic Pyloric Stenosis
Imaging of Pediatric Abdominal Disease Mark S. Finkelstein DO, FAOCR Department of Medical Imaging What is our goal? . Familiarize pediatricians to a variety of common pediatric GI disorders . Outline a practical approach to imaging pediatric GI diseases . Review current methods & discuss current imaging techniques for the evaluation of pediatric GI disease What is the purpose of the plain film abdomen study? . Foundation of GI imaging . Distinguishes surgical vs. non-surgical disease . Considerations – AP supine: . Used to evaluate vague or chronic abdominal pain – Horizontal beam: . Used to demonstrate free intra-peritoneal air (erect,supine cross table lateral or decubitus) – Prone: . Useful for differentiating large from small bowel . Useful for excluding SBO Common Imaging Techniques . Fluoroscopy . Ultrasound . CT . Nuclear Medicine . MRI Fluoroscopy Technique . Fasting time: – Premature = 2-4 hours NPO – Infant < 2 1/2 yrs = 4 hours NPO – Children > 2 1/2 yrs = 6 hours NPO . Digital low dose fluoroscopy with small field size . Contrast medium: – Barium is best – Air – Other options: . Gastrograffin (GG) = High osmolality, water soluble warning: GG should only be used by qualified experienced pediatric radiologists . Metrizimide, Iohexol, Iopamidol, etc.= low osmolality, non-ionic water soluble Ultrasound Technique . Abdomen Prep (Complete/Limited) Fasting time: – Children < 5 yr. = 4 hours NPO – Children > 5 yr. = 8 hours NPO . Renal/Pelvic Prep – Infant < 1 yr. = Patient given formula, juice during exam – 1yr- 10yrs = Child must drink 12-16 oz clear fluid 1 -2 hrs prior to exam – > 11 yr. = Child must drink 24-32 oz clear fluid 1 -2 hrs prior to exam Children who are continent should not empty bladder 3 hrs prior to renal US exam CT Technique . -
Prenatal Ultrasonography of Craniofacial Abnormalities
Prenatal ultrasonography of craniofacial abnormalities Annisa Shui Lam Mak, Kwok Yin Leung Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China REVIEW ARTICLE https://doi.org/10.14366/usg.18031 pISSN: 2288-5919 • eISSN: 2288-5943 Ultrasonography 2019;38:13-24 Craniofacial abnormalities are common. It is important to examine the fetal face and skull during prenatal ultrasound examinations because abnormalities of these structures may indicate the presence of other, more subtle anomalies, syndromes, chromosomal abnormalities, or even rarer conditions, such as infections or metabolic disorders. The prenatal diagnosis of craniofacial abnormalities remains difficult, especially in the first trimester. A systematic approach to the fetal Received: May 29, 2018 skull and face can increase the detection rate. When an abnormality is found, it is important Revised: June 30, 2018 to perform a detailed scan to determine its severity and search for additional abnormalities. Accepted: July 3, 2018 Correspondence to: The use of 3-/4-dimensional ultrasound may be useful in the assessment of cleft palate and Kwok Yin Leung, MBBS, MD, FRCOG, craniosynostosis. Fetal magnetic resonance imaging can facilitate the evaluation of the palate, Cert HKCOG (MFM), Department of micrognathia, cranial sutures, brain, and other fetal structures. Invasive prenatal diagnostic Obstetrics and Gynaecology, Queen Elizabeth Hospital, Gascoigne Road, techniques are indicated to exclude chromosomal abnormalities. Molecular analysis for some Kowloon, Hong Kong SAR, China syndromes is feasible if the family history is suggestive. Tel. +852-3506 6398 Fax. +852-2384 5834 E-mail: [email protected] Keywords: Craniofacial; Prenatal; Ultrasound; Three-dimensional ultrasonography; Fetal structural abnormalities This is an Open Access article distributed under the Introduction terms of the Creative Commons Attribution Non- Commercial License (http://creativecommons.org/ licenses/by-nc/3.0/) which permits unrestricted non- Craniofacial abnormalities are common. -
MR Imaging of Fetal Head and Neck Anomalies
Neuroimag Clin N Am 14 (2004) 273–291 MR imaging of fetal head and neck anomalies Caroline D. Robson, MB, ChBa,b,*, Carol E. Barnewolt, MDa,c aDepartment of Radiology, Children’s Hospital Boston, 300 Longwood Avenue, Harvard Medical School, Boston, MA 02115, USA bMagnetic Resonance Imaging, Advanced Fetal Care Center, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA cFetal Imaging, Advanced Fetal Care Center, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA Fetal dysmorphism can occur as a result of var- primarily used for fetal MR imaging. When the fetal ious processes that include malformation (anoma- face is imaged, the sagittal view permits assessment lous formation of tissue), deformation (unusual of the frontal and nasal bones, hard palate, tongue, forces on normal tissue), disruption (breakdown of and mandible. Abnormalities include abnormal promi- normal tissue), and dysplasia (abnormal organiza- nence of the frontal bone (frontal bossing) and lack of tion of tissue). the usual frontal prominence. Abnormal nasal mor- An approach to fetal diagnosis and counseling of phology includes variations in the size and shape of the parents incorporates a detailed assessment of fam- the nose. Macroglossia and micrognathia are also best ily history, maternal health, and serum screening, re- diagnosed on sagittal images. sults of amniotic fluid analysis for karyotype and Coronal images are useful for evaluating the in- other parameters, and thorough imaging of the fetus tegrity of the fetal lips and palate and provide as- with sonography and sometimes fetal MR imaging. sessment of the eyes, nose, and ears. -
Habilitative Services and Outpatient Rehabilitation Therapy
UnitedHealthcare® Commercial Coverage Determination Guideline Habilitative Services and Outpatient Rehabilitation Therapy Guideline Number: CDG.026.11 Effective Date: May 1, 2021 Instructions for Use Table of Contents Page Related Commercial Policies Coverage Rationale ........................................................................... 1 • Cochlear Implants Definitions ........................................................................................... 6 • Cognitive Rehabilitation Applicable Codes .............................................................................. 9 • Durable Medical Equipment, Orthotics, Medical References .......................................................................................36 Supplies and Repairs/ Replacements Guideline History/Revision Information .......................................36 • Inpatient Pediatric Feeding Programs Instructions for Use .........................................................................36 • Skilled Care and Custodial Care Services Medicare Advantage Coverage Summaries • Rehabilitation: Cardiac Rehabilitation Services (Outpatient) • Rehabilitation: Medical Rehabilitation (OT, PT and ST, including Cognitive Rehabilitation) • Respiratory Therapy, Pulmonary Rehabilitation and Pulmonary Services Coverage Rationale Indications for Coverage Habilitative Services Habilitative services are Medically Necessary, Skilled Care services that are part of a prescribed treatment plan or maintenance program* to help a person with a disabling condition to -
Clinical Vignette Abstracts NASPGHAN Annual Meeting October 10-12, 2013
Clinical Vignette Abstracts NASPGHAN Annual Meeting October 10-12, 2013 Poster Session I Eosphagus Stomach 11 Successful Use of Biliary Ducts Balloon Dilator in Repairing Post-Surgical Esophageal Stricture in premature infant. I. Absah, Department of Pediatirc Gastroenterology and Hepatology, Mayo Clinic college of Medicien, Rochester, Minnesota, UNITED STATES. Absah, M.B. Beg, Department of Pediatirc Gastroenterology and Hepatology, SUNY Upstate Medical University, Syracuse, New York, UNITED STATES. Background: Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common type of gastrointestinal atresia with occurrence rate of I in 3,000 to 5,000 births. There are 5 major varieties of EA. The most common variant of this anomaly consists of a blind esophageal pouch with a fistula between the trachea and the distal esophagus, which occurs in 84% of the time. Treatment is by extra-pleural surgical repair of the esophageal atresia and closure of the tracheoesophageal fistula. Complications may include leakage to the mediastinum, fistula recurrence, GERD, and stricture formation at the anastomosis site. Benign stricture occurs in 40% of the cases after surgical repair. These benign post-surgical strictures cause feeding difficulties and require treatment. Esophageal dilation is 90% effective, but strictures that do not respond to dilation must be resected surgically. Case report: A 52 days old premature baby that was born at 35 weeks presented with feeding difficulty, due to benign esophageal stricture 44 days after surgical repair of EA and TEF. The luminal diameter of the stricture was ≤ 4mm, for that regular balloon esophageal dilators (smallest = 6mm) couldn’t be used. -
Identifying the Misshapen Head: Craniosynostosis and Related Disorders Mark S
CLINICAL REPORT Guidance for the Clinician in Rendering Pediatric Care Identifying the Misshapen Head: Craniosynostosis and Related Disorders Mark S. Dias, MD, FAAP, FAANS,a Thomas Samson, MD, FAAP,b Elias B. Rizk, MD, FAAP, FAANS,a Lance S. Governale, MD, FAAP, FAANS,c Joan T. Richtsmeier, PhD,d SECTION ON NEUROLOGIC SURGERY, SECTION ON PLASTIC AND RECONSTRUCTIVE SURGERY Pediatric care providers, pediatricians, pediatric subspecialty physicians, and abstract other health care providers should be able to recognize children with abnormal head shapes that occur as a result of both synostotic and aSection of Pediatric Neurosurgery, Department of Neurosurgery and deformational processes. The purpose of this clinical report is to review the bDivision of Plastic Surgery, Department of Surgery, College of characteristic head shape changes, as well as secondary craniofacial Medicine and dDepartment of Anthropology, College of the Liberal Arts characteristics, that occur in the setting of the various primary and Huck Institutes of the Life Sciences, Pennsylvania State University, State College, Pennsylvania; and cLillian S. Wells Department of craniosynostoses and deformations. As an introduction, the physiology and Neurosurgery, College of Medicine, University of Florida, Gainesville, genetics of skull growth as well as the pathophysiology underlying Florida craniosynostosis are reviewed. This is followed by a description of each type of Clinical reports from the American Academy of Pediatrics benefit from primary craniosynostosis (metopic, unicoronal, bicoronal, sagittal, lambdoid, expertise and resources of liaisons and internal (AAP) and external reviewers. However, clinical reports from the American Academy of and frontosphenoidal) and their resultant head shape changes, with an Pediatrics may not reflect the views of the liaisons or the emphasis on differentiating conditions that require surgical correction from organizations or government agencies that they represent. -
Esophageal Web in a Down Syndrome Infant—A Rare Case Report
children Case Report Esophageal Web in a Down Syndrome Infant—A Rare Case Report Nirmala Thomas 1, Roy J. Mukkada 2, Muhammed Jasim Abdul Jalal 3,* and Nisha Narayanankutty 3 1 Department of Pediatrics, VPS Lakeshore Hospital, 682040 Kochi, Kerala, India; [email protected] 2 Department of Gastromedicine, VPS Lakeshore Hospital, 682040 Kochi, Kerala, India; [email protected] 3 Department of Family Medicine, VPS Lakeshore Hospital, 682040 Kochi, Kerala, India; [email protected] * Correspondence: [email protected]; Tel.: +91-954-402-0621 Received: 8 November 2017; Accepted: 8 January 2018; Published: 11 January 2018 Abstract: We describe the rare case of an infant with trisomy 21 who presented with recurrent vomiting and aspiration pneumonia and a failure to thrive. Infants with Down’s syndrome have been known to have various problems in the gastrointestinal tract. In the esophagus, what have been described are dysmotility, gastroesophageal reflux and strictures. This infant on evaluation was found to have an esophageal web and simple endoscopic dilatation relieved the infant of her symptoms. No similar case has been reported in literature. Keywords: trisomy 21; recurrent vomiting; aspiration pneumonia; esophageal web 1. Introduction In 1866, John Langdon Down described the physical manifestations of the disorder that would later bear his name [1]. Jerome Lejeune demonstrated its association with chromosome 21 in 1959 [1]. It is the most common chromosomal abnormality occurring in humans and it is caused by the presence a third copy of chromosome 21 (trisomy 21). It is associated with multisystem involvement with manifestations that grossly impact the quality of life of the child. -
A Heads up on Craniosynostosis
Volume 1, Issue 1 A HEADS UP ON CRANIOSYNOSTOSIS Andrew Reisner, M.D., William R. Boydston, M.D., Ph.D., Barun Brahma, M.D., Joshua Chern, M.D., Ph.D., David Wrubel, M.D. Craniosynostosis, an early closure of the growth plates of the skull, results in a skull deformity and may result in neurologic compromise. Craniosynostosis is surprisingly common, occurring in one in 2,100 children. It may occur as an isolated abnormality, as a part of a syndrome or secondary to a systemic disorder. Typically, premature closure of a suture results in a characteristic cranial deformity easily recognized by a trained observer. it is usually the misshapen head that brings the child to receive medical attention and mandates treatment. This issue of Neuro Update will present the diagnostic features of the common types of craniosynostosis to facilitate recognition by the primary care provider. The distinguishing features of other conditions commonly confused with craniosynostosis, such as plagiocephaly, benign subdural hygromas of infancy and microcephaly, will be discussed. Treatment options for craniosynostosis will be reserved for a later issue of Neuro Update. Types of Craniosynostosis Sagittal synostosis The sagittal suture runs from the anterior to the posterior fontanella (Figure 1). Like the other sutures, it allows the cranial bones to overlap during birth, facilitating delivery. Subsequently, this suture is the separation between the parietal bones, allowing lateral growth of the midportion of the skull. Early closure of the sagittal suture restricts lateral growth and creates a head that is narrow from ear to ear. However, a single suture synostosis causes deformity of the entire calvarium. -