Gastroesophageal reflux disease in surgical versus clinical literature: clinicians do not read surgical journals

BACKGROUND: Several diseases may be treated either medically or surgically; however, clinical and surgical therapies are often not treated as different options for the same patient but rather as different medical philosophies. AIM: To assess whether the main surgical and medical journals make references to their counterparts, with gastroesophageal reflux as a model of clinical/surgical disease. METHOD: It was reviewed the leading medical journals in order to verify if surgeons and clinicians make references to their counterparts on their work using gastroesophageal reflux disease as a model of a clinical/surgical disease. It was reviewed the five top-ranked journals in the field of gastroenterology, general surgery and general medicine and a neutral journal. The issues of the year 2008 of the selected journals were searched for papers dealing with gastroesophageal reflux disease. RESULTS: The search in the selected journals retrieved 49 papers, 36 (74%) in clinical journals, 5 (10%) in surgical journals, 2 (4%) in general medicine journals, and 6 (12%) in the neutral journal. Thirty one (63%) had a clinical origin, 13 (26%) a surgical origin, and 5 (10%) a neutral origin. Surgical journals published only surgical papers and general medicine journals published only clinical papers. Clinical journals and general medicine journals showed a higher proportion of clinical/surgical references compared to surgical journals (p<0.001) and the neutral journal (p<0.001). There was no differences in the proportion of clinical/surgical references when surgical and the neutral journal were compared (p=0.06). Clinical journals and general medicine journals showed a similar proportion of clinical/surgical references (p=0.06). CONCLUSION: Clinicians make significantly less references to surgical journals than surgeons do to clinical journals.RACIONAL: Várias doenças podem ser tratadas médica ou cirurgicamente; no entanto, a terapêutica clínica ou cirúrgica não é muitas vezes usada como diferente opção para o mesmo paciente, mas sim como diferente filosofia médica na abordagem. OBJETIVO: Verificar se os principais periódicos cirúrgicos e clínicos fazem referências aos seus congêneres, tendo a doença do refluxo gastroesofágico como um modelo de doença clínico/cirúrgica. MÉTODO: Foram revistos os cinco primeiros periódicos classificados na área de gastroenterologia, cirurgia geral e medicina geral e um jornal neutro. Os números do ano 2008 dos periódicos selecionados foram pesquisados no como lidar com a doença do refluxo gastroesofágico. RESULTADOS: Foram selecionados 49 trabalhos, 36 (74%) em revistas clínicas, 5 (10%) em revistas de cirurgia, 2 (4%) em revistas de medicina geral e 6 (12%) no jornal neutro. Trinta e um (63%) tiveram origem clínica, 13 (26%) cirúrgica, e 5 (10%) a origem foi neutra. Revistas cirúrgicas publicaram apenas artigos cirúrgicos e revistas de medicina geral, publicaram apenas trabalhos clínicos. Revistas e jornais de medicina clínica geral mostraram maior proporção de referências clínico/cirúrgicas em relação às revistas de cirurgia (p<0,001) e do jornal neutro (p<0,001). Não houve diferenças na proporção de referências clínico/cirúrgicas quando revistas cirúrgicas e a neutra foram comparadas (p= 0,06). Revistas clínicas e de medicina geral mostraram semelhante proporção de referências clínico/cirúrgicas (p=0,06). CONCLUSÃO: Os clínicos fazem referências significativamente menores para revistas cirúrgicas do que os cirurgiões fazem para as revistas clínicas.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departmento de CirurgiaUniversity of Chicago Department of SurgeryUNIFESP, EPM, Departmento de CirurgiaSciEL

Obesity and Gastroesophageal Reflux: Quantifying the Association Between Body Mass Index, Esophageal Acid Exposure, and Lower Esophageal Sphincter Status in a Large Series of Patients with Reflux Symptoms

Obesity and gastroesophageal reflux disease (GERD) are increasingly important health problems. Previous studies of the relationship between obesity and GERD focus on indirect manifestations of GERD. Little is known about the association between obesity and objectively measured esophageal acid exposure. The aim of this study is to quantify the relationship between body mass index (BMI) and 24-h esophageal pH measurements and the status of the lower esophageal sphincter (LES) in patients with reflux symptoms. Data of 1,659 patients (50% male, mean age 51 ± 14) referred for assessment of GERD symptoms between 1998 and 2008 were analyzed. These subjects underwent 24-h pH monitoring off medication and esophageal manometry. The relationship of BMI to 24-h esophageal pH measurements and LES status was studied using linear regression and multiple regression analysis. The difference of each acid exposure component was also assessed among four BMI subgroups (underweight, normal weight, overweight, and obese) using analysis of variance and covariance. Increasing BMI was positively correlated with increasing esophageal acid exposure (adjusted R 2 = 0.13 for the composite pH score). The prevalence of a defective LES was higher in patients with higher BMI (p &lt; 0.0001). Compared to patients with normal weight, obese patients are more than twice as likely to have a mechanically defective LES [OR = 2.12(1.63–2.75)]. An increase in body mass index is associated with an increase in esophageal acid exposure, whether BMI was examined as a continuous or as a categorical variable; 13% of the variation in esophageal acid exposure may be attributable to variation in BMI

A comparative study of cranial, blunt trauma fractures as seen at medicolegal autopsy and by Computed Tomography

<p>Abstract</p> <p>Background</p> <p>Computed Tomography (CT) has become a widely used supplement to medico legal autopsies at several forensic institutes. Amongst other things, it has proven to be very valuable in visualising fractures of the cranium. Also CT scan data are being used to create head models for biomechanical trauma analysis by Finite Element Analysis. If CT scan data are to be used for creating individual head models for retrograde trauma analysis in the future we need to ascertain how well cranial fractures are captured by CT scan. The purpose of this study was to compare the diagnostic agreement between CT and autopsy regarding cranial fractures and especially the precision with which cranial fractures are recorded.</p> <p>Methods</p> <p>The autopsy fracture diagnosis was compared to the diagnosis of two CT readings (reconstructed with Multiplanar and Maximum Intensity Projection reconstructions) by registering the fractures on schematic drawings. The extent of the fractures was quantified by merging 3-dimensional datasets from both the autopsy as input by 3D digitizer tracing and CT scan.</p> <p>Results</p> <p>The results showed a good diagnostic agreement regarding fractures localised in the posterior fossa, while the fracture diagnosis in the medial and anterior fossa was difficult at the first CT scan reading. The fracture diagnosis improved during the second CT scan reading. Thus using two different CT reconstructions improved diagnosis in the medial fossa and at the impact points in the cranial vault. However, fracture diagnosis in the anterior and medial fossa and of hairline fractures in general still remained difficult.</p> <p>Conclusion</p> <p>The study showed that the forensically important fracture systems to a large extent were diagnosed on CT images using Multiplanar and Maximum Intensity Projection reconstructions. Difficulties remained in the minute diagnosis of hairline fractures. These inconsistencies need to be resolved in order to use CT scan data of victims for individual head modelling and trauma analysis.</p

Esophageal diverticula and cancer

Esophageal diverticula are rare. the association of cancer and diverticula has been described. Some authors adopt a conservative non-surgical approach in selected patients with diverticula whereas others treat the symptoms by diverticulopexy or myotomy only, leaving the diverticulum in situ. However, the risk of malignant degeneration should be may be taken in account if the diverticulum is not resected. the correct evaluation of the possible risk factors for malignancy may help in the decision making process. We performed a literature review of esophageal diverticula and cancer. the incidence of cancer in a diverticulum is 0.37, 1.8, and 0.6% for pharyngoesophageal, midesophageal, and epiphrenic diverticula, respectively. Symptoms may mimic those of the diverticulum or underlying motor disorder. Progressive dysphagia, unintentional weight loss, the presence of blood in the regurgitated material, regurgitation of peaces of the tumor, odynophagia, melena, hemathemesis, and hemoptysis are key symptoms. Risk factors for malignancy are old age, male gender, long-standing history, and larger diverticula. A carcinoma may develop in treated diverticula, even after resection. Outcomes are usually quoted as dismal because of a delayed diagnosis but several cases of superficial carcinoma have been described. the treatment follows the same principals as the therapy for esophageal cancer; however, diverticulectomy is enough in cases of superficial carcinomas. Patients must be carefully evaluated before therapy and a long-term follow-up is advisable.Universidade Federal de São Paulo, Escola Paulista Med, Dept Surg, São Paulo, BrazilKlinikum Nuernberg Nord, Dept Gen & Thorac Surg, Nurnberg, GermanyUniv Chicago, Pritzker Sch Med, Dept Surg, Chicago, IL 60637 USAUniversidade Federal de São Paulo, Escola Paulista Med, Dept Surg, São Paulo, BrazilWeb of Scienc

When did the esophagus start shrinking? the history of the short esophagus

P>Even though the history of this condition extends for almost 100 years, the short esophagus (SE) is still one of the most controversial topics in esophageal surgery with its existence still denied by some distinguished surgeons. We reviewed the evolution behind the diagnosis and treatment of the SE and the persons who wrote its history, from the first descriptions by radiologists, endoscopists, and surgeons to modern treatment.Universidade Federal de São Paulo, Escola Paulista Med, Dept Surg, Esophagus Div, São Paulo, BrazilUniv Chicago, Med Ctr, Dept Surg, Ctr Esophageal Dis, Chicago, IL 60637 USAUniversidade Federal de São Paulo, Escola Paulista Med, Dept Surg, Esophagus Div, São Paulo, BrazilWeb of Scienc