Treatment strategies in GERD

The goals of treatment of GERD are to :

1. Relieve symtoms
2. Heal oesophagitis
3. Maintain remmision
4. Improve quality of life
5. Prevent complications

Medication the have been used to relive GERD include antacids, prokinetic agent, histamine 2 resceptor antagonist (H2RA) and PPIs. PPIs are the most effective treatment for control of symptoms and healing of oesohagitis and erosive GERD.
While antacids are use for treatment of GERD, ther is only one out of three studies that shows evidence of antacid efficacy in relieving GERD symtoms. H2RA are mos effective than placebo for relieving mild to moderate GERD symtoms with a response rate between 60% to 70%.
Short term trials using PPIs have shown faster healing raes and more complete heart burn relief than H2RA of prokinetics in patiens with erosive GERD. Amongst the PPIs, standar doses have resulted in comparable helaing and remission rates in erosive oesophagitis. For NERDthe PPIs are also significantly superior to prokinetic agents in heartburn remission and to H2RA in overall symptom improvement. However they have a lower efficacy (10% - 30% less) in NERD patients than in patients with erosive GERD.

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Pancreatoblastoma

DEFINITION
Pancreatoblastoma is a primary malignant tumor of the pancreas consisting of an epithelial component showing acinar differentiation, nests of squamoid cells (or squamoid corpuscles), and occasional endocrine cells. There may be a mesenchymal component in some tumors. Although the tumor has a predilection for children, it has also been reported in adults. Synonyms for this tumor include pancreaticoblastoma and carcinoma of the pancreas, infantile type
GROSS PATHOLOGY
Pancreatoblastoma presents as a solitary mass that can arise in any location in the pancreas. The tumor tends to be relatively large, ranging from 7 to 18 cm, and on cross section it has been described as being tan-yellow with incomplete lobulations. The consistency may vary from soft and fleshy to focally fibrous, and there may be areas of necrosis and hemorrhage. Cystic change may be present, and on rare occasion a gritty texture has been described due to abundant calcification.
MICROSCOPIC PATHOLOGY
Pancreatoblastoma may have a partial fibrous pseudocapsule, but there is often invasion into adjacent pancreas, duodenum, or soft tissues. The first case of pancreatoblastoma was illustrated in 1959 by Frantz , and it was the same case reported by Becker in 1957 as the first pancreatic tumor in a child (a 15-month-old boy) treated by pancreaticoduodenectomy.

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Bental procedure

Bental procedure on aortic valve disesase and ascending aortic root aneurysm
Aortic valve sparing operation in patien with ascending aorta and/or aortic root aneurysm have been performed and become an increasingly popular alternative for replacement of the ascending aortic root aneurysm with aortic valve disease. Implantation of a prosthetic valve conduit (Bentall procedure) and modified be protrusion to LVOT, mild aortic stenosis, ascending aortic root aneurysm and coronay artery disease corrected by benttal procedure.
A 64 years old man was diagnosed to have severe aortic regurgitation and heart failure functional class II. CT thorax showed ascending aortic root aneurysm. Multiple vessel disease was shown by coronary arteriography indicated to CABG. Echocardiogram showed RCC protrusion to LVOT, mild AV stenosis, mild but morphologically normal mitral regurgitation, severe LV dilatation (LVIDD 84 mm) decrease LV systolic function by simpson’s rule (EF 38%) , global hypokinesia and mild secondary pulmonary hypertension (estimated PASP 49 mmHg). Bental procedure with bioprothesa graft conduit to replaced aortic valve and ascending aortic root after CABG can be performed successfully. Transthoracic-two dimensional echocardiograpy second day post procedure revealed normal AV function.
By : Mulslim I, Adipranoto JD, Spratt P
Departement of cardiology and vascular medicine airlangga university

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Pheochromocytoma

Clinical presentation of pheochromocytoma

Pheochromocytoma is uncommon tumor arising form pheochormocytes, the predominant cells of adrenal medulla. The pheochoromocytes constitute the chromaffin system. Pheochromocytoma is most common in the fourth through sixth decades of life. Women and man ara affected with similar frequency. Pheochromocytoma has been called “the 10% tumor” because aproximetaly 10% are bilateral, 10% malignant, 10% occur in children and 10% are extraadrenal/ the extra adrenal lesions are also referad to as paragangliomas.

The presence of pheochromocytoma may provoke fatal hypertensive crises during anesthesia and other stresses.pheochromocytoa are often unrecognized, if 20% of the adult population is hypertensive, only abaout five pheochromocytomas would be expected to be found among 100.000 hypertensives each year. However, about 10% of all pheochromocytomas are found incidentally and out 5% of all incidentalomas are pheochromocytomas. We report a case of a patient presenting with cardiogenic shock due to pheochromocytoma crisis. Treatment of choice is total left adrenalectomy.
Hendari SD, Lefi A
Departement of cardiology and vascular medicine airlangga university

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