Praxis
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Achalasia is a rare motility disorder of the distal esophagus, showing reduced or absent swallow induced relaxation of the lower esophageal sphincter region. The onset of the disease can be very slow and correct diagnosis might be delayed over years. Using exact medical history, upper GI endoscopy and barium swallow X-ray the achalasia can be suspected and can be confirmed by esophageal manometry. ⋯ Pneumatic balloon dilatation is therapy of first choice in achalasia. Especially in younger patients laparoscopic fundoplication with subsequent antireflux procedure should be offered early in the therapeutic algorithm when dilatation therapy fails. Medical therapy or intrasphincteric injection of botulinum toxin is only an alternative treatment for high risk patients, treatment failures or residual symptoms.
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This case involved a 65-year-old male with severe hypothermia who presented a cardiorespiratory arrest on his arrival in hospital. He was treated by means of a cardiopulmonary bypass and subsequently made good recovery. In this article we summarise the signs and symptoms of hypothermia, the treatment of a patient with hypothermia and the different rewarming strategies, based on the current literature on the subject.
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Hearing loss is a possible sequel of myelography. We describe a case of bilateral hearing loss of -60 dB, which recovered completely after an epidural blood patch. In hearing loss or tinnitus in association with a possible cerebrospinal fluid loss after a diagnostic or therapeutic puncture of the lumbar dural sack, an epidural blood patch is a viable and recommended therapeutic option.