Obstructive bronchitis and recurrent pneumonia in esophageal achalasia in a child: A CARE compliant case report

RATIONALE

Esophageal achalasia is characterized by impaired relaxation of the cardia and dilation of the intrathoracic part of the esophagus. We describe the late presentation of achalasia in an 11-year old girl.

PATIENT CONCERNS

She suffered from recurrent pneumonia, obstructive bronchitis, and problems with swallowing solid food. Her family noted a wet pillow in the morning.

DIAGNOSES

This case report describes the typical symptoms of achalasia in children in order to facilitate earlier diagnosis of this rare disease. Our patient was admitted to a pediatric hospital for treatment of severe pneumonia, low-grade fever, and pancreatitis. A computed tomography (CT) scan of the thorax showed massive dilation of the esophagus and infiltration and partial atelectasis of the right lung. An upper gastrointestinal contrast study confirmed massive dilation of the esophagus and stenosis at the level of the cardia.

INTERVENTIONS

We performed laparoscopic Heller myotomy combined with Dor fundoplication. Bronchoscopic lavages were conducted in the pre- and postoperative period to relief obstruction of bronchi by purulent mucus secretions.

OUTCOMES

A further upper gastrointestinal contrast study demonstrated patency of the cardia and fast propulsive movement of contrast agent into the stomach. At follow up 2 months after the operation, the girl had gained 3 kg of body weight, and her respiratory, gastrointestinal, and swallowing symptoms had subsided. At follow-up 12 months after the operation, no recurrent symptoms of achalasia were recorded.

LESSONS

Late presentation of achalasia in children can mimic respiratory and gastrointestinal diseases. Laparoscopic Heller myotomy combined with Dor fundoplication is feasible and advisable in children suffering from achalasia of the cardia.

Boltzmann equation and hydrodynamics beyond Navier-Stokes

We consider in this paper the problem of derivation and regularization of higher (in Knudsen number) equations of hydrodynamics. The author's approach based on successive changes of hydrodynamic variables is presented in more detail for the Burnett level. The complete theory is briefly discussed for the linearized Boltzmann equation. It is shown that the best results in this case can be obtained by using the 'diagonal' equations of hydrodynamics. Rigorous estimates of accuracy of the Navier-Stokes and Burnett approximations are also presented.This article is part of the theme issue 'Hilbert's sixth problem'.

Theory of collision algorithms for gases and plasmas based on the boltzmann equation and the landau-fokker-planck equation

A time-explicit formula that describes the time evolution of velocity distribution functions of gases and plasmas is derived from the Boltzmann equation. The formula can be used to construct collision simulation algorithms. Specialization of the formula to the case of the Coulomb interaction shows that the previous method [K. Nanbu, Phys. Rev. E 55, 4642 (1997)] for a Coulomb collision simulation is a solution method of the Landau-Fokker-Planck equation in the limit of a small time step. Also, a collision simulation algorithm for multicomponent plasmas is proposed based on the time-explicit formula derived.

A kinetic model of the agglutination process

We propose a kinetic model of the aggregation process in a system consisting of two different types of particles. Aggregating particles (cells) are polyvalent and bear on the surface a huge number of binding sites for the other type of particles, ligands. The ligand is bivalent and has two identical active sites for binding to cells. The cross-linking of the cells by the ligands causes the aggregation phenomenon called agglutination. We obtained the analytical solution of this model task describing the time dependence of the aggregate mean size versus the composition of the system. The comparison of the analytical solution with the experimental data for the agglutination of bacterial cells by bivalent antibodies shows that the main factors affecting agglutination were correctly taken into account.

[Central hemodynamics, kidney functions and water-salt metabolism in patients with ischemic heart disease and an increased venous blood return to the heart]

A study is presented of the central hemodynamics, renal function and water-salt metabolism in 42 patients with ischemic heart disease and chronic circulatory insufficiency (grades I and II) and revealed a deterioration of these indices in this categories of patients manifested in a retention of sodium, deterioration of central hemodynamics after increase of venous inflow.