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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two infants with torticollis and hiatus hernia (Sandifer Syndrome) are presented. Both infants improved with medical management. Abnormal head and neck positioning is attributed to esophagitis secondary to gastroesophageal reflux, with or without hiatus hernia. Since esophagitis due to reflux is not necessarily accompanied by vomiting, infants with torticollis shoud be studied for gastroesophageal reflux. If present, medical management is usually successful.
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PMID:Torticollis with hiatus hernia in infancy. Sandifer syndrome. 85 42

Esophageal pH monitoring is recognized as the best diagnostic procedure for gastroesophageal reflux (GER) and operation is seldom recommended in the absence of abnormal pH data. To emphasize that operation should not be ruled out for children who may have false-negative pH studies, we report 14 patients operated on for GER in spite of normal pH-monitoring. The mean age was 54 months (range, 18 to 90). Clinical features included vomiting, dysphagia, respiratory disease, anemia, and torticollis. All had radiologic evidence of GER, and 10 had endoscopic and histological esophagitis. Conventional pH-monitoring values were normal but lower esophageal sphincter pressure and propulsive peristalsis were significantly decreased whereas nonpropulsive contractions were predominant. Operation was recommended after an average of 24 months of unsuccessful medical treatment. Independent postoperative assessment showed that 13 of the 14 patients were relieved of their symptoms and dysphagia persists in one. We suggest that the diagnosis of GER should be accepted on the basis of sound clinical judgement plus more than one abnormal test even when pH results are normal. Operation should not be withheld when clinically indicated. There are several explanations for false-negative pH studies, of which alkaline reflux is probably the most important and warrants further investigation in children.
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PMID:Surgery for gastroesophageal reflux in children with normal pH studies. 206 6

Extended esophageal pH-metering is the best method for GER diagnosis, but it has a certain number of false negatives. In a attempt to judge in which extent we can indicate surgery with a "normal" pH-metering study, we have reviewed our 110 operated children since 1982, and selected 12 in whom pH studies were normal. There where five females and seven males with ages ranging between 18 and 90 months. The clinical course until the diagnosis was accepted was long. Nine patients had vomiting, five respiratory disease, six dysphagia, four anemia and three torticollis. Only two were malnourished. There was radiologic GER in all children (with only one hiatal hernia). In spite of "normal" pH-metering, eight had decreased lower esophageal sphincter, and 11 disturbed motility. Nine had endoscopic esophagitis and eight histologic esophagitis. After operation, indicated only after long periods of medical treatment, vomiting disappeared in all, and so did respiratory disease and torticollis. Five families were very satisfied, six rather satisfied (gas bloat syndrome) and one frankly dissatisfied (dysphagia with severe immotility). Based on this evidence, we believe that some limited indications for surgery in GER are acceptable even in the presence of "normal" pH-studies.
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PMID:[False negatives in pH measurement. A retrospective study of 12 surgical cases]. 207 69

We report a case of Sandifer syndrome with chronic torticollis and gastroesophageal reflux (GER). The infant exhibited regurgitations and vomiting from birth. Torticollis with a permanent tilt of the head towards the right developed at age six months. At 16 months, persistence of the vomiting and abnormal attitude of the head and neck led to a CT scan that outruled a brain tumor. Esophageal pH recordings disclosed severe gastroesophageal reflux (pH less than 4 for 46% of the time over 24 hours) and endoscopy showed ulcerated peptic esophagitis. Surgical treatment of the GER ensured both resolution of the reflux and disappearance of the torticollis, establishing the causal relationship between the former and latter manifestations.
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PMID:[Torticollis in children: do not forget the Sandifer syndrome]. 231 62

Since Snyder reported first twelve cases of benign paroxysmal torticollis in infancy (BPT) in 1969, about 30 cases have been reported mainly in the North America and Europe, but not in Japan. The authors experienced such a case of one-year-old boy. The attack occurred at the age of 2 months for the first time and continued to repeat every 2 weeks periodically. The head tiltings were always noticed when he woke up in the morning and lasted for about 5 to 6 days, but they disappeared during sleep. He tilted his head to the lateral side more often to the left than to the right. There were associated symptoms and signs including irritability, vomiting, gait disturbance, and abnormal truncal posture during the attacks. He did not demonstrate any neurological abnormalities between the attacks. The study of cerebrospinal fluid, caloric test, computed tomography, electroencephalography and brainstem auditory evoked responses were also normal. The frequency of the attacks gradually decreased after the age of 2 years and disappeared at the age of 3 years, and he has not complained of severe headache or vertigo up to 6 years of age. This case is reported to emphasize that BPT has to be included in the differential diagnosis of acquired torticollis. And it is required to accumulate such cases to elucidate its etiological factors.
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PMID:[Benign paroxysmal torticollis in infancy: case report]. 236 65

A case of giant, thrombosed, non haemorrhagic aneurysm of the distal portion of the left vertebral artery is reported. The patient came to medical attention with an acute cervical pain after a minimal cervical traumatism and a diagnosis of torticollis from rheumatologic cause was made. In fact, a few weeks before, he had suffered three episodes of right homonymous hemianopsia. Subsequently, hiccup, vomiting, orthostatic dizziness with postural hypotension appeared, suggesting a medullary lesion. CT scan showed a round, heterogeneous high-density lesion near the fourth ventricle. Angiography was normal. MRI showed an oval mass in the fourth ventricle, between the medulla and the cerebellum. Surgery found an aneurysm of the end of the left vertebral artery.
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PMID:[Giant thrombosed aneurysm of the left vertebral artery developing in the fourth ventricle]. 259 70

We report three children with benign paroxysmal torticollis (BPT) and review the literature. BPT represents a self-limited disorder that occurs mainly in infancy and in females. The condition is characterized by recurrent spells of torticollis which may, or may not, be accompanied by other symptoms such as vomiting, pallor, ataxia, irritability and drowsiness. The diagnosis of BPT should be established clinically, although, in some cases, it is necessary to rule out conditions such as posterior fossa tumor, cervical dislocation, ocular palsy, dystonia due to side effects of drugs, or Sandifer's syndrome. The etiology of the syndrome remains unknown and, at present, there is no effective therapy.
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PMID:[Benign infantile paroxysmal torticollis. Apropos of 3 cases]. 305 50

A retrospective study based upon 100 consecutive antireflux operations performed in children for gastroesophageal reflux (GER) in the last 9 years enables the authors to elaborate on indications and their timing. The clinical pictures, often combined in this series, were vomiting (85%), respiratory disease (50%), failure to thrive (47%), haemorrhage (25%), brain damage (16%), rumination (6%), oesophageal stenosis (4%), torticollis (3%) and cricopharyngeal dysphagia (1%). Five children had been previously operated upon for oesophageal atresia. Hiatal hernia was found in only 10 instances. Only 9 children were operated upon before the age of 12 months. Overall operative age was high (52.5 months) and that of patients with neurologic disease was even higher (81.3 months) probably as a result of delayed diagnosis. This experience underlines the limitations of medical treatment beyond the age of 12 months, the poor reliability of disappearance of vomiting as an index of cure during the first year and the need for facing operative indications without prejudgements based on traditional ideas that do not take into consideration clinical manifestations of GER disease which are currently well established.
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PMID:[Indications for the surgery of gastroesophageal reflux in children]. 363 70

We are reporting the cases of five patients who had occipito-atlantal instability, a rare condition that may be due to either trauma or congenital abnormalities. In three of the patients the instability was secondary to trauma. The clinical and neurological manifestations were varied and included cardiorespiratory arrest, motor weakness, quadriplegia, torticollis, pain in the neck, vertigo, and projectile vomiting. All of the patients underwent posterior arthrodesis of the occiput to the first or second cervical vertebra. In the patients who had trauma-related instability, surgery was performed when immobilization in a cast failed to stabilize the spine; in the patients who had a congenital abnormality, arthrodesis was indicated because of persistent symptoms and the potential for catastrophe with minor trauma. Based on our experience, we recommend surgical stabilization by posterior arthrodesis when this form of instability of the cervical spine is diagnosed.
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PMID:Occipito-atlantal instability in children. A report of five cases and review of the literature. 381 5

The two main problems in defining and classifying the syndrome of benign paroxysmal vertigo (BPV) in childhood are the vestibular function pattern and the relationship between BPV and migraine. 13 children suffering from this syndrome were submitted to complete otoneurological examination, including caloric and rotational labyrinthine stimulation with ENG recording, and to headache provocation tests with nitroglycerin, histamine and fenfluramine. Vestibular responses were normal in all except 2 cases which presented signs of central vestibular impairment at the level of the vestibulocerebellar pathways. Headache provocation tests were positive in 9 out of 10 children, and in 4 cases they induced a typical vertiginous attack instead of headache. In addition, several children had a positive family history for migraine, headache was frequently associated with the crisis and other signs of a 'periodic syndrome' (motion sickness, cyclic vomiting, abdominal pain) were present, unrelated to vertiginous attacks. During the follow-up period, some children responded positively to migraine treatment. BPV, like paroxysmal torticollis in infancy and the signs of the periodic syndrome, can be considered a migraine equivalent or a migraine precursor and could be due to the same vascular and/or biochemical mechanisms responsible for the migraine. In children, for anatomical or developmental reasons, these mechanisms could selectively affect parts of the brain stem, including the vestibular nuclei and vestibulocerebellar pathways.
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PMID:Benign paroxysmal vertigo in childhood: a migraine equivalent. 642 77


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