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Cricopharyngeal achalasia associated with laryngomalacia as a cause of failure to thrive
- V Givens, K Brent, M Dunham, S P Kanotra
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- Journal:
- The Journal of Laryngology & Otology / Volume 132 / Issue 9 / September 2018
- Published online by Cambridge University Press:
- 18 June 2018, pp. 852-855
- Print publication:
- September 2018
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Objective
To describe a case of concurrent cricopharyngeal achalasia with laryngomalacia as a cause of failure to thrive, and to review the literature and management options of cricopharyngeal achalasia in the paediatric population.
MethodsA chart review was performed on a four-month-old male, referred for failure to thrive, and diagnosed with cricopharyngeal achalasia and laryngomalacia. A PubMed and Embase search for ‘cricopharyngeal achalasia’ and ‘laryngomalacia’ was conducted. A review of reported paediatric cricopharyngeal achalasia patients, with emphasis on management options, was undertaken.
ResultsA flexible laryngoscopic examination confirmed the laryngomalacia diagnosis, and videofluoroscopic evaluation of swallowing demonstrated cricopharyngeal achalasia via a cricopharyngeal bar. Supraglottoplasty was performed, with botulinum toxin injection into the cricopharyngeus muscle, with resultant improvement in oral intake and resolution of failure to thrive. The literature review revealed no reported case of the combined pathologies as a cause of failure to thrive.
ConclusionFunctional endoscopic evaluation of swallowing and videofluoroscopic evaluation of swallowing are complimentary in the evaluation of paediatric patients with failure to thrive and suspected oropharyngeal dysphagia. Both supraglottoplasty and botulinum toxin injection are effective for definitive management in cases of combined pathology, and can be safely performed in a single surgical setting.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
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A comparison of starchy and fibrous concentrates for milk production, energy utilization and hay intake by Friesian cows
- J. D. Sutton, J. A. Bines, S. V. Morant, D. J. Napper, D. J. Givens
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- Journal:
- The Journal of Agricultural Science / Volume 109 / Issue 2 / October 1987
- Published online by Cambridge University Press:
- 27 March 2009, pp. 375-386
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Twenty-four Friesian cows were allocated to one of four diets for weeks 3–14 of lactation following 2 weeks on a common diet. The diets (kg air-dry feed/day) were 7–2 kg hay and 10·8 kg either starchy or fibrous concentrates (60S and 60F) or 3·5 kg hay and 14·0 kg either starchy or fibrous concentrates (80S and 80F). Rumen samples were taken by stomach tube in weeks 10 and 12 of lactation and the digestibility of the diets was measured with four cows per treatment during weeks 13 and 14. The digestibility of the same feeds was also measured in sheep at maintenance.
The principal carbohydrate constituents of the concentrates were barley, wheat and cassava in the starchy concentrates and citrus pulp, sugar-beet pulp and wheat feed in the fibrous concentrates. The concentrates were designed to have similar concentrations of metabolizable energy (ME) and the diets were planned to provide similar intakes of digestible energy and crude protein.
Milk yield and composition were very similar for treatments 60S and 60F. With the higher proportion of starchy concentrates (80S), milk yield was about 20% greater than on 60S, fat concentration fell severely but protein and lactose concentrations were unaffected. With the higher proportion of fibrous concentrates (80F), milk yield and the protein and lactose concentration were similar to values on 60F but fat concentration was lower, though not nearly so low as on 80S. Milk energy yield was reduced by the higher proportion of concentrates but was unaffected by type of carbohydrates. Live-weight changes were small.
In both the sheep, consuming at maintenance, and the lactating cows consuming at about 3 times maintenance, digestibility of dry matter, organic matter and energy was higher with the higher concentrate diets but was unaffected by type of concentrate. The digestibility of fibre was greater with the fibrous concentrates but the effect of level of concentrate inclusion was inconsistent. Digestibility coefficients were consistently lower for the lactating cows than for the sheep.
The proportion of acetic acid in the rumen volatile fatty acids in the cows was higher and the proportion of propionic acid was lower with the fibrous concentrates. The differences were much greater with the higher proportion of concentrates.
During weeks 15–22 of lactation the cows were reallocated to concentrate treatments and given hay ad libitum. Hay intake was about 1 kg/day higher with the fibrous concentrates but the difference was not significant. Hay intake fell by about 0·6 kg/kg concentrate intake for both concentrate types. No significant differences in milk yield or composition were established, probably because of incomplete adaptation even after 8 weeks.
It is concluded that at concentrate intakes of about 10 kg/day, the source of carbohydrate in the concentrates has little effect on milk production when the concentrates are of similar ME concentration. However, at higher levels of concentrate inclusion, although the diets may have similar ME concentrations, important differences in the yields of fat, protein and lactose occur due to carbohydrate source and these can be related to differences in rumen fermentation.
Use of soluble glass rumen boluses to provide a supplement of copper for suckled calves
- D. I. Givens, G. Zervas, V. R. Simpson, S. B. Telfer
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- Journal:
- The Journal of Agricultural Science / Volume 110 / Issue 1 / February 1988
- Published online by Cambridge University Press:
- 27 March 2009, pp. 199-204
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An experiment was carried out on a site where the copper content of herbage was relatively low (4·7–6·2 mg/kg d.m.) to examine the value of copper contained in soluble glass rumen boluses as a means of providing supplementary copper to calves.
Forty-five spring-born suckled calves (mean live weight 91 kg) were divided into three groups on the basis of body weight. Animals in group GB were given two boluses initially, those in group CI each received copper injections at approximately monthly intervals and those in group C remained as controls throughout. Group C calves became progressively hypocupraemic (minimum mean plasma copper 8·5 μmol/1) compared with those in groups GB and CI which showed an increase in plasma copper concentration. In addition measurements of plasma caeruloplasmin activity, blood haemoglobin concentration and erythrocyte superoxide dismutase activity all showed significant increases due to treatment. No response in live-weight gain was observed but overall live-weight gain was approximately 1·05 kg/day. Although the initial response in plasma copper was quicker with copper injections, measurements of erythrocyte superoxide dismutase activity and haemoglobin showed advantages of glass boluses not shared by copper injections. This possibly resulted from the slow release nature of copper in the glass. Under the conditions of the experiment where herbage molybdenum values were relatively low (1·2–1·9 mg/kg d.m.), copper contained in soluble glass boluses appeared to prevent hypocupraemia in calves as effectively as regular copper injections.
Effect of altering the starch: fibre ratio in the concentrates on hay intake and milk production by Friesian cows
- J. D. Sutton, S. V. Morant, J. A. Bines, D. J. Napper, D. I. Givens
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- Journal:
- The Journal of Agricultural Science / Volume 120 / Issue 3 / June 1993
- Published online by Cambridge University Press:
- 27 March 2009, pp. 379-390
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Sixty-four multiparous Friesian cows were given one of eight diets from weeks 4–20 of lactation at the former National Institute for Research in Dairying, Shinfield, Reading in 1983–84. The diets consisted of 13·5 kg/day of experimental concentrates plus hay at 4·5 kg/day (fixed) or ad libitum. Concentrates were high-starch (S) based on cereal grains and cassava, high-fibre (F) based on highquality by-products, and two intermediate types containing 2:1 (SF) and 1:2 (FS) starch:fibre, all with a crude protein concentration of c. 180 g/kg DM. The diets were designed to provide similar intakes of digestible energy and crude protein at fixed hay intakes.
With ad libitum feeding, hay intake was lowest on S concentrates. With increasing fibre in the concentrates, the yields of milk, protein and lactose fell but fat concentration and yield were increased. These changes were linear and were unaffected by hay intake. Increasing hay intake to ad libitum had no effect on milk yield but increased the concentrations and yields of fat and protein. It also changed a net liveweight loss on fixed intakes to a gain on ad libitum intakes.
Diet digestibility was measured using sheep at about maintenance and cows at production intakes. Digestibility was higher in the sheep, probably because of the difference in level of intake. In the cows, increasing fibre in the concentrates reduced the digestibility of dry matter, organic matter, energy and nitrogen but increased the digestibility of fibre fractions and ether extract. Level of hay intake had variable effects on mean digestibility and on the relationship with concentrate type.
Increasing the fibre in the concentrates increased the molar proportions of acetate and n-butyrate in the rumen and reduced the proportions of propionate, n-valerate and n-caproate.
It is concluded that, with mixed diets of hay and relatively high proportions of concentrates, changes in the starch:fibre ratio of the concentrates by substitution of high quality by-products for starchy ingredients can induce linear changes in the yields of milk and the principal solids constituents and in milk fat concentration. Since changes in yields of fat and protein went in opposite directions, the optimal concentrate composition depends on the milk composition required by the market. These conclusions may not apply if poorer quality by-products are used.
6.14 Serum Vitamin B12 Concentrations in Growing Cattle and Their Relationship with Growth Rate and Cobalt Bullet Therapy
- D. I. Givens, V. R. Simpson
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- Journal:
- BSAP Occasional Publication / Volume 7 / 1983
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- 27 February 2018, pp. 145-146
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- 1983
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The interpretation of serum vitamin B12 concentrations in cattle is not well established but a value <350 ng/1 is commonly used to describe adequacy (MAFF, 1978). Three separate experiments explore this interpretation and the ability of cobalt (Co) bullets to increase serum vitamin B12 concentrations in cattle. In all cases, vitamin B12 has been measured microbiologically, using the organism L. leichmannii. In experiment 3, a number of samples were additionally analyzed using a radio isotope dilution (RID) technique.