The American journal of medicine
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Each cough involves a complex reflex arc beginning with the stimulation of sensory nerves that function as cough receptors. There is evidence, primarily clinical, that the sensory limb of the reflex exists in and outside of the lower respiratory tract. Although myelinated, rapidly adapting pulmonary stretch receptors (RARs), also known as irritant receptors, are the most likely type of sensory nerve that stimulates the cough center in the brain, afferent C-fibers and slowly adapting pulmonary stretch receptors (SARs) also may modulate cough. ⋯ The predominant role of acid in triggering cough by means of this reflex is unclear because of conflicting results from provocative challenge studies. It is interesting to speculate that a distal esophageal-bronchial reflex evolved as an early warning defense so that coughing could be started, just in case the refluxate were to reach the inlet of the lower respiratory tract. That is, thinking teleologically, it is possible that an esophageal-bronchial reflex evolved as one of several mechanisms designed to protect the lungs from aspiration of gastric contents.
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Review
Hiatus hernia: a review of evidence for its origin in esophageal longitudinal muscle dysfunction.
The axial forces exerted on the esophagus by the swallowing-induced contraction of its two longitudinally oriented muscle layers should, if unopposed, herniate the cardia through the diaphragm. A mathematical model of esophageal contraction shows that the magnitude of such a force becomes maximal just above the cardia, which is consistent with anatomic evidence of the existence of an inhibitory innervation in this same region. We propose that the inhibition exerted by these nerves when they discharge in swallowing prevents the supracardiac esophagus from shortening, allowing it to stretch and dissipating the pulling force of longitudinal muscle contraction above the diaphragm. Thus, hiatal hernia could originate from nerve disease, alteration in the viscoelastic properties of distal esophagus, or increased strength of the longitudinal muscle layers.
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Meta Analysis
Ginkgo biloba extract for the treatment of intermittent claudication: a meta-analysis of randomized trials.
The optimal treatment of intermittent claudication has not yet been identified. Ginkgo biloba extract has been reported to have beneficial effects. We performed a meta-analysis of the efficacy of Ginkgo biloba extract for intermittent claudication based on the results of randomized, placebo-controlled, double-blind trials. ⋯ These results suggest that Ginkgo biloba extract is superior to placebo in the symptomatic treatment of intermittent claudication. However, the size of the overall treatment effect is modest and of uncertain clinical relevance.
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Letter Case Reports
Fatal rhabdomyolysis associated with simvastatin in a renal transplant patient.