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Esophageal Rupture

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181. Upadacitinib (Rinvoq) - rheumatoid arthritis

risks of serious infections and potential HBV reactivation. 8.5.2. Adverse Events of Special Interest: Opportunistic Infections: Excluding Tuberculosis Controlled Period Analysis of the “PBO-controlled UPA 15 mg” analysis set showed a similar proportion of opportunistic infections in PBO- and UPA 15 mg-treated subjects (Table 100). All opportunistic infections in the UPA 15 mg group were nonserious mucosal candidiasis including four cases of oral candidiasis and one case of esophageal candidiasis (...) (N=1042) n (%) UPA 15 mg QD (N=1035) n (%) Any Opportunistic Infection 3 (0.3) 5 (0.5) Esophageal candidiasis 0 1 ( 6 AAM 8 1204 1106 6 1058 10Hi 12 Jt.llONTMS SIHCi FIRiT DOH to2 , .. Adapted from Applicant's I SS Figure 2.4 5.12.5.1 .----------­ 18 2• 17 17 Consistent with increased frequency of herpes zoster events associated with UPA treatment during the controlled period, the long-term exposure through the study cutoff for Study M13- 545 demonstrated higher EAERs of herpes zoster

2019 FDA - Drug Approval Package

182. Laryngeal mask airway versus endotracheal tube for percutaneous dilatational tracheostomy in critically ill adults. Full Text available with Trip Pro

Laryngeal mask airway versus endotracheal tube for percutaneous dilatational tracheostomy in critically ill adults. Percutaneous dilatational tracheostomy (PDT) is one of the most common bedside surgical procedures performed in critically ill adults, on intensive care units (ICUs), who require long-term ventilation. PDT is associated with relevant life-threatening complications: Cuff rupture or accidental extubation may lead to hypoxia, aspiration or loss of airway. Puncture of the oesophagus

2018 Cochrane

183. Assessment of acute abdomen

Pyelonephritis Volvulus Intussusception Duodenal ulcer Ruptured ovarian cyst Ovarian torsion Abdominal aortic dissection Ruptured aortic aneurysm Acute mesenteric ischaemia and infarction Meckel's diverticulitis Psoas abscess Oesophageal perforation (Boerhaave’s syndrome) Ischaemic colitis Ruptured splenic artery aneurysm Budd-Chiari syndrome Splenic infarct Uraemia Diabetic ketoacidosis Addisonian crisis Hypercalcaemia Acute intermittent porphyria Radiation enteritis Heavy metal poisoning Spider bite

2018 BMJ Best Practice

184. Assessment of haemoptysis

that the bronchial or systemic circulation is responsible for most cases of haemoptysis. Rabkin JE, Astafjev VI, Gothman LN, et al. Transcatheter embolization in the management of pulmonary hemorrhage. Radiology. 1987 May;163(2):361-5. http://www.ncbi.nlm.nih.gov/pubmed/3562815?tool=bestpractice.com However, the pulmonary circulation has also been implicated, as is the case in catheter-induced pulmonary artery rupture, vasculitis, pulmonary artery aneurysms due to collagen vascular disease, or hereditary (...) Pneumonia Primary lung cancer Lung metastasis Anticoagulants, thrombolytic agents Toxic inhalation Bronchiectasis Pulmonary thromboembolism Mitral valve stenosis Left ventricular failure Coagulopathy Thrombocytopenia Disseminated intravascular coagulation Aspergilloma Endobronchial carcinoid Aspiration of foreign body Aspiration of gastric contents Broncholithiasis Tracheo-oesophageal fistula Bronchial telangiectasia Airway trauma Dieulafoy's disease Thoracic endometriosis Pulmonary artery aneurysm Fat

2018 BMJ Best Practice

185. Assessment of acute abdomen

Pyelonephritis Volvulus Intussusception Duodenal ulcer Ruptured ovarian cyst Ovarian torsion Abdominal aortic dissection Ruptured aortic aneurysm Acute mesenteric ischaemia and infarction Meckel's diverticulitis Psoas abscess Oesophageal perforation (Boerhaave’s syndrome) Ischaemic colitis Ruptured splenic artery aneurysm Budd-Chiari syndrome Splenic infarct Uraemia Diabetic ketoacidosis Addisonian crisis Hypercalcaemia Acute intermittent porphyria Radiation enteritis Heavy metal poisoning Spider bite

2018 BMJ Best Practice

186. Aortic dissection

and haemodynamic support should be instituted without delay when the condition is suspected. Diagnostic modalities include computed tomography scan, magnetic resonance imaging, or trans-thoracic/trans-oesophageal echocardiography. Involvement of the ascending aorta and/or arch warrants urgent surgical repair. Dissections of the descending aorta are managed medically with beta blockade; surgery in this group is reserved for those with end-organ malperfusion, persistent pain, rapid aneurysmal degeneration (...) , or rupture. Lifelong surveillance is needed with regular imaging to detect delayed aneurysmal degeneration of the remaining aorta, which may later require surgery. Definition Aortic dissection describes the condition when a separation has occurred in aortic wall intima, causing blood flow into a new false channel composed of the inner and outer layers of the media. Dissection most commonly occurs with a discrete intimal tear, but can occur without one. An aortic dissection is considered acute

2018 BMJ Best Practice

187. Aortic dissection

and haemodynamic support should be instituted without delay when the condition is suspected. Diagnostic modalities include computed tomography scan, magnetic resonance imaging, or trans-thoracic/trans-oesophageal echocardiography. Involvement of the ascending aorta and/or arch warrants urgent surgical repair. Dissections of the descending aorta are managed medically with beta blockade; surgery in this group is reserved for those with end-organ malperfusion, persistent pain, rapid aneurysmal degeneration (...) , or rupture. Lifelong surveillance is needed with regular imaging to detect delayed aneurysmal degeneration of the remaining aorta, which may later require surgery. Definition Aortic dissection describes the condition when a separation has occurred in aortic wall intima, causing blood flow into a new false channel composed of the inner and outer layers of the media. Dissection most commonly occurs with a discrete intimal tear, but can occur without one. An aortic dissection is considered acute

2018 BMJ Best Practice

188. Proton beam therapy in adults

published a HTA report that mainly focused on secondary literature. 12 Their search was run in October 2016, and was of moderate quality (English and French literature only, unclear selection and data extraction process). In general, the authors concluded that the evidence was inadequate to recommend proton treatment for the studied indications (non-small-cell lung cancer, hepatocellular cancer, prostate cancer, oesophageal cancer, breast cancer, re-irradiation cases). RIHTA published a HTA report

2019 Belgian Health Care Knowledge Centre

189. Quality indicators for the management of head and neck squamous cell carcinoma

that are not measurable with administrative data (N=18) 112 Table 19 – Quality indicators excluded in the final round (N=2) 114 Table 20 – Nomenclature codes multidisciplinary team meeting (MDT) 115 Table 21 – Nomenclature codes RX thorax 116 KCE Report 305 Quality indicators for the management of HNSCC 9 Table 22 – Nomenclature codes RX swallow mechanism/oesophagus 116 Table 23 – Nomenclature codes RX larynx 117 Table 24 – Nomenclature codes CT neck 117 Table 25 – Nomenclature codes CT skull 117 Table 26 (...) , the steps of this improvement cycle have already been implemented for several cancers: rectum (in collaboration with PROCARE), breast, testis, oesophagus, stomach and lung. 2-6 Building on these experiences, it was decided to set up a quality project for head and neck cancer for the following reasons: head and neck cancer presents an important burden and the management of head and neck cancer requires highly specialised care, but is very dispersed in Belgium. 1.1 Head and neck cancer in Belgium Head

2019 Belgian Health Care Knowledge Centre

190. Pregnancy

in early pregnancy . Symptoms usually begin before 9 weeks of gestation, and usually improve, resolving by 16 weeks of gestation in 90% of women. Hyperemesis gravidarum is a diagnosis of exclusion characterized by prolonged and severe nausea and vomiting, dehydration, ketosis, and body weight loss in pregnancy (...) . Complications are more likely in women with severe vomiting and include: Maternal — weight loss, dehydration, hyponatraemia, vitamin deficiencies, Mallory-Weiss tear or oesophageal (...) rupture, increased risk of venous thromboembolism. Fetal — possible higher incidence of low birthweight babies (if hyperemesis gravidarum). Conditions causing nausea and vomiting in pregnancy include: Genito-urinary conditions such as urinary tract infection, pyelonephritis, ovarian torsion. Endocrine conditions 2013 18. Interventions for preventing recurrent urinary tract infection during pregnancy . BACKGROUND: Recurrent urinary tract infections (RUTI) are common in women who are pregnant and may

2018 Trip Latest and Greatest

191. Transjugular Intrahepatic Portosystemic Stent-Shunt (TIPSS) in the management of portal hypertension

gastro-oesophageal variceal bleeding refractory to endoscopic and drug therapy, covered TIPSS is recommended (strong recommendation, moderate quality evidence). Salvage TIPSS is not recommended where the Child-Pugh score is >13 (strong recommendation, low quality of evidence) In patients who have Child’s C disease (C9-13) or MELD = 19, and bleeding from oesophageal varices or GOV1 and GOV2 gastric varices and are hemodynamically stable, early or pre- emptive TIPSS can be considered within 72h (...) prevention of oesophageal variceal bleeding, covered TIPSS is recommended where patients rebleed despite combination of VBL + NSBB (strong recommendation, high quality evidence). Covered TIPSS can be considered where patients are intolerant of or have contraindications to NSBB or VBL (weak recommendation, low quality evidence). In secondary prevention of gastric variceal bleeding, TIPSS is recommended where patients rebleed despite endoscopic injection therapy (strong recommendation, moderate quality

2019 British Society of Gastroenterology

193. Radiologic Management of Gastric Varices

. Cardiovasc Intervent Radiol. 2009;32(6):1209-1216. 41. Barange K, Peron JM, Imani K, et al. Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices. Hepatology. 1999;30(5):1139-1143. 42. Chau TN, Patch D, Chan YW, Nagral A, Dick R, Burroughs AK. "Salvage" transjugular intrahepatic portosystemic shunts: gastric fundal compared with esophageal variceal bleeding. Gastroenterology. 1998;114(5):981-987. 43. Choi YH, Yoon CJ, Park JH, Chung JW, Kwon (...) not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate ACR Appropriateness Criteria ® 2 Radiologic Management of Gastric Varices Clinical Condition: Radiologic Management of Gastric Varices Variant 5: Cirrhotic patient with esophageal and gastric variceal bleeding (gastric varices considered high risk for endoscopic management/failed endoscopic management) with a MELD score of 13 and a history of hepatic wedge pressure of 22 mmHg. Three-phase contrast-enhanced CT demonstrates a small gastrorenal

2019 American College of Radiology

197. Immune Modulating Therapies in Pregnancy and Lactation

treatment during pregnancy may increase the risk of hypertension, preeclampsia, weight gain, hyperglycemia, immunosuppression, gastrointestinal ulceration, prelabor rupture of membranes (also referred to as premature rupture of membranes), and intrauterine growth restriction, but if these risks exist the magnitude is not known ( ). Early data suggested that first trimester exposure to glucocorticoids may be associated with an increased risk of fetal oral clefts ( ), but more recent data have failed (...) in an increase in circulating T regulatory cells and a restored capacity to inhibit cytokine production ( ). With the exception of certolizumab, all TNF-α inhibitors are transferred across the placenta. Placental transfer of certolizumab does not occur because it lacks an Fc portion required for active transport. Initial reports of an association between TNF-α inhibitors and fetal VACTERL (Vertebral anomalies, Anal atresia, Cardiac defects, Tracheoesophageal fistula, Esophageal atresia, Renal anomalies

2019 American College of Obstetricians and Gynecologists

198. CRACKCast E199 – Adult Resuscitation

Tension pneumothorax Pulmonary embolus Abdomen Distended and dull Ruptured abdominal aortic aneurysm or ruptured ectopic pregnancy Distended, tympanitic Esophageal intubation Gastric insufflation Rectal Blood, melena GI Bleed Extremities Asymmetrical pulses Aortic dissection Arteriovenous shunt or fistula Hyperkalemia (think Renal Failure Pt) Skin Needle tracks Intravenous drug abuse Burns Smoke inhalation Electrocution [2] Discuss the process of deterioration to cardiac arrest with respiratory (...) Tension pneumothorax Cardiac tamponade Pulmonary embolus Tracheal deviation Tension pneumothorax Chest Median sternotomy scar Underlying cardiac disease Lungs Unilateral breath sounds Tension pneumothorax Right mainstem intubation Aspiration Distant or no breath sounds or no chest expansion Esophageal intubation Airway obstruction Severe bronchospasm Wheezing Aspiration Bronchospasm Pulmonary edema Rales Aspiration Pulmonary edema Pneumonia Heart Diminished heart tones Hypovolemia Cardiac tamponade

2019 CandiEM

199. Spontaneous rupture of middle thoracic esophagus: thoracoscopic treatment. (Abstract)

Spontaneous rupture of middle thoracic esophagus: thoracoscopic treatment. Spontaneous rupture of the esophagus (so-called Boerhaave's syndrome) is considered a medical emergency. It carries a significant mortality rate and requires prompt treatment. The treatment of choice involves surgical repair of the esophageal defect, usually accomplished via laparotomy, thoracotomy, or both to accomplish esophageal repair and mediastinal debridement. We have treated an elderly patient with severe

2010 Surgical endoscopy

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