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: chest radiography, multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), ventilation/perfusion (V/Q) scans, cardiac perfusion scintigraphy, transesophageal and transthoracic echocardiography, positron emission tomography (PET), spine and rib radiography, barium esophageal and upper GI studies, and abdominal ultrasound (US) [5,6]. Traditionally, most of these examinations have been performed during the ED visit, but there is a trend to perform outpatient testing. Variant: Acute (...) are low . Thoracic calcifications, if present, can indicate pericardial disease, ventricular aneurysm, intracardiac thrombi, or aortic disease. Although chest radiographs are often normal for the presence of PE, the presence of a Hampton hump, Westermark sign, or pulmonary artery enlargement can suggest PE . Mediastinal air can indicate a ruptured viscus or subpleural bleb or other acute pathology. In addition, widening of the mediastinum or an enlarged heart or aortic knob, as well as ill
clinical studies may be necessary to clarify aspects based on expert opinion instead of published data. Thus, these guidelines may be revised as needed to account for new data, changes in clinical practice, or avail- ability of new technology. Key Words: aortoesophageal ?stula, button battery, esophageal food impaction, foreign body ingestion, magnet, superabsorbent (JPGN 2015;60: 562–574) I n 2000 the American Association of Poison Control Centers documented that 75% of the>116,000 ingestions reported (...) of mercury, compiled data on battery ingestions published by the National Capital Poison Center in 1992 of>2300 BB ingestions during a 7-year period found no deaths and only a 0.1% prevalence of major effect (defined as life-threatening or disabling; in this series, there were 2 patients with esophageal stricture) (4). During the ensuing 18 years, however, that clinical experience changed dramatically with a follow-up paper from the National Capital Poison Center in 2010 (5). In this cohort of>8600 BB
,suchashypokalemia. 141 Theseproblemsmayleadto orthostatic hypotension and syncope. Esophageal tears from excessive erosion of throat tissue can lead to serious and dif?cult-to-control bleeding. Binge eating can cause both gastric and esophagealrupture. 142 The mortality rate is estimated to be about 1% in BN patients, but more recent studies suggest that this may be an underestimate. 143,144 Indications for medical hospitalization of children and adolescents have been published by the American Academy
management. Supraglottic airway placement is the preferred rescue strategy to facilitate ventilation after failed intubation. Supraglottic airway devices with an esophageal drain provide access to the stomach to relieve air and stomach contents and may reduce the risk of regurgitation and aspiration pneumonitis. Subsequent exchange with a definitive airway with fiberoptic guidance may be considered for women with ROSC. If oxygenation and ventilation are not successful with a supraglottic device or ETT
in the “Third Universal Definition of Myocardial Infarction.” This statement defines MI caused by a primary coronary artery process such as spontaneous plaque rupture as MI type 1 and one related to reduced myocardial oxygen supply and/or increased myocardial oxygen demand (in the absence of a direct coronary artery process) as a MI type 2 ( and Section 3.4 for an additional discussion on the diagnosis of MI). 2.2. Epidemiology and Pathogenesis 2.2.1. Epidemiology In the United States, the median age at ACS (...) ) Gastrointestinal causes (eg, gastroesophageal reflux, esophageal spasm, peptic ulcer, pancreatitis, biliary disease) Musculoskeletal causes (eg, costochondritis, cervical radiculopathy) Psychiatric disorders Other etiologies (eg, sickle cell crisis, herpes zoster) In addition, the clinician should differentiate NSTE-ACS from acute coronary insufficiency due to a nonatherosclerotic cause and noncoronary causes of myocardial oxygen supply-demand mismatch (Section 2.2.2). 3.2.1. History NSTE-ACS most commonly
dysfunction (Balli 2013 [4a]) ? GI symptoms (nausea, stomach ache, diarrhea and constipation) (Zarate 2010 [4a], Adib 2005 [4a], Hakim 2004 [4a]); eosinophilic esophagitis (EE) (Abonia 2013 [3a]) ? Nonspecific (allergy, rash, nocturia, dysuria, flushing, night sweats, fever, lymph gland pain) (Kirby 2007 [4a]) ? Clumsiness/poor coordination (Adib 2005 [4a]) ? Prior therapy and response to the intervention(s) (Keer 2003 [5a], Hakim 2003 [5b]) 4. It is recommended that therapists complete a comprehensive (...) patients have shown knee cartilage damage (Checa 2012 [5a]). Note 7: There is a positive correlation between JH and these long term associated musculoskeletal impairments: o Chondromalacia patellae (al-Rawi 1997 [3a]) o Carpal tunnel syndrome (Aktas 2008 [4a]) o Headaches (Rozen 2006 [4b]) o Cervical instability (Rozen 2006 [4b]) o Disc prolapse, spondylolysis, and spondylolisthesis (Murray 2006 [5a]) o Trauma, tears, or rupture of the soft tissues surrounding the joint (Rombaut 2012a [4b]) 13
(small bowel from the ampulla of Vater to the terminal ileum, whichcanbeevaluatedbycapsuleendoscopyordouble-balloon enteroscopy), or lower gastrointestinal bleeding in the colon, whichcanbeevaluatedbycolonoscopy(7).Commoncausesof uppergastrointestinalbleedingincludeesophagealvarices,gas- tric and duodenal ulcers, gastritis, esophagitis, Mallory–Weiss tears, and neoplasms. The most common causes of mid gastro- intestinalbleedingareangiodysplasia,neoplasms,Crohndisease, diverticula (...) . Vascular grafts can also alter the normal blood pool anatomy. There are several reports of arterial leaks mimicking gastrointestinal bleeding (82–87). In addition, the litera- ture reports a number of case reports demonstrating aor- toduodenal?stularupture(88),hemangiomasinthe liver or small bowel (89,90), and abdominal varices (92,94). Varices are most commonly seen as static blood pool structures, but they can also rupture and cause bleeding (91,93,95). The literature also contains a report of visu
suggest measuring plasma or urine levels of metanephrines on follow-up to diagnose persistent disease. We suggest lifelong annual biochemical testing to assess for recurrent or metastatic disease. ( 2 |⊕⊕○○) 5.0 Surgery 5.1 We recommend minimally invasive adrenalectomy (eg, laparoscopic) for most adrenal pheochromocytomas. ( 1 |⊕⊕○○) We recommend open resection for large (eg, >6 cm) or invasive pheochromocytomas to ensure complete tumor resection, prevent tumor rupture, and avoid local recurrence. ( 1
and judgment. However, with the increasing sensitivity of troponin assays, biomarker-negative ACS (i.e., UA) is becoming rarer (39). The pathogenesis of ACS is considered in the "Third Universal Definition of Myocardial Infarction" (21). This statement defines MI caused by a primary coronary artery process such as spontaneous plaque rupture as MI type 1 and one related to reduced myocardial oxygen supply and/or increased myocardial oxygen demand (in the absence of a direct coronary artery process) as a MI (...) of chest pain (e.g., aortic dissection, expanding aortic aneurysm, pericarditis, pulmonary embolism) • Noncardiovascular causes of chest, back, or upper abdominal discomfort include: o Pulmonary causes (e.g., pneumonia, pleuritis, pneumothorax) o Gastrointestinal causes (e.g., gastroesophageal reflux, esophageal spasm, peptic ulcer, pancreatitis, biliary disease) o Musculoskeletal causes (e.g., costochondritis, cervical radiculopathy) o Psychiatric disorders o Other etiologies (e.g., sickle cell crisis
, the occurrence of HCC and spontaneous rupture are ra r e ( 122 – 124 ). Th us, a conservative approach should be taken when managing FNH. However, further evaluation of sympto- matic lesions in which a diagnosis of FNH cannot be fi rmly estab- lished is recommended. Although partial hepatic resection is the most common intervention, embolization and radiofrequency ablation have more recently been utilized as they are associated with fewer complications and lower morbidity ( 125 – 127 ). Fol- low-up annual US (...) are rare and most oft en present with features of portal hypertension, such as ascites, splenomegaly, hepatomegaly, and esophageal varices ( 128 – 130 ). Imaging studies are insuffi cient in establishing a defi nitive diagnosis of NRH. Th e lesions are roun- tinely too small to observe radiographically and, when visualized, too difi cult to distinguish from the regenerating nodules of cirrho- sis ( 131 ). Th e defi nitive method for establishing a conclusive diag- nosis of NRH is biopsy. Although NRH
h: nine cases (42.8%); 24-48 h: six cases (28.6%); and >72 h: six cases (28.6%). All patients underwent operative treatment, and the following primary healing rates were achieved: <24 h: 88.9%, 24-48 h: 66.7%, and >72 h: 0. No patients died in this study. All patients were discharged with recovery, and the average hospitalization times were 18.1 days (<24 h), 27.8 days (24-48 h), and 51.2 days (>72 h).Surgical treatment remains an effective method for treating spontaneous esophagealrupture (...) The Role of Operation in the Treatment of Boerhaave's Syndrome This study aims to discuss the appropriate treatment strategy for spontaneous esophageal rupture.Clinical data from twenty-one cases were retrospectively analyzed. The parameters included etiology, time interval between onset and treatment, therapy methods, prognosis, and length of stay.The ratio of males/females was 17/4, age range was 32-82 years (mean = 43.1), and the time interval between onset and treatment was as follows: <24
inflammatory markers, and hypokalemic metabolic alkalosis. CT chest showed an increased size of the bronchogenic cyst (9.64 X 7.7 cm) suggestive of possible partial cyst rupture or infected cyst. X-ray esophagram ruled out esophageal compression or contrast extravasation. Patient's symptoms were refractory to conservative management. The patient ultimately underwent right thoracotomy with cyst excision that resulted in complete resolution of symptoms. Conclusion: Bronchogenic cysts are the most common
Tension hydropneumothorax as the initial presentation of Boerhaave syndrome Boerhaave syndrome, a rare yet frequently fatal diagnosis, is characterized by the spontaneous transmural rupture of the esophagus. The classic presentation of Boerhaave syndrome is characterized by Mackler's triad, consisting of chest pain, vomiting, and subcutaneous emphysema. However, Boerhaave syndrome rarely presents with all the features of Mackler's triad; instead, the common presentation of Boerhaave syndrome (...) syndrome presenting as tension hydropneumothorax and review ten previously reported cases of Boerhaave syndrome presenting as tension hydropneumothorax. This review serves to raise clinician awareness about the expansive and elusive ways by which esophageal perforation may present, and thereby facilitate timely and potentially life-saving diagnosis.
Center Information provided by (Responsible Party): Sheba Medical Center Study Details Study Description Go to Brief Summary: The aim of this study is to evaluate the accuracy and reliability of intra-operative TEE after the induction of anesthesia when assessing proximal thoracic aorta diameters in a cohort of aortic aneurysm patients. Condition or disease Intervention/treatment Phase Aortic Aneurysm, Thoracic Other: Trans-esophageal echocardiography Not Applicable Detailed Description: Dilatation (...) of the ascending aorta often progresses silently in an asymptomatic patient, until an acute complication occurs (such as a dissection or rupture), which is directly related to the diameter of the aortic. To prevent these extremely harmful situations, aortic replacement surgery, as indicated by significant dilatation of the ascending aorta, could be the option of choice (1). The decision to perform elective surgery depends on the measurement of the thoracic aorta diameter, which would rely on the largest aortic
Thoracoscopic primary repair with mediastinal drainage is a viable option for patients with Boerhaaveâ€™s syndrome Spontaneous esophagealrupture (Boerhaave's syndrome) is an emergency that can cause life-threatening conditions. Various procedures have been used to treat Boerhaave's syndrome. However, a standard surgical procedure has not been established. Herein, we report our experience with primary suture of the ruptured esophagus via a thoracoscopy or laparotomy.Between November 2002 (...) =0.7307). The mean operative time was 190 min (group A) and 249 min (group B) (P=0.106). Patient baseline characteristics and surgical outcomes were similar for both surgical procedures. One patient in each group experienced postoperative leakage that did not require surgical intervention.The results suggest that thoracoscopic esophageal repair, as well as suturing via laparotomy, is a good surgical alternative for patients with Boerhaave's syndrome.
of mortality for the operations following a period of 24 h after rupture formation are higher than 50%. Esophagectomy is a type of an operation that is to be considered in the event of an end stage benign esophageal disease or of a large esophageal damage that does not allow primary repair. Significant decrease has been observed in the morbidity and mortality of esophageal perforation due to the improvements in the endoscopical techniques today. Minimally invasive techniques, in which drug eluting stents (...) Thoracic perforationsâ€”surgical techniques Esophageal perforation may occur spontaneously, iatrogenically or in connection with traumas. Sepsis may develop in connection with mediastinal and pleural exposure in a very short time as a consequence of disintegration of the esophagus. Esophageal perforation is an emergency accompanied with a high level of mortality and morbidity. Rate of mortality for the perforations in the thoracic region is higher than that in the cervical and abdominal regions
Boerhaave syndrome due to hypopharyngeal stenosis associated with chemoradiotherapy for hypopharyngeal cancer: a case report Spontaneous esophagealrupture, also known as Boerhaave syndrome, is a very serious life-threatening benign disease of the gastrointestinal tract. It is typically caused by vomiting after heavy eating and drinking. However, in our patient, because of a combination of hypopharyngeal cancer with stenosis and chemoradiotherapy (CRT), which caused chemotherapy-induced (...) vomiting, radiotherapy-induced edema, relaxation failure, and delayed reflexes; resistance to the release of increased pressure due to vomiting was exacerbated, thus leading to Boerhaave syndrome. To the best of our knowledge, this is the first report of a patient with esophagealrupture occurring during CRT for hypopharyngeal cancer with stenosis.A 66-year-old man with a sore throat was referred to our hospital. He was found to have stage IVA hypopharyngeal cancer, cT2N2bM0, and underwent radical
arguments (elastometry> 16 kPa), or on signs of portal hypertension based on echographic, endoscopic or biological (platelets <150000) approaches, Presence of disabling pruritus (permanent, or EVA> 5/10, or objectivable scratching skin lesions), Patient on liver transplantation waiting list or total bilirubin> 50 μmol / L (3 mg / dL), or MELD score ≥ 15 or recent complication (<6 months) of cirrhosis (ascites, hepatic encephalopathy, rupture bleeding) of esophageal varices), Untreated depressive