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Esophageal Rupture

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221. The airway in inhalational injury: diagnosis and management (PubMed)

. For this purpose, a broad PubMed search was conducted. The available literature was found to highlight the importance of airway management in terms of the timing of intubation, method of intubation, trachea-esophageal (TE) fistula formation and TE rupture. It also emphasizes the importance of carbon monoxide intoxication and prompt correction. Drugs such as heparin sulfate, N-acetylcysteine and albuterol have been proven to help in the treatment of patients with inhalational burns, and more research

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2017 Annals of burns and fire disasters

222. Upper Gastrointestinal Complications Following Ablation Therapy for Atrial Fibrillation (PubMed)

developed esophagopericardial fistula (and survived with treatment); (B) 15 had functional UGI complications confirmed by objective motility tests. Nine had newly developed symptoms and six had aggravated symptoms; and (C) the remaining 17 had GI symptoms without relevant diagnostic results. Most UGI issues resolved spontaneously or with conservative treatment. However, 2 died several weeks after ablation procedure; cause of death was suspected atrioesophageal fistula or esophageal rupture. Vagal (...) medical records and an AF ablation database of 5380 patients treated during 17 years, we identified 40 patients with UGI complications. We evaluated vagal dysfunction by electrocardiogram (ECG) showing lack of sinus arrhythmia (variation in R-R interval by ≥120 milliseconds, in presence of normal sinus P waves and constant P-R interval).Among 40 patients: (A) eight had structural GI complications confirmed by diagnostic tests: seven with esophageal ulcer/erosions and no signs of UGI bleeding and one

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2017 Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

223. Posttraumatic Aneurysm of a Patent Umbilical Vein: Diagnosis and Specific Treatment (PubMed)

-Pugh stage C 5 years earlier. Signs of portosystemic shunting had been present at an earlier endoscopy, and esophageal varices were found. Clinical examination revealed typical signs of liver cirrhosis, and ultrasound examination showed an aneurysm of 6 cm of the umbilical vein, which had not been present at earlier examinations. After lowering portal hypertension by inserting a transjugular intrahepatic portosystemic shunt, an open surgical resection of the aneurysmal umbilical vein was performed (...) without complications. The patient recovered well and was discharged from the hospital 10 days later. We hypothesize that the abdominal trauma prompted or aggravated umbilical vein aneurysm in this patient with liver cirrhosis and portal hypertension. Due to the risk of rupture, a surgery-based resection is a valuable treatment option.

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2017 The Surgery Journal

224. Outcomes of patients treated with Sengstaken-Blakemore tube for uncontrolled variceal hemorrhage (PubMed)

National University Hospital from October 2010 to October 2015 were retrospectively analyzed.The overall success rate of initial hemostasis with SB tube was 75.8%, and the independent factors associated with hemostasis were non-intubated state before SB tube (odds ratio, 8.50; p = 0.007) and Child-Pugh score < 11 (odds ratio, 15.65; p = 0.022). Rebleeding rate after successful initial hemostasis with SB tube was 22.0%, and esophageal rupture occurred in 6.1%. Mortality within 30 days was 42.4

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2017 The Korean journal of internal medicine

225. Descending necrotizing mediastinitis after a trigger point injection (PubMed)

Descending necrotizing mediastinitis after a trigger point injection Descending necrotizing mediastinitis (DNM) is a rare form of mediastinal infection. Most cases are associated with esophageal rupture. DNM after a trigger point injection in the upper trapezius has not been described previously. We present a case of DNM after a trigger point injection in the upper trapezius. A 70-year-old man visited the emergency department with chest discomfort and fever after a trigger point injection

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2017 Clinical and experimental emergency medicine

226. Coping with Common GI Symptoms in the Community: A Global Perspective on Heartburn, Constipation, Bloating, and Abdominal Pain/Discomfort

regions, with considerable overlap: o Intestinal: 44% o Esophageal: 42% o Gastroduodenal: 26% o Anorectal: 26% • Females reported higher frequencies of dysphagia, irritable bowel syndrome, constipation, abdominal pain, and biliary pain than males. • Males reported higher frequencies of bloating than females. • Symptom reporting, except for incontinence, declined with age. • Low socio-economic status, low educational attainment, and low income were associated with greater symptom reporting. 1.1.2 (...) disease WGO Global Guidelines Common GI symptoms (long version) 11 © World Gastroenterology Organisation, 2013 (IBD) is a possibility; now routine in many primary care settings (in the United Kingdom) o Celiac serology; considered routine in areas with a high prevalence of celiac disease o Stool testing for ova and parasites • Endoscopy o Visible abnormalities o Biopsy, histology • pH study—24-hour (48–72-hour with the Bravo esophageal pH capsule) esophageal pH or impedance-pH monitoring: measurement

2013 World Gastroenterology Organisation

227. ACMG Practice Guideline: lack of evidence for MTHFR polymorphism testing

of the methylenetetrahydrofolate reductase C677T and A1298C polymorphisms and gastric cancer risk: a huge-GSEC review. Am J Epidemiol 2008;167:505– 516. 40. Langevin SM, Lin D, Matsuo K, et al. Review and pooled analysis of studies on MTHFR C677T polymorphism and esophageal cancer. Toxicol Lett 2009;184:73–80. 41. Qi X, Ma X, Y ang X, et al. Methylenetetrahydrofolate reductase polymorphisms and breast cancer risk: a meta-analysis from 41 studies with 16,480 cases and 22,388 controls. Breast Cancer Res Treat 2010;123:499–506 (...) and their genetic basis: a comprehensive meta-analysis of small and large vessel stroke. Eur Neurol 2009;61:76–86. 48. Peck G, Smeeth L, Whittaker J, Casas JP , Hingorani A, Sharma P . The genetics of primary haemorrhagic stroke, subarachnoid haemorrhage and ruptured intracranial aneurysms in adults. PLoS ONE 2008;3:e3691. 49. Vettriselvi V , Vijayalakshmi K, Paul SF , Venkatachalam P . ACE and MTHFR gene polymorphisms in unexplained recurrent pregnancy loss. J Obstet Gynaecol Res 2008;34:301–306. 50. González

2013 American College of Medical Genetics and Genomics

228. Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery

is not entered. f Consider additional antimicrobial coverage with infected biliary tract. Seethe biliary tract procedures section of this article. g Gentamicin or tobramycin. h Due to increasing resistance of Escherichia coli to fluoroquinolones and ampicillin-sulbactam, local population susceptibility profiles should be reviewed prior to use. i Ciprofloxacin or levofloxacin. j Fluoroquinolones are associated with an increased risk of tendonitis and tendon rupture in all ages. However, this risk would (...) prior to incision, not patients undergoing cholecystectomy for noninfected biliary conditions, including biliary colic or dyskinesia without infection. l Factors that indicate a high risk of infectious complications in laparoscopic cholecystectomy include emergency procedures, diabetes, long procedure duration, intraoperative gallbladder rupture, age of >70 years, conversion from laparoscopic to open cholecystectomy, American Society of Anesthesiologists classification of 3 or greater, episode

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2013 Infectious Diseases Society of America

229. Otitis Media

abnormalities. • Immune deficiency. • Gastro-esophageal reflux. Diagnosis Distinguishing AOM and OME. The distinction between AOM and OME does not refer to etiology or depend on whether pathogenic bacteria are present in the middle ear. No “gold standard” exists for the diagnosis of AOM. The National AOM-guideline defines AOM as a combination of (see Table 1): 1) middle ear effusion, 2) physical evidence of middle ear inflammation, and 3) the acute ( 2 years of age with relatively minor symptoms • 2 years (...) Guideline, April 2013 In most cases, these ruptures will resolve spontaneously. Patients should be seen in follow up after 6 weeks to document healing. Referral to otolaryngology should occur if the perforation has not resolved in 12 months. Patients can be allowed to swim with a perforated ear drum, but should be advised not to dive deeply. Mastoiditis. Because mastoiditis can be a complication of AOM, some have raised concerns that the incidence of acute mastoiditis would increase with decreasing use

2013 University of Michigan Health System

230. Ascites due to cirrhosis, management

to lactulose) or an appendectomy scar. The area of the in- ferior epigastric arteries should be avoided; these ves- sels are located midway between the pubis and anterior superior iliac spines and then run cephalad in the rec- tus sheath. Visible collaterals should also be avoided. A laparoscopic study found that collaterals can be present in the midline and thus present a risk for rupture dur- ing paracentesis. 29 A 1 or 1.5 inch 21 or 22 gauge needle can be used for diagnostic paracentesis in lean

2013 American Association for the Study of Liver Diseases

232. Management of postpartum hemorrhage

to be available in an emergency department. A Blakemore tube is another option (fold the distal tip backwards and inflate the esophageal portion of the tube). A Bakri Balloon Another temporizing option is to attempt external aortic compression. (WHO 2012) Note: Dr. Kerr wanted me to emphasize aortic compression. In her expert opinion, it works quite well. Transfer the patient for definitive management. (ACOG 2017) Transfer the patient to the operating room for hysterectomy or uterine artery ligation (probably (...) per L IV or 10 units IM Methylergonovine 0.2 mg IM Hypertension, preeclampsia, cardiovascular disease Carboprost 250 mcg IM q 15 minutes to max of 8 doses Asthma Misoprostol 800 mcg PO (or sublingual or rectal) From ACOG 2017 Primary differential of postpartum hemorrhage: (ACOG 2017) Uterine Atony Retained uterine products / placenta accreta Coagulopathy Genital tract trauma Uterine inversion (rare) Uterine rupture (rare) What changed from the original post? The original version of this post

2019 First10EM

233. Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association?

and thrombosis. These triggers may lead to atherosclerotic plaque rupture and thrombosis, resulting in vessel occlusion and acute clinical catastrophes such as MI or stroke. Many prevalent risk factors with well-documented impact are shared by ASVD and PD and could confound a relationship between them. Increasing age, smoking, alcohol abuse, race/ethnicity, education and socioeconomic status, male sex, diabetes mellitus, and overweight or obesity are all factors associated with both ASVD and PD (...) and indirect interactions between periodontal pathogens and the endothelium or other mechanisms that impact the atherosclerotic process. Indirect Mechanisms: Systemic Inflammation Atherosclerosis may begin during childhood, with initial infiltration of the endothelium with fatty substances, and progresses over many decades. Chronic, quiescent atheromatous plaque can transition to a more dangerous state in which its vulnerability to rupture is increased. Plaques that contain a soft atheromatous core

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2012 American Heart Association

234. Quality-Improvement Guidelines for Hepatic Transarterial Chemoembolization     - currently under revision

include chole- cystitis, liver abscess formation, tumor rupture, pancreatitis, pleural effusion, gastric ulcer bleeding, esophageal variceal bleeding, and spontaneous bacterial peritonitis. The list of complications of DEB-TACE is relatively shorter than that for c-TACE. This is mainly because the former technique is a relatively new procedure and is not practiced as widely as the latter one, but it could also be due to the lack of lipiodol [14]. A comparison between complication rates leading

2012 Cardiovascular and Interventional Radiological Society of Europe

235. The hTEE system for transoesophageal echocardiographic monitoring of haemodynamic instability

include: cardiac contusion, haemothorax, embolism (air or fat), spinal cord injury, cardiac tamponade, tension pneumothorax, rupture of the heart, aortic injury, uncorrected blood and fluid loss, myocardial ischaemia, arrhythmias, injury, adrenal insufficiency, anaphylaxis, acute severe brain injury, and metabolic causes (Ho 1998). People who have had major surgery, such as organ transplant, are also at risk of perioperative haemodynamic instability. Each of these causes of haemodynamic instability (...) * or hemo-dynam* or haemo-dynam*) and (transesophag* or trans-esophag* or transoesophag* or trans-oesophag* or tee or toe)).ti,ab,kf. (1784) 6 ((in-dwell* or indwell* or in-situ or single-use or disposable or monoplane or mono-plane or single-plane or miniature*) adj5 (tee or toe or hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam* or transesophag* or trans-esophag* or transoesophag* or trans-oesophag*)).ti,ab,kf. (229) 7 or/1-6 (3025) 8 ((in-dwell* or indwell* or in-situ or single-use

2014 National Institute for Health and Clinical Excellence - Advice

237. Coronary Artery Bypass Graft Surgery: Guideline For

multidisciplinary communication) (12–15). (Level of Evidence: B) 4. Afellowship-trainedcardiacanesthesiologist(orexperiencedboard- certi?ed practitioner) credentialed in the use of perioperative trans- esophageal echocardiography (TEE) is recommended to provide or supervise anesthetic care of patients who are considered to be at high risk (16–18). (Level of Evidence: C) CLASS IIa 1. Volatile anesthetic-based regimens can be useful in facilitating early extubation and reducing patient recall (5,19–21). (Level

2011 American College of Cardiology

238. Management of ingested foreign bodies and food impactions

with psychiatric disorders, develop- mental delay, alcohol intoxication, and in incarcerated individuals seeking secondary gain via release to a medi- cal facility. 4,5,8,15,16 Ingestion of multiple foreign objects and repeated episodes of ingestion are common. Edentu- lous adults are also at greater risk of ingesting foreign bodies, including an obstructing food bolus or their dental prosthesis. 17 Patients presenting with food bolus impac- tion often have underlying esophageal pathology directly causing (...) Olderchildrenandnonimpairedadultsmayidentifythe ingestion and localize discomfort. However, the area of discomfort often does not correlate with the site of impac- tion. 26 Frequently, symptoms occur well after the patient ingests the foreign body. 27-30 Young children, mentally impaired adults, and those with psychiatric illness may thus present with choking, refusal to eat, vomiting, drool- ing, wheezing, blood-stained saliva, or respiratory dis- tress. 13,16,31 Oropharyngeal or proximal esophageal per- foration can cause neck swelling

2011 American Society for Gastrointestinal Endoscopy

239. Acute liver failure, management

with increased fetal or maternal mortality. 56-59 A vari- ety of presentations may be seen, generally con?ned to the last trimester. The triad of jaundice, coagulopathy, and low platelets may occasionally be associated with hypoglycemia. Features of pre-eclampsia such as hyper- tension and proteinuria are common. Steatosis docu- mented by imaging studies supports the diagnosis. The Oil-red O staining technique best demonstrates hepatic steatosis on biopsy. Intrahepatic hemorrhage and/or hepatic rupture (...) is recommended only in the setting of hemorrhage or prior to inva- sive procedures (III). Bleeding As noted above, spontaneous bleeding in patients with ALF is uncommon, and clinically signi?cant bleeding (requiring blood transfusion) is rare. 145 Spon- taneous bleeding in ALF is capillary-type, usually from mucosal sites of the stomach, lungs, or genitourinary system. Although portal hypertension occurs in acute liver injury due to architectural collapse of the liver, 146 bleeding from esophageal varices

2011 American Association for the Study of Liver Diseases

240. Evaluation of Gastroesophageal Varices by Transnasal Endoscopy.

, the interobserver matched for the discoveries found in the study is carried out. Condition or disease Esophageal Varices Gastric Varices Hypertension Portal Liver Cirrhosis Detailed Description: It is a descriptive study that proposes to evaluate the feasibility of the transnasal endoscopy to screen for gastroesophageal varices in patients with portal hypertension, cirrhotic and non-cirrhotic. The rupture of gastroesophageal varices is the principal cause of death among cirrhotics, responsible for high rates (...) of morbidity and mortality. Current medical literature recommends that the cirrhotic and the carriers of non-cirrhotic portal hypertension screen for gastric-esophageal varices in order to establish prophylactic and therapeutic measures, when recommended. Usually, the conventional peroral esophagogastroduodenoscopy is used for such purpose but the need for sedation reduces productivity, increases costs and introduces a small but not insignificant risk concerning complications, especially in decompensated

2016 Clinical Trials

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