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Esophageal Rupture

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222. Coronary revascularisation: Cangrelor

clinical risk (for example, aortic dissection or rupture, oesophageal tear, pericarditis). People in an unconscious state undergoing emergency PCI in whom bleeding risk is deemed to be low. Coronary revascularisation: Cangrelor (ESNM63) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 20 of 25Two further caveats apply to the use of cangrelor. Firstly, in CHAMPION PHOENIX (Bhatt et al. 2013) almost all participants

2015 National Institute for Health and Clinical Excellence - Advice

224. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: executive summary of an ASTRO evidence-based guideline.

, infectious pneumonia, and pericardial effusion. Other retrospective studies have also reported severe toxicities and fatal complications following stereotactic or hypofractionated radiation therapy directed at central tumors. These include potentially devastating toxicities, such as tracheal or great vessel rupture, esophageal ulceration, and spinal cord myelopathy. Interpretation of surveillance imaging following SBRT is challenging and may lead to unnecessary biopsies, salvage surgery, or false (...) . Recommendation strength: Conditional Quality of evidence: Low Key Question 3: For medically inoperable early stage lung cancer patients, how can SBRT techniques be individually tailored to provide an adequate dose for tumor eradication with minimal risk to normal structures in "high-risk" clinical scenarios, including : Tumors with intimal proximity/involvement of mediastinal structures (bronchial tree, esophagus, heart, etc.) Tumors abutting or invading the chest wall? For tumors with intimal proximity

2017 National Guideline Clearinghouse (partial archive)

226. CRACKCast E092 – Small Intestine

to necrosis and perforation** Blood supply to the gut is key! The celiac trunk (foregut – distal esophagus to the duodenum at the entrance of the bile duct) superior mesenteric artery (midgut – distal half of the duodenum to the proximal two-thirds of the transverse colon) and inferior mesenteric artery (hindgut – distal third of the transverse colon to the rectum) are the major arterial blood vessels. Question 1) List the types of mechanical small bowel obstruction. Let’s quickly talk through (...) , but devastating!!! Mortality remains 60-80%. By 6 hours of ischemic time to the small bowel, transmural necrosis is complete All these lesions are out to get the jejunum! Type Etiology Risk factor Mesenteric arterial embolus Arterial emboli make up 50% of cases (think left sided atrial/vent/valvular source) The SMA is the most common vessel occluded. -Age >70 -Female>>Male -MI -cardiomyopathies -ventricular aneurysms -endocarditis -atrial fibrillation Mesenteric arterial thrombosis Rupture of atheromatous

2017 CandiEM

227. CRACKCast E130 – Viruses

impairment, and ocular disturbances. Most severe infections occur in immunocompromised people: Post solid organ transplant HIV with CD4 < 100/mcL CMV manifests initially as fever, malaise, and myalgias. The infection can then progress to cause leukopenia, pneumonia, esophagitis/gastritis, hepatitis, colitis, encephalitis, polyradiculopathy, and retinitis. Diagnosis PCR, viral culture, or antibody testing. Treatment: Immunocompetent patients: supportive care (as for EBV) unless life-threatening infection (...) , streptococcal pharyngitis, toxoplasmosis, and other causes of viral pharyngitis should all be considered in potential mononucleosis patients. Splenomegaly (50% of patients) – with subsequent risk of rupture (<0.5%) advise patients to avoid contact sports for at least 3 weeks to avoid the feared complication of splenic rupture. Abdominal ultrasound for assessment of spleen size may have a role in determining when it is safe to return to sports. Airway obstruction in children – <5% Iatrogenic rash – post

2017 CandiEM

230. CRACKCast E077 – Pleural Disease

difference on supine apical capping obliteration of the hemidiaphragm widened minor fissure 12) Describe Light’s Criteria for pleural effusion and list 5 other tests to perform on pleural fluid. Spaced repetition from last chapter… Cell count (High counts = empyema) Glucose (Pleurisy, malignancy or esophageal rupture) Amylase (pancreatitis, esophageal rupture or malignancy) Gram stain and culture Cytology A pH <7.0 is strongly suggestive of empyema or esophageal rupture: these patients need a tube (...) : due to underlying pulmonary disease 1) List 5 risk factors for 1° spontaneous pneumothorax Tall Male Smoker Changes in Ambient atmospheric pressures Hx Mitral valve prolapse Marfan Syndrome Family History of primary pneumothorax 2) What is the most common pathophysiologic cause of pneumothorax? Primary: Even though this is technically in a person without lung disease, the most common cause is unrecognized pleural disease and rupture of a bleb Secondary: Easy, COPD – accounts for 70% of cases

2017 CandiEM

231. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

of the cytokine cascade, chemokine response, and inducible NO synthase expression associated with coronary plaque rupture. , As previously described, putative mechanisms also are associated with a “wet and warm” CS presentation wherein a systemic inflammatory response syndrome and vasodilation can occur after an MI. , This phenotype is characterized by systemic inflammatory response syndrome features, lower systemic vascular resistance, and a higher risk of sepsis and mortality. , Overlaid on this framework (...) syndrome (ACS). Thus, among patients with CS within the appropriate demographic or with risk factors for coronary artery disease, ACS should be the focus of initial diagnostic testing, and this testing should include an ECG within 10 minutes of presentation. Although 5% to 12% of ACS cases are complicated by CS, this presentation is often associated with a large degree of at-risk myocardium. , In patients with a recent ACS, mechanical complications (including papillary muscle rupture, ventricular

2017 American Heart Association

232. Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

- TERL and CHARGE syndromes. These syndromes consist of vertebral defects, anal atresia, cardiac defects, tra- cheo-esophageal fistula, renal anomalies, and limb ab- normalities in VACTERL and coloboma of the eye, heart defects, atresia of the choanae, retardation of growth and development, and ear abnormalities in CHARGE. A small retrospective series reported that 30% of pa- tients with CHD also had renal anomalies. 42 Although the true prevalence is likely lower, many pediatric car- diac centers

2017 American Heart Association

233. Shaken baby syndrome or non-accidental head injury caused by shaking

axial images, diffusion-weighted images, and T2-weighted images*. It allows for a complete assessment of parenchymal and extra-parenchymal lesions, whether haemorrhagic or not; it makes it possible to highlight ruptures in bridging veins (T2* sequences) in the form of rounded or linear images called “lollipop” or “tadpole” signs. ? In case of diagnostic uncertainty, a complete cervical examination must be carried out with sagittal STIR sequence for ligament injuries and an axial T1 sequence (...) be completely constant and concordant. Only accidental injuries with high deceleration (motor vehicle accident type) can cause multifocal SDH and a rupture of the bridging veins. These SDH are then most often associated with other brain injuries. A fall from less than 1.5 m cannot cause a multifocal SDH or diffuse and/or bilateral retinal haemorrhage. It never leads to the combination of SDH and RH. Incorrect diagnoses are often made: ? in case of vomiting, diagnosis of acute gastroenteritis even when

2017 HAS Guidelines

234. The role of endoscopy in subepithelial lesions of the GI tract

of a duplication cyst of the digestive tract. Mayo Clin Proc 1985;60: 772-5. 89. Bulajic M, Savic-Perisic M, Korneti V, et al. Use of endoscopy to diag- nose symptomatic duodenal duplication cyst in an adult. Endoscopy 1991;23:234-6. 90. Neo EL, Watson DI, Bessell JR. Acute ruptured esophageal duplication cyst. Dis Esophagus 2004;17:109-11. 91. Seeliger B, Piardi T, Marzano E, et al. Duodenal duplication cyst: a potentially malignant disease. Ann Surg Oncol 2012;19:3753-4. 92. Zheng J, Jing H. Adenocarcinoma (...) heterotopic pancreas. World J Gastroenterol 2009;15:2805-8. 74. Nakajima M, Domeki Y, Takahashi M, et al. Removal of broad-based esophageal hemangioma using endoscopic submucosal dissection. Esophagus 2013;10:161-4. 75. Radaelli F, Minoli G. Granular cell tumors of the gastrointestinal tract: questions and answers. Gastroenterol Hepatol 2009;5:798-800. 76. Narra SL, Tombazzi C, Datta V, et al. Granular cell tumor of the esoph- agus: report of five cases and review of the literature. Am J Med Sci 2008;335

2017 American Society for Gastrointestinal Endoscopy

237. Suspected Thoracic Aortic Aneurysm

aortic aneurysms (AAA) that may present with pain or a pulsatile abdominal mass [1]. Although individuals with TAA are generally asymptomatic, some patients may describe chest or back pain. When patients with known or suspected TAA present with sudden onset of pain, complications such as dissection, hemorrhage, or impending rupture should be considered [2,3]. Although uncommon, cases involving a large TAA may present with anatomical mass effect, which can manifest due to compression of adjacent (...) structures such as the esophagus, blood vessels, or nerves [4]. As intervention planning and follow-up are not within the scope of this document, readers should refer to the ACR Appropriateness Criteria ® “Thoracic Aorta Interventional Planning and Follow-up” [5]. Normal thoracic aorta diameter varies from the aortic sinuses to the diaphragm, decreasing in size as it courses distally. The adult thoracic aorta diameter is dependent on the individual, but measures between 3.5 to 4.0 cm at the aortic root

2017 American College of Radiology

239. The hTEE system for transoesophageal echocardiographic monitoring 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 (...) or disposable or monoplane or mono-plane or single-plane or miniature*) adj5 (gaug* or instrument* or measure* or monitor* or sensor* or device*1 or system or systems or probe*1)).ti,ab,kf. (23279) 9 (tee or toe or hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam* or transesophag* or trans-esophag* or transoesophag* or trans-oesophag* or echo-cardiograph* or echocardiograph*).ti,ab,kf. (238085) The hTEE system for transoesophageal echocardiographic monitoring of haemodynamic instability (MIB7) © NICE

2014 National Institute for Health and Clinical Excellence - Advice

240. Zurampic - lesinurad

can occur. Tophi may be small and symptomless, or large and bothersome, causing chronic arthritis, malfunction of joints and rupture of the overlying skin (“leaking tophi”). Tophus forming in the kidney may lead to lithiasis and inflammation, and if uncontrolled, to renal failure. Gout is the most common type of inflammatory arthritis (Doherty 2012). The prevalence of gout is estimated as 1-2 % in Europe. Gout is primarily diagnosed in middle-aged and elderly males. Patients with a genetic (...) underlying the GI toxicity in animals is not known. The applicant proposed that it could be a local direct toxic effect or an off-target toxicity at the supra-physiological concentrations in the GI tract, since most of the GI toxicity occurred at a dose exceeding the MTD. The safety margins, based on systemic exposures, at the NOAEL in rats and monkeys are 4 and 12 times the human exposure at MHD. Clinical data do not point to evidence of significant GI tract safety issues. and Gastro-oesophageal reflux

2016 European Medicines Agency - EPARs

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