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Esophageal Rupture

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261. Nausea/vomiting in pregnancy

% of pre-pregnancy weight. Findings which may suggest an alternative diagnosis include: Onset of symptoms after 11 weeks of gestation. Abdominal pain or tenderness (more than mild epigastric tenderness after retching). Fever. Headache or abnormal neurological examination. Goitre. 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 (...) , metabolic acidaemia can occur). Abnormal liver function test results. Vitamin deficiencies (for example thiamine [vitamin B 1 ] which may cause Wernicke's encephalopathy). Mechanical complications: Retinal haemorrhage. Splenic avulsion. Mallory–Weiss tears or oesophageal rupture. Pneumothorax or pneumomediastinum. The combination of immobility and dehydration associated with hyperemesis gravidarum may increase a woman's risk of venous thromboembolism [ ]. Today, maternal death from nausea and vomiting

2018 NICE Clinical Knowledge Summaries

262. Bites - human and animal

, haematoma, avulsion, amputation). The degree of crush injury, devitalized tissue, nerve or tendon damage, and involvement of muscle, bones, joints, or blood vessels. Examine wounds overlying a joint through the full range of motion to detect retracted injuries and tendon rupture. Neurovascular function in the area distal to the bite — check pulses and sensation. The range of movement of any adjacent joints. Any lymphadenopathy. The presence of any foreign bodies (for example teeth) in the wound. Any (...) , and involvement of muscle, bones, joints, or blood vessels. Examine wounds overlying a joint through the full range of motion to detect retracted injuries and tendon rupture. Neurovascular function in the area distal to the bite — check pulses and sensation. The range and movement of any adjacent joints. Any lymphadenopathy. The presence of any foreign bodies (for example teeth) in the wound. Any signs of infection (for example redness, swelling, induration, necrotic tissue, purulent discharge, pain

2018 NICE Clinical Knowledge Summaries

263. Dyspepsia - proven functional

Dyspepsia - proven functional Dyspepsia - proven functional - NICE CKS Share Dyspepsia - proven functional: Summary The term 'dyspepsia' is used to describe a complex of upper gastrointestinal tract symptoms which are typically present for four or more weeks, including upper abdominal pain or discomfort, heartburn, acid reflux, nausea and/or vomiting. If symptoms of heartburn and acid regurgitation predominate, then gastro-oesophageal reflux disease (GORD) is the more likely diagnosis (...) . Functional dyspepsia (also known as non-ulcer dyspepsia) refers to people with dyspepsia symptoms and normal findings on endoscopy (gastric or duodenal ulcer, gastric malignancy, or oesophagitis have been excluded). Functional dyspepsia is the most common diagnosis when endoscopy is performed to investigate dyspepsia symptoms. Two sub-types of functional dyspepsia have been defined, which can overlap: Epigastric pain syndrome, where intermittent or burning pain is localized to the epigastrium. Post

2018 NICE Clinical Knowledge Summaries

264. Ovarian cancer

, MRI, X-ray and CT for people with suspected cancer. Statement 2. People presenting in primary care with symptoms that suggest oesophageal or stomach cancer have an urgent direct access upper gastrointestinal endoscopy. Statement 3. Adults presenting in primary care with symptoms that suggest colorectal cancer, who do not meet the referral pathway criteria, have a test for blood in their faeces. Statement 4. People with suspected cancer who are referred to a cancer service are given written (...) : Peritoneal trauma, disease, or irritation. Other cancers, such as primary peritoneal cancer, lung cancer, and pancreatic cancer. See the CKS topics on and for more information. Endometriosis. See the CKS topic on for more information. PID. See the CKS topic on for more information. Ovarian cyst torsion, rupture, or haemorrhage. Pregnancy. Heart failure. See the CKS topic on for more information. Basis for recommendation Basis for recommendation Other conditions that could cause symptoms similar to those

2018 NICE Clinical Knowledge Summaries

265. Dyspepsia - proven peptic ulcer

Dyspepsia - proven peptic ulcer Dyspepsia - proven peptic ulcer - NICE CKS Share Dyspepsia - proven peptic ulcer: Summary The term 'dyspepsia' is used to describe a complex of upper gastrointestinal tract symptoms which are typically present for four or more weeks, including upper abdominal pain or discomfort, heartburn, acid reflux, nausea and/or vomiting. If symptoms of heartburn and acid regurgitation predominate, then gastro-oesophageal reflux disease (GORD) is the more likely diagnosis (...) in primary care. Treatment with a second-line H. pylori eradication regimen has been unsuccessful. There are limited antibiotic options for H. pylori eradication therapy. A proven gastric ulcer has not healed on repeat endoscopy. A non-peptic cause of ulcer disease is suspected. Have I got the right topic? Have I got the right topic? From age 18 years onwards. This CKS topic is largely based on the National Institute for Health and Care Excellence (NICE) clinical guideline Gastro-oesophageal reflux

2018 NICE Clinical Knowledge Summaries

266. Dyspepsia - unidentified cause

who have not had an endoscopy. The most common causes of dyspepsia include: Gastro-oesophageal reflux disease (GORD). Peptic ulcer disease (gastric or duodenal ulcers). Functional dyspepsia (non-ulcer dyspepsia) Dyspepsia symptoms are estimated to occur in about 40% of the population each year. Assessment of a person with unexplained dyspepsia should include: Asking about any alarm symptoms that may suggest a complication or other serious underlying pathology. Asking about lifestyle factors (...) . Treatment with a second-line H. pylori eradication regimen has been unsuccessful. There are limited antibiotic options for H. pylori eradication therapy. Have I got the right topic? Have I got the right topic? From age 18 years onwards. This CKS topic is largely based on the National Institute for Health and Care Excellence (NICE) clinical guideline Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management [ ]. This CKS topic covers the management of adults with dyspepsia

2018 NICE Clinical Knowledge Summaries

267. Polyhydramnios in singleton pregnancies

OR: Odds ratio PPROM: Preterm primary rupture of membranes RR: Relativ risiko SDP: Single deepest pocket SDVP: Single deepest vertical pocket SF: Symfysefundus UL: Ultralyd 3 Indholdsfortegnelse: Nøgleord: 1 Indledning: 1 Arbejdsgruppens medlemmer: 1 Relevante koder: 1 Anvendte forkortelser: 1 Indledning: 5 Guideline: 6 Definition: 9 Diagnostik/målemetoder: 9 Klinisk vurdering: 9 Fostervandsvolumen i forhold til GA: 9 Metodevalg: 10 Grænser for AFI og DVP: 13 Fysiologi vedrørende fostervandets volumen (...) system. In: Thurnburn GD, Harding R, editors. Textbook of fetal physiology. Oxford: Oxford University Press, 1994:140-167 24. Brace RA, Wlodek ME, Cock ML, et al. Swallowing of lung liquid and amniotic fluid by the ovine fetus under normoxic and hypoxic conditions. Am J Obstet Gynecol 1994;171:764-770. 25. Kunisaki SM, Bruch SW, Hirchkl RB, et al. The diagnosis of fetal esophageal atresia and its implications on perninatal outcome. Pediatr Surg Int 2014;10:971-7. 26. Spaggiari E, Faure G, Rosseau V

2016 Nordic Federation of Societies of Obstetrics and Gynecology

268. Acute Coronary Syndromes Guidelines

be considered include gastro-oesophageal pathology, pleur- itis and other pulmonary disease, muscular and skeletal causes including costochondritis, and herpes zoster. In addi- tion, patients with myocardial oxygen supply–demand mis- match due to non-atherosclerotic and non-coronary conditions (e.g. Type 2 MI, Refer to Section 3.1.3) may also present with chest pain but who require a different manage- ment pathway to patients with type 1 MI (i.e. plaque rupture). 2.3. Initial Clinical Management Practice (...) of the aorta) and expanding aortic aneurysm Pulmonary embolism Pericarditis and myocarditis Gastrointestinal causes (e.g. gastro-oesophageal re?ux, oesophageal spasm, peptic ulcer, pancreatitis, biliary disease) Non-cardiovascular causes Musculoskeletal causes (e.g. costochondritis, cervical radiculopathy, ?brositis) Pulmonary (e.g. pneumonia, pleuritis, pneumothorax) Other aetiologies (e.g. sickle cell crisis, herpes zoster) National Heart Foundation of Australia & Cardiac Society of Australia

2016 Cardiac Society of Australia and New Zealand

270. Pilot study on preventing anastomotic leakage in stapled gastroesophageal anastomosis (Full text)

Pilot study on preventing anastomotic leakage in stapled gastroesophageal anastomosis This study explored how to improve the surgical technique to reduce or avoid anastomotic leakage.From January 2012 to December 2016, 101 consecutive patients with cancer of the esophagus or gastroesophageal junction underwent stapled gastroesophageal anastomosis. The procedure included creating a tube-type stomach, fixing an inserted anvil, inspecting mucosa-to-mucosa alignment in the lumen under direct vision (...) after firing the stapler, and, if found, manually repairing a rupture of the mucous membrane of the anastomosis.A rupture of the mucous membrane of the anastomosis was found in four out of the 101 patients and manually repaired. No postsurgical anastomotic leakage occurred. All patients recovered well and the average postoperative stay was 10.4 days. There was no mortality within 30 days after surgery.It is critical to inspect the integrality of the luminal mucous membrane of the anastomosis under

2017 Thoracic cancer PubMed abstract

271. Liver Disease and Pregnancy

, on their treatment with penicillamine, trientine, or zinc (strong recommen- dation, very low level of evidence). Pregnant women with suspected portal hypertension should undergo screening with upper endoscopy for esophageal varices in the second trimester (strong recommendation, low level of evidence). Pregnant women who are found to have large esophageal varices should be treated with beta-blockers and/or band ligation (conditional recommendation, very low level of evidence). Pregnant women with a history (...) , hemolysis, elevated liver enzymes, low platelets; HG, hyperemesis gravidarum; IHCP, intrahepatic cholestasis of preg- nancy. Liver Disease and Pregnancy © 2016 by the American College of Gastroenterology The American Journal of GASTROENTEROLOGY 7 whereas abdominal swelling or shock presentation can occur with hepatic rupture ( 61,62 ). Supportive management is appropriate for most contained hematomas. Surgery is indicated for those with enlarging hematomas or evidence of rupture with hemodynamic

2016 American College of Gastroenterology

272. Practice Guidelines for the Diagnosis and Management of Aspergillosis (Full text)

accompanied by systemic antifungal therapy with voriconazole (strong recommendation; low-quality evidence) . What Are the Treatment Recommendations for Esophageal, Gastrointestinal, and Hepatic Aspergillosis? Recommendations 58. We suggest voriconazole and surgical consultation in attempts to prevent complications of hemorrhage, perforation, obstruction, or infarction (weak recommendation; low-quality evidence) . 59. We suggest antifungal therapy with voriconazole or a lipid formulation of AmB as initial

2016 Infectious Diseases Society of America PubMed abstract

273. CRACKCast E038 – Pediatric Trauma

and NPA’s are tougher to insert Floppy epiglottis more U shaped “use miller blade” (false dogma) and change in intubation technique – ‘insert Miller blade into the esophagus and then SLOWLY withdraw until you see the glottis’ Cephalad, anterior larynx tougher to visualize the cords, need to angle 45 deg. forward to see them Cricoid ring the most narrow part of the airway (the first cricoid cartilage of the trachea) May need uncuffed tubes in kids <8 yrs (or need to downsize slightly) Narrow tracheal (...) be indicated by: pupil size and reactivity extremity movement and tone posturing and reflexes Treatment: mannitol 0.5 g/kg IV; maintain CPP of at least 50 assess for spinal injury 6) List 7 indications for laparotomy hemodynamic instability despite aggressive resuscitation free fluid on FAST and unstable vitals signs massive bleeding (intraperitoneal) pneumoperitoneum / intraperitoneal bladder rupture / grade V renovascular injury gunshot wound evisceration peritonitis 7) List 6 signs of elevated ICP

2016 CandiEM

274. Investigation and management of eosinophilia

involvement. Miscellaneous Causes Atheroembolic disease: cholesterol atheroembolic disease develops as a consequence of cholesterol microembolisation following rupture of atheromatous aortic plaques after 17 arterial catheterisation procedures, vascular surgery or following anticoagulant or thrombolytic therapy. A transient eosinophilia has been reported in the acute phase of the illness (Kasinath & Lewis 1987; Scolari et al, 2007), thought to be driven by increased IL-5 production by activated T cells

2016 British Committee for Standards in Haematology

275. Neonatal resuscitation

Positive pressure ventilation PPROM Preterm prelabour rupture of membranes RhD Rh Blood Type D (Rh positive) SpO2 Peripheral capillary oxygen saturation UVC Umbilical venous catheter Definitions Acrocyanosis Blue hands and feet due to inadequate circulation of blood and oxygen to the extremities normally found in the first few hours after birth. Cold stress Temperature between 36.0 °C and 36.4°C Corrected age Gestation plus postnatal age in weeks Hyperthermia Temperature greater than 37.5 °C Mild (...) the baby at risk of requiring resuscitation at birth. The list is not exhaustive and the magnitude of the risk varies depending on the number and severity of the problem. 1 Table 3 Risk factors Aspect Consideration Maternal 1 · Prolonged rupture of membranes (greater than 18 hours) · Bleeding in second or third trimester · Hypertension in pregnancy · Substance use · Prescribed medication (e.g. lithium, magnesium, adrenergic blocking agents, narcotics) · Diabetes mellitus · Chronic illness (e.g. anaemia

2016 Clinical Practice Guidelines Portal

276. Neonatal resuscitation

Positive pressure ventilation PPROM Preterm prelabour rupture of membranes RhD Rh Blood Type D (Rh positive) SpO2 Peripheral capillary oxygen saturation UVC Umbilical venous catheter Definitions Acrocyanosis Blue hands and feet due to inadequate circulation of blood and oxygen to the extremities normally found in the first few hours after birth. Cold stress Temperature between 36.0 °C and 36.4°C Corrected age Gestation plus postnatal age in weeks Hyperthermia Temperature greater than 37.5 °C Mild (...) the baby at risk of requiring resuscitation at birth. The list is not exhaustive and the magnitude of the risk varies depending on the number and severity of the problem. 1 Table 3 Risk factors Aspect Consideration Maternal 1 · Prolonged rupture of membranes (greater than 18 hours) · Bleeding in second or third trimester · Hypertension in pregnancy · Substance use · Prescribed medication (e.g. lithium, magnesium, adrenergic blocking agents, narcotics) · Diabetes mellitus · Chronic illness (e.g. anaemia

2016 Clinical Practice Guidelines Portal

277. Secukinumab (Cosentyx)

Amy S. Woitach, DO BLA 125-504 Cosentyx (secukinumab) 52 Palpitations 2 (0.18) 0 (0.00) 2 (0.07) 0 (0.00) 0 (0.00) Pulmonary edema 2 (0.18) 0 (0.00) 2 (0.07) 0 (0.00) 0 (0.00) Rib fracture 0 (0.00) 2 (0.17) 2 (0.07) 0 (0.00) 0 (0.00) Tendon rupture 0 (0.00) 2 (0.17) 2 (0.07) 0 (0.00) 0 (0.00) Vomiting 2 (0.18) 0 (0.00) 2 (0.07) 0 (0.00) 0 (0.00) Infections, including pneumonia and bacterial abscess, were reported more frequently with secukinumab treatment, but not reported for either placebo (...) treatment periods. Infections related to Candida did appear to show a dose response as shown in section 7.5.1. All Candida infections on secukinumab were mild or moderate in severity. 4 cases of esophageal candidiasis were reported (1 on 150 mg and 3 on 300 mg). Two of these cases were mild and two were moderate in severity. All were managed successfully with antifungal treatment and did not result in any interruption or discontinuation of study treatment. There was 1 additional case of esophageal

2014 FDA - Drug Approval Package

278. UK National Guidelines on the Management of infection with Chlamydia Trachomatis

on “Test of cure below) 24 Other antimicrobials There is less information from published studies on antimicrobials other than doxycycline and azithromycin. Ofloxacin (Level Ib, Grade A) ? Ofloxacin has similar efficacy to doxycycline 119 but carries a risk of C. difficile infection and tendon rupture. It is also considerably more expensive than doxycycline. Erythromycin (Level IV, Grade C) ? Erythromycin is less efficacious than either azithromycin or doxycycline. 120 ? When taken four times daily, 20 (...) -intestinal upset including nausea, vomiting, abdominal discomfort, and diarrhoea. These side-effects are more common with erythromycin than with azithromycin. With all macrolides, hepatotoxicity (including cholestatic jaundice) and rash may occur but are infrequent. Azithromycin may be associated with prolongation of the QT interval and should be used with caution or avoided in individuals with abnormalities of cardiac rhythm. Doxycycline may cause dysphagia and oesophageal irritation. Patients should

2015 British Association for Sexual Health and HIV

279. Provision of interventional radiology services

– the specialty IR procedures are minimally invasive, targeted treatments performed under imaging guidance. A wide range of procedures are included, extending from treatment of obstructed kidneys to the emergency management of ruptured arterial aneurysms and the treatment of cancer and its complications. IR procedures often replace open surgical procedures as they are less invasive, reduce morbidity and mortality and allow more rapid patient recovery and hospital discharge. Over 90% of procedures (...) . Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial I): randomised controlled trial. Lancet 2005; 365: 2179–2186. 4. National Institute of Health and Care Excellence. Abdominal Aortic Aneurysm – endovascular stent grafts: guidance. London: NICE, 2012. 5. IMPROVE trialists, Powell JT, Thompson SG et al. The immediate management of the patient with rupture: Open versus endovascular repair (IMPROVE) aneurysm trial – ISRCTN 48334791 IMPROVE Trial. Acta Chir

2014 Royal College of Radiologists

280. Systematic review of needs for medical devices for ageing populations

, diagnosis and treatment . . . . . . . . . . . . .32 4.3 OESOPHAGEAL CANCER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 Table 14 Oesophageal cancer – key studies (...) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Table 15 Oesophageal cancer – devices identified for diagnosis and treatment . . . . . . . . . . . . . . . . . . . . .35 4.4 CANCER OF THE LUNG, TRACHEA AND BRONCHUS . . . . . . . . . . . . . . . . . . . . . . . . . .36 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 Results

2015 Publication 80

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