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Esophageal Rupture

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281. ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management Full Text available with Trip Pro

stress. In the case of peri- operative myocardial ischaemia, two mechanisms are important: (i) a mismatch in the supply–demand ratio of blood ?ow, in response to metabolic demand due to a coronary artery stenosis that may become ?ow-limiting by perioperative haemodynamic ?uctuations and (ii) acute coronary syndromes (ACS) due to stress-induced rupture of a vulnerable atherosclerotic plaque in combination with vascular in?ammation and altered vasomotion, as well as haemosta- sis. LV dysfunction (...) cannot be ignored. 9 With regard to cardiac risk, surgical interventions—which include open or endovascular procedures—can be broadly divided into low-risk, intermediate-risk, and high-risk groups, with estimated 30-day cardiac event rates (cardiac death and myocardial infarction) of,1%, 1–5%, and.5%, respectively (Table3). The need for, and value of, pre-operative cardiac evaluation will also depend on the urgency of surgery. In the case of emergency sur- gical procedures, such as those for ruptured

2014 European Society of Cardiology

282. Aortic Diseases

arteries, can bevisualizedtoruleoutAAA. Transoesophageal echocardiography The relative proximity of the oesophagus and the thoracic aorta permitshigh-resolutionimageswithhigher-frequencytransoesopha- geal echocardiography (TOE) (Web Figure 2). 68 Also, multi-plane imaging permits improved assessment of the aorta from its root to thedescendingaorta. 68 Transoesophagealechocardiographyissemi- invasive and requires sedation and strict blood pressure control, as well as exclusion of oesophageal (...) ulcer (PAU) and traumatic aortic injury (TAI), pseudoaneurysm, aortic rupture, atherosclerotic and in?ammatory affections, as well asgeneticdiseases(e.g.Marfansyndrome)andcongenitalabnormal- itiesincludingthecoarctationoftheaorta(CoA). Similarly to other arterial diseases, aortic diseases may be diag- nosed after a long period of subclinical development or they may have an acute presentation. Acute aortic syndrome is often the ?rst sign of the disease, which needs rapid diagnosis and decision

2014 European Society of Cardiology

283. Guidelines for the treatment of malaria. Third edition

in the host, from merozoite invasion of red blood cells to schizont rupture (merozoite ? ring stage ? trophozoite ? schizont ? merozoites). The duration is approximately 24 h in Plasmodium knowlesi, 48 h in P. falciparum, P. ovale and P. vivax and 72 h in P. malariae. Asexual parasitaemia. The presence of asexual parasites in host red blood cells. The level of asexual parasitaemia determined by microscopy can be expressed in several ways: the percentage of infected red blood cells, the number of infected

2015 World Health Organisation Guidelines

284. Vascular Rings in Adults: Outcome of Surgical Management. (Abstract)

-SA and KD (n=20, 31%), double aortic arch (n=12, 18%), right arch with mirror imaging and persistent ligamentum off KD (n=7, 11%), and others (n=4, 6%). Indications for operation included dysphagia (n=43, 63%), respiratory symptoms (n=28, 43%), aneurysmal KD (n=12, 18%) and dissection/rupture (n=7, 11%).Kommerell's diverticulum was found in 51(78%) patients. Surgical approach included left-thoracotomy (n=50, 77%), right-thoracotomy (n=7, 11%), sternotomy (n=5, 8%) and hybrid-repair (n=3, 5%). A 2 (...) -stage repair with carotid-SA transposition followed by transthoracic KD excision was done in 51% of aberrant-SA (n=23). There was 1 early death. Morbidity included recurrent laryngeal nerve injury (n=5, 8%) and chylothorax (n=3, 5%). Symptomatic improvement occurred in 97%. Survival was 96.1%, 85.0%, and 73.4% at 1, 5, and 10years respectively. Dysphagia recurred in 9(14%) which included 7(11%) with esophageal dysmotility.Repair of VR in adults can be performed safely. Dysphagia is the most common

2019 Annals of Thoracic Surgery

285. Comparison of Surgical Intervention and Mortality for Seven Surgical Emergencies in England and the United States. (Abstract)

admissions in English hospitals and 1,863,626 admissions in US hospitals due to the index surgical emergencies.Proportion of patients receiving no surgical intervention, for all 7 conditions was greater in the England (OR 4.25, 1.55, 8.53, 1.92, 2.06, 2.42, 1.75) and population in-hospital mortality was greater in England (OR 1.34, 1.67, 2.22, 1.65, 2.7, 4.46, 3.22) for ruptured abdominal aortic aneurysm, aortic dissection, appendicitis, perforated esophagus, peptic ulcer, small bowel or large bowel (...) Comparison of Surgical Intervention and Mortality for Seven Surgical Emergencies in England and the United States. To examine differences between England and the USA in the rate of surgical intervention and in-hospital mortality for 7 index surgical emergencies.Considerable international variation exists in the configuration, provision, and outcomes of emergency healthcare.Patients aged <80 years hospitalized with 1 of 7 surgical emergencies (ruptured abdominal aortic aneurysm, aortic

2019 Annals of Surgery

286. Effect of local retropharyngeal steroids on fusion rate after anterior cervical discectomy and fusion. (Abstract)

levels treated, and smoking status. The case group had an overall fusion rate of 64.7%, whereas the control group had a fusion rate of 91%. When analyzed at each level of attempted fusion, the case group had a fusion rate of 81% compared to 93% in the control group. There was a single patient in the case group that developed esophageal rupture and retropharygeal abscess requiring surgical intervention with irrigation, debridement and repair at 8 months after index operation.The use of retropharyngeal

2019 The Spine Journal

287. Is Peritoneal Tumor Penetration of Prognostic Importance in Gastrointestinal Stromal Tumors? (Abstract)

with extraperitoneal tumors (esophagus, rectum) or ruptured tumors were excluded from the study. Rupture was defined according to the Oslo criteria, and PP was assessed via routine histopathologic examination by sarcoma pathologists.The study enrolled 341 patients. The median follow-up period was 51 months (range 0-175) months. In 82 (24%) of the 341 patients, PP was recorded. There were 32 recurrences, 9 in patients with PP and 23 in patients without PP. Despite statistically significant associations between PP (...) Is Peritoneal Tumor Penetration of Prognostic Importance in Gastrointestinal Stromal Tumors? Peritoneal tumor penetration (PP) strongly affects prognosis in gastrointestinal carcinomas. In gastrointestinal stromal tumor (GIST), its significance in the absence of tumor rupture has not been subjected to detailed analysis.Patients undergoing complete resection for non-metastatic GIST from 2000 to 2017 were identified in the regional sarcoma database at Oslo University Hospital. Patients

2019 Annals of Surgical Oncology

288. Partial Splenic Embolization is a Safe and Effective Alternative in the Management of Portal Hypertension in Children. (Abstract)

patients (80.8%). Children with prior esophageal varices showed improvement after PSE with only nine (34.6%) requiring further endoscopic therapy. After PSE, patients developed transient abdominal pain, distention, fever, and peri-splenic fluid collections. Serious complications such as splenic abscess, splenic rupture, bleeding, pancreatic infarction, opportunistic infection or death were not observed. One patient experienced thrombotic complications following PSE and was later diagnosed

2019 Journal of Pediatric Gastroenterology and Nutrition

292. Parathyroid Cancer Treatment (PDQ®): Health Professional Version

laryngeal nerve, trachea, or esophagus. Some patients are not identified preoperatively or intraoperatively as having parathyroid carcinoma and undergo parathyroid procedures devised to treat parathyroid adenoma. Only after review of the postsurgical pathology, or when these patients experience local or distant recurrence, is a correct diagnosis of parathyroid carcinoma made.[ ] Parathyroid carcinoma tends to be localized in the inferior parathyroid glands; one series reported that the primary tumor (...) , pp 1473-9. Shane E: Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab 86 (2): 485-93, 2001. [ ] Localized Parathyroid Cancer Treatment options: [ - ] The initial operation should include an en bloc resection of the tumor that takes care to avoid rupture of the tumor capsule and to ensure that the margins are free of tumor. This procedure will involve a parathyroidectomy, typically an ipsilateral thyroidectomy (thyroid lobectomy), and possibly resection of adjacent cervical

2017 PDQ - NCI's Comprehensive Cancer Database

293. Gastrointestinal Stromal Tumors Treatment (PDQ®): Health Professional Version

%). Small intestine (30%). Duodenum (5%). Rectum (3%). Colon (1%). Esophagus (<1%). Omentum/mesentery (rare). Gastrointestinal stromal tumors (GISTs) may be found anywhere in or near the gastrointestinal tract. Less frequently, GIST may arise in the appendix, gallbladder, pancreas, retroperitoneum, and paravaginal and periprostatic tissues.[ ] Approximately 20% to 25% of gastric GIST and 40% to 50% of small intestinal GIST are clinically aggressive.[ , ] It has been estimated that approximately 10 (...) % to 25% of patients present with metastatic disease.[ , ] The clinical presentation of patients with GIST varies depending on the anatomic location of the tumor and the tumor size and aggressiveness.[ ] The most common presentation of GIST is GI bleeding, which may be acute (melena or hematemesis) or chronic and results in anemia.[ ] GIST patients may also present with: An acute abdomen caused by tumor rupture. GI obstruction. Appendicitis-like pain. Other clinical symptoms include the following

2017 PDQ - NCI's Comprehensive Cancer Database

294. Hiccups

arrhythmias, insomnia, weight loss, and oesophagitis. Have I got the right topic? Have I got the right topic? From birth onwards. This CKS topic covers the management of transient, persistent, and intractable hiccups (also called 'hiccoughs' or 'singultus'). This CKS topic does not cover the use of drug treatments for intractable hiccups in children. There is a separate CKS topic on . The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first (...) and phrenic nerve irritation include: subphrenic abscess, splenomegaly, hepatomegaly, myocardial infarction, pericarditis, hiatus hernia, oesophageal cancer, or an aberrant cardiac pacemaker electrode. Underlying causes of vagus nerve irritation can result from pathologies which interfere with its function at any point along the length of the nerve. This is a long list of possible differential diagnoses which include: a foreign body irritating the tympanic membrane, pharyngitis, laryngitis, goitre or neck

2017 NICE Clinical Knowledge Summaries

295. Chest pain

, or arrhythmias. Respiratory causes of chest pain include: Pulmonary embolus, pneumothorax or tension pneumothorax, community-acquired pneumonia, asthma, or pleural effusion. Other causes of chest pain include: Gastroenterological causes, such as acute pancreatitis, oesophageal rupture, peptic ulcer disease, gastro-oesophageal reflux, oesophageal spasm, or oesophagitis. Musculoskeletal causes, such as rib fracture, costochondritis, spinal disorders (disc prolapse, cervical spondylosis, facet joint dysfunction (...) last for several days. There is associated nausea and vomiting. Signs — abdominal tenderness (mild tenderness in the upper abdomen to generalized peritonitis), abdominal distension, Cullen's sign (a bluish discolouration around the umbilicus), or Grey–Turner's sign (bluish discolouration around the flank), and low blood pressure. There may be a low-grade fever. To confirm a diagnosis of acute pancreatitis, see the CKS topic on . Oesophageal rupture History — a recent history of a medical procedure

2017 NICE Clinical Knowledge Summaries

296. Self-expandable Esophageal Stent Versus Balloon Tamponade in Refractory Esophageal Variceal Bleeding.

pressure > 70 mmHg and heart rate < 100 bpm) could be achieved. Exclusion Criteria: Age < 18 years. Esophageal rupture. Esophageal, gastric or upper respiratory tract tumor. Esophageal stenosis. Recent esophageal surgery. Previous esophageal tamponade to treat the index bleed. Big hiatal hernia precluding the correct placement of the esophageal devices. Known hepatocellular carcinoma surpassing Milan criteria. Terminal disease. No written consent to participate in the study. Contacts and Locations Go (...) Self-expandable Esophageal Stent Versus Balloon Tamponade in Refractory Esophageal Variceal Bleeding. Self-expandable Esophageal Stent Versus Balloon Tamponade in Refractory Esophageal Variceal Bleeding. - Full Text View - Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please

2010 Clinical Trials

298. Insertion of Colonic Stents

and management of colorectal obstruction. Clinical expert opinion indicates that these may apply to both single- stage and multi-stage resection procedures. MBS item no Type of resection procedure 30375 Caecostomy, Enterostomy, Colostomy, Enterotomy, Colotomy, Cholecystostomy, Gastrostomy, Gastrotomy, Reduction of intussusception, Removal of Meckel's diverticulum, Suture of perforated peptic ulcer, Simple repair of ruptured viscus, Reduction of volvulus, Pyloroplasty (adult) or Drainage of pancreas Fee (...) noted that the current comparator is colorectal surgery, an open surgical procedure, and noted that it may be more appropriate to base the fee for SEMS insertion on similar stenting procedures such as the insertion of oesophageal stents. ESC indicated a greater breakdown of the inputs to this fee would assist their understanding of the rationale for this fee being higher compared to surgery i.e. colostomy for both time and technical skills required. 14. Other significant factors Table 61: ‘colostomy

2012 Medical Services Advisory Committee

299. Transition of a Mallory-Weiss syndrome to a Boerhaave syndrome confirmed by anamnestic, necroscopic, and autopsy data: A case report. Full Text available with Trip Pro

Transition of a Mallory-Weiss syndrome to a Boerhaave syndrome confirmed by anamnestic, necroscopic, and autopsy data: A case report. Spontaneous esophageal rupture (Boerhaave syndrome) is a rare, though frequently fatal, event. It is generally caused by a sudden increase in pressure inside the esophagus. In some cases, full-thickness perforations of the esophagus may develop from previous lesions that initially involve only the esophageal mucosa (Mallory-Weiss syndrome) and which, following (...) further triggering events, give rise to a transmural lesion.Here, we present the case of a 45-year-old subject who suddenly died of acute cardio-respiratory failure, an autopsy was performed to identify the cause of death.The autopsy examination revealed a full-thickness rupture of the esophageal wall. Through the integration of necroscopy findings, anamnestic data, and histopathological examination, it has been possible to establish that complete esophageal rupture resulted from the evolution

2018 Medicine

300. Bacteriology and clinical outcomes of patients with culture-positive pleural infection in Western Australia: A 6-year analysis. Full Text available with Trip Pro

hospitals electronic record. Culture isolates, admission dates, vital status, co-morbidities, radiology, blood and pleural fluid tests were extracted.In total, 601 cases (71.4% males; median age: 63 years (IQR: 50-74); median hospital stay 13 days) involving 894 bacterial isolates were identified. Hospital-acquired (HA)-CPPI was defined in 398 (66.2%) cases, community-acquired (CA)-CPPI in 164 (27.3%) cases and the remaining classified as oesophageal rupture/leak. Co-morbidities, most frequently cancer

2018 Respirology

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