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Esophageal Rupture

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641. Duodenal Atresia

-bubble appearance with no distal gas are characteristic of duodenal atresia (see the images below). Distal bowel gas indicates stenosis, incomplete membrane, or a hepatopancreatic ductal anomaly. Occasionally, a radiograph must be obtained with the patient in the erect or the decubitus position to delineate the duodenal component. If a combination of esophageal atresia and duodenal atresia is present, ultrasonography is preferred. [ ] Anteroposterior radiograph of the abdomen depicts the double (...) -bubble sign of duodenal atresia. Note the flattened acetabular angles and broadened ilia of a patient with trisomy 21. Lateral radiograph demonstrates the double-bubble sign of duodenal atresia. Anteroposterior projection of the chest and abdomen demonstrates the double-bubble sign of duodenal atresia in the abdomen, as well as a proximal dilated pouch (right arrow) resulting from esophageal atresia; this displaces the trachea (left arrow) toward the right side in the superior mediastinum

2014 eMedicine Radiology

642. Empyema

, septa, or gas bubbles in the pleural space (indicated in the first image below). Gas bubbles in the pleural space strongly suggest an empyema in the proper clinical context (ie, in the absence of recent thoracentesis). Lung windows can demonstrate pneumonia adjacent to the abnormal pleural collection. Soft-tissue windows can demonstrate a cause for the empyema, such as esophageal rupture or mediastinal surgery. With most empyemas, enhanced chest CT scans demonstrate the split-pleura sign (see (...) ; these are called complicated effusions. The resulting infection and inflammatory response can proceed until adhesive bands form. The infected fluid becomes loculated pus in the pleural space. may also result from causes other than . Any process that introduces pathogens into the pleural space can lead to an . Some of these other causes are the following: Thoracic trauma (in about 1-5% of cases) Rupture of a lung abscess into the pleural space Extension of a non–pleural-based infection (eg, , abdominal

2014 eMedicine Radiology

643. Esophagus, Tear

30, 2018 Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR; Chief Editor: Eugene C Lin, MD Share Email Print Feedback Close Sections Sections Esophageal Tear Imaging Practice Essentials is defined as a breach of the esophageal wall resulting from a mucosal tear, perforation, or rupture. Tears of the esophagus are life-threatening conditions that require prompt diagnosis and emergency treatment. Esophageal perforations allow the upper gastrointestinal (GI) contents to egress from the esophageal lumen (...) and therapeutic endoscopy and esophageal surgery have made endoscopic instrumentation the most common cause of esophageal rupture. [ ] , and rare spontaneous esophageal hematomas are all forms of esophageal tear that usually occur during vomiting. Other precipitating factors of spontaneous tears include straining, hiccupping, coughing, primal scream therapy, blunt abdominal trauma, cardiopulmonary resuscitation, or any event accompanied by a marked and often sudden elevation of abdominal pressure. In a few

2014 eMedicine Radiology

644. Sternoclavicular Joint Injury (Overview)

, signifying a complete breach of the sternoclavicular ligament but at most, only a partial tear of the costoclavicular ligament. With a third-degree injury, complete rupture of the sternoclavicular and costoclavicular ligaments permits the clavicle to completely dislocate from the manubrium. A significant direct or indirect force to the shoulder region can cause a traumatic dislocation of the SCJ. [ ] Anterior dislocations of the SCJ are much more common (by a 20:1 ratio), usually resulting from (...) , thrombosis, and pseudoaneurysm formation of the adjacent blood vessels (including the aorta, superior vena cava, subclavian artery or vein, brachiocephalic artery or vein, mammary artery, and jugular vein) Nerve injury (including cerebrovascular accident, phrenic nerve and brachial plexus injury) Esophageal injury These and other complications can cause significant disability, including even cerebrovascular accident and death. [ , , ] Sex Overall incidence of sternoclavicular joint injury is higher

2014 eMedicine Emergency Medicine

645. Shock, Hypovolemic (Follow-up)

, and then the esophageal one is inflated if bleeding continues. The use of this tube has been associated with severe adverse reactions, such as esophageal rupture, asphyxiation, aspiration and mucosal ulceration. For this reason, its use should be considered only as a temporary measure in extreme circumstances. Virtually all causes of acute gynecological bleeding that cause hypovolemia (eg, ectopic pregnancy, placenta previa, abruptio placenta, ruptured cyst, miscarriage) require surgical intervention. Early (...) secondary to more definitive measures. H 2 blockers are relatively safe but have no proven benefit. Somatostatin and octreotide infusions have been shown to reduce gastrointestinal bleeding from varices and peptic ulcer disease. These agents possess the advantages of vasopressin without the significant side effects. In patients with variceal bleeding, use of a Sengstaken-Blakemore tube can be considered. These devices have a gastric balloon and an esophageal balloon. The gastric one is inflated first

2014 eMedicine Emergency Medicine

646. Spontaneous perforation of the esophagus in a patient with achalasia. (Abstract)

Spontaneous perforation of the esophagus in a patient with achalasia. Esophageal perforation in achalasia is rare. The risk would mainly follow pneumatic dilatation, and spontaneous perforation has not been described. We report a case of spontaneous rupture of the midesophagus in a 56-year-old woman with treated achalasia in whom the perforation occurred during a meal and was not preceded by emesis. A gastrografin swallow confirmed extravasation of contrast medium from the esophagus (...) , and endoscopy revealed significant esophageal food stasis, consistent with achalasia, with a large tear in the midesophagus and gross mediastinal contamination. She subsequently underwent a three-stage esophagectomy with an uneventful recovery. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

2013 Annals of Thoracic Surgery

647. A Study of Onartuzumab as Single Agent and in Combination With Sorafenib in Patients With Advanced Hepatocellular Carcinoma

treatment, with the exception of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections Known active infection with human immunodeficiency virus (HIV) or known HIV-seropositivity Inability to take oral medication or untreated malabsorption syndrome Pregnant or lactating women History of transplantation including organ, bone marrow transplantation, and peripheral blood stem cell transplantation with the exception of corneal transplantation Active bleeding diathesis (including active esophageal (...) varices) or tumor rupture within 8 weeks prior to Cycle 1 Day1 that are not successfully treated Uncontrolled hypertension Treatment with any other investigational drug within 4 weeks of Cycle 1 Day Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials.gov identifier (NCT number

2013 Clinical Trials

648. Study Comparing Two Ventilation Modes NAVA (Neurally Adjusted Ventilatory Assist) Mode and Spontaneous Breathing With Inspiratory Pressure Support (IPS) Mode in Consecutive Patients Hospitalized for Acute Respiratory Failure Requiring Mechanical Ventilati

tube or to the repositioning of a tube already in place: Recent gastrointestinal suture ; Esophageal varices rupture with gastrointestinal bleeding within 4 days prior to inclusion; Therapeutic limitation or active treatment discontinuation; Pregnant women; Minors; Protected adults; Patient already included in the study; Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using

2013 Clinical Trials

649. Preemie Hypothermia for Neonatal Encephalopathy

hypothermia for 72 hours in preterm infants 33-35 weeks gestational age (GA) who present at <6 hrs postnatal age with moderate to severe neonatal encephalopathy. Infants 33 0/7 to 35 6/7 weeks GA (best obstetrical estimate) and greater than or equal to 1500 grams birth weight (selected to minimize potential difficulties placing esophageal probe) who meet clinical, biochemical and neurologic criteria for moderate to severe NE will be randomized to either whole body hypothermia or participate in a non (...) : Arms and Interventions Go to Arm Intervention/treatment Experimental: Whole-body Hypothermia Induced Whole-body hypothermia (with a target esophageal temperature of 33.5°C) for 72 hours Device: Hypothermia Induced Whole-body hypothermia (with a target esophageal temperature of 33.5°C) for 72 hours Placebo Comparator: Normothermia Control group (with esophageal temperature at or near 37.0°C) for 72 hours Procedure: Normothermic Control Normothermic Control group (with esophageal temperature

2013 Clinical Trials

650. Treatment Schistosomal Portal Hypertension: Efficacy of Endoscopy or Surgery

Information provided by (Responsible Party): Celina Maria Costa Lacet, Universidade Estadual de Ciências da Saúde de Alagoas Study Details Study Description Go to Brief Summary: Upper gastrointestinal bleeding (UGIB) is a major cause of morbidity and mortality in patients with portal hypertension secondary to schistosomiasis mansoni. Taking into account the endemic nature of schistosomiasis mansoni in our region and the high morbidity and mortality directly associated with rupture of esophageal varices (...) criteria for exclusion received the current standard of care and follow-up and were analyzed as a third group in the study. Over a two-year period, 79 patients were recruited for elective treatment of SPH. The criteria for selection were: a) an established diagnosis of hepatosplenic schistosomiasis as the cause of portal hypertension; b) a history of UGIB secondary to rupture of esophageal varices, with at least 20 days having elapsed since the most recent episode of bleeding; and c) age between 15

2013 Clinical Trials

651. Boramae Liver Cirrhosis Cohort Study

ml of blood will be collected for freezing and storage of serum and plasma, and constitution of a DNA library. Monitoring: Patients will have regular surveillance with blood test, liver ultrasonography and medical consultation at least every 6 months, periodic assessment of esophageal, gastric varices and portal hypertensive gastropathy (every 1 year) and prevention of their rupture if any. An additional blood sampling of 20 ml will be taken at baseline and every year in order to perform whole

2013 Clinical Trials

652. False Passage to the Trachea after Emergency Intubation in a Victim of Near Hanging Full Text available with Trip Pro

False Passage to the Trachea after Emergency Intubation in a Victim of Near Hanging Emergency medicine physicians should have enough knowledge and experience to deal with emergent and traumatic difficult airway. In this paper, we present a case of near hanging with neck soft tissue injury, tracheal and esophageal rupture that is complicated by a displaced intubation and false passage to the trachea.

2013 Case Reports in Emergency Medicine

653. Cytomorphology of Boerhaave's syndrome: A critical value in cytology Full Text available with Trip Pro

of such critical condition and help in better and early management of this disease. We describe a case of an 81-year-old female with esophageal perforation who presented with a left sided pleural effusion. The correct diagnosis was established in this case by observing gastrointestinal-like fluid characteristics of the thoracic drainage upon cytological and chemical analyses and the rupture was confirmed by esophagography. The cytological examination of pleural fluid revealed benign reactive squamous cells (...) Cytomorphology of Boerhaave's syndrome: A critical value in cytology Spontaneous esophageal perforation into the pleural cavity (Boerhaave's syndrome) is a rare life-threatening condition, which requires early diagnosis and urgent management. The diagnosis of such critical condition in many cases is delayed because of atypical clinical presentation, resulting in increased morbidity and mortality. Cytological examination of pleural fluid can provide early, fast and accurate diagnosis

2013 CytoJournal

654. Autosomal Dominant Polycystic Kidney Disease

) ADPKD1 gene on short arm of 16 PKD1 encodes integral membrane protein Polycystin-1 End-stage renal disease average age of onset: 57 Associated with a higher risk of progression to end-stage renal disease than for the PKD2 gene mutation PKD2 : (14% of cases) ADPKD2 gene on 4 PKD2 encodes integral membrane protein Polycystin-2 End-stage renal disease average age of onset: 69 V. Symptoms Symptom onset is delayed until patients are in their 30-40s Flank or (60%) causes rupture Enlarged compression (...) years (males): 6 or more cysts in each s Age 45 to 59 years (females): 9 or more cysts in each s References X. Complications (at least 45% of cases) Accounts for 5-10% of ( ) By age 70 years old, 80% have end-stage renal disease or have died of other cause Children: 30% Adults: 60% : 80% Extra- s Extra- s most commonly occur in the liver (34-78%) s also occur in the ovaries, s, , and central nervous system (26%) (due to aortic root dilitation) (associated with rupture) (20%) (5-10%) At least twice

2015 FP Notebook

655. Obesity Surgery

complications See specific complications below High risk presentations (red flag) (red flag) or Bleeding with Approach Involve bariatric surgeon early in presentation to discuss evaluation and management strategy (often indicated, but beware false negatives) When performing , consider CT chest for given similar presentations caution with oral due to small proximal pouch Avoid harmful measures Avoid s, , and other irritative agents Avoid Risk of proximal pouch rupture Ineffective at decompression after most (...) M&M size or smaller Avoid enteric coated, delayed-release or sustained release products s is preferred Avoid s due to peptic ulcer risk (or if absolutely unavoidable, combine with ) Medications requiring dose modification (or elimination) as weight loss occurs Antihypertensives s (e.g. s) Diabetes Medications Avoid agents associated with (e.g. s) (increased risk after Bariatric Surgery) Obtain 2 years after surgery Avoid oral due to esophageal ulcer risk (at least in short term following

2015 FP Notebook

656. Nasogastric Tube

Esophagitis or Esophageal reflux Rupture of X. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Nasogastric Tube." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Ontology: Nasogastric tube (C0085678) Definition (UMD) Tubes designed to access the stomach through the nose, nasopharynx, and esophagus for examination, treatment, or other purposes (...) ) Increased secretions and need for suctioning Increased need for repositioning Clogged or kinked Secondary mechanical obstruction from (pylorus obstruction or ) Nasopharyngeal Nasopharyngeal erosions Trachea, and lung Post-cricoid perichondritis Misdirected tube into airway (with risk of infusion directly into lung) Tracheoesophageal fistula Gastric aspiration with secondary pneumonitis Tracheobronchial perforation Airway obstruction Esophagus Esophageal bleeding Esophageal or duodenal perforation

2015 FP Notebook

657. Transesophageal Ultrasonography

and not interfere with efforts Heart function and compression quality can be accurately monitored Distinguishes cardiac standstill (true PEA or ) from ineffective contraction May identify , PE with RV strain, vascular rupture III. Contraindications Severe esophageal stenosis Tracheoesophageal fistula More common in gastrostomy IV. Technique: Scope Assumes or TEE is inserted and steered in similar fashion to bronchoscope, or endoscope Multiplane transducer lies in the scopes flat head Transducer direction (...) is manipulated with thumb pad on scope handle Examiner hand positions Examiner holds scope with non-dominant hand by patients mouth to insert, secure or withdraw the tube Examiner uses dominant hand to hold the scope handle and manipulate the transducer direction Key Views (see below) Mid-Esophageal Four-Chamber View (MEFC View) Transgastric Mid-Papillary Short-Axis View (TGMPSA) V. Imaging: Mid-Esophageal Four-Chamber View (MEFC View) Positioning Visualized on initial probe insertion Multiplane transducer

2015 FP Notebook

658. Aortic Dissection

to (TEE) or MRA : 100% with new generation CT (older studies quoted 94%) : 98% with new generation CT (older studies quoted 90%) : 97% : 75-90% MRA Not recommended as an emergency evaluation (may be indicated in some stable patients) : 98% : 98% : 90% : Low (non-diagnostic) Unlikely to demonstrate anything more than intrathoracic catastrophe (progressive), aortic knob widening Tracheal, al or esophageal deviation XIII. Complications Neurologic deficits Unequal perfusion Unequal pulses Unequal (...) extremity s (with ) Aortic valve rupture XIV. Management Lower (in addition to lowering) Goals (confirm goal levels with accepting vascular surgeon) goal: <120 mmHg (based on consensus expert opinion) goal: <60 bpm (based on consensus expert opinion) First-Line Agents Clevidipine 20-40 mg incremental boluses IV Consider while awaiting CT imaging and diagnosis Adjunctive measures Decreasing pain will decrease Older agents that have largely been replaced 0.5-10 ug/kg/min IV Trimethaphan 1-4 mg/min IV

2015 FP Notebook

659. Pneumomediastinum

: Pneumomediastinum From Related Chapters II. Pathophysiology Spontaneous rupture of alveolus or bleb Results from increased pressure gradient Negative (Inhalation) Positive (Valsalva) Air tracks along vessels and Air coalesces in mediastinum III. Causes (e.g. ) ing Weight lifting Parturition IV. Symptoms Worse with lying Better with sitting V. Signs Subcutaneous (50%) VI. Differential Diagnosis Tension Pneumomediastinum VII. Radiology: Chest XRay As many as 50% Pneumomediastinum cases missed on PA Review Lateral (...) or other situations that lead to air escaping from the lungs, airways or bowel into the chest cavity. Definition (NCI) The presence of air in the mediastinum. It is caused by injury, most often esophageal or intestinal perforation. Definition (MSH) Presence of air in the mediastinal tissues due to leakage of air from the tracheobronchial tree, usually as a result of trauma. Concepts Pathologic Function ( T046 ) MSH ICD10 SnomedCT 155627006 , 390899006 , 196144009 , 266411000 , 16838000 English

2015 FP Notebook

660. Comparing the preventive effect of midazolam and midazolam-dexamethasone on postoperative nausea and vomiting in elective middle ear surgery. Full Text available with Trip Pro

Comparing the preventive effect of midazolam and midazolam-dexamethasone on postoperative nausea and vomiting in elective middle ear surgery. Nausea and vomiting are common postoperative complications with incidence of 20-80% depends on the surgery type, anesthetic drugs, age, sex, etc. This complication may lead to patient discomfort, intraocular, and intracerebral pressures increase, sutures rupture, esophageal injury, and rarely death. Many studies reported that midazolam and dexamethasone

2012 Advanced biomedical research Controlled trial quality: uncertain

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