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Sample records for esophageal injury complicated

  1. [Esophageal stenting complications].

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    Smoliar, A N; Radchenko, Iu A; Nefedova, G A; Abakumov, M M

    2014-01-01

    The aim of the study was to analyze esophageal stenting complications in case of cancer and benign diseases. It was investigated complications in 8 patients in terms from 7 days to 1 year after intervention. In 4 patients esophageal stenting was performed for constrictive esophageal cancer and compression with pulmonary cancer metastases into mediastinal lymphatic nodes. 2 patients had esophageal stenting for post-tracheostomy tracheo-esophageal fistula, 1 patient - for spontaneous esophageal rupture, 1 patient - for post-burn scar narrowing of esophagus and output part of the stomach. Severe patients' condition with tumor was determined by intensive esophageal bleeding in 2 cases, bilateral abscessed aspiration pneumonia, tumor bleeding, blood aspiration (1 case), posterior mediastinitis (1 case). Severe patients' condition with benign disease was associated with decompensated esophageal narrowing about proximal part of stent (1 case), increase of tracheo-esophageal fistula size complicated by aspiration pneumonia (1 case), stent migration into stomach with recurrence of esophago-mediastino-pleural fistula and pleural empyema (1 case), decompensated narrowing of esophagus and output part of the stomach (1 case). Patients with cancer died. And patients with benign diseases underwent multi-stage surgical treatment and recovered. Stenting is palliative method for patients with esophageal cancer. Patients after stenting should be under outpatient observation for early diagnosis of possible complications. Esophageal stenting in patients with benign diseases should be performed only by life-saving indications, in case of inability of other treatment and for the minimum necessary period.

  2. Complications following esophageal surgery.

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    Horváth, O P; Lukács, L; Cseke, L

    2000-01-01

    Chronologically, complications can be classified as intraoperative, early, and late. The authors analyze complications according to this classification on the basis of more than 400 esophageal operations and related literary data. As regards intraoperative complications, they deal only with those occurring at transhiatal esophagectomy (e.g., tracheal tear, bleeding, pneumothorax, laryngeal nerve injury). Among the early complications, they survey the incidence of transplant necrosis and related mortality, further sequelae ensuing from subacute ischemia of the replaced organ and analyze in detail the questions which arise regarding anastomotic leakage. Firstly, they deal with those causative factors that influence the frequency of anastomotic insufficiency, such as the technical "know-how" of anastomosis making (e.g., one layer vs two layers; stapling or manual suture; interrupted or running suture), the way of replacement using whole stomach or tube-stomach and the consequences originating from the route of replacement (e.g., anterior or posterior mediastinal route). Incidence and management of chylothorax are also dealt with. While dealing with late complications, the authors give a detailed comment on anastomotic strictures and also other factors facilitating the development of late dysphagia, such as peptic stricture and tumor of the organ remnant. Finally, some cases successfully treated by surgery are presented (skin-tube formation in cases following transplant necrosis; abolition of a pharyngogastric anastomosis stricture using a free jejunal transplant and surgical solution of an anastomotic stricture from median sternotomy approach).

  3. Combined esophageal injury complicated by progression to a second perforation: a case report

    Directory of Open Access Journals (Sweden)

    Krieg Andreas

    2009-09-01

    Full Text Available Abstract Introduction Intramural dissection of the esophagus is a rare disorder characterized by a lesion between the submucosa and mucosa dividing the esophagus into a false and true lumen. The etiology of esophageal dissection remains uncertain but it affects predominantly women in their seventies and eighties. Symptoms may include uncharacteristic ones such as retrosternal pain, odynophagia or dysphagia. Conservative management is thought to be adequate and surgery should only be performed if complications such as abscess formation or perforation appear. Here we report the case and surgical management of a combined esophageal perforation and dissection. Case presentation We report the case of a combined esophageal perforation and dissection in a 45-year-old Caucasian woman with a history of relapsing periods of dysphagia since her childhood. The clinical course in this patient was complicated by progression to a second perforation, which made a definitive surgical management by esophagectomy necessary. Conclusion To the best of our knowledge, this is the first reported case of a combined esophageal perforation and dissection complicated by progression to a second perforation. This emphasizes that cautious and intensive observation is necessary in patients with esophageal dissection.

  4. Avoiding complications in esophageal cancer surgery

    DEFF Research Database (Denmark)

    Mortensen, Michael Bau

    2013-01-01

    as a direct consequence of complications related to the esophagectomy procedure. Primarily based on results from randomized studies published after 2000 this review describes some of the factors that may contribute to the development of postoperative complications following esophageal cancer surgery as well...... as studies intended to finding ways of reducing the complication rate....

  5. Chronic xerostomia increases esophageal acid exposure and is associated with esophageal injury

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    Korsten, M.A.; Rosman, A.S.; Fishbein, S.; Shlein, R.D.; Goldberg, H.E.; Biener, A. (Gastrointestinal Section, Veterans Affairs Medical Center, Bronx, New York (USA))

    1991-06-01

    OBJECTIVES: To assess the effects of chronic xerostomia on parameters of gastroesophageal reflux and esophagitis. DESIGN: Observational study of a cohort of male patients with xerostomia and age-matched control subjects. SETTING: Tertiary-care Veterans Affairs Medical Center. SUBJECTS: Sixteen male patients with chronic xerostomia secondary to radiation for head and neck cancers or medications. Nineteen age-matched male control subjects with comparable alcohol and smoking histories. MEASUREMENTS AND MAIN RESULTS: Esophageal motility was similar in patients with xerostomia and controls. Clearance of acid from the esophagus and 24-hour intraesophageal pH were markedly abnormal in patients with xerostomia. Symptoms and signs of esophagitis were significantly more frequent in subjects with xerostomia. CONCLUSIONS: Chronic xerostomia may predispose to esophageal injury, at least in part, by decreasing the clearance of acid from the esophagus and altering 24-hour intraesophageal pH. Esophageal injury is a previously unreported complication of long-term salivary deficiency.

  6. Multiple Ligament Knee Injury: Complications

    OpenAIRE

    Manske, Robert C.; Hosseinzadeh, Pooya; Giangarra, Charles E.

    2008-01-01

    Non-operative and operative complications are common following multiple ligament knee injuries. This article will describe common complications seen by the surgeon and physical therapist following this complex injury. Complications include fractures, infections, vascular and neurologic complications following injury and surgery, compartment syndrome, complex regional pain syndrome, deep venous thrombosis, loss of motion and persistent laxity issues. A brief description of these complications ...

  7. esophageal carcinoma complicating achalasia, 25 years post ...

    African Journals Online (AJOL)

    mine

    Wychulis and associates 9 reported on. 1,318 patients treated for esophageal achalasia at the Mayo clinic for an average of 13 years per patient. Carcinoma developed in seven of these patients, an incidence almost seven times that in the general population. In Nigeria, Pindiga 10 retrospectively analysed 177 histologically.

  8. Caustic esophageal injury by impaction of cell batteries.

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    García Fernández, Francisco José; León Montañés, Rafael; Bozada Garcia, Juan Manuel

    2016-12-01

    The ingestion of cell batteries can cause serious complications (fistula, perforation or stenosis) at the esophageal level. The damage starts soon after ingestion (approximately 2 hours) and is directly related to the amount of time the battery is lodged in said location, the amount of electrical charge remaining in the battery, and the size of the battery itself. Injury is produced by the combination of electrochemical and chemical mechanisms and pressure necrosis. The ingestion of multiple cells and a size > = 20 mm are related with more severe and clinically significant outcomes. A female patient, 39 years old, with a history of previous suicide attempts, was admitted to the Emergency Room with chest pain and dysphagia after voluntary ingestion of 2 cell batteries. Two cell batteries are easily detected in a routine chest X-ray, presenting a characteristic double-ring shadow, or peripheral halo. Urgent oral endoscopy was performed 10 hours after ingestion, showing a greenish-gray lumpy magma-like consistency due to leakage of battery contents. The 2 batteries were sequentially removed with alligator-jaw forceps. After flushing and aspiration of the chemical material, a broad and circumferential injury with denudation of the mucosa and two deep ulcerations with necrosis were observed where the batteries had been. The batteries' seals were eroded, releasing chemical contents. Despite the severity of the injuries, the patient progressed favorably and there was no esophageal perforation. Esophageal impaction of cell batteries should always be considered an endoscopic urgency.

  9. [Esophageal candidiasis as complication of inhaled steroid therapy].

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    Shuto, Hiroshi; Nagata, Makoto; Terashi, Yoshinori; Yamaguchi, Michiya; Takizawa, Takao; Shuto, Chizuru; Watanabe, Kensuke; Tosaka, Kaoru; Okano, Masahiko; Noguchi, Hisashi

    2003-11-01

    Gastrointestinal endoscopy was performed in two bronchial asthma patients using inhaled corticosteroid who complained of odynophagia. The endoscopic finding was high grade with white moss (Grade III) in both patients. Esophageal candidiasis is often recognized in bronchial asthmatic patients receiving long-term fluticasone propionate (FP) dry powder (Diskhaler) inhalation. We therefore examined the complicated context of esophageal candidiasis in patients with long-term FP inhalation. Out of 20 bronchial asthmatic patients who had been using FP inhalation long-term, seven showed signs of esophageal candidiasis. Three patients had mild grade (Grade I), one middle grade (Grade II) and three high grade (Grade III) candidiasis, with a frequency of 35%. This rate is higher than the usual spontaneous occurrence rate of esophageal candidiasis, and it is suggested that inhalation of corticosteroid medication can penetrate into the esophagus after deep inhalation. We tested this hypothesis in two studies. 1) To measure the esophageal concentration of FP, four healthy adults inhaled 200 microg FP once. Right after inhalation, FP concentration in the esophageal washing fluid was 3.3 microg. On another day, 30 minutes after the same dose of inhaled FP, one FP concentration in the esophageal washing fluid was 0.67 microg (immediately laydown), and another was 0.11 microg (remained standing). This indicates that even though FP dissipates quickly, it remains in the esophagus 30 minutes after inhalation. 2) We observed the process in one patient with high grade (Grade III) esophageal candidiasis. The time of inhalation was changed from just after getting up and just before going to bed to before breakfast and before dinner. Under this regimen, the signs of esophageal candidiasis improved from high to middle grade. If asthmatic patients do not go to sleep immediately after FP inhalation, the remaining FP in the esophagus decreases rapidly, thereby decreasing the risk of esophageal

  10. Complications of endoscopic dilation for esophageal stenosis after endoscopic submucosal dissection of superficial esophageal cancer.

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    Kishida, Yoshihiro; Kakushima, Naomi; Kawata, Noboru; Tanaka, Masaki; Takizawa, Kohei; Imai, Kenichiro; Hotta, Kinichi; Matsubayashi, Hiroyuki; Ono, Hiroyuki

    2015-10-01

    Endoscopic dilation (ED) is used for the treatment of benign strictures caused by reflux esophagitis or anastomotic stenosis after esophagectomy. Esophageal stenosis is a major complication after endoscopic submucosal dissection (ESD) of large superficial esophageal cancer, but little is known regarding the incidence of complications of ED for stenosis caused by esophageal ESD. This was a retrospective study conducted at a single institution. From September 2002 to December 2012, a total of 1,337 ED procedures were performed for stenosis after esophageal ESD in 121 patients. The incidence of complications of ED and related clinical characteristics were analyzed. The incidence of bleeding was 0.8 % (1/121) per patient and 0.07 % (1/1,337) per procedure. The incidence of perforation was 4.1 % (5/121) per patient and 0.37 % (5/1,337) per procedure. Perforation occurred at a median of third time of ED procedures (range 2-9 procedures) and at a median of 18 days (range 8-29 days) after ESD. There were no significant characteristics correlated to perforation, such as location, circumferential extent, or diameter of mucosal defect after ESD. The total number of ED procedures was significantly larger among perforation cases (37, range 6-57) compared with those without perforation (7, range 1-70) (p = 0.01), and the treatment duration tended to be longer (190 vs. 69 days, respectively). The incidence of bleeding caused by ED for esophageal stenosis after ESD was very low. Relevant risk of perforation should be considered for patients requiring multiple ED procedures.

  11. Esophageal thermal injury by hot adlay tea.

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    Go, Hoon; Yang, Hyeon Woong; Jung, Sung Hee; Park, Young A; Lee, Jung Yun; Kim, Sae Hee; Lim, Sin Hyung

    2007-03-01

    Reversible thermal injury to the esophagus as the result of drinking hot liquids has been reported to generate alternating white and red linear mucosal bands, somewhat reminiscent of a candy cane. This phenomenon is associated with chest pain, dysphagia, odynophagia, and epigastric pain. Here, we report a case of thermal injury to the esophageal and oral cavity due to the drinking of hot tea, including odynophagia and dysphagia. A 69-year-old man was referred due to a difficulty in swallowing which had begun a week prior to referral. The patient, at the time of admission, was unable to swallow even liquids. He had recently suffered from hiccups, and had consumed five cups of hot adlay tea one week prior to admission, as a folk remedy for the hiccups. Upon physical examination, the patient's oral cavity evidenced mucosal erosion, hyperemia, and mucosa covered by a whitish pseudomembrane. Nonspecific findings were detected on the laboratory and radiological exams. Upper endoscopy revealed diffuse hyperemia, and erosions with thick and whitish pseudomembraneous mucosa on the entire esophagus. The stomach and duodenum appeared normal. We diagnosed the patient with thermal esophageal injury inflicted by the hot tea. He was treated with pantoprazole, 40 mg/day, for 14 days, and evidenced significant clinical and endoscopic improvement.

  12. Preoperative iodine staining may complicate the demarcation of esophageal carcinoma.

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    Asada-Hirayama, Itsuko; Ono, Satoshi; Kodashima, Shinya; Niimi, Keiko; Mochizuki, Satoshi; Yamamichi, Nobutake; Fujishiro, Mitsuhiro; Matsusaka, Keisuke; Fukayama, Masashi; Koike, Kazuhiko

    2013-07-01

    A 53-year-old man was suspected of having an esophageal neoplasm. An endoscopic examination including Lugol chromoendoscopy suggested an esophageal squamous cell neoplasm limited to the lamina propria. A targeted biopsy showed atypical squamous cells, and an endoscopic submucosal dissection was performed 22 days after the previous endoscopy. Although a single 40 mm unstained area was observed by preoperative Lugol chromoendoscopy, intraoperative endoscopy revealed a 25 mm iodine-unstained area, with small unstained areas scattered on the oral side. We included the small unstained areas in the extent of the resection through assessment by preoperative endoscopy. Histopathologically, the tumor extent appeared to coincide with the preoperative assessment. Tumor cells were found in the basal-parabasal layers of the mucosa, in which small unstained areas were scattered, although the superficial layers exhibited well-differentiated cells containing glycogen in the cytoplasm. Although Lugol chromoendoscopy, which can induce chemical esophagitis, is widely used, re-epithelialization after mucosal damage by preoperative iodine staining may complicate the intraoperative demarcation of tumors.

  13. Mid-esophageal ulceration and candidiasis-associated distal esophagitis as two distinct clinical patterns of tetracycline or doxycycline-induced esophageal injury.

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    Gencosmanoglu, Rasim; Kurtkaya-Yapicier, Ozlem; Tiftikci, Arzu; Avsar, Erol; Tozun, Nurdan; Oran, Ebru Sen

    2004-07-01

    Tetracyclines may cause esophageal injury. The aims of this study are to describe 2 distinct clinical patterns of esophageal injury induced by tetracycline or its derivate doxycycline and to compare these patterns with respect to demographic, endoscopic, and clinical characteristics of the patients. Forty-eight patients with the diagnosis of doxycycline- or tetracycline-induced esophageal injury by endoscopy were analyzed retrospectively. The patients were considered in 2 groups according to the type and the location of esophageal lesions (Group A: mid-esophageal ulceration, n = 18; Group B: distal esophagitis, n = 30). Patients in Group A were significantly younger than in Group B (P = 0.0014). In Group A, 15 patients (83%) had single ulceration, 2 (11%) double, and 1 (6%) circumferential at the mid-esophagus. In Group B, all patients had multiple micro-ulcerations in the distal esophagus. Development of mid-esophageal ulceration was induced predominantly by doxycycline, whereas distal esophagitis was induced by tetracycline. The description of drug ingestion with little or no water by patients in Group A was significantly more frequent than in Group B (94% vs. 10%, P esophageal candidiasis were significantly more frequent in Group B (P = 0.006, P esophageal injury because mid-esophageal ulceration seems to be more frequently associated with doxycycline and distal esophagitis with or without candidiasis with tetracycline.

  14. Correlation between Electroencephalogram Alterations and Frontal Cognitive Impairment in Esophageal Cancer Patients Complicated with Depression

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    Yin Cao; Xia Chen; Hui Xie; Ling Zou; Li-Jun Hu; Xian-Ju Zhou

    2017-01-01

    Background: Some esophageal cancer patients complicated with depression exhibit cognitive impairments. Frontal electroencephalogram (EEG) may be used as a reliable biomarker for prefrontal-mediated cognitive functions. This study was to investigate alterations of EEG and frontal cognitive impairment in esophageal cancer patients complicated with depression and to assess their correlation. Methods: Sixty-five esophageal cancer patients with depression (study group) and 62 healthy controls (...

  15. Predictors of Postoperative Complications After Trimodality Therapy for Esophageal Cancer

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    Wang, Jingya [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wei, Caimiao [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tucker, Susan L. [Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Myles, Bevan; Palmer, Matthew [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Hofstetter, Wayne L.; Swisher, Stephen G. [Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Ajani, Jaffer A. [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Cox, James D.; Komaki, Ritsuko; Liao, Zhongxing [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lin, Steven H., E-mail: SHLin@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-08-01

    Purpose: While trimodality therapy for esophageal cancer has improved patient outcomes, surgical complication rates remain high. The goal of this study was to identify modifiable factors associated with postoperative complications after neoadjuvant chemoradiation. Methods and Materials: From 1998 to 2011, 444 patients were treated at our institution with surgical resection after chemoradiation. Postoperative (pulmonary, gastrointestinal [GI], cardiac, wound healing) complications were recorded up to 30 days postoperatively. Kruskal-Wallis tests and χ{sup 2} or Fisher exact tests were used to assess associations between continuous and categorical variables. Multivariate logistic regression tested the association between perioperative complications and patient or treatment factors that were significant on univariate analysis. Results: The most frequent postoperative complications after trimodality therapy were pulmonary (25%) and GI (23%). Lung capacity and the type of radiation modality used were independent predictors of pulmonary and GI complications. After adjusting for confounding factors, pulmonary and GI complications were increased in patients treated with 3-dimensional conformal radiation therapy (3D-CRT) versus intensity modulated radiation therapy (IMRT; odds ratio [OR], 2.018; 95% confidence interval [CI], 1.104-3.688; OR, 1.704; 95% CI, 1.03-2.82, respectively) and for patients treated with 3D-CRT versus proton beam therapy (PBT; OR, 3.154; 95% CI, 1.365-7.289; OR, 1.55; 95% CI, 0.78-3.08, respectively). Mean lung radiation dose (MLD) was strongly associated with pulmonary complications, and the differences in toxicities seen for the radiation modalities could be fully accounted for by the MLD delivered by each of the modalities. Conclusions: The radiation modality used can be a strong mitigating factor of postoperative complications after neoadjuvant chemoradiation.

  16. [Esophageal reconstruction for esophageal stricture after corrosive injury].

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    Hatta, C; Ogasawara, H; Tsuyu, M; Kakibuchi, M; Yamada, N; Nakai, Y; Yoshinaga, K; Sakagami, M

    1999-08-01

    Swallowing a corrosive agent (alkali or acid) often causes severe pharyngeal, laryngeal or esophageal stricture (caustic stenosis), which is usually very difficult to treat. This paper reports two cases of esophageal stricture treated by esophagoplasty. Both cases had attempted suicide by swallowing a sodium hydroxide solution or acid. Case 1 was a 66-year-old man found to have severe hypopharynx and thoracic esophagus stenosis with supraglottic stricture. The supraglottic stricture was reconstructed with an ileocolon graft and laryngectomy. The intestinal anastomosis was patent, but the peristaltic motion in the ileocolon was not good. The patient continues to have difficulty achieving sufficient oral feeding and to receive supplemental feeding via a jejunostomy. Case 2 was a 81-year-old woman with severe thoracic esophagus stenosis after gastrectomy. The lesion was reconstructed with a jejenum graft. The intestinal anastomosis was patent. She achieved oral alimentation of both liquids and solids without aspiration after surgery. Esophagectomy in these cases can be difficult and hazardous due to extensive fibrosis and many adhesions to adjacent structures. In both cases, the reconstructed intestine passed through the ante-sternal route, so there was severe scar formation in the mediastinum, and an esophago-skin fistula formed in the cervical skin. Cervical vessels and intestinal vessels were anastomosed for blood supply to the reconstructed intestinal tract. This method is useful because it is safe and results in good deglution.

  17. Neglected Esophageal Injury Presenting With Spontaneously Shrunken Retroesophageal Pocket

    Directory of Open Access Journals (Sweden)

    Chin-Chih Chang

    2008-09-01

    Full Text Available Cervical stab wounds with a thoracic-inlet esophageal injury are extremely rare. A 30-year-old man presented with dysphagia and stridor. He had attempted suicide by stabbing his neck with a screwdriver followed by jumping from a building 10 days previously, when a cervical tracheal injury was found and surgically repaired. Physical examination was unremarkable. Lateral cervical radiography revealed an air-fluid level within an extensive retropharyngeal pocket. Follow-up radiography showed that the retropharyngeal lesion had shrunk spontaneously. Contrast esophagography demonstrated an extravasation at the thoracic inlet. The patient underwent surgical exploration of the esophagus via a lower neck incision. A thoracic-inlet esophageal slit was found and primary repair was performed. He resumed oral intake uneventfully on the 8th postoperative day. This was a rare case of esophageal injury secondary to cervical stabbing wounds, presenting with delayed occurrence and spontaneously shrunken retroesophageal pocket. Esophageal perforation can be easily missed if tracheal lesion is found. Both bronchoscopy and esophagoscopy are mandatory. In patients highly suspected to have esophageal injury but with a negative esophagoscopy result, contrast esophagography is indicated and can decrease the incidence of false-negative results.

  18. Monitoring Neutrophil-Expressed Cell Surface Esophageal Cancer Related Gene-4 after Severe Burn Injury.

    Science.gov (United States)

    Costantini, Todd W; Coimbra, Raul; Lopez, Nicole E; Lee, Jeanne G; Potenza, Bruce; Smith, Alan; Baird, Andrew; Eliceiri, Brian P

    2015-12-01

    We identified recently esophageal cancer related gene-4 (ECRG4) as a candidate cytokine that is expressed on the surface of quiescent polymorphonuclear leukocytes (PMNs) and shed in response to ex vivo treatment with lipopolysaccharide. To investigate the potential biologic relevance of changes in cell surface ECRG4 in human samples, we performed a pilot study to examine a population of burn patients in whom blood could be analyzed prospectively. We hypothesized that cutaneous burn injury would alter cell surface expression of ECRG4 on PMNs. Patients admitted with more than 20% total burn surface area (TBSA) (n = 10) had blood collected at the time of admission and weekly thereafter. For comparison, blood was obtained from a control group of healthy human volunteers (n = 4). We used flow cytometry to measure changes in ECRG4(+) PMNs from patients during recovery from injury. Esophageal cancer related gene-4 expression at each time point was compared with the patient's clinical status based on a Multiple Organ Dysfunction (MOD) score. Esophageal cancer related gene-4 was detected on the PMN surface of cells collected from healthy volunteers, however, within 48 h of admission after burn injury (n = 10 patients), the number of PMNs with cell surface ECRG4 was decreased. Esophageal cancer related gene-4 expression in PMNs was re-established over the course of patient recovery, unless complications occurred. In this case, the decrease in cell surface ECRG4(+) PMNs preceded the clinical diagnosis of infectious complications and was reflected by increased organ injury scores. From a small sample set, we were able to determine that PMN cell surface ECRG4 expression was decreased after burn injury and returned to baseline during recovery from injury. Although larger studies are needed to define the role of ECRG4 in human PMNs further, this report is the first assessment of cell surface ECRG4 protein in a patient population to support analogous findings in

  19. Interesting case of spontaneously resolved dysphagia in a young female due to complicated esophageal tuberculosis

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    Dhaval Choksi

    2017-11-01

    Full Text Available Mycobacterium tuberculosis can affect any organ of the body. Gastrointestinal tubercular involvement is fairly common. Esophageal tuberculosis though is uncommon. Esophageal tuberculosis accounts for only 0.3% of gastrointestinal tuberculosis. It presents with dysphagia, retrosternal pain, cough or constitutional symptoms. Complications like hemorrhage from the ulcer and development of fistulas like esophagomediastinal fistula is extremely uncommon. We report a case of a 27 years old female who presented with retrosternal pain, dysphagia and hematemesis. The patient had esophageal ulcer secondary to erosion of the esophagus by the subcarinal lymph nodes. Imaging was suggestive of esophagomediastinal fistula. Esophageal ulcer biopsy showed chronic tubercular infection. Culture from the esophageal biopsy confirmed the presence of tubercular bacilli. Patient responded to anti-tubercular therapy. Spontaneous dysphagia resolution prior to starting therapy was likely due to the rupture of the lymph node into the esophagus, which was compressing it initially. Esophageal tuberculosis presenting with hematemesis and fistula is extremely uncommon.

  20. Thermal Esophageal Injury following Ingestion of Boiling Mushroom Water

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    Allison Prevost

    2017-01-01

    Full Text Available Thermal esophageal and gastric damage from ingestion of hot liquids is poorly studied in pediatrics. Limited case reports exist in the literature. Many cases presented with chest pain, dysphagia, and odynophagia. Variable histologic findings were reported. No definitive management guidelines exist for such injuries. We provide a report of the acute assessment and management of an obvious thermal esophageal injury and contribute to what is known about this presentation. A 16-year-old male presented with odynophagia, dysphagia, and hematemesis following ingestion of “nearly boiling” mushroom water. Ondansetron, pantoprazole, ketorolac, maintenance intravenous fluids, and a clear liquid diet were started. At sixty hours after ingestion, an esophagogastroduodenoscopy (EGD revealed blistering and edema of the soft palate and epiglottis, circumferential erythema of the entire esophagus with an exudate likely to be desquamated mucosa, and linear erythema of the body and fundus of the stomach. An EGD one month after ingestion showed no residual effects from the injury. The pantoprazole was weaned and restrictions to his diet were lifted. To better standardize care in these rare esophageal injuries, the development of a clinical care algorithm may be beneficial to provide clinicians with a guide for management based on outcomes of previously reported cases.

  1. Esophageal Achalasia: An Uncommon Complication during Pregnancy Treated Conservatively

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    Dimitrios Spiliopoulos

    2013-01-01

    Full Text Available A 38-year-old Caucasian woman, gravida 3 para 2, was admitted at 29 weeks of gestation because of vomiting, dysphagia for solids and liquids, and loss of weight. An enlargement of the anterior left neck region was noted on the palpation of the thyroid gland. An MRI of the neck showed a marked esophageal dilatation with the presence of food remnants along its length and the displacement of the trachea to the right. The findings of the upper gastrointestinal endoscopy and manometry were suggestive of esophageal achalasia. Conservative management with total parenteral nutrition (TPN through a peripheral line proved to be successful. A healthy male baby was born by a cesarean section at 37 weeks. The patient underwent laparoscopic esophageal myotomy and fundoplication seven days postpartum.

  2. Esophagitis and esophageal strictures.

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    Glazer, Alan; Walters, Patricia

    2008-05-01

    Esophagitis and esophageal strictures are relatively uncommon but significant diseases in companion animals. Often, an esophageal disorder is suspected on the animal's medical history and clinical signs. Esophagitis and acquired esophageal strictures are caused by prolonged contact of caustic substances or foreign bodies with the esophageal lining, leading to mucosal injury. In cases of stricture, damage extends into the submucosal and muscular layers. Timely detection and appropriate management of esophagitis and esophageal strictures significantly improve nutritional status, dysphagia, and pain and often return the animal to a normal quality of life. This article reviews the current literature and focuses on the diagnosis and treatment of esophagitis and esophageal strictures caused by fibrosis secondary to esophageal inflammation.

  3. Doxycyclin induced esophageal injury: A Case series

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    İsmail Demiryılmaz

    2013-01-01

    Full Text Available Some drugs have been known to damage to esophagusfor a long time. Half of the cases reported are of tetracyclineand its derivatives. The damage caused by thesedrugs is depends on the drug itself and the patient.In this paper we present 5 patients having diagnosedesophageal damage endoscopically after due to doxycyclinuse. The mean age of the patients was 26 years.Three of them for acne and 2 for heir complaints gynecologicalinfection were taking these drugs. Lesions werelocated at the middle in 4 cases and lover part in 1 patient.The common complaint was retrosternal pain and heartburnafter taking the drug with insufficient water or withoutwater. All the patients were relieved by symtomatic teratment.Esophageal damage is to be remembered in patientscomplaning sudden pain and difficult swallowing on doxycyclintreatment and endoscopic procedure should beemployed for definition of diagnosis and evaluation of theseverity of the damage. After treatment, endoscopic controlis not necessary. Physicians must not forget to advicethe patients to take these drugs with splendid amount ofwater.Key words: Doxycycline, esophagus damage, endoscopy

  4. Risk Factors for Complications of Traumatic Injuries.

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    de Aguiar Júnior, Wagner; Saleh, Carmen Mohamad Rida; Whitaker, Iveth Yamaguchi

    2016-01-01

    Complications in hospitalized trauma patients are major causes of morbidity and mortality. The aims of this study were to identify the in-hospital trauma patients' complications and identify the risk factors for complications in this population. A retrospective analysis was conducted in a sample from a Brazilian hospital. The sample consisted of 407 patients, 194 (47.66%) of whom had records of complications. The most common complications were infections (41.80%). The risk factors related to the complications were age, length of hospital stay, external causes, and injury severity. The complications were frequent in this sample, and the risk for complications was characterized by multiple factors.

  5. Traumatic brain injury complicated by environmental hyperthermia

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    Hermstad Erik

    2010-01-01

    Full Text Available Temperature variations after traumatic brain injury are common and devastating. This has been shown most clearly with hypothermia, but the complications associated with hyperthermia in the setting of traumatic brain injury can be just as problematic. We present the case of a soldier with traumatic brain injury exposed to environmental temperatures of 115-120° F with a core temperature of over 108° F. The complications of his conditions are discussed as well as potential treatments for the deadly combination of traumatic brain injury and environmental hyperthermia.

  6. Evaluation of esophageal injuries secondary to ingestion of unlabeled corrosive substances: pediatric case series.

    Science.gov (United States)

    Kucuk, Gonul; Gollu, Gulnur; Ates, Ufuk; Cakmak, Zeynep A; Kologlu, Meltem; Yagmurlu, Aydın; Aktug, Tanju; Dindar, Huseyin; Cakmak, Ahmet M

    2017-04-01

    Esophageal or gastric injuries secondary to caustic substance ingestion is still an important issue in developing countries. Its clinical spectrum can vary from absence of mucosal injury to complications such as severe burns, strictures and perforation. Physical examination and first endoscopic evaluation are very important in the diagnosis. The objective of this study is to present 154 children who were undergone upper gastrointestinal endoscopy because of caustic substance ingestion including descaler, degreaser, unlabeled bleach, drain opener, surface cleaner, dishwasher rinse aid, hydrochloric acid. Sixty-nine children had positive oropharyngeal findings. Sixtythree children were found to have burns in the first endoscopic examination and forty of these burns were severe burn. In the follow-up, twenty children developed strictures that were undergone dilatation program. Fourteen children in the dilatation program had successful dilatation and intralesional steroid injection. However three children had undergone colonic interposition and three undergone laparoscopic gastroduodenostomy and gastrojejunostomy. Sociedad Argentina de Pediatría.

  7. Aortobronchial fistula after esophagectomy for esophageal cancer—A very rare complication

    Directory of Open Access Journals (Sweden)

    Hsien-Pin Li

    2011-06-01

    Full Text Available Most aorto-respiratory fistulas are related to aortic pathology or procedures, but fistula formation after esophageal resection has never been reported in the literature. We are now reporting a case of hemoptysis that occurred after esophagectomy for locally advanced esophageal cancer. Aortobronchial fistula was detected by computed tomography scan. The patient was finally saved by emergency surgery—Dacron graft interposition of the descending thoracic aorta. There was no malignant cell in the postoperative specimen of the fistula. The erosion of the ligaclips (Johnson & Johnson might be responsible for the aortobronchial fistula formation. For esophageal surgery, avoidance of trauma to aortic wall and careful using of ligaclips are important to circumvent this complication.

  8. [Epidermolysis bullosa acquisita complicated by esophageal stenosis. Endoscopic treatment with thermoplastic dilators and intralesional steroid injection].

    Science.gov (United States)

    Moura, E G; Couto-Júnior, D S; Alvarado-Escobar, H; da Costa-Martins, B; Sallum, R A; Artifon, E L; Sakai, P

    2011-01-01

    Epidermolysis bullosa acquisita (EBA) is a rare auto-immune dermatologic disease, produced by auto-antibodies against colagen VII. We report a 44 years old male patient with EBA diagnosed 15 years before, who presented with progressive disphagia, being diagnosed an esophageal involvement of EBA. The patient was submitted to endoscopic treatment with thermoplastic bougie dilation and intralesional corticosteroid injection. The patient improved clinically with recovery of nutritional status. Esophageal involvement in EBA is very rare and its reason is still unknown. Endoscopic approach must be cautiously performed with the use of small diameter endoscopes, small caliber dilators, intralesional injection of corticosteroid and enteral tube in order to minimize the risks of complications, as well as esophageal rest from food trauma and better reparatory molding of the epithelium.

  9. Bowel injury as a complication of laparoscopy

    NARCIS (Netherlands)

    van der Voort, M.; Heijnsdijk, E. A. M.; Gouma, D. J.

    2004-01-01

    Background: Bowel injury is a rare but serious complication of laparoscopic surgery. This review examines the incidence, location, time of diagnosis, causative instruments, management and mortality of laparoscopy-induced bowel injury. Methods: The review was carried out using the MeSH browser within

  10. Esophageal foreign bodies in children: Emphasis on complicated cases

    Directory of Open Access Journals (Sweden)

    Tariq I. Altokhais

    2017-09-01

    Conclusion: EFBs are a relatively common problem in pediatric patients, and underlying predisposing factors to EFB impaction are not uncommon. Long-retained EFBs are associated with a higher incidence of complications. Rigid esophagoscopy was successful in extracting most of the EFBs and was shown to be a safe and effective procedure.

  11. Complications after treating esophageal strictures with prostheses and stents – 20 years’ experience

    Directory of Open Access Journals (Sweden)

    Mariusz P. Łochowski

    2016-12-01

    Full Text Available Introduction : Over 80% of patients with esophageal cancer are qualified only for palliative treatment. The main goal of the therapy is to eliminate symptoms of dysphagia. Aim: To analyze complications after insertion of prostheses and stents in patients with inoperable cancer of the esophagus/cardia. Material and methods : From 1996 to 2015 prostheses of the esophagus were implanted in 1309 patients. In the strictures of the lower part of the esophagus, Barbin-Mousseau prostheses (102 cases and Häring prostheses (324 cases were placed. In the strictures of the upper and middle part of the esophagus, Wilson-Cook prostheses (65 cases and Sumi prostheses (51 cases were implanted using rigid oesophagoscopy. Since 2001, 867 esophageal stents have been implanted. Results: Complications occurred in 146 (11% patients, including 7 (0.6% cases of death. The most common complication was the recurrence of swallowing disorders (74 patients. In 51 patients, tumor overgrowth over the stent/prosthesis was responsible for that symptom, and in 23 patients its clogging. A fistula (22 cases and the passage of the prosthesis/stent (25 cases were the second most common group of complications. Compression of the trachea, bleeding, and dehiscence of wounds occurred in a total of 18 patients. Complications were mostly treated through the repositioning of the prosthesis/stent or the insertion of an additional one. Conclusions : The most common complications after esophageal prosthetics are the recurrence of dysphagia, a fistula and the displacement of the prosthesis/stent. The basic treatment of complications is the repositioning or insertion of an additional prosthesis.

  12. [Pleural hernia of an esophageal graft--late postoperative complication].

    Science.gov (United States)

    Grabowski, K; Lewandowski, A; Moroń, K; Strutyńska-Karpińska, M; Błaszczuk, J; Machała, R

    1997-01-01

    Pleural hernia of the oesophageal substitute from pedicled intestinal segment is one of the late postoperative complications. 13 cases of patients with oesophagus reconstructed because of lye ingestion stenosis are presented. Problems concerning diagnosis and treatment of pleural hernia are analysed. Eight patients with minor symptoms were treated conservatively. Five patients were operated, two of them from acute necrosis of the substitute. Necrosis was caused by incarceration of the bowel and torsion of the mesentery. Elective operative treatment consisted of reduction of hernia sac contents, closing of the hernia orifice, chest drainage and temporary gastronomy. In patient operated as an emergency cases necrotic part of substitute was removed. This resulted in oesophageal exclusion in the neck, creating gastronomy. Chest drainage was also performed.

  13. Respiratory Disorders in Complicated Cervical Spine Injury

    Directory of Open Access Journals (Sweden)

    S. A. Pervukhin

    2016-01-01

    Full Text Available Objective. Evaluating the results of respiratory therapy in patients with complicated traumatic injury of the cervical spine.Materials and methods. A retrospective comparative analysis of the clinical course was carried out in 52 patients with complicated traumatic injury of the cervical spine: group A: complete spinal cord injury (ASIA A, 37 patients and group B: incomplete injury (ASIA B, 15 patients. The severity of patients' status on integral scales, parameters of the respiratory pattern and thoracopulmonary compliance, gas composition, and acidbase status of the blood were assessed. Data on patients who required prolonged mechanical ventilation, duration of mechanical ventilation, incidence of nosocomial pneumonia, duration of stay in the ICU, time of hospital treatment, and mortality were included in the analysis. Results. The average APACHE II and SOFA scores were higher in group A patients. The development of the acute respiratory failure required longterm mechanical ventilation (more than 48 hours in 91.4% of group A patients and in 53.3% of group B patients. Ventilatorassociated pneumonia complicated the disease in 81.3% of group A patients and 62.5% of group B patients and was accompanied by sepsis in 25% and 12.5% of cases, respectively. Statistically significant deterioration of biomechanical properties and gas exchange function of the lungs was observed in patients complicated with septic pneumonia.Conclusion. Patients with complicated ASIA A and ASIA B cervical spine injuries demonstrate the presence of respiratory failure of neurogenic origin. In addition, the infectious bronchopulmonary complications aggravated respiratory failure in patients with ASIA A injury in 70.3% versus 33.3% in patients with ASIA B. Developmentof pulmonogenic sepsis led to deterioration of the biomechanical and gas exchange functions of the lungs and increased the likelihood of unfavorable outcome of the disease in 77.8% of cases. The high

  14. Complications of ocular paintball injuries in children.

    Science.gov (United States)

    Hargrave, S; Weakley, D; Wilson, C

    2000-01-01

    To evaluate the ocular complications of paintball injuries in children. The clinical course of four children with traumatic ocular paintball injuries was evaluated. All patients underwent a complete ocular examination. Their age, injuries sustained, surgical procedure(s) performed, presence of protective eyewear at the time of injury, and final visual outcome was assessed. The presence of directly related anterior and posterior segment abnormalities were also evaluated. Four boys sustained traumatic paintball injuries. Average patient age was 11.25 years (range: 10-12 years). None of the children were wearing ocular or facial protection at the time of the initial injury. All patients had hyphema and traumatic cataract, and some form of retinal pathology (vitreous hemorrhage, epiretinal membrane, retinal hemorrhage, and choroidal rupture). One child had a partial-thickness corneal laceration that did not require surgical intervention. All other patients underwent ophthalmic surgery. Final visual acuity was 20/30 or better in two patients, and 20/100 or worse in the others. The cause of decreased visual acuity in these children was directly related to macular pathology. Ocular injuries resulting from paintball impact are often severe and usually occur when the participants are not wearing eye protection or this protection becomes dislodged. Treatment of these injuries is sometimes limited to an attempt to salvage what remains of useful vision. Unfortunately, most of these sports-related injuries could have been prevented if patients wore adequate eye protection when involved in this sport.

  15. [Endoscopic methods of gastro-esophageal reflux disease (GERD) treatment and their complications].

    Science.gov (United States)

    Gil, Jerzy; Błaszak, Antoni; Wojtuń, Stanisław; Wojtkowiak, Marek

    2007-05-01

    Tretament in gastro-esophageal reflux disease (GERD) is in constant change. It is caused by the fact of change and development of diagnostic and therapeutic methods. Alternative methods of treatment are still searched beacause patients do not accept many years long drug treatment or surgical procedures. New methods are developed. Some of them as endoscopic fundoplication or methods of polimerizing substances injection in the area of lower esophageal sphincer have been abandoned because of low quickly diminishing efficacy Endoscopic sewing that implicate all layers of gaster is still under clinical trials and is considered as interesting. Stertt's procedure that is based on electromagnetic wave application in the area of lower esophageal sphincter is used in clinical practice. Despite effective methods of diagnosing and treatment of GERD there is no evidence of lowering incidence of complications of GERD. It is still common to find esophagus stricture as the first illness manifastation. Chronic character of GERD is associated with intestinal metaplasia and adenocarcinoma of the esophagus in its distal part. The most effective endoscopic methods of the treatment include: endoscopic dilation of the strictures and endoscopic methods of patological epithelium removal in Barrett's esophagus. These are: photodynamic therapy, argon coagulation, laser thermoablation, multipolar ablation and endoscpic mucosectomy. The paper is the review of the methods aimed at GERD and its complication treatment.

  16. Ureteric injuries complicating obstetric and gynecologic operations ...

    African Journals Online (AJOL)

    A retrospective study to determine the rate and pattern of ureteric injuries complicating gynecologic and obstetric operations in the University of Calabar Teaching Hospital (UCTH) during a ten-year period (1990 –1999) was undertaken. The number of major operations carried out during the period was 9350. Of these, 8670 ...

  17. Impact of Body Mass Index on Complications and Survival after Surgery for Esophageal and Gastro-Esophageal-Junction Cancer

    DEFF Research Database (Denmark)

    Kruhlikava, Iryna; Kirkegård, Jakob; Mortensen, Frank Viborg

    2017-01-01

    Background and Aims: The impact of body mass index on complications and survival in patients undergoing esophagectomy has been extensively studied with conflicting results. In this study, we assess the impact of body mass index on complications and survival following surgery for esophageal...... patients included in the study. Body mass index was calculated as weight in kilograms divided by height in meters squared. We grouped patients according to their body mass index, using the World Health Organization definition, as underweight (body mass index body mass index......: 18.5–24.9 kg/m2), overweight (body mass index: 25–29.9 kg/m2), and obese (body mass index ⩽ 30 kg/m2). Results: Median age at surgery was 65 years (range: 27–84 years), of which 207 (72.6%) were males. Patients with the lowest body mass index and the obese patients seemed to have a higher frequency...

  18. Esophageal rupture in a child after vertical expandable prosthetic titanium rib expansion thoracoplasty: first report of a rare complication.

    Science.gov (United States)

    van Vendeloo, Stefan; Olthof, Kees; Timmerman, Jan; Mostert, Adriaan

    2011-05-01

    Case report and clinical discussion. To illustrate the significance of esophageal rupture as a rare complication after expansion thoracoplasty with implementation of a vertical expandable prosthetic titanium rib (VEPTR). Chest wall deformities and secondary scoliosis are rare complications after a repair operation for esophageal atresia. The new technique of VEPTR expansion thoracoplasty directly treats the chest wall deformity and indirectly corrects the scoliosis. We describe a patient with an esophageal rupture after VEPTR expansion thoracoplasty. We report the case of an 11-year-old boy who developed a progressive scoliosis caused by fused ribs after multiple reoperations for esophageal atresia. The patient was treated operatively by an expansion thoracoplasty via an opening wedge thoracostomy with implementation of two VEPTRs. After surgery, the patient developed a respiratory insufficiency because of rupture of the esophagus. The complication was treated conservatively. A second operation was needed to remove an infected VEPTR. The patient fully recovered after this severe complication. To our knowledge, this is the first report of esophageal rupture after VEPTR expansion thoracoplasty. This promising new technique treats scoliosis in patients with severe chest wall deformities. When a patient presents with fused ribs and there is a history of esophageal atresia, we should keep in mind that the esophagus is at risk of rupturing during the scoliosis correcting procedure.

  19. Esophageal injuries: Spectrum of multidetector row CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Lutio di Castelguidone, Elisabetta de [Department of Radiology, I.N.T., IRCCS Fondazione G. Pascale, Via M. Semmola, I-80131 Naples (Italy)]. E-mail: e.delutio@virgilio.it; Merola, Stefanella [Department of Diagnostic Imaging, ' A. Cardarelli' Hospital, I-80131 Naples (Italy); Pinto, Antonio [Department of Diagnostic Imaging, ' A. Cardarelli' Hospital, I-80131 Naples (Italy); Raissaki, Maria [Department of Radiology, University Hospital of Iraklion, University of Crete Medical School, P.O. Box 1352, 711 10 Iraklion Crete (Greece); Gagliardi, Nicola [Department of Diagnostic Imaging, ' A. Cardarelli' Hospital, I-80131 Naples (Italy); Romano, Luigia [Department of Diagnostic Imaging, ' A. Cardarelli' Hospital, I-80131 Naples (Italy)

    2006-09-15

    Background: Aim of this study is to illustrate the multidetector row computed tomographic findings related to oesophageal injuries and their significance for therapeutic decisions. Method: From April 2002 to April 2005 we studied 16 patients with suspected oesophageal injury. Ten patients underwent standard chest radiograph, while five patients with suspected foreign body ingestion were submitted to cervical plain film and gastrografin swallow study. All 16 patients underwent multidetector row CT examination. Results: In six patients with cervical, thoracic and abdominal trauma, CT showed the presence of thoracic traumatic lesions and findings suggestive of perforation of the oesophagus. In five patients with foreign body ingestion cervical radiography was positive in only one case, while CT showed the presence of a foreign body in all cases. In three patients with post-intubation complications, CT showed the presence of perioesophageal fluid collection containing small gas bubbles in two cases and an oesophageal-aortic fistula in one case. In the remaining two patients with suspected spontaneous oesophageal perforation, CT demonstrated an oesophageal wall oedema and thickening in one case, and oesophageal fluid distension with perioesophageal small bubbles gas and fluid in the second case. Conclusion: Oesophageal injuries, when complicated with perforation, constitute a life-threatening condition. Knowledge of the CT signs of oesophageal injuries has important implications for the role of imaging at the time of initial diagnosis.

  20. Stents in patients with esophageal cancer before chemoradiotherapy: high risk of complications and no impact on the nutritional status.

    Science.gov (United States)

    Mão-de-Ferro, S; Serrano, M; Ferreira, S; Rosa, I; Lage, P; Alexandre, D P; Freire, J; Mirones, L; Casaca, R; Bettencourt, A; Pereira, A D

    2016-03-01

    Preoperative chemoradiotherapy is the standard of care for locally advanced esophageal cancer, causing persistent deterioration in the nutritional status. We performed a prospective study to evaluate the safety and efficacy of esophageal double-covered self-expandable metal stents in patients with esophageal cancer before chemoradiotherapy. The nutritional status and dysphagia were prospectively recorded. Eleven patients were included: eight were moderate and three were severely malnourished. After stent placement, dysphagia improved in all patients. With regard to complications, one patient developed an esophageal perforation that required urgent esophagectomy. Four patients presented stent migration. Three of these patients required enteral nutrition and none was submitted to surgery because of poor nutritional status. Of the other six patients, only four were operated upon. Stent placement presented a high complication rate and did not prevent weight loss or malnutrition. Other alternatives, including naso-gastric tube placement or endoscopic percutaneous gastrostomy or jejunostomy, should be considered.

  1. Aortoesophageal fistula--an unusual complication of esophagitis caused by Dieffenbachia ingestion.

    Science.gov (United States)

    Snajdauf, Jirí; Mixa, Vladimír; Rygl, Michal; Vyhnánek, Martin; Morávek, Jirí; Kabelka, Zdenĕk

    2005-06-01

    Aortoesophageal fistula (AEF) is a rare and mostly lethal cause of upper gastrointestinal bleeding in children. We report a successful outcome of surgical treatment after resuscitation of a girl aged 12 1/2 years with AEF as a complication of esophagitis caused by Dieffenbachia ingestion. The girl ate a leaf of Dieffenbachia picta in a suicidal attempt. After 5 weeks of medical treatment of esophagitis, small blood-stained vomitus and melena appeared. Within a few hours, it was followed by a massive gastrointestinal bleeding leading to exsanguination. The girl survived despite the pitfalls in clinical presentation and errors in diagnostic approach and treatment. Emergency exploration of cervical esophagus, followed by laparotomy and thoracotomy, was performed in attempt to find the source of bleeding and to control it. Aortoesophageal fistula was located between the ascending aorta near the origin of the brachiocephalic trunk and thoracic esophagus. Resection of the fistula led to prompt circulatory stabilization. The common houseplant, Dieffenbachia picta, causes edematous swelling of mucus membranes when chewed. Dieffenbachia-caused esophagitis is very rare and this etiology of AEF has not been reported in children.

  2. Correlation between Electroencephalogram Alterations and Frontal Cognitive Impairment in Esophageal Cancer Patients Complicated with Depression.

    Science.gov (United States)

    Cao, Yin; Chen, Xia; Xie, Hui; Zou, Ling; Hu, Li-Jun; Zhou, Xian-Ju

    2017-08-05

    Some esophageal cancer patients complicated with depression exhibit cognitive impairments. Frontal electroencephalogram (EEG) may be used as a reliable biomarker for prefrontal-mediated cognitive functions. This study was to investigate alterations of EEG and frontal cognitive impairment in esophageal cancer patients complicated with depression and to assess their correlation. Sixty-five esophageal cancer patients with depression (study group) and 62 healthy controls (control group) were included in this study. The study group were assigned into psychotic depressed (PD, n = 32) and nonpsychotic depressed (NPD, n = 33) subgroups based on complication with psychotic symptoms (Brief Psychiatric Rating Scale [BPRS] >35). EEG examination, Beck self-rating depression scale, and BPRS were used to assess clinical symptoms. Chi-square test, two independent sample t-test, one-way analysis of variance, and Kruskal-Wallis test were utilized to compare the variables between two groups. EEG abnormalities and scores of frontal cognitive function test were analyzed by partial correlation analysis in the PD and NPD subgroups. Compared with control group, the study group displayed greater scores either in the Stroop test (19.89 ± 2.05 vs. 24.12 ± 2.19, P = 0.006) or Color Trails Test (CTT; 11.92 ± 1.01 vs. 15.02 ± 1.63, P = 0.008), and reduced score (35.05 ± 2.01 vs. 32.11 ± 2.38, P = 0.007) in the verbal fluency test (VFT). Compared to NPD subgroup, PD subgroup exhibited increased scores in Stroop test (22.89 ± 2.07 vs. 25.38 ± 2.32, P = 0.009) and CTT (13.16 ± 1.71 vs. 15.82 ± 1.13, P = 0.008). Moreover, increased scores in Stroop test and CTT as well as scores in VFT were associated with the severity of depression. The study group had an abnormal frontal EEG, such as α forward, α asymmetry, α moderation, and increased θ activity relative to control group. Similarly, compared with NPD subgroup, PD subgroup displayed α forward, α asymmetry, and α moderation. The

  3. The Sternocleidomastoid Muscle Flap: A Versatile Local Method for Repair of External Penetrating Injuries of Hypopharyngeal-Cervical Esophageal Funnel.

    Science.gov (United States)

    Ellabban, Mohamed A

    2016-04-01

    A primary repair of external penetrating injury to hypopharyngeal-cervical esophageal (HP-CE) funnel without reinforcement has more complications if compared with muscle reinforcement. The aim of the present study was to assess the outcome of using sternocleidomastoid (SCM) muscle flap for reinforcement of primary repair of HP-CE funnel injury. The study proposed an algorithm for different uses of SCM flap repair according to site and size of funnel perforation. A prospective analysis of 12 patients, who had surgical treatment for external penetrating injuries of HP-CE funnel between January 2011 and September 2014, was recorded. The following factors were studied for each case: demographic data, Revised Trauma Score (RTS), mechanism of injury, time interval between injury and definitive surgical care, injury morphology, any associated injuries, technique of SCM flap used, length of hospital stay, and surgical outcome and complications. They were 10 males and 2 females and the mean age was 31.9 years. The cause of injury was stab wound in 5 (41.7 %) cases, gunshot injury in 4 (33.3 %) cases and 3 (25 %) cases after anterior cervical spine surgery. Isolated injury to HP and CE was recorded in 5 cases (41.7 %) for each site. However, 2 (16.7 %) cases had injury to both HP and CE. Cranially based SCM flap was mainly used in cases with HP injury and caudally based flap in CE cases with some limitations. The whole muscle flap was used in large (≥ 1 cm) defects while and the split muscle flap in small (injury with the advantages of high success rates of leakage prevention.

  4. Pathophysiology of acute acid injury in rabbit esophageal epithelium.

    OpenAIRE

    Orlando, R C; Powell, D. W.; Carney, C N

    1981-01-01

    To increase our understanding of the pathophysiology of reflux esophagitis, we sought the early sequence of changes in mucosal structure and function in acutely acid-damage rabbit esophagus. Using a perfused catheter technique esophageal potential difference (PD) profiles were obtained in anesthetized rabbits before, during, and after perfusion of the lower one-half of the esophagus with phosphate-buffered saline or 80 mM NaCl. When acid perfusion reduced the lower esophageal PD by 40-50% or ...

  5. Lymphatic injury at sacrocolpopexy: an unusual complication.

    Science.gov (United States)

    Suen, Michael W H; Geoffrion, Roxana

    2014-04-01

    Lymphorrhea is a rare condition with a paucity of reports in the gynaecologic literature. The most frequent causes are invasive procedures and surgical interventions. A multiparous woman underwent a total abdominal hysterectomy with prophylactic bilateral salpingectomy and abdominal sacrocolpopexy for pelvic organ prolapse. During retroperitoneal dissection, clear fluid discharge was encountered. Ureteric injury was subsequently ruled out. A sample of the fluid was taken to confirm lymphatic injury. Ligation suture and closing the peritoneum slowed fluid drainage. To our knowledge, this is the first reported lymphatic injury in association with a urogynaecologic procedure. Gynaecologists should be aware of this potential complication and should have an approach to diagnosis and management. This case highlights the importance of intraoperative consultation.

  6. Impact of esophageal temperature monitoring guided atrial fibrillation ablation on preventing asymptomatic excessive transmural injury

    Science.gov (United States)

    Kiuchi, Kunihiko; Okajima, Katsunori; Shimane, Akira; Kanda, Gaku; Yokoi, Kiminobu; Teranishi, Jin; Aoki, Kousuke; Chimura, Misato; Toba, Takayoshi; Oishi, Shogo; Sawada, Takahiro; Tsukishiro, Yasue; Onishi, Tetsuari; Kobayashi, Seiichi; Taniguchi, Yasuyo; Yamada, Shinichiro; Yasaka, Yoshinori; Kawai, Hiroya; Yoshida, Akihiro; Fukuzawa, Koji; Itoh, Mitsuaki; Imamura, Kimitake; Fujiwara, Ryudo; Suzuki, Atsushi; Nakanishi, Tomoyuki; Yamashita, Soichiro; Hirata, Ken-ichi; Tada, Hiroshi; Yamasaki, Hiro; Naruse, Yoshihisa; Igarashi, Miyako; Aonuma, Kazutaka

    2015-01-01

    Background Even with the use of a reduced energy setting (20–25 W), excessive transmural injury (ETI) following catheter ablation of atrial fibrillation (AF) is reported to develop in 10% of patients. However, the incidence of ETI depends on the pulmonary vein isolation (PVI) method and its esophageal temperature monitor setting. Data comparing the incidence of ETI following AF ablation with and without esophageal temperature monitoring (ETM) are still lacking. Methods This study was comprised of 160 patients with AF (54% paroxysmal, mean: 24.0±2.9 kg/m2). Eighty patients underwent ablation accompanied by ETM. The primary endpoint was defined as the occurrence of ETI assessed by endoscopy within 5 d after the AF ablation. The secondary endpoint was defined as AF recurrence after a single procedure. If the esophageal temperature probe registered >39 °C, the radiofrequency (RF) application was stopped immediately. RF applications could be performed in a point-by-point manner for a maximum of 20 s and 20 W. ETI was defined as any injury that resulted from AF ablation, including esophageal injury or periesophageal nerve injury (peri-ENI). Results The incidence of esophageal injury was significantly lower in patients whose AF ablation included ETM compared with patients without ETM (0 [0%] vs. 6 [7.5%], p=0.028), but not the incidence of peri-ENI (2 [2.5%] vs. 3 [3.8%], p=1.0). AF recurrence 12 months after the procedure was similar between the groups (20 [25%] in the ETM group vs. 19 [24%] in the non-ETM group, p=1.00). Conclusions Catheter ablation using ETM may reduce the incidence of esophageal injury without increasing the incidence of AF recurrence but not the incidence of peri-ENI. PMID:26949429

  7. Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer.

    Science.gov (United States)

    Inoue, J; Ono, R; Makiura, D; Kashiwa-Motoyama, M; Miura, Y; Usami, M; Nakamura, T; Imanishi, T; Kuroda, D

    2013-01-01

    Postoperative pulmonary complications (PPCs) after esophagectomy have been reported to occur in 15.9-30% of patients and lead to increased postoperative morbidity and mortality, prolonged duration of hospital stay, and additional medical costs. The purpose of this retrospective cohort study was to investigate the possible prevention of PPCs by intensive preoperative respiratory rehabilitation in esophageal cancer patients who underwent esophagectomy. The subjects included 100 patients (87 males and 13 females with mean age 66.5 ± 8.6 years) who underwent esophagectomy. They were divided into two groups: 63 patients (53 males and 10 females with mean age 67.4 ± 9.0 years) in the preoperative rehabilitation (PR) group and 37 patients (34 males and 3 females with mean age 65.0 ± 7.8 years) in the non-PR (NPR) group. The PR group received sufficient preoperative respiratory rehabilitation for >7 days, and the NPR group insufficiently received preoperative respiratory rehabilitation or none at all. The results of the logistic regression analysis and multivariate analysis to correct for all considerable confounding factors revealed the rates of PPCs of 6.4% and 24.3% in the PR group and NPR group, respectively. The PR group demonstrated a significantly less incidence rate of PPCs than the NPR group (odds ratio: 0.14, 95% confidential interval: 0.02~0.64). [Correction added after online publication 25 June 2012: confidence interval has been changed from -1.86~ -0.22] This study showed that the intensive preoperative respiratory rehabilitation reduced PPCs in esophageal cancer patients who underwent esophagectomy. © 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  8. Reliable temperature probe monitoring - Favorable esophageal motion for consistent probe contact during atrial fibrillation catheter ablation

    Directory of Open Access Journals (Sweden)

    Masahiro Esato

    2013-10-01

    Full Text Available Left atrial-esophageal (LA-Eso fistula is now a well-recognized and fatal complication of percutaneous catheter ablation performed using radiofrequency energy for atrial fibrillation (AF. We noted an important esophageal motion during temperature monitoring by a multipolar sensing probe, which could resolve several potential concerns of accurate esophageal temperature measurement and could consequently minimize esophageal injuries including LA-Eso fistulas during catheter ablation for AF.

  9. Is the Geriatric Nutritional Risk Index a Significant Predictor of Postoperative Complications in Patients with Esophageal Cancer Undergoing Esophagectomy?

    Science.gov (United States)

    Yamana, Ippei; Takeno, Shinsuke; Shibata, Ryosuke; Shiwaku, Hironari; Maki, Kenji; Hashimoto, Tatsuya; Shiraishi, Takeshi; Iwasaki, Akinori; Yamashita, Yuichi

    2015-01-01

    The Geriatric Nutritional Risk Index (GNRI) is a new index recently introduced for predicting the risk of nutrition-related complications. The GNRI has mainly been reported as a simple and accurate tool to assess the nutritional status and prognosis of elderly patients. So far, there have been no reports of the GNRI in patients with gastrointestinal cancer. Our objective was to examine the association between the GNRI and short-term outcomes, especially postoperative complications, in patients with esophageal cancer who underwent esophagectomy and gastric tube reconstruction. The present study enrolled 122 consecutive patients with esophageal cancer who underwent esophagectomy and gastric tube reconstruction. The GNRI at admission to the hospital was calculated as follows: (1.489 × albumin in g/l) + (41.7 × present/ideal body weight). The characteristics and short-term outcomes were compared between two groups: the high (GNRI ≥90) and the low (GNRI nutritional status and predict the development of postoperative respiratory complications in patients with esophageal cancer undergoing esophagectomy and gastric tube reconstruction. 2015 S. Karger AG, Basel.

  10. Compartment syndrome and popliteal vascular injury complicating unicompartmental knee arthroplasty

    NARCIS (Netherlands)

    Kort, Nanne Pieter; Van Raay, Jos J. J. A. M.; van Horn, Jim R.

    Popliteal vascular injury and the compartment syndrome of the leg are rare but important complications of knee arthroplasties. Early diagnosis and treatment are of paramount importance in preventing the devastating complications of these conditions. To our knowledge, these complications have not

  11. Avoidable birth injury complicated with limb gangrene: a reflection of ...

    African Journals Online (AJOL)

    Gangrene of the lower extremities in neonates is a rare event except in traumatic cases. When risk factors for trauma to the limb of the newborn exist, it is important to prevent such injuries and when they are inevitable, appropriate management of injuries should further prevent complications such as limb gangrene.

  12. Tracheal injury during extraction of an esophageal foreign body: Repair utilizing venovenous ECMO

    Directory of Open Access Journals (Sweden)

    Shunpei Okochi, MD

    2017-05-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO is a form of life support with an ever-expanding range of indications. Veno-venous (VV ECMO is often utilized to support children with respiratory compromise, and has been employed successfully in the acute setting of traumatic tracheobronchial injury as well as during elective tracheal surgery. We present a successful case of VV ECMO used in the perioperative management of a tracheal repair for a traumatic laceration caused by attempts to retrieve an esophageal foreign body. While this mechanism of injury appears to be rare, we believe that VV-ECMO allowed for the optimal management of this child and should be considered for other extensive tracheal injuries in children.

  13. Multi-sensor esophageal temperature probe used during radiofrequency ablation for atrial fibrillation is associated with increased intraluminal temperature detection and increased risk of esophageal injury compared to single-sensor probe.

    Science.gov (United States)

    Carroll, Brett J; Contreras-Valdes, Fernando M; Heist, E Kevin; Barrett, Conor D; Danik, Stephan B; Ruskin, Jeremy N; Mansour, Moussa

    2013-09-01

    Radiofrequency (RF) ablation in the posterior left atrium has risk of thermal injury to the adjacent esophagus. Increased intraluminal esophageal temperature has been correlated with risk of esophageal injury. The objective of this study was to compare esophageal temperature monitoring (ETM) using a multi-sensor temperature probe with 12 sensors to a single-sensor probe during catheter ablation for atrial fibrillation (AF). We compared the detection of intraluminal esophageal temperature rises in 543 patients undergoing RF ablation for AF with ETM. Esophageal endoscopy (EGD) was performed on all patients with maximum esophageal temperature ≥ 39°C. Esophageal lesions were classified by severity as mild or severe ulcerations. Four hundred fifty-five patients underwent RF ablation with single-sensor ETM and 88 patients with multi-sensor ETM. Thirty-nine percent of patients with single-sensor versus 75% with multi-sensor ETM reached a maximum detected esophageal temperature ≥ 39°C (P temperature ≥ 39°C by single-sensor versus 46% of patients with multi-sensor ETM (P = 0.021). Thirty-nine percent of patients with lesions in the single-sensor probe group had severe ulcerations compared to 33% of patients in the multi-sensor probe group (P = 0.641). Intraluminal esophageal temperature ≥ 39°C is detected more frequently by the multi-sensor temperature probe versus the single-sensor probe, with more frequent esophageal injury and with comparable severity of injury. Despite detecting esophageal temperature rises in more patients, the multi-sensor probe may not have any measurable benefit compared to a single-sensor probe. © 2013 Wiley Periodicals, Inc.

  14. Western Trauma Association Critical Decisions in Trauma: Diagnosis and management of esophageal injuries.

    Science.gov (United States)

    Biffl, Walter L; Moore, Ernest E; Feliciano, David V; Albrecht, Roxie A; Croce, Martin; Karmy-Jones, Riyad; Namias, Nicholas; Rowell, Susan; Schreiber, Martin; Shatz, David V; Brasel, Karen

    2015-12-01

    This is a recommended management algorithm from the Western Trauma Association addressing the diagnostic evaluation and management of esophageal injuries in adult patients. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, the recommendations herein are based primarily on published observational studies and expert opinion of Western Trauma Association members. The algorithms and accompanying comments represent a safe and sensible approach that can be followed at most trauma centers. We recognize that there will be patient, personnel, institutional, and situational factors that may warrant or require deviation from the recommended algorithm. We encourage institutions to use this guideline to formulate their own local protocols.The algorithm contains letters at decision points; the corresponding paragraphs in the text elaborate on the thought process and cite pertinent literature. The annotated algorithm is intended to (a) serve as a quick bedside reference for clinicians; (b) foster more detailed patient care protocols that will allow for prospective data collection and analysis to identify best practices; and (c) generate research projects to answer specific questions concerning decision making in the management of adults with esophageal injuries.

  15. [Clinical characteristics of gastroesophageal reflux disease with esophageal injury in korean: focusing on risk factors].

    Science.gov (United States)

    Lee, Seung Jun; Jung, Min Kyu; Kim, Sung Kook; Jang, Byung Ik; Lee, Si Hyung; Kim, Kyeong Ok; Kim, Eun Soo; Cho, Kwang Bum; Park, Kyung Sik; Kim, Eun Young; Jung, Jin Tae; Kwon, Joong Goo; Lee, Joong Hyun; Yang, Chang Hun; Park, Chang Keun; Seo, Hyang Eun; Jeon, Seong Woo

    2011-05-25

    Recent studies suggest that the prevalence of gastroesophageal reflux disease (GERD) is increasing in Korea. However, studies on risk factors for GERD have yielded inconsistent results. The aims of this study were to compare clinical features between symptomatic syndromes without esophageal injury (=non-erosive disease [NED]) and syndromes with esophageal injury (=erosive disease [ED]), and to determine risk factors associated ED. A total of 450 subjects who visited gastroenterology clinics of six training hospitals in Daegu from March 2008 to April 2010 were consecutively enrolled. The subjects were asked to complete a questionnaire which inquired about gastroesophageal reflux symptoms. The questionnaire also included questions about smoking, alcohol drinking, consumption of coffee, use of drugs, exercise, and other medical history. The subjects were subdivided into NED and ED groups. The proportion of subjects in each NED and ED group was 172 (38.2%) and 278 (61.8%). Male gender, smoking, alcohol drinking, consumption of coffee, large waist circumference, infrequent medication of antacids, aspirin and NSAIDs, infrequent and mild GERD symptoms were all significantly associated with ED on univariate analysis. Age, hiatal hernia, diabetes mellitus, body mass index, change in weight during 1 year, and number of typical GERD symptoms were not independent risk factors for ED. However, the association between ED and alcohol drinking, infrequent medication of antacids, mild typical GERD symptoms remained as strong risk factors after adjustments on multivariate logistic analysis. Independent risk factors associated with ED were alcohol drinking, infrequent medication of antacids and mild typical GERD symptoms.

  16. Transorbital Craniocerebral Occult Penetrating Injury with Cerebral Abscess Complication

    Directory of Open Access Journals (Sweden)

    Arif Abdulbaki

    2012-01-01

    Full Text Available Transorbital intracranial penetrating injury is an uncommon mechanism of head injury. These injuries can be occult during the initial clinical presentation. Certain patients develop an intracranial cerebral infection. Herein, we report a 5-year-old child with an occult transorbital intracranial penetrating injury caused by a pen. A retained pen tip was found at the superior orbital roof and was not noticed at initial presentation. This was complicated by a right frontal lobe cerebral abscess. This paper emphasizes the importance of orbitocranial imaging in any penetrating orbital injury. A review of the literature on intracranial infection locations in relation to the route and mechanism of injury is included to complement this report.

  17. The Complicated Facial War Injury: Pitfalls and Mismanagement.

    Science.gov (United States)

    Abu-Sittah, Ghassan S; Baroud, Joe; Hakim, Christopher; Wakil, Cynthia

    2017-01-01

    The aim of this paper is to share the authors' experience in the management of complicated facial war injuries using free tissue transfer. A discussion on the most commonly encountered pitfalls in management during the acute and complicated settings is presented in an effort to raise insight on facial war wound complications. Two patients of complicated facial war injuries are presented to exemplify the pitfalls in acute and chronic management of the mandibular region in the first patient and the orbito-maxillary region in the second. The examples demonstrate free tissue transfer for early as well as late definitive reconstructions. A reconstruction algorithm or consensus regarding the optimal management plan of complicated facial war injuries is not attainable. The main principles of treatment, however, remain to decrease bacterial burden by adequate aggressive debridement followed by revisit sessions, remove of all infected hardware followed by replacement with external bony fixation if necessary and reviving the affected area by coverage with well-vascularized tissues and bone. The later is feasible via local, regional, or distant tissue transfer depending on the extent of injury, surgeon's experience, and time and personnel available. Free tissue transfer has revolutionized the management of complicated facial war injuries associated with soft tissue or bone loss as it has allowed the introduction of well-vascularized tissues into a hostile wound environment. The end result is a reduced infection rate, faster recovery time, and better functional outcome compared with when loco-regional soft tissue coverage or bone grafting is used. When soft tissue or bone loss is present, free tissue transfer should be the first management plan if time and personnel are available. The ultimate treatment of a complicated war wound remains prevention by accurate initial management.

  18. Rare complication of percutaneous endoscopic gastrostomy: Ostomy metastasis of esophageal carcinoma

    Science.gov (United States)

    Sousa, Ana Lúcia; Sousa, Diamantino; Velasco, Francisco; Açucena, Francisco; Lopes, Ana; Guerreiro, Horácio

    2013-01-01

    The authors present the case of a 55-year-old male with a stage III (T4N1M0) squamous-cell esophageal carcinoma, who underwent percutaneous endoscopic gastrostomy (PEG). The pull method of tube placement was used. Five months after the procedure, the patient was referred to the hospital with a hard palpable tumour at the ostomy site. The histologic exam revealed an abdominal wall metastasis of the esophageal cancer. The authors present this case because of the rarity of metastasis in ostomy after placement of PEG in patients with tumours located in the head and neck. In this particular context and judging by the rarity of situation, the clinical impact of this phenomenon is limited. Nevertheless, metastasis in ostomy site could be prevented by the push method, laparoscopy or laparotomy. PMID:24244807

  19. Early and late complications of ocular burn injuries.

    Science.gov (United States)

    Cabalag, Miguel S; Wasiak, Jason; Syed, Quaderi; Paul, Eldho; Hall, Anthony J; Cleland, Heather

    2015-03-01

    Ocular involvement in facial burns may lead to significant long-term morbidity. The aims of this study were to analyse the epidemiology, management and outcomes of ocular burn injuries, as well as to identify risk factors for developing early and late ocular complications. A retrospective medical chart review was conducted for 125 patients with ocular burns who were admitted to the Victorian Adult Burns Service (VABS), from November 2000 to January 2010. Univariate analyses was utilised to identify demographic and injury related variables associated with early and late complications. The majority of patients were male (n=101, 80.8%), and the mean (range) age was 40.7 (15-86) years. The most common mechanism was flame burns (n=77, 61.6%), and most were accidental (n=114, 91.2%). Early ocular complications occurred in 50 (40.0% [95% CI: 31.3%-49.1%]) patients, with the commonest being visual loss (n=39, 31.2%). Chemical burns, ocular discomfort, peri-orbital oedema, corneal injury, as well as eyelid and facial burns of increasing severity were associated with developing an early complication. Late ocular complications occurred in 19 (15.2% [95% CI: 9.4%-22.7%]) patients, with visual loss being the most frequent (n=13, 10.4%). Chemical burns, ocular discomfort, corneal injury of increasing severity, visual loss on presentation, ectropion, as well as eyelid burns of increasing depth were associated with late morbidity. Chemical burns, ocular discomfort, as well as corneal injury and eyelid burns of increasing severity were risk factors for both early and late ocular complications. III (retrospective comparative study). Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  20. Complications associated with blood alcohol concentration following injury.

    Science.gov (United States)

    Friedman, Lee S

    2014-06-01

    Alcohol increases the risk of injuring oneself and others. However, following an injury there appears to be a benefit to alcohol in mediating the body's response to a traumatic injury and reducing mortality. The physiological mechanism underlying this reported association is poorly understood. One approach to explaining the pathways by which alcohol affects acute mortality following a traumatic injury is to identify differential prevalence of medical complications associated with increased mortality. The goal of this study was to evaluate the association between blood alcohol concentration and complications subsequent to a traumatic injury that are associated with increased in-hospital mortality. This study involved a retrospective analysis of traumatic injuries occurring between 2000 and 2009 as reported by all level I and II trauma units in the state of Illinois. The study includes all patients with blood alcohol toxicological examination levels ranging from zero to 500 mg/dL and meeting additional inclusion criteria (n = 84,974). A reduction in complications of cardiac and renal function by 23.5% and 30.0%, respectively, was attributable to blood alcohol concentration. In addition, blood alcohol concentration was associated with fewer cases of pneumothorax and convulsions. However, blood alcohol concentration continued to be positively associated with aspiration pneumonitis and acute pancreatitis in the final models. The net impact of alcohol following an injury is protective, largely attributable to a reduction in complications relating to cardiac and renal function. This study helps to explain the observed protective effect from blood alcohol concentrations in reducing in-hospital mortality after an injury, as reported in many studies. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. associated injuries and complications in floating knee management

    African Journals Online (AJOL)

    Objective: This retrospective study set out to explore associated injuries and complications in floating knee management. Design: A retrospective study. Materials and Methods: The investigation lasted ten years from 1st January, 2000 to 31st December, 2009. All the patients admitted in that period with a floating knee were ...

  2. Moving bullet syndrome: a complication of penetrating head injury.

    Science.gov (United States)

    Zafonte, R D; Watanabe, T; Mann, N R

    1998-11-01

    Penetrating injuries, by definition, result in retained bullets or fragments. Usually, these fragments are removed surgically during wound debridement. Occasionally, the position of the bullet may preclude removal if it is thought that surgery could exacerbate neurologic damage. Complications from retained fragments are uncommon. One rare complication is the spontaneous migration of the fragment. Two cases of spontaneous migration of retained bullets are presented. In both cases neurologic deterioration was noted and computed tomographic imaging was diagnostic. In one case, this complication delayed transfer from the acute care hospital to rehabilitation. In the other case, the migrating bullet was removed during the inpatient rehabilitation stay. Each person improved neurologically after the migrating bullet fragment was removed. Additionally, functional progress was marked in both persons and symptomatic relief noted. Rehabilitation physicians caring for survivors of penetrating brain injuries need to be aware of this potentially devastating phenomenon.

  3. Revision of vertical banded gastroplasty complicated by a large para-esophageal hernia.

    Science.gov (United States)

    Khan, Mansoor; Lee, Fred; Ackroyd, Roger

    2010-07-01

    Patients who have undergone bariatric surgery and present with upper abdominal symptoms pose a diagnostic and management challenge. This is a case report of a 53-year-old lady who presented a number of years after vertical banded gastroplasty with upper abdominal pain and weight gain. Radiological investigation demonstrated a large para-esophageal hernia including the stapled area of the stomach, but with a staple-line dehiscence. She successfully underwent repair of the hiatus hernia and conversion to a Roux-en-Y gastric bypass resulting in resolution of the abdominal pain and weight loss.

  4. Computed tomographic study of the complication of head injury

    Energy Technology Data Exchange (ETDEWEB)

    Kojima, T.; Waga, S. (Mie Univ., Tsu (Japan). School of Medicine)

    1982-08-01

    Computed tomography (CT) is quite effective in the diagnosis of traumatic intracranial hemorrhage and cerebral contusion. Two hundred and nine consecutive patients with head injury were admitted to the hospital and studied by CT in the year from 1977 to 1980. Fourty-seven of 209 patients had the complications of head injury, including 6 patients with carotidcavernous fistula (CCF), 6 with traumatic aneurysm, 10 with pneumocephalus, 4 with intracranial foreign body, 15 with optic nerve injury, and 14 with other cranial nerve palsy. Five patients with CCF had abnormal finding on CT. Two traumatic aneurysms of the superficial temporal artery were visualized on CT after injection of contrast material, but all traumatic aneurysms of the carotid siphon were not seen on CT. CT in all 10 patients with pneumocephalus and in all 4 patients with intracranial foreign body was of diagnostic value: On CT in two patients even small air bubbles were seen in details. In the CT examination of 29 patients who presented with cranial nerve injury, we could not find out any abnormality on CT. We emphasize that CT is much less effective in the diagnosis of vascular complication of head injury and traumatic cranial nerve injury.

  5. Ureter Injury as a Complication of Oblique Lumbar Interbody Fusion.

    Science.gov (United States)

    Lee, Hyeong-Jin; Kim, Jin-Sung; Ryu, Kyeong-Sik; Park, Choon Keun

    2017-06-01

    Oblique lumbar interbody fusion is a commonly used surgical method of achieving lumbar interbody fusion. There have been some reports about complications of oblique lumbar interbody fusion at the L2-L3 level. However, to our knowledge, there have been no reports about ureter injury during oblique lumbar interbody fusion. We report a case of ureter injury during oblique lumbar interbody fusion to share our experience. A 78-year-old male patient presented with a history of lower back pain and neurogenic intermittent claudication. He was diagnosed with spinal stenosis at L2-L3, L4-L5 level and spondylolisthesis at L4-L5 level. Symptoms were not improved after several months of medical treatments. Then, oblique lumbar interbody fusion was performed at L2-L3, L4-L5 level. During the surgery, anesthesiologist noticed hematuria. A retrourethrogram was performed immediately by urologist, and ureter injury was found. Ureteroureterostomy and double-J catheter insertion were performed. The patient was discharged 2 weeks after surgery without urologic or neurologic complications. At 2 months after surgery, an intravenous pyelogram was performed, which showed an intact ureter. Our study shows that a low threshold of suspicion of ureter injury and careful manipulation of retroperitoneal fat can be helpful to prevent ureter injury during oblique lumbar interbody fusion at the upper level. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. MRI of cervical spine injuries complicating ankylosing spondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Koivikko, Mika P.; Koskinen, Seppo K. [Helsinki Medical Imaging Center, Helsinki University Central Hospital, Toeoeloe Hospital, Department of Radiology, Helsinki (Finland)

    2008-09-15

    The objective was to study characteristic MRI findings in cervical spine fractures complicating ankylosing spondylitis (AS). Technical issues related to MRI are also addressed. A review of 6,774 consecutive cervical spine multidetector CT (MDCT) scans obtained during 6.2 years revealed 33 ankylosed spines studied for suspected acute cervical spine injury complicating AS. Of these, 20 patients also underwent MRI. On MRI, of these 20 patients, 19 had a total of 29 cervical and upper thoracic spine fractures. Of 20 transverse fractures traversing both anterior and posterior columns, 7 were transdiskal and exhibited less bone marrow edema than did those traversing vertebral bodies. One Jefferson's, 1 atlas posterior arch (Jefferson's on MDCT), 2 odontoid process, and 5 non-contiguous spinous process fractures were detectable. MRI showed 2 fractures that were undetected by MDCT, and conversely, MDCT detected 6 fractures not seen on MRI; 16 patients had spinal cord findings ranging from impingement and contusion to complete transection. Magnetic resonance imaging can visualize unstable fractures of the cervical and upper thoracic spine. Paravertebral hemorrhages and any ligamentous injuries should alert radiologists to seek transverse fractures. Multiple fractures are common and often complicated by spinal cord injuries. Diagnostic images can be obtained with a flexible multipurpose coil if the use of standard spine array coil is impossible due to a rigid collar or excessive kyphosis. (orig.)

  7. Analysis of Intensity-Modulated Radiation Therapy (IMRT), Proton and 3D Conformal Radiotherapy (3D-CRT) for Reducing Perioperative Cardiopulmonary Complications in Esophageal Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Ling, Ted C.; Slater, Jerry M.; Nookala, Prashanth; Mifflin, Rachel; Grove, Roger; Ly, Anh M.; Patyal, Baldev; Slater, Jerry D.; Yang, Gary Y., E-mail: gyang@llu.edu [Department of Radiation Medicine, Loma Linda University Medical Center, 11234 Anderson Street, A875, Loma Linda, CA 92354 (United States)

    2014-12-05

    Background. While neoadjuvant concurrent chemoradiotherapy has improved outcomes for esophageal cancer patients, surgical complication rates remain high. The most frequent perioperative complications after trimodality therapy were cardiopulmonary in nature. The radiation modality utilized can be a strong mitigating factor of perioperative complications given the location of the esophagus and its proximity to the heart and lungs. The purpose of this study is to make a dosimetric comparison of Intensity-Modulated Radiation Therapy (IMRT), proton and 3D conformal radiotherapy (3D-CRT) with regard to reducing perioperative cardiopulmonary complications in esophageal cancer patients. Materials. Ten patients with esophageal cancer treated between 2010 and 2013 were evaluated in this study. All patients were simulated with contrast-enhanced CT imaging. Separate treatment plans using proton radiotherapy, IMRT, and 3D-CRT modalities were created for each patient. Dose-volume histograms were calculated and analyzed to compare plans between the three modalities. The organs at risk (OAR) being evaluated in this study are the heart, lungs, and spinal cord. To determine statistical significance, ANOVA and two-tailed paired t-tests were performed for all data parameters. Results. The proton plans showed decreased dose to various volumes of the heart and lungs in comparison to both the IMRT and 3D-CRT plans. There was no difference between the IMRT and 3D-CRT plans in dose delivered to the lung or heart. This finding was seen consistently across the parameters analyzed in this study. Conclusions. In patients receiving radiation therapy for esophageal cancer, proton plans are technically feasible while achieving adequate coverage with lower doses delivered to the lungs and cardiac structures. This may result in decreased cardiopulmonary toxicity and less morbidity to esophageal cancer patients.

  8. Analysis of Intensity-Modulated Radiation Therapy (IMRT, Proton and 3D Conformal Radiotherapy (3D-CRT for Reducing Perioperative Cardiopulmonary Complications in Esophageal Cancer Patients

    Directory of Open Access Journals (Sweden)

    Ted C. Ling

    2014-12-01

    Full Text Available Background. While neoadjuvant concurrent chemoradiotherapy has improved outcomes for esophageal cancer patients, surgical complication rates remain high. The most frequent perioperative complications after trimodality therapy were cardiopulmonary in nature. The radiation modality utilized can be a strong mitigating factor of perioperative complications given the location of the esophagus and its proximity to the heart and lungs. The purpose of this study is to make a dosimetric comparison of Intensity-Modulated Radiation Therapy (IMRT, proton and 3D conformal radiotherapy (3D-CRT with regard to reducing perioperative cardiopulmonary complications in esophageal cancer patients. Materials. Ten patients with esophageal cancer treated between 2010 and 2013 were evaluated in this study. All patients were simulated with contrast-enhanced CT imaging. Separate treatment plans using proton radiotherapy, IMRT, and 3D-CRT modalities were created for each patient. Dose-volume histograms were calculated and analyzed to compare plans between the three modalities. The organs at risk (OAR being evaluated in this study are the heart, lungs, and spinal cord. To determine statistical significance, ANOVA and two-tailed paired t-tests were performed for all data parameters. Results. The proton plans showed decreased dose to various volumes of the heart and lungs in comparison to both the IMRT and 3D-CRT plans. There was no difference between the IMRT and 3D-CRT plans in dose delivered to the lung or heart. This finding was seen consistently across the parameters analyzed in this study. Conclusions. In patients receiving radiation therapy for esophageal cancer, proton plans are technically feasible while achieving adequate coverage with lower doses delivered to the lungs and cardiac structures. This may result in decreased cardiopulmonary toxicity and less morbidity to esophageal cancer patients.

  9. Complications and Causes of Death in Spinal Cord Injury Patients in ...

    African Journals Online (AJOL)

    Conclusion: Most common complication and cause of death following SCI are muscle spasm and respiratory failure respectively. The risk factors associated with mortality are age, GCS<9, cervical spinal injury, and complete neurologic injury and those for complications were cervical spinal injury and Frankel Type A injury.

  10. {sup 18}F-Fluorodeoxyglucose Positron Emission Tomography Can Quantify and Predict Esophageal Injury During Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Niedzielski, Joshua S., E-mail: jsniedzielski@mdanderson.org [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); University of Texas Houston Graduate School of Biomedical Science, Houston, Texas (United States); Yang, Jinzhong [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); University of Texas Houston Graduate School of Biomedical Science, Houston, Texas (United States); Liao, Zhongxing; Gomez, Daniel R. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Stingo, Francesco [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mohan, Radhe; Martel, Mary K.; Briere, Tina M.; Court, Laurence E. [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); University of Texas Houston Graduate School of Biomedical Science, Houston, Texas (United States)

    2016-11-01

    Purpose: We sought to investigate the ability of mid-treatment {sup 18}F-fluorodeoxyglucose positron emission tomography (PET) studies to objectively and spatially quantify esophageal injury in vivo from radiation therapy for non-small cell lung cancer. Methods and Materials: This retrospective study was approved by the local institutional review board, with written informed consent obtained before enrollment. We normalized {sup 18}F-fluorodeoxyglucose PET uptake to each patient's low-irradiated region (<5 Gy) of the esophagus, as a radiation response measure. Spatially localized metrics of normalized uptake (normalized standard uptake value [nSUV]) were derived for 79 patients undergoing concurrent chemoradiation therapy for non-small cell lung cancer. We used nSUV metrics to classify esophagitis grade at the time of the PET study, as well as maximum severity by treatment completion, according to National Cancer Institute Common Terminology Criteria for Adverse Events, using multivariate least absolute shrinkage and selection operator (LASSO) logistic regression and repeated 3-fold cross validation (training, validation, and test folds). This 3-fold cross-validation LASSO model procedure was used to predict toxicity progression from 43 asymptomatic patients during the PET study. Dose-volume metrics were also tested in both the multivariate classification and the symptom progression prediction analyses. Classification performance was quantified with the area under the curve (AUC) from receiver operating characteristic analysis on the test set from the 3-fold analyses. Results: Statistical analysis showed increasing nSUV is related to esophagitis severity. Axial-averaged maximum nSUV for 1 esophageal slice and esophageal length with at least 40% of axial-averaged nSUV both had AUCs of 0.85 for classifying grade 2 or higher esophagitis at the time of the PET study and AUCs of 0.91 and 0.92, respectively, for maximum grade 2 or higher by treatment completion

  11. Visualized Evaluation of Blood Flow to the Gastric Conduit and Complications in Esophageal Reconstruction.

    Science.gov (United States)

    Noma, Kazuhiro; Shirakawa, Yasuhiro; Kanaya, Nobuhiko; Okada, Tsuyoshi; Maeda, Naoaki; Ninomiya, Takayuki; Tanabe, Shunsuke; Sakurama, Kazufumi; Fujiwara, Toshiyoshi

    2018-03-01

    Evaluation of the blood supply to gastric conduits is critically important to avoid complications after esophagectomy. We began visual evaluation of blood flow using indocyanine green (ICG) fluorescent imaging in July 2015, to reduce reconstructive complications. In this study, we aimed to statistically verify the efficacy of blood flow evaluation using our simplified ICG method. A total of 285 consecutive patients who underwent esophagectomy and gastric conduit reconstruction were reviewed and divided into 2 groups: before and after introduction of ICG evaluation. The entire cohort and 68 patient pairs after propensity score matching (PS-M) were evaluated for clinical outcomes and the effect of visualized evaluation on reducing the risk of complication. The leakage rate in the ICG group was significantly lower than in the non-ICG group for each severity grade, both in the entire cohort (285 subjects) and after PS-M; the rates of other major complications, including recurrent laryngeal nerve palsy and pneumonia, were not different. The duration of postoperative ICU stay was approximately 1 day shorter in the ICG group than in the non-ICG group in the entire cohort, and approximately 2 days shorter after PS-M. Visualized evaluation of blood flow with ICG methods significantly reduced the rate of anastomotic complications of all Clavien-Dindo (CD) grades. Odds ratios for ICG evaluation decreased with CD grade (0.3419 for CD ≥ 1; 0.241 for CD ≥ 2; and 0.2153 for CD ≥ 3). Objective evaluation of blood supply to the reconstructed conduit using ICG fluorescent imaging reduces the risk and degree of anastomotic complication. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  12. MICROBIOLOGICAL METHODS APPLICATION EXPERIENCE IN THE SEVERE INJURIES INFECTIOUS COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    S. A. Svistunov

    2016-01-01

    Full Text Available Modern clinical medicine and surgery problems are associated with infections complications after medical care. In recent years, surgery has made substantial progress related to the new organizational approaches and medical technology specialized medical care to the wounded and injured. However, these gains are offset by a high rate of infectious complications that require finding effective measures emerging infectious complications timely diagnosis and their prevention. Clinical manifestations are often nosocomial in patients with severe injuries and are largely determined by the influence of clinical and pathogenetic risk factors. Such infectious complications require a comprehensive assessment, including microbiological testing. The main causative agents of infectious complications in surgical hospitals are S. aureus, K. pneumoniae, P. aeruginosa, Acinetobacter spp., which can cause bloodstream infections, soft tissue, respiratory and urinary tract infections, especially in debilitated and immunocompromised patients and patients in intensive care units. These micro organisms are dangerous to patients and medical staff, as they can survive for a long time in the hospital environment, as well as to spread from patient to patient in violation of isolation restrictive measures and requirements for hygiene of medical workers hands. Clinical patterns of infection associated with medical care for severe injuries are to the possibility of serial and parallel development, both in different and in the same time frame of local, visceral and generalized infection with prevalence of combined forms of patients surgical hospital with a high risk of nosocomial infection against the background of factors, diagnostic and treatment process and hospital environment, introduction of the agent. Early etiological diagnosis allows timely assign empirical causal treatment and arrange for infection control to prevent the spread of microorganisms in the hospital. The

  13. Frequency distribution of gastro esophageal reflux disease in inhalation injury: A historical cohort study

    Directory of Open Access Journals (Sweden)

    Ashraf Karbasi

    2015-01-01

    Full Text Available Background: There is no data on the prevalence and the association of gastro esophageal reflux disease (GERD with toxic fume inhalation. Therefore, we aimed to evaluate the frequency distribution of GERD symptoms among the individuals with mild respiratory disorder due to the past history of toxic fume exposure to sulfur mustard (SM. Materials and Methods: In a historical cohort study, subjects were randomly selected from 7000 patients in a database of all those who had a history of previous exposure to a single high dose of SM gas during war. The control group was randomly selected from adjacent neighbors of the patients, and two healthy male subjects were chosen per patient. In this study, we used the validated Persian translation of Mayo Gastroesophageal Reflux Questionnaire to assess the frequency distribution of reflux disease. Results: Relative frequency of GERD symptoms, was found to be significantly higher in the inhalation injury patients with an odds ratio of 8.30 (95% confidence interval [CI]: 4.73-14.55, and after adjustment for cigarette smoking, tea consumption, age, and body mass index, aspirin and chronic cough the odds ratio was found to be 4.41 (95% CI: 1.61-12.07. Conclusion: The most important finding of our study was the major GERD symptoms (heartburn and/or acid regurgitation once or more per week among the individuals with the past history of exposure to SM toxic gas is substantially higher (4.4-fold than normal populations.

  14. Common complication of crush injury, but a rare compartment syndrome

    Directory of Open Access Journals (Sweden)

    Shaikh Nissar

    2010-01-01

    Full Text Available Compartment syndrome (CS is a common complication of crush injury but it is rare to find bilateral gluteal compartment syndrome (BGCS. Only six cases of BGCS have been reported in the literature. This syndrome has been reported after crush injury, drug overdose, surgical positioning, and vascular surgery. Apart from CS, crush injury is associated with multi-system adverse effects and these patients are at high risk for renal failure and sepsis. CS patients may present with dehydration; coagulation disorders; elevated creatine phosphokinase and myoglobin levels; hyperkalemia and hypocalcaemia, which may cause life-threatening arrhythmias and therefore need urgent and aggressive therapy. The early goal in these patients is prevention of acute renal failure with aggressive fluid therapy, alkalinization of urine, and forced diuresis. Early treatment of hyperkalemia, antibiotic therapy, immunoprophylaxis, and wound care will minimize the risk of arrhythmias and sepsis. CS must be considered when any patient is diagnosed with crush injury syndrome. CS is defined as elevation of interstitial/intracompartmental pressure, leading to microvascular and myoneural dysfunction and secondary hypoxia; it may cause functional loss or even death if not detected early and treated properly. The increase in pressure in one or all compartments of the gluteal region causes CS with devastating effects on muscle and neurovascular bundles. CS is traditionally diagnosed on the basis of five ′p′s: pain, pallor, paraesthesia, pulselessness and paralysis. Diagnosis of gluteal CS is difficult as the peripheral pulses are preserved and the condition is usually only diagnosed when neurological abnormality is noticed. Diagnosis of CS can be made by direct measurement of the compartment pressure and magnetic resonance imaging or computerized tomography. Gluteal CS is managed by fasciotomy and debridement of necrosed tissue, with secondary closure of fascia. A high index of

  15. Covered Esophageal Stenting Is Effective for Symptomatic Gastric Lumen Narrowing and Related Complications Following Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Aburajab, Murad A; Max, Joshua B; Ona, Mel A; Gupta, Kapil; Burch, Miguel; Michael Feiz, F; Lo, Simon K; Jamil, Laith H

    2017-11-01

    Laparoscopic sleeve gastrectomy (LSG) is gaining popularity in treating morbid obesity. Prior studies showed a 3.5% risk of gastric sleeve stenosis (GSS). There is no consensus on how to treat these patients, and the role of endoscopic therapy has been addressed in only a few studies. We aim to assess the efficacy and safety of endoscopic stenting in the management of GSS following LSG. Retrospective data were reviewed from July 2009 to November 2013. Patients were referred for endoscopic therapy for symptoms or imaging findings suggestive of gastric leak or narrowing following LSG. Endoscopic therapy included the use of fully covered self-expanding esophageal metal stents (FCSEMS) in addition to over-the-scope clip system (OTSC) when necessary. All 27 patients were females with mean age of 40 years; six patients were excluded from the study. Major symptom was nausea and vomiting in 57% of the patients. Five of 21 patients had concomitant leaks. All 21 patients underwent FCSEMS placement, and four out of five patients (80%) with concomitant leak had OTSC. The success rate in both groups for resolution of stricture and leak was 100%, and no surgical intervention was required. There were no immediate or delayed complications of endoscopic therapy. Median follow-up of 6 months was available for 20/21 patients. Among patients with gastric leak, 80% had resolution of their symptoms compared with 93% of patients with GSS. Endoscopic therapy for LSG-related GSS or leaks with FCSEMS is highly effective and safe.

  16. ESPGHAN-NASPGHAN Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Esophageal Atresia-Tracheoesophageal Fistula.

    Science.gov (United States)

    Krishnan, Usha; Mousa, Hayat; Dall'Oglio, Luigi; Homaira, Nusrat; Rosen, Rachel; Faure, Christophe; Gottrand, Frédéric

    2016-11-01

    Esophageal atresia (EA) is one of the most common congenital digestive anomalies. With improvements in surgical techniques and intensive care treatments, the focus of care of these patients has shifted from mortality to morbidity and quality-of-life issues. These children face gastrointestinal (GI) problems not only in early childhood but also through adolescence and adulthood. There is, however, currently a lack of a systematic approach to the care of these patients. The GI working group of International Network on Esophageal Atresia comprises members from ESPGHAN/NASPGHAN and was charged with the task of developing uniform evidence-based guidelines for the management of GI complications in children with EA. Thirty-six clinical questions addressing the diagnosis, treatment, and prognosis of the common GI complications in patients with EA were formulated. Questions on the diagnosis, and treatment of gastroesophageal reflux, management of "cyanotic spells," etiology, investigation and management of dysphagia, feeding difficulties, anastomotic strictures, congenital esophageal stenosis in EA patients were addressed. The importance of excluding eosinophilic esophagitis and associated GI anomalies in symptomatic patients with EA is discussed as is the quality of life of these patients and the importance of a systematic transition of care to adulthood. A systematic literature search was performed from inception to March 2014 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation.

  17. New surgical approach for late complications from spinal cord injury

    Directory of Open Access Journals (Sweden)

    Reis Antonio J

    2006-10-01

    Full Text Available Abstract Background The most frequent late complications in spinal cord injury result from arachnoiditis and consequent alterations in dynamics of cerebrospinal fluid flow. A surgical procedure carried out on patients with these alterations, resolved the various pathologies more efficiently in all cases. Methods From October 2000 to March 2006, 23 patients were selected for surgery: three showed signs of syringomyelia, three presented with microcystic lesions, three presented with arachnoid cysts in different locations but always confluent to the scar area, and 14 showed evidence of tethered cords. The surgery consisted of laminectomy at four levels, followed by dural opening in order to remove all the arachnoiditis at the level of the scar and to remove the altered arachnoid and its cysts, at least at two levels above and below the lesion. The dentate ligaments were cut at all exposed levels. Results The patients had no postoperative problems and not only retained all neurological functions but also showed neurological recovery. According to the motor and sensory scale of the American Spinal Injury Association, the recoveries were motor 20.6% (P Conclusion This alternative surgery resolved the pathologies provoking neurological deterioration by releasing the complete spinal cord at the level of the scar and the levels above and below it. It thus avoids myelotomies and the use of shunts and stents, which have a high long-term failure rate and consequent relapses. Nevertheless, this surgical procedure allows patients the chance to opt for any further treatment that may evolve in the future.

  18. Twin pregnancy complicated by esophageal atresia, duodenal atresia, gastric perforation, and hypoplastic left heart structures in one twin: a case report and review of the literature.

    Science.gov (United States)

    Abou Chaar, Mohamad K; Meyers, Mariana L; Tucker, Bethany D; Galan, Henry L; Liechty, Kenneth W; Crombleholme, Timothy M; Marwan, Ahmed I

    2017-03-18

    The antenatal diagnosis of a combined esophageal atresia without tracheoesophageal fistula and duodenal atresia with or without gastric perforation is a rare occurrence. These diagnoses are difficult and can be suspected on ultrasound by nonspecific findings including a small stomach and polyhydramnios. Fetal magnetic resonance imaging adds significant anatomical detail and can aid in the diagnosis of these complicated cases. Upon an extensive literature review, there are no reports documenting these combined findings in a twin pregnancy. Therefore we believe this is the first case report of an antenatal diagnosis of combined pure esophageal and duodenal atresia in a twin gestation. We present a case of a 30-year-old G1P0 white woman at 22-week gestation with a monochorionic-diamniotic twin pregnancy discordant for esophageal atresia, duodenal atresia with gastric perforation, hypoplastic left heart structures, and significant early gestation maternal polyhydramnios. In this case, fetal magnetic resonance imaging was able to depict additional findings including area of gastric wall rupture, hiatal hernia, dilation of the distal esophagus, and area of duodenal obstruction and thus facilitated the proper diagnosis. After extensive counseling at our multidisciplinary team meeting, the parents elected to proceed with radiofrequency ablation of the anomalous twin to maximize the survival of the normal co-twin. The procedure was performed successfully with complete cessation of flow in the umbilical artery and complete cardiac standstill in the anomalous twin with no detrimental effects on the healthy co-twin. Prenatal diagnosis of complex anomalies in twin pregnancies constitutes a multitude of ethical, religious, and cultural factors that come into play in the management of these cases. Fetal magnetic resonance imaging provides detailed valuable information that can assist in management options including possible prenatal intervention. The combination of a cystic

  19. From reflux esophagitis to Barrett's esophagus and esophageal adenocarcinoma.

    Science.gov (United States)

    Wang, Rui-Hua

    2015-05-07

    The occurrence of gastroesophageal reflux disease is common in the human population. Almost all cases of esophageal adenocarcinoma are derived from Barrett's esophagus, which is a complication of esophageal adenocarcinoma precancerous lesions. Chronic exposure of the esophagus to gastroduodenal intestinal fluid is an important determinant factor in the development of Barrett's esophagus. The replacement of normal squamous epithelium with specific columnar epithelium in the lower esophagus induced by the chronic exposure to gastroduodenal fluid could lead to intestinal metaplasia, which is closely associated with the development of esophageal adenocarcinoma. However, the exact mechanism of injury is not completely understood. Various animal models of the developmental mechanisms of disease, and theoretical and clinical effects of drug treatment have been widely used in research. Recently, animal models employed in studies on gastroesophageal reflux injury have allowed significant progress. The advantage of using animal models lies in the ability to accurately control the experimental conditions for better evaluation of results. In this article, various modeling methods are reviewed, with discussion of the major findings on the developmental mechanism of Barrett's esophagus, which should help to develop better prevention and treatment strategies for Barrett's esophagus.

  20. Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases).

    Science.gov (United States)

    Ren, Zhong; Zhong, Yunshi; Zhou, Pinghong; Xu, Meidong; Cai, Mingyan; Li, Liang; Shi, Qiang; Yao, Liqing

    2012-11-01

    The aim of this study was to investigate the management and treatment for complications during and after peroral endoscopic myotomy (POEM) for patients suffering from esophageal achalasia (EA). The data of 119 cases of EA patients who underwent POEM from October 2010 to July 2011 and the complications that arose during the operation, after the operation, and during follow-up were analyzed. Complications that occurred during the operation included cutaneous emphysema (22.7 %, 27/119) and pneumothorax (2.5 %, 3/119). Postoperative complications included pneumothorax (25.2 %, 30/119), subcutaneous emphysema (55.5 %, 66/119), mediastinal emphysema (29.4 %, 35/119), delayed hemorrhage (0.8 %, 1/119), pleural effusion (48.7 %, 58/119), minor inflammation or segmental atelectasis of the lungs (49.6 %, 59/119), and gas under diaphragm or aeroperitoneum (39.5 %, 47/119). Complications that occurred during follow-up included one case of difficulty eating caused by the stricture of mucosa and one case of dehiscence at the mouth of the tunnel created during surgery, with food retention. No deaths occurred. All complications were resolved through traditional treatment. No additional surgery was needed. Complications arising during and after POEM should be treated quickly and can be resolved by using traditional treatment. POEM can be expected to become the preferred treatment for EA.

  1. Risk factors for central bile duct injury complicating partial liver resection

    NARCIS (Netherlands)

    Boonstra, E. A.; de Boer, M. T.; Sieders, E.; Peeters, P. M. J. G.; de Jong, K. P.; Slooff, M. J. H.; Porte, R. J.

    Background: Bile duct injury is a serious complication following liver resection. Few studies have differentiated between leakage from small peripheral bile ducts and central bile duct injury (CBDI), defined as an injury leading to leakage or stenosis of the common bile duct, common hepatic duct,

  2. Acute phase complications following traumatic spinal cord injury in Dutch level 1 trauma centres.

    Science.gov (United States)

    van Weert, Karin C M; Schouten, Evert J; Hofstede, José; van de Meent, Henk; Holtslag, Herman R; van den Berg-Emons, Rita J G

    2014-10-01

    To assess the number and nature of complications during the acute phase following traumatic spinal cord injury and to explore the relationship between number of complications and length of hospital stay. Multi-centre prospective cohort study. A total of 54 patients with traumatic spinal cord injury, referred to 3 level 1 trauma centres in The Netherlands. The number and nature of complications were registered weekly from September 2009 to December 2011. A total of 32 patients (59%) had 1 or more medical complications. The most common complications were pressure ulcers (17 patients, 31%) and pulmonary complications (15 patients, 28%). PATIENTS with 3 or 4 complications had significantly (p < 0.01) longer hospital stays (58.5 [32.5] days) compared with those with 1 or 2 complications (33.1 [14.8] days) or no complications (21.5 [15.6] days). Complications, particularly pressure ulcers and pulmonary complications, occurred frequently during the acute phase following traumatic spinal cord injury. More complications were associated with longer hospital stays. Despite the existence of protocols, more attention is needed to prevent pressure ulcers during the acute phase following traumatic spinal cord injury for patients in The Netherlands.

  3. Analysis of risk factors for post-operative complications and prognostic predictors of disease recurrence following definitive treatment of patients with esophageal cancer from two medical centers in Northwest China.

    Science.gov (United States)

    Wang, Jichang; Zhang, Boxiang; Meng, Jinying; Xiao, Guodong; Li, Xiang; Li, Gang; Qin, Sida; Du, Ning; Zhang, Jia; Zhang, Jing; Xu, Chongwen; Tang, Shou-Ching; Liang, Rui; Ren, Hong; Sun, Xin

    2017-09-01

    Evaluating the clinicopathological features of patients receiving definitive treatment for esophageal cancer may facilitate the identification of patterns and factors associated with post-operative complications, and enable the development of a surveillance strategy for surviving patients at a higher risk of disease recurrence. In the present study, clinical data from 579 patients with esophageal cancer that underwent radical resection of esophagus were collected. These patients were admitted to two medical centers in Northwest China, and information regarding the presence or absence of basic chronic diseases and post-operative results were retrospectively analyzed. The level of selected stem cell markers, including aldehyde dehydrogenase 1, CD133, integrin subunit α 6, integrin subunit β 4 and T-cell factor-4, were determined in esophageal cancer tissue samples in order to determine whether these markers may be useful predictors of disease prognosis and recurrence. Post-operative complications in patients receiving radical resection of the esophagus included respiratory system complications, cardiovascular abnormalities and esophageal anastomotic fistulae. Diabetes, basic respiratory disease and lower pre-surgical serum albumin levels were observed to be individual risk factors associated with post-operative complications, including respiratory system complications of acute respiratory failure and pulmonary infection, cardiovascular abnormalities of atrial fibrillation and arrhythmia, as well as the development of esophageal anastomotic fistulae. Diagnosis of esophageal cancer at later stage was significantly correlated with anastomotic fistula. Molecular detection of stem cell markers for prognosis prediction was achieved by immunohistochemical and immunofluorescence staining assays. The results demonstrated that the presence of stem-like cells in cancer tissues was associated with poor disease prognosis and a high recurrence ratio. In conclusion, the results

  4. Prevention of Infections Associated With Combat-Related Eye, Maxillofacial, and Neck Injuries

    Science.gov (United States)

    2011-08-01

    endocarditis ; and to patients having gunshot wounds or penetrating injuries from military weaponry.23 Studies © 2011 Lippincott Williams & Wilkins...exploratory surgery on infectious complications. When upper aerodigestive tract injury is suspected, diagnostic workup should be expeditious as...predictor of infectious complications. When an esophageal injury is found early, surgical management should include copious wound irrigation

  5. Cervical Spine Injury: Nature and Complication | Yiltok | Nigerian ...

    African Journals Online (AJOL)

    BACKGROUND: Traumatic cervical spine injury is the commonest and most devastating injuries of the musculoskeletal system occurring more commonly in young patients from high energy vehicular accidents. This is particularly important considering the state of health care delivery system in Nigeria, increasing use of ...

  6. Avoidable birth injury complicated with limb gangrene: a reflection of ...

    African Journals Online (AJOL)

    2015-11-10

    Nov 10, 2015 ... Abstract: Gangrene of the lower extremities in neonates is a rare event except in traumatic cases. When risk factors for trauma to the limb of the newborn exist, it is important to prevent such injuries and when they are inevitable, ap- propriate management of injuries should further prevent complica-.

  7. Corrosive injuries of the upper gastrointestinal tract

    Directory of Open Access Journals (Sweden)

    Babu Lal Meena

    2017-01-01

    Full Text Available Corrosive injury of the upper gastrointestinal tract is a worldwide clinical problem, mostly occurring in children. Alkaline agents produce deeper injuries whereas acidic agents produce superficial injuries usually. Hoarseness, stridor, and respiratory distress indicate airway injury. Dysphagia, odynophagia, and drooling of saliva suggest esophageal injury whereas abdominal pain, nausea, and vomiting are indicative of stomach injury. X-rays should be done to rule out perforation. Endoscopy is usually recommended in the first 12–48 h although it is safe up to 96 h after caustic ingestion. Endoscopy should be performed with caution and gentle insufflation. Initial management includes getting intravenous access and replacement of fluids. Hyperemia and superficial ulcerations have excellent recovery while deeper injuries require total parenteral nutrition or feeding jejunostomy. Patients suspected of perforation should be subjected to laparotomy. Common complications after corrosive injury are esophageal stricture, gastric outlet obstruction, and development of esophageal and gastric carcinoma.

  8. Contemporary methods of treatment of injuries and their complications in immature permanent teeth in children

    OpenAIRE

    Tzigkounakis, Vasileios

    2010-01-01

    This study deals with the evaluation of endodontic treatment using calcium hydroxide materials in immature permanent teeth that have sustained traumas, especially after severe periodontal tissue injuries. - The aim of this work was: a. to analyze the factors that contribute to occurrence of post-traumatic complications, especially after avulsion injuries in immature permanent teeth , b. to investigate the effectiveness of endodontic therapy of these complications with the use of calcium hydro...

  9. Distribution, Complications, and Outcome of Footpad Injuries in Pet and Military Working Dogs.

    Science.gov (United States)

    Hansen, Lane A; Hazenfield, Kurt M; Olea-Popelka, Francisco; Smeak, Dan D

    2015-01-01

    This study reports the findings of 120 traumatic pad injuries in pet and military dogs. Most dogs (68%) presented with a laceration to a thoracic limb footpad, and one-third of dogs were middle-aged castrated males. Metacarpal pads were most commonly injured. Short-term complications were noted in 27% of dogs. No long-term complications were identified. No disability from pad injury was present at the completion of healing. Concurrent injuries to adjacent structures were uncommon and did not affect outcome. Dogs with full-thickness pad lacerations were at greater risk for major short-term complications compared to dogs with partial-thickness pad lacerations (odds ratio, 7.27; P = .001). Military working dogs with full-thickness pad lacerations were at greater risk for major short-term complications than pet dogs with a similar injury. When major complications developed in dogs with full-thickness pad injuries, time to final healing was significantly longer (by a median of 12 days). The partial-thickness pad lesions healed uneventfully regardless of whether they were bandaged, surgically repaired, or left to heal by second intention. Suture repair and bandaging of full-thickness lesions could not be shown to either decrease the risk for complications or improve healing. Future work should focus on establishing standards for footpad treatment to reduce complications.

  10. Oral surgery: part 4. Minimising and managing nerve injuries and other complications.

    Science.gov (United States)

    Renton, T

    2013-10-01

    Many post-operative complications can be avoided with good patient selection, training and surgical planning. Obtaining explicit patient consent is also an essential component of treatment. The most significant complications from oral surgical interventions are iatrogenic trigeminal nerve injuries, which can result in permanent altered sensation and pain, causing considerable functional and psychological disability. This paper provides some useful suggestions on minimising the risks of these injuries. By understanding the risk factors and modifying the resulting intervention, more of these injuries may be prevented.

  11. Complications of Spinal Cord Injury Over the First Year After Discharge From Inpatient Rehabilitation.

    Science.gov (United States)

    Stillman, Michael D; Barber, Jason; Burns, Steve; Williams, Steve; Hoffman, Jeanne M

    2017-09-01

    To describe the prevalence and cumulative incidence of secondary complications of spinal cord injury (SCI) in the first year after discharge from inpatient rehabilitation (IR); and to evaluate potential associations between risk of complications and sociodemographic and injury-specific factors. Secondary analysis of data collected for a single-site, single-blind, randomized controlled trial comparing telephone follow-up with usual care. Inpatient rehabilitation units. Adults ages ≥18 years (N=169) within 1 year of discharge from IR after SCI. Not applicable. Self-report of 10 secondary complications of SCI. Participants experienced a mean of 4.7 complications over 12 months. The most frequently reported complications were urinary tract infection (UTI), autonomic dysreflexia (AD), and pressure ulcers, with cumulative incidences of 62%, 43%, and 41%, respectively. Bone and soft tissue injuries (cumulative incidence, 35%) and bowel problems, including impaction or severe constipation (cumulative incidence, 33%), were also common. Cumulative incidences of AD, decubitus ulcers, UTI, and problems with bladder were greater in participants with higher level and more complete injuries, and some recurrent complications were common. Age at injury and impairment level significantly affected rates of complications, and subjects developed an average of 2.33 distinct complications during the study period. People with SCI are at high risk for a number of secondary complications over the first year after discharge from IR. Although these data offer some insight into who with SCI is at highest risk for first time and recurrent complications, further study is needed to refine this understanding and to develop effective educational and prevention strategies. Copyright © 2017 American Congress of Rehabilitation Medicine. All rights reserved.

  12. Oral verrucous carcinoma complicating a repetitive injury by the ...

    African Journals Online (AJOL)

    Verrucous carcinoma (VC) is an unusual, well differentiated, and low-grade type of squamous cell carcinoma, characterized by benign histology and cytology but markedly invasive clinical behavior. They have a ... Here we reported a case of VC of oral cavity a particularly very aggressive, arising from prosthesis injury.

  13. Endoscopic Assessment of Children with Esophageal Atresia: Lack of Relationship of Esophagitis and Esophageal Metaplasia to Symptomatology

    Directory of Open Access Journals (Sweden)

    Julie Castilloux

    2010-01-01

    Full Text Available BACKGROUND: Late complications of esophageal atresia (EA, particularly esophagitis and Barrett’s esophagus, are increasingly being recognized. With the exception of patients with dysphagia associated with esophageal stricture, it is unknown whether patient symptomatology can predict endoscopic findings.

  14. Esophageal Stricture Post Endoscopic Injection Sclerotherapy ...

    African Journals Online (AJOL)

    Background: Post endoscopic sclerotherapy esophageal stricture is usually not fatal but may requires several sessions of esophageal dilation as an effective palliative treatment yet has its own complications. Aim: The purpose of this study is to find out the predictors of sclerotherapy esophageal stricture. Methods: This is a ...

  15. Complications of high grade liver injuries: management and outcomewith focus on bile leaks

    Directory of Open Access Journals (Sweden)

    Bala Miklosh

    2012-03-01

    Full Text Available Abstract Background Although liver injury scale does not predict need for surgical intervention, a high-grade complex liver injury should alert the physician to expect an increased risk of hepatic complications following trauma. The aim of the current study was to define hepatic related morbidity in patients sustaining high-grade hepatic injuries that could be safely managed non-operatively. Patients and methods This is a retrospective study of patients with liver injury admitted to Hadassah-Hebrew University Medical Centre over a 10-year period. Grade 3-5 injuries were considered to be high grade. Collected data included the number and types of liver-related complications. Interventions which were required for these complications in patients who survived longer than 24 hours were analysed. Results Of 398 patients with liver trauma, 64 (16% were found to have high-grade liver injuries. Mechanism of injury was blunt trauma in 43 cases, and penetrating in 21. Forty patients (62% required operative treatment. Among survivors 22 patients (47.8% developed liver-related complications which required additional interventional treatment. Bilomas and bile leaks were diagnosed in 16 cases post-injury. The diagnosis of bile leaks was suspected with abdominal CT scan, which revealed intraabdominal collections (n = 6, and ascites (n = 2. Three patients had continuous biliary leak from intraabdominal drains left after laparotomy. Nine patients required ERCP with biliary stent placement, and 2 required percutaneous transhepatic biliary drainage. ERCP failed in one case. Four angioembolizations (AE were performed in 3 patients for rebleeding. Surgical treatment was found to be associated with higher complication rate. AE at admission was associated with a significantly higher rate of biliary complications. There were 24 deaths (37%, the majority from uncontrolled haemorrhage (18 patients. There were only 2 hepatic-related mortalities due to liver failure

  16. Brain Abscess after Esophageal Dilatation

    DEFF Research Database (Denmark)

    Gaïni, S; Grand, M; Michelsen, J

    2007-01-01

    Brain abscess formation is a serious disease often seen as a complication to other diseases and to procedures. A rare predisposing condition is dilatation therapy of esophageal strictures. A case of brain abscess formation after esophageal dilatations is presented. A 59-year-old woman was admitted...... with malaise, progressive lethargy, fever, aphasia and hemiparesis. Six days before she had been treated with esophageal dilatation for a stricture caused by accidental ingestion of caustic soda. The brain abscess was treated with surgery and antibiotics. She recovered completely. This clinical case...... illustrates the possible association between therapeutic esophageal dilatation and the risk of brain abscess formation....

  17. The psychotic mummified hand: an unusual hand injury complication.

    Science.gov (United States)

    Mathieu, L; Guillibert, E; Mamane, W; Masmejean, E H

    2013-12-01

    The authors report the case of a patient with psychotic symptoms secondary to a posttraumatic stress disorder following a work-related hand injury. The somatic presentation was a "mummified" hand neglected for several years in a splint without any care. The psychiatric analysis concluded that this was part of a delusion of persecution expressing a conflict against the patient's employer and insurance company. Surgical treatment was limited to a hand cleaning with hardware removal. Despite 3 years of antipsychotic medication the patient was still suffering from delusion and the hand remained neglected at the last follow-up. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  18. Esophageal Cancer

    Science.gov (United States)

    ... from your throat to your stomach. Early esophageal cancer usually does not cause symptoms. Later, you may ... You're at greater risk for getting esophageal cancer if you smoke, drink heavily, or have acid ...

  19. Esophageal Cancer

    Science.gov (United States)

    ... your primary physician about your risk for esophageal cancer. You can print these sample questions to use as a basis for discussion with your doctor. The sooner esophageal cancer is found, the better the chance of recovery; ...

  20. Pulmonary Pyoseptic Complications in Severe Concomitant Injury: Prevention and Intensive Care

    OpenAIRE

    Ye. A. Kameneva; S. S. Koval; Ye. V Grigoryev; A. S. Razumov; O N Yegorova

    2008-01-01

    Objective: to enhance the efficiency of intensive therapy and prevention of pyoseptic complications (PSC) of severe concomitant injury. Subjects and methods: A hundred patients who were divided into three groups were examined. A control group consisted of 30 apparently healthy individuals (donors). A study group comprised 38 patients to whom the standard of intensive care and prevention of PSC of severe concomitant injury was applied. A comparison group included 32 patients who received speci...

  1. Complications following spinal cord injury: occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation

    NARCIS (Netherlands)

    Haisma, H.J.; van der Woude, L.H.V.; Stam, H.J.; Bergen, M.P.; Sluis, T.A.; Post, M.W.; Bussmann, J.B.

    2007-01-01

    Objective: To assess the occurrence and risk factors for complications following spinal cord injury during and after inpatient rehabilitation. Design: Multicentre longitudinal study. Subjects: A total of 212 persons with a spinal cord injury admitted to specialized rehabilitation centres. Methods:

  2. Efficacy and safety of sitagliptin for the treatment of diabetes mellitus complicated by chronic liver injury

    OpenAIRE

    Asakawa, Masahiro; Mitsui, Hiroshi; Akihisa, Momoko; Sekine, Tetsuo; Niitsu, Yoshihiro; Kobayashi, Arisa; Miyake, Atsuko; Hashimoto, Naoaki; Kawamura, Mitsunobu; Ogawa, Yoshihiro

    2015-01-01

    Aim To investigate the efficacy and safety of a dipeptidyl peptidase-4 inhibitor, sitagliptin, for treating diabetes mellitus complicated by chronic liver injury. Methods Sitagliptin was administered for 13.7???10.1?months to 122 patients with DM complicated by chronic liver injury (including 19 patients with liver cirrhosis), and changes in hemoglobin A1c (HbA1c) and liver enzymes (transaminases, etc.) were evaluated. Results HbA1c was reduced from 8.48???1.43% to 7.87???1.35% (P?

  3. Acid suppression increases rates of Barrett's esophagus and esophageal injury in the presence of duodenal reflux.

    LENUS (Irish Health Repository)

    2012-01-31

    BACKGROUND: The contribution of gastric acid to the toxicity of alkaline duodenal refluxate on the esophageal mucosa is unclear. This study compared the effect of duodenal refluxate when acid was present, decreased by proton pump inhibitors (PPI), or absent. METHODS: We randomized 136 Sprague-Dawley rats into 4 groups: group 1 (n = 33) were controls; group 2 (n = 34) underwent esophagoduodenostomy promoting "combined reflux"; group 3 (n = 34) underwent esophagoduodenostomy and PPI treatment to decrease acid reflux; and group 4, the \\'gastrectomy\\' group (n = 35) underwent esophagoduodenostomy and total gastrectomy to eliminate acid in the refluxate. Esophaguses were examined for inflammatory, Barrett\\'s, and other histologic changes, and expression of proliferative markers Ki-67, proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR). RESULTS: In all reflux groups, the incidence of Barrett\\'s mucosa was greater when acid was suppressed (group C, 62%; group D, 71%) than when not suppressed (group B, 27%; P = 0.004 and P < .001). Erosions were more frequent in the PPI and gastrectomy groups than in the combined reflux group. Edema (wet weight) and ulceration was more frequent in the gastrectomy than in the combined reflux group. Acute inflammatory changes were infrequent in the PPI group (8%) compared with the combined reflux (94%) or gastrectomy (100%) groups, but chronic inflammation persisted in 100% of the PPI group. EGFR levels were greater in the PPI compared with the combined reflux group (P = .04). Ki-67, PCNA, and combined marker scores were greater in the gastrectomy compared with the combined reflux group (P = .006, P = .14, and P < .001). CONCLUSION: Gastric acid suppression in the presence of duodenal refluxate caused increased rates of inflammatory changes, intestinal metaplasia, and molecular proliferative activity. PPIs suppressed acute inflammatory changes only, whereas chronic inflammatory changes persisted.

  4. Urological Surveillance and Medical Complications after Spinal Cord Injury in the United States

    NARCIS (Netherlands)

    Cameron, Anne P.; Lai, Julie; Saigal, Christopher S.; Clemens, J. Quentin; Wijmenga, T. J.

    OBJECTIVE To evaluate the national patterns of urologic follow up after spinal cord injury (SCI) and the occurrence and predictors of urological complications. MATERIALS AND METHODS This retrospective cohort study used a 5% sample of Medicare data 2007-2010. The minimum adequate urologic

  5. ocular complications among cases of head injury seen in a neurosurgi

    African Journals Online (AJOL)

    EZENWUGO CHIEDOZIE OBIORA

    ocular cranial nerves were the most commonly occurring complication ... Ocular cranial nerve injury (involving the facial, ... The variation in the. 7. 8 figures observed in the studies could be accounted for by factors such as type of study, sample size and type of hospital. While this study examined 26 consecutively seen.

  6. [Effect of single lumen endobronchial tube and double lumen endobronchial tube on ventilation and lung injury in patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy].

    Science.gov (United States)

    Sun, Y L; Bai, Y; Li, T K; Lü, S G; Wang, L; Lu, X H

    2017-07-25

    Objective: To investigate the effect of the single lumen endobronchial tube and the double lumen endobronchial tube on ventilation and lung injury in patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy. Methods: Sixty patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy were divided into single lumen endobronchial tube group (D group, n=30) and double lumen endobronchial tube group (S, n=30) according to the random number table. Blood samples were harvested at the moment of tracheal intubation (T(0)), after artificial pneumothorax (one lung ventilation) 30 min (T(1)), after artificial pneumothorax (one lung ventilation) 90 min (T(2)), artificial pneumothorax over (double lung ventilation) 30 min (T(3)) and after extubation 30 min (T(4)) for arterial blood gas analysis. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO(2)), oxygen tension (PaO(2)), carbon dioxide partial pressure (PaCO(2)) and airway pressure (PAW) were recorded at T(0)-T(4). The incidences of pneumonia of two groups were record at 3 days after operation. Results: There were no obvious differences in HR, MAP, SpO(2), PaO(2), PaCO(2) between two groups at T(0)-T(4) (P>0.05). Compared with T(0), the levels of HR and PaO(2) were increased remarkably at T(1)-T(3) (P0.05). Compared with T(0), the levels of TNF-α, IL-6, IL-8 in BALF were increased remarkably at T(3), T(5) (Pventilation effect of the single lumen endobronchial tube on lung injury for patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy is the same as that of the double lumen endobronchial tube, however the single lumen endobronchial tube has less injury on the lung.

  7. Normal tissue complication models for clinically relevant acute esophagitis (≥ grade 2) in patients treated with dose differentiated accelerated radiotherapy (DART-bid).

    Science.gov (United States)

    Zehentmayr, Franz; Söhn, Matthias; Exeli, Ann-Katrin; Wurstbauer, Karl; Tröller, Almut; Deutschmann, Heinz; Fastner, Gerd; Fussl, Christoph; Steininger, Philipp; Kranzinger, Manfred; Belka, Claus; Studnicka, Michael; Sedlmayer, Felix

    2015-05-28

    One of the primary dose-limiting toxicities during thoracic irradiation is acute esophagitis (AE). The aim of this study is to investigate dosimetric and clinical predictors for AE grade ≥ 2 in patients treated with accelerated radiotherapy for locally advanced non-small cell lung cancer (NSCLC). 66 NSCLC patients were included in the present analysis: 4 stage II, 44 stage IIIA and 18 stage IIIB. All patients received induction chemotherapy followed by dose differentiated accelerated radiotherapy (DART-bid). Depending on size (mean of three perpendicular diameters) tumors were binned in four dose groups: 6 cm 90 Gy. Patients were treated in 3D target splitting technique. In order to estimate the normal tissue complication probability (NTCP), two Lyman models and the cutoff-logistic regression model were fitted to the data with AE ≥ grade 2 as statistical endpoint. Inter-model comparison was performed with the corrected Akaike information criterion (AICc), which calculates the model's quality of fit (likelihood value) in relation to its complexity (i.e. number of variables in the model) corrected by the number of patients in the dataset. Toxicity was documented prospectively according to RTOG. The median follow up was 686 days (range 84-2921 days), 23/66 patients (35 %) experienced AE ≥ grade 2. The actuarial local control rates were 72.6 % and 59.4 % at 2 and 3 years, regional control was 91 % at both time points. The Lyman-MED model (D50 = 32.8 Gy, m = 0.48) and the cutoff dose model (Dc = 38 Gy) provide the most efficient fit to the current dataset. On multivariate analysis V38 (volume of the esophagus that receives 38 Gy or above, 95 %-CI 28.2-57.3) was the most significant predictor of AE ≥ grade 2 (HR = 1.05, CI 1.01-1.09, p = 0.007). Following high-dose accelerated radiotherapy the rate of AE ≥ grade 2 is slightly lower than reported for concomitant radio-chemotherapy with the additional benefit of markedly

  8. Periodontal healing complications following concussion and subluxation injuries in the permanent dentition: a longitudinal cohort study

    DEFF Research Database (Denmark)

    Hermann, Nuno Vibe; Lauridsen, Eva; Ahrensburg, Søren Steno

    2012-01-01

    Purpose The purpose of the study was to analyze the risk of periodontal ligament (PDL) healing complications following concussion and subluxation injuries in the permanent dentition. Material and method A total 469 permanent teeth (358 patients) with concussion and 404 permanent teeth.......004). For teeth with mature root development, the risk of periodontal healing complications after 3 years was: repair-related resorption, 3.6% (95% CI: 0–7.6%); infection-related resorption, 0.6% (95% CI: 0–1.7%); replacement-related resorption, 0.6% (95% CI: 0–1.7%); and marginal bone loss, 0.6% (95% CI: 0......–1.7%). No teeth were lost in the observation period. Conclusion The risk of periodontal healing complications after concussion as well as subluxation injuries in permanent teeth is very low....

  9. Acute Kidney Injury Complicated Epstein-Barr Virus Infection in Infancy

    Directory of Open Access Journals (Sweden)

    Gamze Ozgurhan

    2015-01-01

    Full Text Available Infectious mononucleosis is an acute lymphoproliferative disorder caused by the Epstein-Barr virus (EBV and seen most commonly in children and young adults. Clinical presentation of the disease is characterized by fever, tonsillopharyngitis, lymphadenopathy, and hepatosplenomegaly, whereas serological findings of this benign disorder include positive heterophilic antibody formation (transient increase in heterophilic antibodies and prominence of hematological lymphocytosis of more than 10% of atypical lymphocytes. An EBV infection is usually asymptomatic in childhood, but acute kidney injury can be a rare complication during its course. Most cases recover from the disease completely. Early recognition of EBV infection and estimation of its complication are important for its prognosis. In light of previous literature, we discuss the case evaluated as an EBV infection complicated by acute kidney injury in early childhood and results of tubulointerstitial nephritis shown on a renal biopsy that was later diagnosed as an EBV infection by serological examination.

  10. Urinary complications of gynecologic surgery: iatrogenic urinary tract system injuries in obstetrics and gynecology operations.

    Science.gov (United States)

    Ozdemir, E; Ozturk, U; Celen, S; Sucak, A; Gunel, M; Guney, G; Imamoglu, M A; Danisman, A N

    2011-01-01

    To evaluate iatrogenic urinary tract system injuries in obstetrics and gynecology operations and compare the results with the literature. We examined the records of patients who had obstetric and gynecology operations at the Ministry of Health, Dr. Zekai Tahir Burak Women's Health, Training and Research Hospital between June 2007 and June 2010. All the patients who were diagnosed as having urinary system injuries in either the intraoperative or postoperative period were determined. During this period, 25,998 gynecologic and obstetrical operations were performed, 0.03% ureteric, 0.20% bladder, and one case of urethral injury, in a total of 0.24% urinary tract injuries were observed. The bladder was the most frequently injured organ. Total urinary tract injury rates were 0.79% (0.49% bladder, 0.24% ureteral) in gynecologic operations and 0.19% (0.18% bladder and 0.01% ureteral) in obstetric operations. Urinary system injuries are seen in approximately 1% of all gynecologic and obstetric surgeries. The complication rates observed in our patients were comparable with the other studies in the literature. A gynecologic surgeon must become familiar with the anatomy of the urinary tract and must be aware of common intraoperative and postoperative complications to decrease the risk of morbidity.

  11. Infection and Complications After Low-velocity Intra-articular Gunshot Injuries.

    Science.gov (United States)

    Nguyen, Mai P; Reich, Michael S; OʼDonnell, Jeffrey A; Savakus, Jonathan C; Prayson, Nicholas F; Golob, Joseph F; McDonald, Amy A; Como, John J; Vallier, Heather A

    2017-06-01

    The purpose of this study is to characterize the demographics, interventions, infection rates, and other complications after intra-articular (IA) gunshot wounds. Retrospective review. Level I trauma center. Fifty-three patients with 55 civilian low-velocity IA gunshot injuries with a minimum of 4 weeks follow-up were included in the study. Seven patients had associated vascular injuries. Most patients (84.9%) received antibiotic prophylaxis, consisting most often of cefazolin (93.3%). Based on injury pattern and surgeon preference, joint injuries were either treated nonoperatively (43.6%), with surgical debridement only (20.0%), with surgical debridement plus fracture fixation and/or neurovascular repair (32.7%), or with percutaneous fracture fixation without debridement (3.6%). Incidence of deep infection. Two joints (3.6%) developed deep infections. Both had associated vascular injuries. Patients with vascular injuries were at higher risk of infection compared with those without vascular injury (28.6% vs. 0.0%, P = 0.02). Two of 24 (8.3%) injuries that were originally managed nonoperatively required delayed surgical procedures, 1 for bullet removal and 1 for ulnar nerve allograft. No patient treated nonoperatively developed an infection. The incidence of infection after IA gunshot injuries is low with the routine use of antibiotic prophylaxis. In the absence of IA pathology, IA gunshot injuries do not appear to necessitate surgical debridement to decrease the risk of infection. Patients with vascular injury deserve special attention, as they are at higher risk of infection. Prognostic Level III. See Instructions for authors for a complete description of levels of evidence.

  12. Esophageal strictures during treatment for acute lymphoblastic leukemia.

    Science.gov (United States)

    Kelly, Kevin; Storey, Lorna; O' Sullivan, Maureen; Butler, Karina; McDermott, Michael; Corbally, Martin; McMahon, Corrina; Smith, Owen P; O' Marcaigh, Aengus

    2010-03-01

    Esophageal stricture is a rare complication of paediatric cancer treatment that usually occurs after esophageal exposure to radiotherapy. We describe 4 cases of esophageal stricture during chemotherapy for acute lymphoblastic leukemia. All patients presented with refractory vomiting and were diagnosed with radiologic contrast studies. None of the patients had received radiotherapy. Esophageal candidiasis was seen in 2 patients but the remaining 2 patients had earlier systemic candidiasis. High-dose dexamethasone may predispose these children to both esophageal candidiasis and peptic esophagitis. The etiology of esophageal strictures during treatment for acute leukemia is likely to be multifactorial but systemic candidiasis may play a significant role.

  13. Esophageal strictures during treatment for acute lymphoblastic leukemia.

    LENUS (Irish Health Repository)

    Kelly, Kevin

    2012-02-01

    Esophageal stricture is a rare complication of paediatric cancer treatment that usually occurs after esophageal exposure to radiotherapy. We describe 4 cases of esophageal stricture during chemotherapy for acute lymphoblastic leukemia. All patients presented with refractory vomiting and were diagnosed with radiologic contrast studies. None of the patients had received radiotherapy. Esophageal candidiasis was seen in 2 patients but the remaining 2 patients had earlier systemic candidiasis. High-dose dexamethasone may predispose these children to both esophageal candidiasis and peptic esophagitis. The etiology of esophageal strictures during treatment for acute leukemia is likely to be multifactorial but systemic candidiasis may play a significant role.

  14. Herpetic esophagitis

    Energy Technology Data Exchange (ETDEWEB)

    Shortsleeve, M.J.; Gauvin, G.P.; Gardner, R.C.; Greenberg, M.S.

    1981-12-01

    Four patients with herpetic esophagitis were examined. In three of them, the presenting symptom was odynophagia. Early in the course of herpetic esophagitis, shallow round and oval ulcers were seen on barium esophagograms. Later, the ulcers filled with fibrinous exudate, forming nodular plaques that projected into the esophageal lumen. Although these findings are diagnostic of esophagitis, they are not specific for a herpes virus infection. The definitive diagnosis must be established by histologic examination, which demonstrates the cytopathic effect of the herpes virus infection within the squamous epithelium.

  15. From reflux esophagitis to Barrett’s esophagus and esophageal adenocarcinoma

    Science.gov (United States)

    Wang, Rui-Hua

    2015-01-01

    The occurrence of gastroesophageal reflux disease is common in the human population. Almost all cases of esophageal adenocarcinoma are derived from Barrett’s esophagus, which is a complication of esophageal adenocarcinoma precancerous lesions. Chronic exposure of the esophagus to gastroduodenal intestinal fluid is an important determinant factor in the development of Barrett’s esophagus. The replacement of normal squamous epithelium with specific columnar epithelium in the lower esophagus induced by the chronic exposure to gastroduodenal fluid could lead to intestinal metaplasia, which is closely associated with the development of esophageal adenocarcinoma. However, the exact mechanism of injury is not completely understood. Various animal models of the developmental mechanisms of disease, and theoretical and clinical effects of drug treatment have been widely used in research. Recently, animal models employed in studies on gastroesophageal reflux injury have allowed significant progress. The advantage of using animal models lies in the ability to accurately control the experimental conditions for better evaluation of results. In this article, various modeling methods are reviewed, with discussion of the major findings on the developmental mechanism of Barrett’s esophagus, which should help to develop better prevention and treatment strategies for Barrett’s esophagus. PMID:25954094

  16. Serum Transforming Growth Factor-β1 Change After Neoadjuvant Chemoradiation Therapy Is Associated With Postoperative Pulmonary Complications in Esophageal Cancer Patients Undergoing Combined Modality Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Shao-Lun; Hsu, Feng-Ming; Tsai, Chiao-Ling; Wu, Jian-Kuan [Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (China); Lee, Jang-Ming; Huang, Pei-Ming [Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan (China); Hsu, Chih-Hung [Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (China); Koong, Albert C.; Chang, Daniel T. [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Chia-Hsien Cheng, Jason, E-mail: jasoncheng@ntu.edu.tw [Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (China); Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan (China)

    2015-12-01

    Purpose: Our aim was to investigate the association of clinical factors, dosimetric parameters, and biomarkers with postoperative pulmonary complications (PPCs) in patients with locally advanced esophageal squamous cell carcinoma (ESCC) treated by neoadjuvant concurrent chemoradiation therapy (CCRT) under strict pulmonary dose constraints and esophagectomy. Methods and Materials: We prospectively enrolled 112 patients undergoing trimodality treatment (including radiation therapy [40 Gy], concurrent taxane-/5-fluorouracil-based regimens, and radical esophagectomy) for ESCC. A PPC was defined as pneumonia or acute respiratory distress syndrome within 30 days after surgery. Serum samples were collected before and within 1 month after CCRT. The association of serum biomarkers with PPCs was detected by proximity ligation assay (PLA) and verified by enzyme-linked immunosorbent assay. Associations of clinical factors, lung dosimetric parameters, and biomarkers with PPC were tested statistically. Results: Thirty-three patients (29.5%) had PPCs. None of the dosimetric parameters was associated with PPCs. Preoperative functional vital capacity (FVC) was significantly associated with PPCs (P=.004). Of the 15 PLA-screened biomarkers, posttreatment transforming growth factor-β1 (TGF-β1) was borderline significantly associated with PPCs (P=.087). Patients with PPCs had significantly larger pre-CCRT to post-CCRT decrease in serum TGF-β1 concentration (−11,310 vs −5332 pg/mL, P=.005) and higher pre-CCRT to post-CCRT percent decline in serum TGF-β1 concentration (−37.4% vs −25.0%, P=.009) than patients without PPCs. On multivariate analysis, preoperative FVC (P=.003) and decrease in TGF-β1 >7040 pg/mL (P=.014) were independent factors associated with PPCs. Conclusions: Preoperative FVC and decrease in serum TGF-β1 level after dose-limited CCRT to the lung are associated with the development of PPCs.

  17. Bowel injury as a complication of microdiscectomy: case report and literature review.

    Science.gov (United States)

    Houten, John K; Frempong-Boadu, Anthony K; Arkovitz, Marc S

    2004-06-01

    Intestinal injury is a rare complication of lumbar disc surgery, resulting from inadvertent penetration of the anterior annulus fibrosus and anterior longitudinal ligament. Patients typically complain of abdominal pain and distention developing over the course of several days. Imaging with plain upright chest radiographs or abdominal computed tomography may demonstrate free air in the abdominal cavity. We report a case of intestinal perforation after microscopic lumbar discectomy and present the diagnostic postoperative imaging. In addition, we review the relevant literature and discuss techniques that may be employed to avoid this complication.

  18. A Rare and Dangerous Complication of Central Venous Catheterization: Intimal Injury

    Directory of Open Access Journals (Sweden)

    Emine Akkuzu

    2017-12-01

    Full Text Available Central venous catheters are frequently used for urgent patient resuscitation and for prolonged intravenous route requirements. However, the patient may be injured or may need additional intervention due to complications associated with catheter insertion. Various mechanical complications such as catheter malposition, arterial puncture, hemothorax and pneumothorax can be seen in 5-19% of patients and early recognition has a vital effect. Here, we present a case of pleural effusion leading to significant hypoxemia due to intimal injury to the superior vena cava which developed in the second day of catheter insertion.

  19. Esophageal foreign bodies.

    Science.gov (United States)

    Al-Qudah, A; Daradkeh, S; Abu-Khalaf, M

    1998-05-01

    A retrospective review was performed on 180 patients from 1975 to 1997 to evaluate the diagnosis, and management of esophageal foreign bodies. All patients except two were symptomatic and 145 of them were younger than 14 years of age. Plain films were performed in every patient with a suspected esophageal foreign body (EFB). In all patients, rigid esophagoscopy was done under general anesthesia once the diagnosis of impacted EFB is made. Fifty-five percent of the foreign bodies were coins. In children, the majority of impacted esophageal foreign bodies were located at the level of the cricopharyngeus muscle while in adults the site of impaction was the lower esophageal sphincter. The most common symptoms were vomiting and or regurgitation. Of the 180 EFBs encountered, 169 were extracted endoscopically, five were pushed into the stomach, five were not found, and one patient needed cervicotomy. There were no deaths in this series. Predisposing factors were found in 15 patients. Fifteen patients (8.3%) had benign strictures. In ten patients (5.5%), minor complications were encountered, none of which were esophagoscopically related. Alternative diagnostic and therapeutic modalities are discussed. All patients with a history of suspected foreign body ingestion should have direct endoscopic examination. If the EFB is not detected a thorough radiographic examination, including CT scan, should be performed to detect a possible intra- or extraluminal object. Preservation of the airway is regarded to be the most important consideration in esophageal foreign body management.

  20. Ruptured semimembranosus bursa--an unusual complication following sports injury of the knee.

    Science.gov (United States)

    Andersen-Ranberg, F; Hejgaard, N

    1986-01-01

    An exceptional complication of a slight sports injury of the knee with rupture of the semimembranosus bursa in a 29-year-old male football player is reported. The diagnosis was verified by immediate arthrography, consequently the possibility of thrombophlebitis could be ruled out. Anticoagulation is dangerous and contraindicated in rupture of the semimembranosus bursa due to the risk of developing compartment syndrome. Simple bed-rest for a week gave complete relief of pain. Images Fig. 1 PMID:3697597

  1. Tranexamic acid in life-threatening military injury and the associated risk for infectious complications

    Science.gov (United States)

    Lewis, C. J.; Li, P.; Stewart, L.; Weintrob, A. C.; Carson, M. L.; Murray, C. K.; Tribble, D. R.; Ross, J. D.

    2015-01-01

    Background Tranexamic acid (TXA) has been shown to reduce mortality from severe hemorrhage. Although recent data suggest that TXA has anti-inflammatory properties, few analyses have investigated the impact of TXA on infectious complications in trauma patients. We examined the association between TXA administration and infection risk among injured military personnel. Methods Patients administered TXA were matched by injury severity score to patients who did not receive TXA. Conditional logistic regression was used to examine risk factors associated with infections within 30 days. A Cox proportional analysis evaluated risk factors in a time-to-first infection model. Results A total of 335 TXA recipients were matched to 626 patients not administered TXA. A greater proportion of TXA recipients had an infection compared to the comparative group (P risk; however, upon multivariable analysis, TXA administration was not significant (OR: 1.3; CI: 0.8–1.9). Blast injuries, intensive care unit (ICU) admission, and receipt of ≥10 units of blood within 24 hours post-injury were independently associated with infection risk. The Cox proportional model confirmed association with ICU admission and blood transfusions. Moreover, traumatic amputations were also significantly associated with a reduced time-to-first infection. Conclusion In life-threatening military injuries matched for injury severity, TXA recipients did not have a higher risk for infections nor was time to developed infections shorter than in non-recipients. Extent of blood loss, blast injuries, extremity amputations, and intensive care stay were associated with infections. PMID:26791625

  2. Prevention of Esophageal Variceal Rebleeding

    Directory of Open Access Journals (Sweden)

    Gin-Ho Lo

    2006-12-01

    Full Text Available The rate of rebleeding of esophageal varices remains high after cessation of acute esophageal variceal hemorrhage. Many measures have been developed to prevent the occurrence of rebleeding. When considering their effectiveness in reduction of rebleeding, the associated complications cannot be neglected. Due to unavoidable high incidence of complications, shunt surgery and endoscopic injection sclerotherapy are now rarely used. Transjugular intrahepatic portosystemic stent shunt was developed to replace shunt operation but is now reserved for rescue therapy. Nonselective beta-blockers alone or in combination with isosorbide mononitrate and endoscopic variceal ligation are currently the first choices in the prevention of variceal rebleeding. The combination of nonselective beta-blockers and endoscopic variceal ligation appear to enhance the efficacy. With the advent of newly developed measures, esophageal variceal rebleeding could be greatly reduced and the survival of cirrhotics with bleeding esophageal varices could thereby be prolonged.

  3. [Glenohumeral instability in patients over 40 years-old: injuries, treatment and complications].

    Science.gov (United States)

    López-Hualda, A; Marín-Aguado, M A; Valencia-García, H; López-González, D; Gavín-González, C

    2014-01-01

    Recurrent shoulder dislocation is infrequent after forty years and presents different injuries than younger patients. To compare injuries and complications after surgery between one group older than forty years of age and another younger group. A review was made o all patients who had undergone arthroscopic surgery due to glenohumeral instability from 1999 until 2011. The mean follow-up was 64 months. The case group consisted of all patients older than 40 years at the time of the surgery (n=21), which was compared with a similar sized control group of randomly selected younger patients (n=27). The mean age in the older group was 54 years (SD 11.86), while it was 26 years (SD 5.80) in the younger group. No differences were founded between both groups in labrum injury, Hill-Sachs injury, and bone Bankart lesion (P>.05). Rotator cuff tears were 7.3 times (95% CI; 2.5-21.6) more frequent in the older group (81%) compared to the younger group (P.05). Anterior recurrent dislocation after forty years of age is usually associated with rotator cuff tears. Arthroscopic treatment of instability was effective with no more postoperative complications. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  4. Hyperbaric oxygenation therapy for crush injuries reduces the risk of complications: research report.

    Science.gov (United States)

    Yamada, Noriaki; Toyoda, Izumi; Doi, Tomoaki; Kumada, Keisuke; Kato, Hisaaki; Yoshida, Shozo; Shirai, Kunihiro; Kanda, Norihide; Ogura, Shinji

    2014-01-01

    Hyperbaric oxygen (HBO2) therapy has been adopted for crush injuries, but there are few studies supporting its use. We therefore investigated the effects of HBO2 on management of patients with complicated crush injuries. This historic cohort study included patients with crush injuries and open fractures with severities greater than or equal to Gustilo class IIIA. We divided the patients into two groups: Control and HBO2. The control group received conventional treatment, while the HBO2 group received conventional treatment plus HBO2. We compared the groups with respect to the incidence of infection, need for additional surgery, and length of intensive care unit (ICU) and hospital stays. There were 16 patients in the HBO2 group and 13 in the control group. There were no patients with infections in the HBO2 group, whereas in the control group six patients had infections and five needed another drainage procedure. These incidences were significantly lower in the HBO2 group (p = 0.003 and 0.013). However, the durations of ICU and hospital stays were similar across the two groups. HBO2 is effective in the management of crush injuries from the viewpoint of reducing complications and reoperations. These observations should be verified in additional studies with larger sample sizes because the patient number is limited.

  5. Decompressive craniectomy after severe traumatic brain injury in children: complications and outcome.

    Science.gov (United States)

    Pechmann, Astrid; Anastasopoulos, Constantin; Korinthenberg, Rudolf; van Velthoven-Wurster, Vera; Kirschner, Janbernd

    2015-02-01

    Decompressive craniectomy (DC) is a controversially discussed neurosurgical procedure to reduce elevated intracranial pressure after severe traumatic brain injury (TBI). In contrast to adults, several studies could show a benefit for the pediatric population, but still DC is considered as an emergency procedure only. The aim of our study was to identify secondary complications and long-term sequelae of the procedure. All children presenting to the University Medical Center Freiburg between 2005 and 2013 who underwent DC after severe TBI were retrospectively reviewed with respect to complications and outcome. Twelve children were included with a mean Glasgow Coma Scale of 4.5 ± 1.7. The most frequent complications after TBI and DC were formation of hygroma (83%), aseptic bone resorption of the reimplanted bone flap (50%), posttraumatic hydrocephalus (42%), secondary infection or dysfunction of ventriculoperitoneal shunt (25%) or cranioplasty (33%), and epilepsy (33%). Because of these complications, 75% of patients required further surgery in addition to cranioplasty with up to eight interventions. At follow-up, mean Glasgow Outcome Scale was 3.3 ± 1.2. Within our patient population, we demonstrated high incidence of complications after DC, leading to further surgical procedures and longer hospitalization. These potential complications have to be considered in any decision about DC as an emergency procedure. Georg Thieme Verlag KG Stuttgart · New York.

  6. Bladder management methods and urological complications in spinal cord injury patients

    Directory of Open Access Journals (Sweden)

    Roop Singh

    2011-01-01

    Full Text Available Background: The optimal bladder management method should preserve renal function and minimize the risk of urinary tract complications. The present study is conducted to assess the overall incidence of urinary tract infections (UTI and other urological complications in spinal cord injury patients (SCI, and to compare the incidence of these complications with different bladder management subgroups. Materials and Methods: 545 patients (386 males and 159 females of traumatic spinal cord injury with the mean age of 35.4±16.2 years (range, 18 - 73 years were included in the study. The data regarding demography, bladder type, method of bladder management, and urological complications, were recorded. Bladder management methods included indwelling catheterization in 224 cases, clean intermittent catheterization (CIC in 180 cases, condom drainage in 45 cases, suprapubic cystostomy in 24 cases, reflex voiding in 32 cases, and normal voiding in 40 cases. We assessed the incidence of UTI and bacteriuria as the number of episodes per hundred person-days, and other urological complications as percentages. Results: The overall incidence of bacteriuria was 1.70 / hundred person-days. The overall incidenceof urinary tract infection was 0.64 / hundered person-days. The incidence of UTI per 100 person-days was 2.68 for indwelling catheterization, 0.34 for CIC, 0.34 for condom drainage, 0.56 for suprapubic cystostomy, 0.34 for reflex voiding, and 0.32 for normal voiding. Other urological complications recorded were urethral stricture (n=66, 12.1%, urethritis (n=78, 14.3%, periurethral abscess (n=45, 8.2%, epididymorchitis (n=44, 8.07%, urethral false passage (n=22, 4.03%, urethral fistula (n=11, 2%, lithiasis (n=23, 4.2%, hematuria (n=44, 8.07%, stress incontinence (n=60, 11%, and pyelonephritis (n=6, 1.1%. Clean intermittent catheterization was associated with lower incidence of urological complications, in comparison to indwelling catheterization. Conclusions

  7. Esophageal Foreign Bodies

    Directory of Open Access Journals (Sweden)

    Ufuk Cobanoglu

    2014-04-01

    Full Text Available Esophageal foreign body aspiration is a common event which can cause serious morbidity and mortality in the children and adult population. For that reason, early diagnosis and treatment are crucial for preventing these life threateining complications. Children most often ingest coins and toys whereas adults commonly tend to have problems with meat and bones. Esophageal foreign bodies are located at the cricopharyngeus muscle level in 70%, the thoracic esophagus in 15% and the gastroesophageal junction in the remaining 15%. Symptoms can vary according to the shape and structure of the ingested object, type of location, patient%u2019s age and complications caused by the foreign body. Delay in treatment, esophageal perforation and an underlying esophageal disease are poor prognostic factors. In treatment, observation, foley catheter, rigid or flexible esophagoscopy and removing the foreign body with a Magill forceps, pushing the foreign body into the stomach, giving intravenous glucagon and surgical treatment methods can be used. Rigid esophagoscopy is an effective and safe procedure for foreign body diagnosis and removal. Improved endoscopic experience and clinical management of thoracic surgeons led to reduced morbidity and mortality in recent years. Most of those emergencies of childhood are preventable. Family education is very important.

  8. Complications of treating terrible triad injury of the elbow: a systematic review.

    Directory of Open Access Journals (Sweden)

    Hong-wei Chen

    Full Text Available Terrible triad injury of the elbow (TTIE, comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. The objective of this systematic review was to summarize the most recent available evidence regarding functional outcomes and complications following surgical management of TTIE.Medline, EMBASE, Cochrane Library, and Google Scholar were searched to identify relevant studies, which were included if they were retrospective or prospective in design, involved participants who had TTIE, and were published in English. Outcomes of interest were functional outcomes and complications.Sixteen studies, involving 312 patients, were included in the systematic review. Mean follow up after surgery was typically 25 to 30 months. Mean Mayo elbow performance scores ranged from 78 to 95. Mean Broberg-Morrey scores ranged from 76 to 90. Mean DASH scores ranged from 9 to 31. The proportion of patients who required reoperation due to complications ranged from 0 to 54.5% (overall  = 70/312 [22.4%]. Most of these complications were related to hardware fixation problems, joint stiffness, joint instability, and ulnar neuropathy. The most common complications that did not require reoperation were heterotopic ossification (39/312 [12.5%] patients and arthrosis (35/312 [11.2%] patients.The results of this systematic review indicate that functional outcomes after surgery for TTIE are generally satisfactory and that complications are common. Further research is warranted to determine which surgical techniques optimize functional outcomes and reduce the risk of complications.

  9. Oral blastomycosis, laryngeal papillomatosis and esophageal tuberculosis

    OpenAIRE

    Montoya, Manuel; Hospital Regional del Cusco. Cusco, Perú. Universidad Nacional de San Antonio Abad del Cusco. Cusco, Perú. Médico infectólogo.; Chumbiraico, Robert; Hospital Regional del Cusco. Cusco, Perú. Universidad Nacional de San Antonio Abad del Cusco. Cusco, Perú. médico internista.; Ricalde, Melvin; Hospital Regional del Cusco. Cusco, Perú. Universidad Nacional de San Antonio Abad del Cusco. Cusco, Perú. médico neumólogo.; Cazorla, Ernesto; Hospital Regional del Cusco. Cusco, Perú. Universidad Nacional de San Antonio Abad del Cusco. Cusco, Perú. médico gastroenterólogo.; Hernández-Córdova, Gustavo; Universidad Nacional de San Antonio Abad del Cusco. Cusco, Perú. Sociedad Científica de Estudiantes de Medicina ASOCIEMH-CUSCO. Cusco, Perú. estudiante de Medicina.

    2014-01-01

    Esophageal involvement is an extremely rare complication of tuberculosis even in countries with high prevalence of infection. We report the case of a 57 year-old hiv-seronegative patient with simultaneous diagnoses of oral blastomycosis and laryngeal papillomatosis. Both were confirmed by anatomopathological analysis. The esophageal biopsy revealed granulomatous esophagitis with necrosis and ziehl–neelsen stain showed acid-fast alcohol resistant bacilli suggestive of tuberculosis. The pat...

  10. Management of Malnutrition in Esophageal Cancer Patients

    OpenAIRE

    Xu, Yu-juan; Cheng, Jason Chia-Hsien; Lee, Jang-Ming; Chen, Cheryl Chia-Hui

    2014-01-01

    The prevalence of malnutrition in patients with esophageal cancer is estimated to be as high as 78.9%. Malnutrition in esophageal cancer is significantly correlated with an increased risk of treatment toxicity and postoperative complications. It is therefore important to maintain an optimal nutritional status, particularly during the course of neoadjuvant chemoradiation. This article aims to review the mechanism, evaluation, and management strategies of malnutrition for patients with esophage...

  11. Imaging of postarthroscopic complications after knee injuries; Bildgebung postarthroskopischer Komplikationen nach Knieverletzungen

    Energy Technology Data Exchange (ETDEWEB)

    Schueller-Weidekamm, C. [Medizinische Universitaet Wien, Abteilung fuer Neuroradiologie und muskuloskelettale Radiologie, Klinik fuer Radiodiagnostik, Wien (Austria); Skrbensky, G. von [Medizinische Universitaet Wien, Klinik fuer Orthopaedie, Wien (Austria)

    2012-11-15

    The most common joint injuries in professional and recreational sports participants and also in the total population are knee injuries. Arthroscopy is indicated if this modality will improve the patient outcome and potential long-term complications can be avoided. Although uncommon, complications following arthroscopy are mostly evaluated by magnetic resonance imaging (MRI). For planning further therapy strategies following postarthroscopic complications, e.g. if anterior cruciate ligament (ACL) reconstruction is required, digital radiographs and computed tomography (CT) are helpful. This article provides an overview of the different procedures for surgical treatment which are a prerequisite for the analysis of postarthroscopic images. In addition typical complications after treatment of meniscal and chondral injuries as well as after ACL reconstruction are described and typical signs in MRI, radiography and CT are explained in detail. (orig.) [German] Kniegelenkverletzungen sind nicht nur bei Profisportlern, sondern auch in der Gesamtbevoelkerung die haeufigsten Gelenkverletzungen. Die Indikation zur arthroskopischen Operation wird gestellt, wenn im Vergleich zur konservativen Therapie ein besseres Ergebnis postarthroskopisch zu erwarten ist und potenzielle Spaetkomplikationen verhindert werden koennten. Die selten aber dennoch auftretenden postarthroskopischen Komplikationen werden zumeist mit der Magnetresonanztomographie (MRT) abgeklaert. Zur weiteren Therapieplanung nach Komplikationen, z. B. wenn eine Kreuzbandrevision notwendig ist, sind die digitale Projektionsradiographie und die Computertomographie (CT) hilfreich. Dieser Artikel bietet eine kurze Uebersicht ueber die unterschiedlichen Operationstechniken, die eine Voraussetzung fuer das Verstaendnis der bildgebenden postoperativen Veraenderungen sind. Weiter wird auf die haeufigsten Komplikationen nach Meniskus- und Knorpeloperationen sowie nach vorderer Kreuzbandrekonstruktion und den damit

  12. Factors associated with wound complications in women with obstetric anal sphincter injuries (OASIS).

    Science.gov (United States)

    Stock, Laura; Basham, Elizabeth; Gossett, Dana R; Lewicky-Gaupp, Christina

    2013-04-01

    We sought to determine factors associated with perineal wound complications in women with obstetric anal sphincter injuries (OASIS). A retrospective chart review of women who sustained an OASIS from Nov. 2, 2005, through March 1, 2010, was performed. In all, 1629 women sustained an OASIS; 909 had follow-up data. Wound complications (infection, breakdown, packing, operative intervention, secondary repair) occurred in 7.3% (n = 66) of patients. Smoking (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.4-12.2; P = .01), increasing body mass index (OR, 1.06; 95% CI, 1.01-1.12; P = .04), fourth-degree laceration (OR, 1.89; 95% CI, 0.99-3.61; P = .05), operative vaginal delivery (OR, 1.76; 95% CI, 1.15-2.68; P = .009), and use of postpartum antibiotics (OR, 2.46; 95% CI, 1.11-5.63; P = .03) were associated with complications; intrapartum antibiotics were protective (OR, 0.29; 95% CI, 0.14-0.59; P = .001). In all, 44% of patients with a complication (n = 29) required hospital readmission; most (72%) were in the first 2 postpartum weeks. Wound complications after OASIS are associated with modifiable factors and often require hospital readmission. Copyright © 2013 Mosby, Inc. All rights reserved.

  13. Cardiac tamponade related to a coronary injury by a pericardial calcification: an unusual complication

    Directory of Open Access Journals (Sweden)

    Cypierre Anne

    2012-04-01

    Full Text Available Abstract Background Cardiac tamponade is a rare but severe complication of pericardial effusion with a poor prognosis. Prompt diagnosis using transthoracic echocardiography allows guiding initial therapeutic management. Although etiologies are numerous, cardiac tamponade is more often due to a hemopericardium. Rarely, a coronary injury may result in such a hemopericardium with cardiac tamponade. Coronary artery aneurysm are the main etiologies but blunt, open chest trauma or complication of endovascular procedures have also been described. Case presentation A 83-year-old hypertensive man presented for dizziness and hypotension. The patient had oliguria and mottled skin. Transthoracic echocardiography disclosed a circumferential pericardial effusion with a compressed right atrium, confirmed by contrast-enhanced thoracic CT scan. A pig-tail catheter allowed to withdraw 500 mL of blood, resulting in a transient improvement of hemodynamics. Rapidly, recurrent hypotension prompted a reoperation. An active bleeding was identified at the level of the retroventricular coronary artery. The pericardium was thickened with several "sharping" calcified plaques in the vicinity of the bleeding areas. On day 2, vasopressors were stopped and the patient was successfully extubated. Final diagnosis was a spontaneous cardiac tamponade secondary to a coronary artery injury attributed to a "sharping"calcified pericardial plaque. Conclusion Cardiac tamponade secondary to the development of a hemopericardium may develop as the result of a myocardial and coronary artery injury induced by a calcified pericardial plaque.

  14. Esophageal Spasms

    Science.gov (United States)

    ... Symptom Checker Esophageal spasms Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  15. The risk of healing complications in primary teeth with concussion and subluxation injury

    DEFF Research Database (Denmark)

    Lauridsen, Eva; Blanche, Paul; Amaloo, Catherina

    2017-01-01

    BACKGROUND/AIM: Traumatic dental injuries (TDIs) in the primary dentition occur frequently. Long term complications may potentially cause damage to the permanent successor. The aim of this study was to report the risk of pulp necrosis (PN), pulp canal obliteration (PCO), repair related resorption...... (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR) and premature tooth loss (PTL) in primary teeth following concussion and subluxation injuries, and to identify possible risk factors for PN, PCO and PTL following subluxation. MATERIAL AND METHODS: The study...... was a retrospective analysis of a cohort comprising 31 patients (36 teeth) with concussion injury and 174 patients (241 teeth) with subluxation injury. No treatment was performed. The follow-up program included examination after 4 weeks, 8 weeks, 6 months, 1 year, and when the patients were 6 years of age. Minimum...... follow-up was 1 year or until the time of tooth loss. STATISTICS: Kaplan Meier- and Aahlen Johansson methods and Cox regression analysis. Level of significance was set at 5%. RESULTS: Risk estimated after one year. Concussion: PCO 8.6% (95% CI: 0 - 17.9), PN 5.7% (95% CI: 0 - 13.4), PTL 5.6% (95% CI: 0...

  16. Multidrug-resistant chronic osteomyelitis complicating war injury in Iraqi civilians.

    Science.gov (United States)

    Murphy, Richard A; Ronat, Jean-Baptiste; Fakhri, Rasheed M; Herard, Patrick; Blackwell, Nikki; Abgrall, Sophie; Anderson, Deverick J

    2011-07-01

    War-related orthopedic injury is frequently complicated by environmental contamination and delays in management, placing victims at increased risk for long-term infectious complications. We describe, among Iraqi civilians with war-related chronic osteomyelitis, the bacteriology of infection at the time of admission. In the Médecins Sans Frontières Reconstructive Surgery Project in Amman, Jordan, we retrospectively reviewed baseline demographics and results of initial intraoperative surgical cultures among Iraqi civilians with suspected osteomyelitis. One hundred thirty-seven patients (90% male; median age, 35 years [interquartile range {IQR}, 28-46]; median time since initial injury, 19 months [IQR, 10-35]) were admitted with suspected chronic osteomyelitis after war-related injury. One hundred seven patients had a positive intraoperative culture. Before arrival, patients had undergone a median of 4 (IQR, 2-6) surgical procedures in Iraq. Fifty-nine (55%) of 107 patients with confirmed osteomyelitis had a multidrug-resistant (MDR) organism isolated at admission: cefepime-resistant Enterobacteriaceae (n = 40), methicillin-resistant Staphylococcus aureus (n = 16), and MDR Acinetobacter baumannii (n = 3). An association of borderline significance existed between a history of more than two prior surgical procedures in Iraq and an MDR isolate at program entry (multivariate: odds ratio, 5.3; 95% confidence interval, 0.9-30.6; p = 0.064). Health care actors, including Iraqi health facilities and humanitarian medical organizations, must be aware of the link between chronic war injury and antimicrobial drug resistance in this region and should be prepared for the management challenges involved with the treatment of chronic drug-resistant osteomyelitis.

  17. [Esophageal resections and plastics].

    Science.gov (United States)

    Bagajevas, Aleksandras

    2004-01-01

    The aim was to evaluate interim results of surgery and plastics for esophageal diseases. From March 2002 to August 2003, 31 patients underwent esophageal resections in the Department of Thoracic Surgery of Klaipeda Hospital. The following operations were performed: 10 patients (32.3%) had transthoracic resections, 10 patients (32.3%) - transhiatal resections, 2 patients (6.5%) - Lewis type, 5 patients (16.1%) - Garlock type and 4 patients (12.9%) - first step of Thoreck type operations. Twenty-five patients (80.6%) underwent surgery due to cancer, 3 patients (9.7%) due to esophagus perforation, 1 patient (3.2%) due to peptic stricture, 1 patient (3.2%) due to post-burn stricture, and 1 patient (3.2%) due to gastric necrosis. In 7 cases (22.6%) combined esophageal resections were performed: 2 patients (6.5%) with lung segmentectomies, 2 patients (6.5%) with liver metastasis resections, 1 patient (3.25%) with right lower lobectomy, and 2 patients (6.5%) with proximal gastric metastasis resection. In 58% of patients we observed postoperative complications; lethal outcome was present in 5 patients (16.1%). Subtotal esophageal resection with gastric pipe reconstruction and two-level lymphadenectomies are sufficient radical treatment in cancer patients. Postoperative mortality (16.1%) after 31 resections depends on stage of disease, performance status, comorbidity, surgeon experience and type of operation.

  18. Sarcopenia and Visceral Obesity in Esophageal and Gastric Cancer

    Science.gov (United States)

    2017-02-17

    Esophageal Cancer; Gastric Cancer; Sarcopenia; Sarcopenic Obesity; Obesity; Visceral Obesity; Quality of Life; Surgery; Complication of Treatment; Chemotherapeutic Toxicity; Physical Activity; Oncology

  19. Endoscopic Diagnosis and Management of Iatrogenic Cervical Esophageal Perforation in Extremely Premature Infants

    Directory of Open Access Journals (Sweden)

    Wen-Jue Soong

    2007-04-01

    Full Text Available Blind oro-(naso-pharyngeal suction and feeding catheter intubation are very common practices in pediatric critical care. However, these simple procedures may produce unexpected complications in friable tiny patients. We encountered 3 extremely premature infants in whom cervical esophageal perforation and further submucosal excavation were caused by traumatic catheter injury and subsequently led to catastrophes. These episodes of iatrogenic trauma were all successfully diagnosed early, documented and managed with the aid of ultrathin flexible endoscopy.

  20. Day of Injury CT and Late MRI Findings: Cognitive Outcome in a Pediatric Sample with Complicated Mild Traumatic Brain Injury

    Science.gov (United States)

    Jantz, Paul B; Farrer, Thomas J.; Abildskov, Tracy J.; Dennis, Maureen; Gerhardt, Cynthia A.; Rubin, Kenneth H.; Stancin, Terry; Taylor, H. Gerry; Vannatta, Kathryn; Yeates, Keith Owen

    2016-01-01

    Objectives Complicated mild traumatic brain injury (mTBI) or cmTBI is based on the presence of visibly identifiable brain pathology on the day-of-injury computed tomography (CT) scan. In a pediatric sample the relation of DOI CT to late MRI findings and neuropsychological outcome was examined. Methods MRI (> 12 months) was obtained in pediatric cmTBI patients and a sample of orthopedically injured (OI) children. Those children with positive imaging findings (MRI+) were quantitatively compared to those without (MRI-) or with the OI sample. Groups were also compared in neurocognitive outcome from WASI subtests and the WISC-IV Processing Speed Index (PSI), along with the Test of Everyday Attention for Children (TEA-Ch) and a parent-rated behavioral functioning measure (ABAS-II). Results Despite the MRI+ group having significantly more DOI CT findings than the MRI-group, no quantitative differences were found. WASI Vocabulary and Matrix Reasoning scores were significantly lower, but not PSI, TEA-Ch or ABAS-II scores. MRI+ and MRI-groups did not differ on these measures. Conclusions Heterogeneity in the occurrence of MRI-identified focal pathology was not associated with uniform changes in quantitative analyses of brain structure in cmTBI. Increased number of DOI CT abnormalities was associated with lowered neuropsychological performance. PMID:26186038

  1. Facial Nerve Injury and Other Complications Following Retromandibular Subparotid Approach for the Management of Condylar Fractures.

    Science.gov (United States)

    Bruneau, Stéphane; Courvoisier, Delphine S; Scolozzi, Paolo

    2017-12-06

    To estimate the prevalence and identify risk factors for facial nerve paralysis (FNP) and other postoperative complications after the use of the retromandibular subparotid approach (RMSA) for the treatment of condylar fractures. Radiologic and clinical data from all patients who underwent an RMSA from 2007 through 2015 at the University Hospital of Geneva (Geneva, Switzerland) were retrospectively reviewed. The primary and secondary outcome variables were, respectively, FNP and other complications (unesthetic scars, infection, nonunion, malocclusion, salivary fistula, Frey syndrome, and loosening or breaking of plates and screws). Predictor variables included age, gender, mechanism of injury, delay from injury to surgery, surgeon's experience, location of fracture, side and pattern of fracture, concomitant facial fractures, and status of healing. Univariable logistic regression statistics were computed. Forty-eight subcondylar fractures in 43 consecutive patients were treated using the RMSA. Six fracture sites (12.5%) developed a temporary FNP that completely resolved within 4 months. Fractures at the neck level and with the comminution pattern were significant risk factors of postoperative FNP (P = .04 and P FNP rate after the RMSA to surgery for condylar fractures was similar to that reported after the transparotid variant; 2) the FNP was transient and completely resolved in all patients; 3) neck and comminuted condylar fractures were statistically associated with increased risk of developing a postoperative temporary FNP; and 4) the final outcome was favorable with no major complications in any of the patients. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Esophageal scintigraphy

    DEFF Research Database (Denmark)

    Jørgensen, F; Hesse, B; Tromholt, N

    1992-01-01

    Esophageal scintigraphy has been rather widely used, but much debated as a simple screening method of esophageal dysfunction. However, reports of normal ranges, age dependence and reproducibility are very limited. We studied 60 healthy subjects with a mean age of 43 yr (26, 19, 15 subjects aged 20......-39, 40-59, and 60-79 yr) to establish normal ranges and variations of esophageal mean transit time and residual activity measured by a radionuclide method using [99mTc] pertechnetate labeled water. Mean transit time was calculated by Zierler's formula. The median values and 95% percentiles of single...... were reduced to 10% for MTT and 40% for residual activity in the supine position. The values did not change with age except for a higher frequency of spikes in subjects over 40 yr. The study has demonstrated that mean transit time for radiolabeled water in the esophagus of healthy subjects, measured...

  3. Esophago-pleural fistula with multiple esophageal ulcers in human immunodeficiency virus infected patients: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Soo Hee; Lee, Young Kyung; Choi, Jae Phil; Son, Jin Sung [Seoul Medical Center, Seoul(Korea, Republic of)

    2014-03-15

    Esophagitis is a common complication in patients with human immunodeficiency virus (HIV) infection. Esophagitis in HIV infected patient is caused by candidiasis, cytomegalovirus, herpes simplex virus, or idiopathic esophagitis with no detectable etiology. Esophagitis in HIV infected patient is occasionally combined with esophageal ulcers. We report chest CT findings and clinical manifestation of esophago-pleural fistula with pneumothorax in a HIV infected patient, who was treated for aspiration pneumonia and esophageal ulcers.

  4. Occurrence and timing of complications following traumatic dental injuries: A retrospective study in a dental trauma department

    Science.gov (United States)

    Lin, Shaul; Pilosof, Nir; Karawani, Munir; Wigler, Ronald; Kaufman, Arieh Y.; Teich, Sorin T.

    2016-01-01

    Background This study explores the pattern of complications occurrence resulting from traumatic dental injuries, the relation of this pattern to the number of years from the time of the injury to its first diagnosis, and other contributing characteristics such as root development and trauma characteristic. Material and Methods Patients’ data treated following dental trauma from 2002 to 2014 were classified and grouped according to age, gender, tooth type, injury type, diagnosis and the time that elapsed between the traumatic event and the diagnosis of complications (TIC). The distribution function of the quantitative parameters was determined with the Kolmogorov-Smirnov test. Fisher exact test was used to test differences between categorical parameters. Results The review identified 166 patients (114 male and 52 female), with a total of 287 traumatized teeth, and a mean of 1.8 injured teeth per incident. Maxillary teeth were involved significantly more often in traumatic dental injuries. The follow-up period range (TIC) had a mean of 2.99 years. The most frequent complication was pulp necrosis (34.2%). The most frequent complication related to avulsion was ankylotic root resorption (50%) diagnosed after a median TIC of 1.18 years. Open apices at the occurrence of trauma were observed in 52 teeth. Of these, 54.9% experienced pulp necrosis and 9.8% inflammatory root resorption with a median TIC of 1.63 years. Teeth that experienced multiple traumatic events showed significantly more late pulp necrosis compared to teeth that experienced a single traumatic injury (61.9% vs. 25.3%, respectively, pdental injury and the severity of the potential complications for the tooth. Current recommendations for follow-up after traumatic dental injury should be revised to reflect the need for more frequent and overall prolonged follow-up. Key words:Dental trauma, avulsion, open apex, pulp necrosis, root resorption, follow-up, complications. PMID:27703612

  5. Predicting serious complications and high cost of treatment of tooth-knuckle injuries: a systematic literature review.

    Science.gov (United States)

    Smith, H R; Hartman, H; Loveridge, J; Gunnarsson, R

    2016-12-01

    The tooth-knuckle injury (TKI) is a serious and potentially costly injury seen in orthopaedic practice. The aim was to conduct a systematic literature review on the factors associated with serious complications and high treatment costs in tooth-knuckle injuries. MEDLINE, Scopus and CINAHL were used as the literature sources. Original research papers that reported on factors predicting serious complications and high treatment costs in TKIs were included. There were no restrictions placed on study size, language, study design or date of publication. Case studies, case series and review articles were not included. After duplicates were removed, 403 unique studies remained; after titles and abstracts were screened, 48 titles remained and were retrieved in full text. Of these, 14 titles met the inclusion criteria and were included in the data synthesis. Tenosynovitis, septic arthritis, osteomyelitis and residual stiffness were common serious complications occurring in up to 36.3, 70.0, 47.6 and 65.3 % of cases, respectively. Amputation was also common in up to 18.0 % of injuries. Treatment costs were measured by length of hospital stay and the number of debridements required. On average, patients required 3.8-8 days of admission and 1.3-2.7 debridements each. Increased time delay from injury to treatment, deeply penetrating injuries, proximal interphalangeal joint (PIPJ) injuries and, possibly, E. corrodens infections were associated with serious complications in TKIs. Delayed treatment, inadequate treatment, PIPJ injuries and deeply penetrating injuries predicted higher treatment costs. PROSPERO CRD42016029949 ( http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016029949 ).

  6. Esophageal cancer

    DEFF Research Database (Denmark)

    Mortensen, M. B.

    2007-01-01

    The distribution of adenocarcinomas and squamous cell carcinomas in esophageal cancer (EC) has changed, and focus directed towards tumors of the distal esophagus and the esophagogastric junction. The genetic events leading to EC are not fully clarified, but important risk factors have been...

  7. Successfull management of a cervical oesophageal injury after an ...

    African Journals Online (AJOL)

    The anterior surgical approach for spinal repair, with or without the insertion of stabilizing hardware, is an established procedure in the management of anterior cervical spine (ACS) pathology. Esophageal injury during this approach is a rare complication that can be life threatening. No treatment protocol has yet been ...

  8. Esophageal button battery ingestions: decreasing time to operative intervention by level I trauma activation.

    Science.gov (United States)

    Russell, Robert T; Griffin, Russell L; Weinstein, Elizabeth; Billmire, Deborah F

    2014-09-01

    The incidence of button battery ingestions is increasing and injury due to esophageal impaction begins within minutes of exposure. We changed our management algorithm for suspected button battery ingestions with intent to reduce time to evaluation and operative removal. A retrospective study was performed to identify and evaluate time to treatment and outcome for all esophageal button battery ingestions presenting to a major children's hospital emergency room from February 1, 2010 through February 1, 2012. During the first year, standard emergency room triage (ST) was used. During the second year, the triage protocol was changed and Trauma I triage (TT) was used. 24 children had suspected button battery ingestions with 11 having esophageal impaction. One esophageal impaction was due to 2 stacked coins. Time from arrival in emergency room to battery removal was 183minutes in ST group (n=4) and 33minutes in TT group (n=7) (p=0.04). One patient in ST developed a tracheoesophageal fistula. There were no complications in the TT group. The use of Trauma 1 activations for suspected button battery ingestions has led to more expedient evaluation and shortened time to removal of impacted esophageal batteries. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Doxycycline induced Esophagitis

    Directory of Open Access Journals (Sweden)

    Banu Karakus Yilmaz

    2014-02-01

    Full Text Available Esophagitis is a hazardous condition such as acid reflux of esophageal mucosa, infection, systemic diseases, radiation, drugs and trauma. Drug- induced esophagial injury (DIEI is a disease with the use of variety of drugs that caused serious damage and ulcer in the mucosa of the esophagus. The most commonly implicated drugs are non-steroidal anti-inflammatory drugs (NSAIDs, chloride and especially antibiotics. Thirty-six year-old female patient presented to the emergency department with odynophagia during swallowing and complaining of retrosternal pain. One week before 100 mg doxycycline (2x1 PO for therapeutic abortion were prescribed. It was learned that in the third day of the initiation of medication, the patient\\'s symptoms began and stopped using drug by the fourth day due to advers effect of drugs, but her symptoms didn’t regressed although she didn’t use them. Endoscopy appointment was taken, proton pump inhibitor and antiacid treatment was given, than patient was discharged from the emergency department. In the endoscopy, 20 mm segment esophageal ulcer was seen approximately in the 30.th cm of the esophagius. DIEI is a relatively common, although under-recognized, so this case was presented for remainding DIEI to emergency medicine personals and reweiving its diagnosis, treatment and follow-up.

  10. A ten year analysis of the traumatic maxillofacial and brain injury patient in Amsterdam: complications and treatment.

    Science.gov (United States)

    Salentijn, Erik G; Collin, John D; Boffano, Paolo; Forouzanfar, Tymour

    2014-12-01

    Maxillofacial trauma is often associated with injuries to the cranium, especially in high-energy trauma. The management of such cases can be challenging and requires close cooperation between oral and maxillofacial surgery and neurosurgical teams. There are few reports in the current literature describing the complications that develop in patients with maxillofacial trauma and traumatic brain injury (TBI). Complications can be categorized as early or late and/or minor and major. The exact definition of complications and their categorization remains a matter of current debate. We present a 10 year retrospective study of complications and their subsequent management in patients receiving maxillofacial and neurosurgical treatment for maxillofacial trauma associated with TBI. The study population consisted of 47 people, excluded from a maxillofacial trauma population of 579 patients. The severity of the trauma was scored as mild, moderate or severe, using the Glasgow Coma Scale at presentation of the Emergency Department. In total 36 patients (76.6%) developed complications. Patients involved in road traffic collision were most likely to develop complications (92.3%). This was followed by falls (66.7%) as mechanism of the injury. Patients aged 60-69 years experienced the highest complication rate (5), followed by patients aged 20-29 years (4.1) and 30-39 years (3.5). The majority of complications were infection and inflammation (36.4%), followed by neurological deficit (24.0%), physiological dysregulation (11.6%) and facial bone deformity (8.3%). Patients who developed no complications, most often presented with mild TBI (72.7%). The most common treatment modality employed to manage complications was pharmacological, followed by antibiotic treatment, conservative treatment and decompression therapy. The mean hospital stay after the trauma for the patients with complications was 28 days. Thirteen patients (36.1%) were transferred to a rehabilitation centre, a nursing

  11. Esophageal Mucormycosis

    Directory of Open Access Journals (Sweden)

    Benjamin Boatright

    2014-01-01

    Full Text Available Mucormycosis is a rare invasive fungal infection with high mortality. It usually affects patients with poorly controlled diabetes, immunosuppression, or hematological malignancies. Gastroenterologists need to be aware of this rare infection because endoscopy can facilitate early diagnosis and prompt appropriate therapy. Here we describe a case of invasive esophageal mucormycosis that developed in a 63-year-old man with diabetes, acute promyelocytic leukemia, and prolonged leukopenia after chemotherapy. Upper endoscopy showed distal circumferential esophageal wall thickening with devitalization. The mucosa did not bleed after endoscopic biopsy. Histopathology confirmed mucormycosis. He was treated with various antifungal agents including echinocandins, fluconazole, and liposomal amphotericin B. Despite aggressive antifungal therapy and supportive care, the patient died 24 days later.

  12. Community-based InterVentions to prevent serIous Complications (CIVIC) following spinal cord injury in Bangladesh

    DEFF Research Database (Denmark)

    Hossain, Mohammad S; Harvey, Lisa A; Rahman, Md Akhlasur

    2016-01-01

    INTRODUCTION: In low-income and middle-income countries, people with spinal cord injury (SCI) are vulnerable to life-threatening complications after they are discharged from hospital. The aim of this trial is to determine the effectiveness and cost-effectiveness of an inexpensive and sustainable ...

  13. Physical fitness in people with a spinal cord injury : the association with complications and duration of rehabilitation

    NARCIS (Netherlands)

    Haisma, J. A.; Bussmann, J. B. J.; Stam, H. J.; Sluis, T. A. R.; Bergen, M. P.; Post, M. W. M.; Dallmeijer, A. J.; van der Woude, L. H. V.

    2007-01-01

    Objective: To assess the association between physical fitness and its recovery over time on the one hand, and complications and duration of phases of rehabilitation on the other. Design and setting: Prospective cohort study at eight rehabilitation centres. Subjects: People with a spinal cord injury

  14. External fixation in the treatment of severe tibial fractures complicated by soft tissue injury.

    Science.gov (United States)

    Słuzałek, Maciej; Gaździk, Tadeusz S; Mrozek, Stanisław; Ryba, Jan

    2004-02-28

    Background. In recent years multiple injuries to the tibial shaft have become increasingly common. High-energy impacts cause comminuted fractures, often accompanied by damage to neural and vascular structures, muscle, and surface layers. The key to good healing is preserving normal blood supply. Serious damage to the tibia should be treated by external stabilization. Material and methods. A group of 23 patients with severe tibial fractures accompanied by soft-tissue injures were treated surgically, using Polfix, Ilizarov and Dynastab external stabilizers. Open fractures were classified according to the Gustillo-Anderson scale. Internal bone transport and the Ilizarov apparatus were used for the treatment of fractures with bone defect. Bone infections were treated with targeted antibiotic therapy and flush drainage. In cases with staphylococcus infection anti-vaccination was used. Plastic surgery was performed to cover soft tissue defects. Polfix stabilizers were removed after 35 weeks, Ilizarov after 45 weeks, and Dynastab after 18 weeks. The Sarmiento cast was applied in 6 cases. Results. In all patients treated with external fixation good results we observed. Conclusions. In the treatment of open tibial fractures complicated by significant bone defects and soft-tissue defects (type IIIB/C), the methods of choice are Ilizarov or Dynastab stabilizers. Polfix or Dynastab stabilizers are suitable for open fractures of types I-IIIA. Serious tibial injury necessitates the use of various kinds of skin grafts, so the best solution is regular cooperation with a plastic surgeon. Treatment with Sarmiento's functional plaster cast is a valuable supplement to external fixation.

  15. Postmortem changes in lungs in severe closed traumatic brain injury complicated by acute respiratory failure

    Directory of Open Access Journals (Sweden)

    V. A. Tumanskiy

    2013-08-01

    Full Text Available V.А. Tumanskіy, S.І. Ternishniy, L.M. Tumanskaya Pathological changes in the lungs were studied in the work of 42 patiens who died from severe closed intracranial injury (SCII. It was complicated with acute respiratory insufficient (ARI. The most modified subpleural areas were selected from every lobe of the lungs for pathological studies. Prepared histological sections were stained by means of hemotoxylin and eosin and by Van Giеson for light microscopy. The results of the investigation have shown absence of the significant difference of pathological changes in the lungs of patients who died from ARI because of severe brain injury and traumatic intracranial hemorrhage. Pathognomic pathological changes in the lungs as a result of acute lung injury syndrome (ALIS were found in deceased patients on the third day since the SCII (n=8. There was a significant bilateral interstitial edema and mild alveolar edema with the presence of red and blood cells in the alveoli, vascular plethora of the septum interalveolar and stasis of blood in the capillaries, the slight pericapillary leukocyte infiltration, subpleural hemorrhage and laminar pulmonary atelectasis. In deceased patients on 4-6 days after SCII that was complicated with ARI (n=14, morphological changes had been detected in the lungs. It was pathognomic for acute respiratory distress syndrome (ARDS with local pneumonic to be layered. A significant interstitial pulmonary edema was observed in the respiratory part of the lungs. The edema has spread from the walls of the alveoli into the interstitial spaces of the bronchioles and blood vessels, and also less marked serous-hemorrhagic alveolar edema with presence of the fibrin in the alveoli and macrophages. The ways of intrapleural lymphatic drainage were dilatated. Histopathological changes in the lungs of those who died on the 7-15th days after severe closed craniocerebral injury with ARI to be complicated (n=12 have been indicative of two

  16. Recovery of episodic memory subprocesses in mild and complicated mild traumatic brain injury at 1 and 12 months post injury.

    Science.gov (United States)

    Tayim, Fadi M; Flashman, Laura A; Wright, Matthew J; Roth, Robert M; McAllister, Thomas W

    2016-11-01

    Episodic memory complaints are commonly reported after traumatic brain injury (TBI). The contributions of specific memory subprocesses (encoding, consolidation, and retrieval), however, are not well understood in mild TBI (mTBI). In the present study, we evaluated subprocesses of episodic memory in patients with mTBI using the item-specific deficit approach (ISDA), which analyzes responses on list learning tasks at an item level. We also conducted exploratory analyses to evaluate the effects of complicated mTBI (comp-mTBI) on memory. We compared episodic verbal memory performance in mTBI (n = 92) at approximately 1 and 12 months post TBI, as well as in a healthy comparison (HC) group (n = 40) at equivalent time points. Episodic memory was assessed using the California Verbal Learning Test-2nd Edition (CVLT-II), and both standard CVLT-II scores and ISDA indices were evaluated. Compared to the HC group, the mTBI group showed significantly poorer encoding and learning across time, as measured by ISDA and CVLT-II. Further analyses of these mTBI subgroups [(noncomplicated mTBI (NC-mTBI, n = 77) and comp-mTBI (n = 15)], indicated that it was the comp-mTBI group who continued to demonstrate poorer encoding ability than the HC group. When the patient groups were directly compared, the NC-mTBI group improved slightly on the ISDA Encoding Deficit Index. While the comp-mTBI group worsened slightly over time, their poorer encoding ability was not likely clinically meaningful. These findings indicate that, while the NC-mTBI and HC groups' performances were comparable by 12 months, a primary, long-term deficit in encoding of auditory verbal information remained problematic in the comp-mTBI group.

  17. Cognitive reserve as a moderator of postconcussive symptoms in children with complicated and uncomplicated mild traumatic brain injury.

    Science.gov (United States)

    Fay, Taryn B; Yeates, Keith Owen; Taylor, H Gerry; Bangert, Barbara; Dietrich, Ann; Nuss, Kathryn E; Rusin, Jerome; Wright, Martha

    2010-01-01

    The occurrence of postconcussive symptoms (PCS) following mild traumatic brain injury (TBI) in children may depend on cognitive reserve capacity. This prospective, longitudinal study examined whether the relationship between mild TBI and PCS is moderated by cognitive ability, which served as a proxy for cognitive reserve. Participants included 182 children with mild TBI and 99 children with orthopedic injuries (OI), ranging from 8 to 15 years of age when injured. Mild TBI were classified as complicated (n = 32) or uncomplicated (n = 150) depending on whether they were associated with trauma-related intracranial abnormalities on magnetic resonance imaging. PCS were assessed initially within 3 weeks of injury, and again at 1, 3, and 12 months post injury. The initial assessment also included standardized tests of children's cognitive skills and retrospective parent ratings of pre-injury symptoms. Hierarchical linear modeling indicated that ratings of PCS were moderated jointly by cognitive ability and injury severity. Children of lower cognitive ability with a complicated mild TBI were especially prone to cognitive symptoms across time according to parents and to high acute levels of PCS according to children's self-ratings. Cognitive reserve is an important moderator of the outcomes of mild TBI in children and adolescents.

  18. The protective mechanism of quercetin-3-O-β-D-glucuronopyranoside (QGC) in H2O2-induced injury of feline esophageal epithelial cells.

    Science.gov (United States)

    Sohn, Uy Soo; Lee, Se Eun; Lee, Sung Hee; Nam, Yoonjin; Hwang, Wan Kyunn; Sohn, Uy Dong

    2016-09-01

    Quercetin-3-O-β-D-glucuronopyranoside (QGC) is a flavonoid glucoside extracted from Rumex Aquaticus. Recent studies have shown that QGC exhibits anti-inflammatory, anti-oxidateve effect in vivo and cytoprotective effect in vitro. Reactive oxygen species (ROS), at low concentration, play role as a primary signal or second messenger, however, at high concentration, ROS are cytotoxic. In this study, we investigated the protective mechanism of QGC in H2O2-induced injury of Feline Esophageal Epithelial Cells. Primary-cultured feline esophagus cells were identified by an indirect immunofluorescent staining method using a cytokeratin monoclonal antibody. Cell viability was determined by the conventional MTT reduction assay. Western blot analysis was performed with specific antibodies to investigate the activation of MAPKs, NF-κB, and IκB-α, and the expression of COX-2. When the cells were exposed to 600 μM H2O2 medium for 24 h, cell viability decreased to 54 %. However, when cells were pretreated with 50-150 μM QGC for 12 h, the viability of cells exposed to H2O2 significantly increased in the dose dependent manner. QGC (50 μM, 12 h) also inhibited the expression of COX-2 induced by 10 μM H2O2 for 24 h. We found that treatment of H2O2 activated p38 MAPK and JNK, but not ERK. However QGC inhibited the H2O2-induced p38 MAPK and JNK phosphorylation. In addition, NF-κB was activated by H2O2 and translocated into the nucleus, but QGC inhibited the activation of NF-κB by blocking degradation of IκB. These data suggest that QGC reduces H2O2-induced COX-2 production by modulating the p38 MAPK, JNK, NF-κB signal pathway in feline esophageal epithelial cells.

  19. PET-CT manifestation of Candida esophagitis

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Yong Whee [Sung-Ae Hospital, Seoul (Korea, Republic of); O, Joo Hyun [Kangnam St. Mary' s Hospital, Catholic University Medical School, Seoul (Korea, Republic of)

    2007-04-15

    Candida esophagitis (moniliasis) is the most common infection of the gullet and has generally been attributed to as a complication of immune suppressed state. However, as the current case. Holt found the disease to occur in 3 of his 13 patients without predisposing condition. Predisposing factors other than immune deficient conditions include aplastic anemia, alcoholism and Parkinson's disease and age, diabetes mellitus, and disruption of mucosal integrity. Growing prevalence of Candida esophagitis in recent years is accounted for by an increase in the number of patients with organ transplantation, malignancy and AIDS as well as populrization of endoscopy. Microorganisms that reached the esophagus in oral secretions are rarely cultured from the esophageal surface. Of many species C. albicans is the most common offender although C. tropicalis has also been isolated with high prevalence, particularly in the patients with cancer and disseminated candidiasis. Clinically, the patients with Candida esophagitis seek medical care for esophageal or retrosternal pain, dysphagia or distress. Candida esophagitis may be the extension from oropharyngeal infection but in the majority the esophagus is the sole site of infection. The middle and lower thirds of the esophagus are more typically affected than the upper third. Diagnosis can be indicated by double contrast esophagography or endoscopy and confirmed by potassium hydroxide (KOH) stain or biopsy. It is to be noted that the more presence of Candida in smear or cultured specimen cannot indict Candida as definitive offender. Differential diagnosis includes herpes simplex infection, cytomegalovirus infection, reflux esophagitis or radiation esophagitis.

  20. [A Case of Delayed Vascular Injury as a Complication Related to Implanted Central Venous Port Catheter].

    Science.gov (United States)

    Sumiyoshi, Tetsuya; Kondo, Tomohiro; Fujii, Ryoji; Minagawa, Takeyoshi; Fujie, Shinya; Kimura, Tomohiro; Ihara, Hideyuki; Yoshizaki, Naohito; Kondo, Hitoshi; Kitayama, Hiromitsu; Sugiyama, Junko; Hirayama, Michiaki; Tsuji, Yasushi; Yamamoto, Kazuyuki; Kawarada, You; Okushiba, Shunichi; Nishioka, Noriko; Shimizu, Tadashi

    2015-12-01

    A 74-year-old woman with advanced gastric cancer was admitted to our hospital. A central venous (CV) port catheter was implanted into the right subclavian vein for preoperative chemotherapy and parenteral nutritional management. On the 35th day after implantation, she complained of diarrhea, fever and dyspnea. The chest radiograph showed a right-sided massive pleural effusion. As the patient progressively fell into severe respiratory distress, endotracheal intubation was performed for management of respiration by mechanical ventilation. Initially, given the patient's symptoms, she was diagnosed with septic shock. Therefore, after placement of a CV catheter through the right femoral vein, in consideration of the possibility of a port infection, she was treated with thoracentesis and infusion of antibiotics. The patient gradually recovered, and again received parenteral nutrition through the CV port catheter. After the infusion was administered, she complained of dyspnea. A CT scan of the chest revealed a right pleural effusion and displacement of the tip of the CV port catheter out of the wall of the superior vena cava. We diagnosed delayed vascular injury (DVI), and the CV port catheter was removed. She soon recovered with conservative treatment. We speculated that the initial respiratory symptoms such as the pleural effusion were caused by DVI. DVI should therefore be recognized as a complication related to implanted CV port catheters.

  1. Airway and esophageal stenting in patients with advanced esophageal cancer and pulmonary involvement.

    Directory of Open Access Journals (Sweden)

    Fabrice Paganin

    Full Text Available BACKGROUND: Most inoperable patients with esophageal-advanced cancer (EGC have a poor prognosis. Esophageal stenting, as part of a palliative therapy management has dramatically improved the quality of live of EGC patients. Airway stenting is generally proposed in case of esophageal stent complication, with a high failure rate. The study was conducted to assess the efficacy and safety of scheduled and non-scheduled airway stenting in case of indicated esophageal stenting for EGC. METHODS AND FINDINGS: The study is an observational study conducted in pulmonary and gastroenterology endoscopy units. Consecutive patients with EGC were referred to endoscopy units. We analyzed the outcome of airway stenting in patients with esophageal stent indication admitted in emergency or with a scheduled intervention. Forty-four patients (58+/-\\-8 years of age with esophageal stenting indication were investigated. Seven patients (group 1 were admitted in emergency due to esophageal stent complication in the airway (4 fistulas, 3 cases with malignant infiltration and compression. Airway stenting failed for 5 patients. Thirty-seven remaining patients had a scheduled stenting procedure (group 2: stent was inserted for 13 patients with tracheal or bronchial malignant infiltration, 12 patients with fistulas, and 12 patients with airway extrinsic compression (preventive indication. Stenting the airway was well tolerated. Life-threatening complications were related to group 1. Overall mean survival was 26+/-10 weeks and was significantly shorter in group 1 (6+/-7.6 weeks than in group 2 (28+/-11 weeks, p<0.001. Scheduled double stenting significantly improved symptoms (95% at day 7 with a low complication rate (13%, and achieved a specific cancer treatment (84% in most cases. CONCLUSION: Stenting the airway should always be considered in case of esophageal stent indication. A multidisciplinary approach with initial airway evaluation improved prognosis and decreased

  2. Management of Malnutrition in Esophageal Cancer Patients

    Directory of Open Access Journals (Sweden)

    Yu-Juan Xu

    2014-06-01

    Full Text Available The prevalence of malnutrition in patients with esophageal cancer is estimated to be as high as 78.9%. Malnutrition in esophageal cancer is significantly correlated with an increased risk of treatment toxicity and postoperative complications. It is therefore important to maintain an optimal nutritional status, particularly during the course of neoadjuvant chemoradiation. This article aims to review the mechanism, evaluation, and management strategies of malnutrition for patients with esophageal cancer. The optimal management strategy involved both non-pharmacological and pharmacological approaches. We hope that by increasing awareness among professionals, early detection and timely intervention could lead to improved care.

  3. [Clinical Analysis of Esophageal Bypass Surgery with Nutritional Assessment in Patients with Unresectable Esophageal Cancer].

    Science.gov (United States)

    Funaki, Hiroshi; Fujii, Yoritaka; Fujita, Jun; Morioka, Emi; Kaida, Daisuke; Ohonishi, Toshio; Tomita, Yasuto; Noguchi, Miki; Fujita, Hideto; Kinami, Shinichi; Nakano, Yasuharu; Ueda, Nobuhiko; Kosaka, Takeo

    2015-11-01

    Esophageal bypass surgery is palliative surgery for unresectable esophageal cancer with esophageal stenosis, which often leads to poor nutrition. We investigated the clinical characteristics, nutritional status, and outcomes of patients who underwent esophageal bypass surgery. We reviewed 11 cases of esophageal bypass surgery for unresectable esophageal cancer performed in our hospital between 1992 and 2015, and we examined the surgical outcome along with preoperative nutritional assessment. There were 1, 9, and 1 cases of cStage Ⅲ, Ⅳa, and Ⅳb, respectively. For the bypass, a gastric tube was used in 8 cases and colon reconstruction in 3. Postoperative complications were 1 case of recurrent laryngeal nerve palsy (9%), 4 cases of anastomotic leakage (36%), and 4 cases of pneumonia (36%). The preoperative nutritional status (total protein, albumin, and cholinesterase levels) in the esophageal bypass group (n=11) was significantly worse than that in the esophagectomy group (n=40). The median survival of all patients (n=11) was 5.7 months. Patients receiving induction chemoradiotherapy followed by bypass surgery (n=7) had a median survival of 15.2 months. Since patients undergoing esophageal bypass surgery often present with malnutrition, attention to anastomotic leakage and infectious complications is necessary.

  4. [Vascular injury as a complication of knee arthroscopic surgery. Report of two cases and review of the literature].

    Science.gov (United States)

    Enríquez-Vega, María Elizabeth; Cruz-Castillo, Juan Ernesto; Pacheco-Pittaluga, Ernesto; Solorio-Rosette, Hugo; Linarte-Márquez, Lizbeth; Iturburu-Enríquez, Alessandra

    2013-01-01

    Arthroscopy of the knee is a surgical performed world-wide considered extremely safe, rates of complication ranging from 0.56 to 8.2%. Vascular complications are even more rare (0.0032%), and generally related to the popliteal artery injury. We are reporting the cases of two patients who had unsuspected vascular complications after arthroscopy. Both cases presented vascular injuries after elective knee arthroscopy. First case was a patient with thrombosed pseudoaneurysm in the popliteal artery and total section of the popliteal vein, unfortunately the diagnosis was done 72 hrs after knee arthroscopy and finally required amputation, the 2nd case presented popliteal arteriovenous fistula, the diagnosis was done 3 weeks after knee arthroscopy, the patient was successfully treated by resection of the fistula and direct repair of the artery and vein. Although extremely infrequent, the vascular injury after knee arthroscopy should be remembered as a surgical complication, a low index of suspicion may have caused an unfortunate and untimely delay in diagnosis and treatment with potential risk of leg amputation and death.

  5. Phlegmonous Esophagitis Treated with Internal Drainage and Feeding Jejunostomy

    Directory of Open Access Journals (Sweden)

    Won Gi Woo

    2017-12-01

    Full Text Available We report the case of a 67-year-old woman presenting with epigastric pain. Computed tomography identified diffuse phlegmonous esophagitis. Esophagogastroduodenoscopy revealed multiple perforations in the mucosal layer of the esophagus. A large amount of pus was drained internally through the gut. The patient was treated with antibiotics and early jejunostomy feeding. Although phlegmonous esophagitis is a potentially fatal disease, the patient was successfully treated medically with only a minor complication (esophageal stricture.

  6. Bilateral gluteal compartment syndrome complicated by rhabdomyolysis and acute kidney injury in a patient with alcohol intoxication

    Directory of Open Access Journals (Sweden)

    Jae Young Cho

    2012-12-01

    Full Text Available Bilateral gluteal compartment syndrome is a rare clinical entity that can be complicated by rhabdomyolysis or acute kidney injury (AKI. We report the a case of a 30-year-old woman without any comorbid diseases who was diagnosed with bilateral gluteal compartment syndrome complicated by rhabdomyolysis and dialysis-requiring AKI, which was caused by prolonged immobilization under the influence of alcohol. Although the patient’s renal function recovered fully after 5 sessions of hemodialysis, sciatic neuropathy caused by gluteal compartment syndrome led to permanent foot drop.

  7. [Effect of enteral naloxone on the incidence of gastritis and esophagitis in mechanically ventilated patients].

    Science.gov (United States)

    Meissner, W; Hartmann, M; Kähler, G; Brauer, M

    2004-09-01

    Gastrtis and esophagitis are frequent and severe complications in intensive care patients, mainly caused by increased duodenogastral reflux. Opioids, commonly used in intensive care, are known to impair gastrointestinal (GI) motility which increases retrograd flow of gastric content. In a previous study, we showed that enteral administered naloxone reduces gastric reflux by selectively blocking GI opioid receptors. Therefore, in a subpopulation of these patients we studied the effect of enteral naloxone on the incidence of mucosal injury in opioid-treated, mechanically ventilated patients. After IRB approval, mechanically ventilated, fentanyl-treated patients without gastrointestinal surgery or diseases were assigned to receive 8 mg naloxone or placebo four times daily via a gastric tube. Additional inclusion criteria were opioid treatment for at least three days and endoscopy of the upper GI tract. Frequency of gastritis and esophagitis was quantified according to the Savary-Miller Score, and further parameter of GI motility (frequency of propulsive medication, amount of enteral feeding) were measured. In four of seventeen patients of the naloxone group (24 %) and 14 of 22 patients of the placebo group (64 %; p = 0.02), esophageal or gastral mucosal injuries were detected. In the naloxone group, gastral reflux as well as need for propulsive medication were significantly lower. Volume of enteral feeding showed an increasing trend in the second half of the study. Reduction of esophagogastral mucosal injury and reduced need for procinetic medication suggests an improvement of GI motility by enteral naloxone in fentanyl-treated, mechanically ventilated patients.

  8. Amniotic fluid insulin and C-peptide as predictive markers for fetal macrosomia, birth injuries, and delivery complications?

    Science.gov (United States)

    Stein, Roland Gregor; Meinusch, Malgorzata; Diessner, Joachim; Dietl, Johannes; Hönig, Arnd; Zollner, Ursula

    2014-01-15

    Gestational diabetes mellitus (GDM) occurs in 3-5% of all pregnancies. GDM increases both maternal and fetal risks, causes fetal macrosomia, and hence increases the rates of caesarean sections and delivery complications such as shoulder dystocia. An early predictive marker and consequent early treatment could be beneficial, so amniotic fluid insulin and C-peptide have been examined in several studies. Increased amniotic fluid insulin in early amniocentesis between the 14th and 20th gestational week predicted a later GDM. A potential direct association with fetal macrosomia remains to be determined. This retrospective study investigated amniotic fluid insulin/C-peptide from amniocenteses between 14 and 20 weeks of gestation in correlation with fetal birth weight, type of delivery, and complications. To focus on effects of fetal hyperinsulinism apart from therapeutic confounders, we included patients who did not participate in GDM screening. Insulin and C-peptide were measured in 144 samples of frozen amniotic fluid. Birth weight, type of delivery, complications, and birth injuries were noted. Birth weights ranged from 760 g to 4410 g with a mean weight of 3424 g at an average of 40 weeks gestation. The mean amniotic fluid insulin was 4.36 U/ml and the mean C-peptide concentration was 0.076 ng/ml. There was no correlation between amniotic fluid insulin or C peptide and birth weight, type of delivery, complications, and birth injuries. Amniotic fluid insulin and C-peptide are unsuitable as predictive marker for fetal macrosomia, type of delivery, complications, or birth injuries.

  9. Temporary esophageal stenting allows healing of esophageal perforations following atrial fibrillation ablation procedures.

    Science.gov (United States)

    Bunch, T Jared; Nelson, Jennifer; Foley, Tom; Allison, Scott; Crandall, Brian G; Osborn, Jeffrey S; Weiss, J Peter; Anderson, Jeffrey L; Nielsen, Peter; Anderson, Lars; Lappe, Donald L; Day, John D

    2006-04-01

    Left atrial catheter ablation (LACA) has emerged as a successful method to eliminate atrial fibrillation (AF). Recent reports have described atrio-esophageal fistulas, often resulting in death, from this procedure. Temporary esophageal stenting is an established therapy for malignant esophageal disease. We describe the first case of successful temporary esophageal stenting for an esophageal perforation following LACA. A 48-year-old man with symptomatic drug refractory lone AF underwent an uneventful LACA. Fifty-nine ablations with an 8-mm tip ablation catheter (30 seconds, 70 Watts, 55 degrees C), as guided by 3-D NavX mapping, were performed in the left atrium to isolate the pulmonary veins as well as a left atrial flutter and roof ablation line. In addition, complex atrial electrograms in AF and sites of vagal innervation were ablated. Two weeks later, he presented with sub-sternal chest pain, fever, and dysphagia. A chest CT showed a 3-mm esophageal perforation at the level of the left atrium with mediastinal soiling and no pericardial effusion. An urgent upper endoscopy with placement of a PolyFlex removable esophageal stent to seal off the esophago-mediastinal fistula was performed. After 3 weeks of i.v. antibiotics, naso-jejunal tube feedings, and esophageal stenting, the perforation resolved and the stent was removed. Over 18 months of follow-up, there have been no other complications, and he has returned to a physically active life and remains free from AF on previously ineffective anti-arrhythmic drugs. Early diagnosis of esophageal perforations following LACA may allow temporary esophageal stenting with successful esophageal healing. Prompt chest CT scans with oral and i.v. contrast should be considered in any patient with sub-sternal chest pain or dysphagia following LACA.

  10. [Esophageal moniliasis].

    Science.gov (United States)

    Ramírez Degollado, J; Martínez Aguilar, A; Peniche Bojórquez, J

    1978-01-01

    Esophageal moniliasis is found rarely. It has been described mainly in chronically ill patients, who receive antibiotics and corticoesteroids. Early diagnosis and treatment betters their prognosis. Nine patients, 5 males and 4 females were studies in Hospital General del Centro Medico Nacional in Mexico City. Their agesranged from 26 to 77 years, with a mean of 49 years. All patients were chronically ill and 7 of them were treated in the intensive care unit. Three had disphagia, 3 retrosternal pain, and 2 gastrointestinal hemorrhage. Eight patients had high W.B.C., 3 irregular filling defects on X ray studies, and on endoscopy, all showed a pseudomembranous white yellowish exudate, underneath it the mucosa was inflamed, irregular and bled scantily. In 5 out of 9 patients biopsy and a smear confirmed the diagnosis. Eight patients treated with nystatin were cured. This disorder must be suspected in patients with disphagia and retrosternal pain; esophagoscopy is the prefered procedure to establish this diagnosis.

  11. Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission.

    Science.gov (United States)

    Marenzi, Giancarlo; Assanelli, Emilio; Campodonico, Jeness; De Metrio, Monica; Lauri, Gianfranco; Marana, Ivana; Moltrasio, Marco; Rubino, Mara; Veglia, Fabrizio; Montorsi, Piero; Bartorelli, Antonio L

    2010-02-01

    To evaluate the clinical and prognostic relevance of acute kidney injury (AKI) in the setting of ST-elevation acute myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Prospective study. Single-center study, 13-bed intensive cardiac care unit at a University Cardiological Center. Ninety-seven consecutive STEMI patients with CS at admission, undergoing intra-aortic balloon pump (IABP) support and primary percutaneous coronary intervention (PCI). None. We measured serum creatinine at baseline and each day for the following 3 days. Acute kidney injury was defined as a rise in creatinine >25% from baseline. Overall, AKI occurred in 52 (55%) patients, and in 12 of these patients, a renal replacement therapy was required. In multivariate analysis, age >75 yrs (p = .005), left ventricular ejection fraction < or = 40% (p = .009), and use of mechanical ventilation (p = .01) were independent predictors of AKI. Patients developing AKI had a longer hospital stay, a more complicated clinical course, and significantly higher mortality rate (50% vs. 2.2%; p <.001) than patients without AKI. In our population, AKI was the strongest independent predictor of in-hospital mortality (relative risk 12.3, 95% confidence intervals 1.78 to 84.9; p <.001). In patients with STEMI complicated by CS, AKI represents a frequent clinical complication associated with a poor prognosis.

  12. Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature

    Science.gov (United States)

    Hershman, Stuart H.; Kunkle, William A.; Kelly, Michael P.; Buchowski, Jacob M.; Ray, Wilson Z.; Bumpass, David B.; Gum, Jeffrey L.; Peters, Colleen M.; Singhatanadgige, Weerasak; Kim, Jin Young; Smith, Zachary A.; Hsu, Wellington K.; Nassr, Ahmad; Currier, Bradford L.; Rahman, Ra’Kerry K.; Isaacs, Robert E.; Smith, Justin S.; Shaffrey, Christopher; Thompson, Sara E.; Wang, Jeffrey C.; Lord, Elizabeth L.; Buser, Zorica; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.

    2017-01-01

    Study Design: Multicenter retrospective case series and review of the literature. Objective: To determine the rate of esophageal perforations following anterior cervical spine surgery. Methods: As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients’ charts and created case report forms for each event identified. Case report forms were then sent to the AOSpine North America Clinical Research Network Methodological Core for data processing and analysis. Results: The records of 9591 patients who underwent anterior cervical spine surgery were reviewed. Two (0.02%) were found to have esophageal perforations following anterior cervical spine surgery. Both cases were detected and treated in the acute postoperative period. One patient was successfully treated with primary repair and debridement. One patient underwent multiple debridement attempts and expired. Conclusions: Esophageal perforation following anterior cervical spine surgery is a relatively rare occurrence. Prompt recognition and treatment of these injuries is critical to minimizing morbidity and mortality. PMID:28451488

  13. Traumatic upper cervical esophageal perforation in childhood with ...

    African Journals Online (AJOL)

    morbidity and mortality if misdiagnosed. There is still no consensus on the assessment and elective management of children with trauma and esophageal rupture .... saliva aspiration may lead to complications ranging from mild aspiration pneumonia to severe respiratory distress. In cases of cervical esophageal perforations ...

  14. Denture Mis-swallowing in the Sliding Esophageal Hiatal Hernia Mimics Esophageal Perforation

    Directory of Open Access Journals (Sweden)

    Chao-Yang Chen

    2008-08-01

    Full Text Available Mis-swallowing of a foreign body in the esophagus coexisting with sliding hernia might be misdiagnosed as esophageal perforation with mediastinal abscess. We report an 89-year-old woman, bedridden for a long period in a nursing home after a previous cerebrovascular accident, who was sent to our emergency department in a state of sepsis because she had swallowed a radio-opaque partial denture. The retention of the denture as an esophageal foreign body was complicated with mediastinitis and bilateral pleural effusion. The inability of the patient to give a reliable clinical history delayed the diagnosis. This report highlights the difficulty in precisely locating a partial denture because of conflicting radiologic findings and the coexistence of esophageal sliding hernia, all of which led to a misdiagnosis of possible esophageal perforation. A right posterolateral thoracotomy with gastrostomy was performed to remove the lower esophageal foreign body after esophagoscopy failed. The surgical finding of a coincidental sliding esophageal hiatal hernia correlated well with the clinical presentation. Managing such a complicated esophageal foreign body in this elderly patient was challenging.

  15. Intramural esophagic hematoma secondary to coumarinic anticoagulation: a case report

    Science.gov (United States)

    2009-01-01

    Esophagic Intramural Hematoma is an uncommon clinical condition, with a prognosis which is essentially benign. On most cases, a predisposing or precipitating factor may be seen, with the most common ones being the history of esophagic instrumentation, food impactations and thrombocytopenia. In the following manuscript, the authors present the case of a 54-years-old male with history of valve replacement surgery, who was treated at the Clinica Cardiovascular (Medellin, Colombia), with a clinical case of Intramural Esophagic Hematoma that was later confirmed to be due to a Coumarinic overanticoagulation. On this case, it is evidenced that Intramural Esophagic Hematoma is an unrecognized complication of Courmarinic anticoagulation therapy. PMID:20069068

  16. Radiologic features of esophagitis

    Energy Technology Data Exchange (ETDEWEB)

    Kressel, H.Y.; Glick, S.N.; Laufer, I.; Banner, M.

    1981-05-15

    The radiographic features of 31 cases of esophagitis confirmed by endoscopy and biopsy were studied by double-contrast techniques. The morphologic findings are analyzed and the changes noted in the infectious and peptic types of esophagitis are contrasted.

  17. Esophageal Strictures in Children

    Directory of Open Access Journals (Sweden)

    Ahmad Bazrafshan

    2014-07-01

    Conclusion: Anastomotic stricture after surgical repair of esophageal atresia comprised the most common cause of esophageal stricture. Proximal esophagus was the most common site of stricture. Most of the patients recovered with dilatation, surgery, or a combination of the two.

  18. The role of specialist units to provide focused care and complication avoidance following traumatic spinal cord injury: a systematic review.

    Science.gov (United States)

    Maharaj, Monish M; Hogan, Jarred A; Phan, Kevin; Mobbs, Ralph J

    2016-06-01

    Current recommendations for traumatic spinal cord injury treatment recommend immediate transfer to a spinal injury unit (SIU) where available following patient stabilisation. Although transfer is dependent on a variety of factors, the largest review was unable to justify implementation of such units on the basis of insufficient and lack of quality data in favour of care at the SIU as opposed to non-SIU centres. Our study sought to investigate: are subspecialty spinal injury units (SIUs) able to provide superior care compared with traditional trauma/rehab units? Is the standard of care of acute spinal cord injured patients to be managed in SIU's? A literature search was conducted across five major databases using the key terms: "spinal cord injury" AND "Spinal Injury Unit" OR "spinal rehabilitation" OR "spinal injury centre" OR "specialist care" OR "care requirements." After review of over 500 studies, only 9 met inclusion criteria, 3 of which were past reviews. There were no relevant RCT's obtained. Standardised roles of global SIU units are needed to deliver equitable and high quality care as current evidence demonstrates variable standards of care and service (mean LOS range: 16-174 days). There is low quality evidence supporting earlier admission into SIU units being associated with improved neurological outcome, complication rates and reduced LOS, despite variations in the definition of "early admission" across studies. Our review demonstrates a lack of standardisation within SIU on a global scale, with significantly different outcomes reported across published studies. New and higher quality evidence directly comparing SIU to non-SIU based care is required. Earlier transfer (injury and stabilisation is advised.

  19. Incremental change in acute esophageal necrosis: report of two cases.

    Science.gov (United States)

    Wu, Ming-Ho; Wu, Han-Yun

    2014-02-01

    Acute esophageal necrosis, also called "black esophagus" because of its characteristic appearance on endoscopy, is a life-threatening disease; however, its temporal evolution on endoscopy is not well understood. We describe the serial changes in acute esophageal necrosis in two patients, who underwent four upper endoscopic examinations each. Serial endoscopy demonstrated progressive necrosis extending from the lower esophagus proximally to involve the middle or upper thoracic esophagus in both patients. The first patient was treated with transhiatal esophagectomy, followed by esophageal reconstruction, and medical control of repeated duodenal ulcer bleeding. The second patient died of esophageal perforation, as a complication of Sengstaken-Blakemore tube stent placement to control esophageal bleeding. We report these cases to demonstrate the importance of early detection and prompt surgical treatment of acute esophageal necrosis.

  20. Methyl Iodide Exposure Presenting as Severe Chemical Burn Injury with Neurological Complications and Prolonged Respiratory Insufficiency.

    Science.gov (United States)

    Held, Manuel; Medved, Fabian; Rothenberger, Jens; Rahmanian-Schwarz, Afshin; Schaller, Hans-Eberhard

    Methyl iodide (iodomethane) is a monohalomethane that is mainly used as an intermediate in the manufacturing of different pharmaceuticals and pesticides. Until now, only 13 cases of methyl iodide poisoning have been described in the literature. The authors present the first case of severe chemical burn injury due to methyl iodide exposure in a 36-year-old Caucasian man who suffered superficial to partial-thickness burn injuries over 75% of his BSA and developed neurological malfunctions and prolonged respiratory insufficiency. Human poisoning with methyl iodide is very rare. In addition to the already described neurological symptoms and respiratory insufficiency, severe chemical burn injury can cause a life-threatening medical emergency.

  1. Tightrope fixation of ankle syndesmosis injuries: clinical outcome, complications and technique modification.

    LENUS (Irish Health Repository)

    Naqvi, Gohar A

    2012-06-01

    Ankle syndesmotic injuries are complex and require anatomic reduction and fixation. Tightrope fixation is a relatively new technique and we present the largest series of syndesmosis fixation using Arthrex Tightrope™ (Naples, FL, USA).

  2. Aortic intimal separation resulting from manual cardiopulmonary resuscitation-completing the spectrum of blunt thoracic aortic injury complicating CPR.

    Science.gov (United States)

    Williams, Andrew S; Castonguay, Mathieu; Murray, Shawn K

    2016-11-01

    Blunt thoracic aortic injury (BTAI) resulting from cardiopulmonary resuscitation (CPR) is rarely reported and most reports are of aortic rupture. Clinical reports have also documented aortic dissection and intramural hematomas with sequential imaging showing the development of these aortic injuries after the administration of CPR, suggesting that non-transmural aortic injury may also result from CPR. We report partial separation of an aortic intimal atheromatous plaque as a component injury in a case with multiple complications of manual CPR. A 74-year-old male presented to the emergency room (ER) with a 2-day history of chest pain. While in the ER, he suffered witnessed cardiac arrest and resuscitative attempts were pursued for 60 min prior to declaring death. At autopsy, there were numerous injuries attributable to CPR, including bilateral rib fractures, sternal fracture, retrosternal and mediastinal hemorrhage, epicardial ecchymoses, and ruptured pericardium. There was a perforated inferior wall myocardial infarct with a large left hemothorax. There was partial separation/laceration of an intimal atheromatous plaque on the anterior wall of the ascending aorta proximal to the origin of the brachiocephalic artery, forming a triangular flap, without associated intramedial dissection or hematoma. There was no thrombus formation, effectively excluding existence of the laceration prior to circulatory arrest. This aortic injury provides pathologic confirmation of non-transmural BTAI definitively sustained during manual CPR. Pathologists and clinicians alike should be cognizant of the possibility of BTAI resulting from CPR, which may manifest the full range of severity from intimal tear through aortic rupture.

  3. Femoral Nerve Injury as a Complication of Percutaneous Simple Renal Cyst Sclerotherapy with Ethanol: A Case Report

    Directory of Open Access Journals (Sweden)

    Alireza Ashraf

    2012-01-01

    Full Text Available Simple renal cysts are benign, common, and often asymptomatic disease in old age, sometimes treated with ethanol sclerotherapy. We report a case of iatrogenic femoral nerve injury following percutaneous injection of ethanol into a renal cyst under sedation. The percutaneous injection was guided by sonography. At the end of the procedure, the cyst ruptured so the patient progressed to loss of consciousness due to alcohol intoxication. Ethanol was damaged to the femoral nerve, so patient was developed with limping, numbness, and weakness in anteromedial aspect of the right thigh. To the best of our knowledge, this is the first report of femoral nerve injury caused by percutaneous simple renal cyst sclerotherapy with ethanol. This rare event has not been previously described, Physicians should be aware of the possibility of this complication.

  4. Clinical factors associated with intracranial complications after pediatric traumatic head injury: an observational study of children submitted to a neurosurgical referral unit

    DEFF Research Database (Denmark)

    Åstrand, Ramona Alice; Undén, Johan; Hesselgard, Karin

    2010-01-01

    Clinically validated guidelines for the management of head injury in children do not exist, and the treatment is often based upon adult management routines. In order to examine the safety of this procedure, an analysis of clinical factors associated with complications after pediatric head injury...

  5. Intracranial complications of preinjury anticoagulation in trauma patients with head injury.

    Science.gov (United States)

    Mina, Alfred A; Knipfer, John F; Park, David Y; Bair, Holly A; Howells, Greg A; Bendick, Phillip J

    2002-10-01

    We have evaluated our recent experience as a Level I trauma center to test the hypothesis that preinjury anticoagulation adversely affects the morbidity and mortality of trauma patients with an intracranial injury. Records of 380 patients admitted to the trauma service from January 1997 to December 1998 who at the time of admission were taking warfarin, low-molecular-weight heparin, aspirin, nonsteroidal anti-inflammatory drugs, clopidogrel, dipyridamole, pentoxifylline, or naproxen were reviewed. Thirty-seven patients with intracranial injuries were identified and compared with a matched (age, gender, mechanism, and severity of injury) control group of 37 patients with similar head injury but not taking any anticoagulant randomly selected from the trauma registry for that same time period. The control and anticoagulated groups were comparable in terms of age, 75 +/- 8 versus 74 +/- 11 years (p = 0.655); gender, 22 men/15 women versus 21 men/16 women; mechanism of injury, 30 falls/7 motor vehicle crashes versus 30 falls/7 motor vehicle crashes; and length of hospital stay, 11 +/- 14 versus 10 +/- 11 days (p = 0.853). In the anticoagulated group, the mean Injury Severity Score was 17.0 +/- 7.8 and the mean Glasgow Coma Scale score was 11.8 +/- 4.0; these were not significantly different from the control group, which had a mean Injury Severity Score of 19.8 +/- 8.1 (p = 0.143) and a Glasgow Coma Scale score of 12.5 +/- 2.6 (p = 0.378). There were 14 deaths (38%) in the anticoagulation group, versus 3 deaths in the control group (8%) (p = 0.006). In the anticoagulation group, 4 of 12 patients (33%) taking warfarin died, whereas 9 of 19 patients (47%) taking aspirin died (p = 0.285). All deaths were secondary to head injuries; all deaths in the control group and all but one in the anticoagulated group were the result of a fall; 6 of 10 anticoagulated patients who fell on stairs died, and 5 of these were taking aspirin only. These data indicate that the trauma patient

  6. Brain contusion as the main risk factor of memory or emotional complaints in chronic complicated mild traumatic brain injury.

    Science.gov (United States)

    Su, Bei-Yi; Guo, Nai-Wen; Chen, Nan-Chun; Lin, Sheng-Sian; Chuang, Ming-Tsung; Liao, Yu-Chi; Kuo, Chia-Min; Lin, Cheng-Wei; Chou, Willy; Kuo, Jinn-Rung; Yen, Shih-Yin

    2017-01-01

    To investigate the risk factors for memory or emotional complaints in patients with complicated mild traumatic brain injury (mTBI). Retrospective analysis of medical records was conducted by physicians in a teaching hospital in Southern Taiwan, and complicated mTBI had been identified by means of computed tomography. Psychological complaints, including problems with memory and emotions, were collected by structured telephone interviews, 10-15 minutes long, and were held with subjects who agreed to participate in our study. Among 327 patients who were injured for more than two years, 190 agreed to join this study (mean age: 41.6 years; male: 60.5%; stably employed: 50.0%). We used demographic data and neurological factors to predict memory or emotional complaints without muscle power or response speed (MEMR) complaints. Only the presence or absence of cerebral contusions predicted memory or emotional complaints without MEMR complaints in different employed status, and the odds ratio was 4.82-13.50 times higher for those with cerebral contusions than for those without. Cerebral contusions were the primary risk factor for MEMR complaints in chronic complicated mTBI. Early preventive psychological intervention might be necessary for patients with complicated mTBI and cerebral contusions.

  7. Esophageal variceal ligation by reloading with inexpensive hemorrhoidal O-ring--is an overtube necessary?

    Science.gov (United States)

    Wong, S Y; Ng, F H; Kng, C

    1999-09-01

    The overtube is the major cause for severe complications during endoscopic variceal ligation with a single-shot ligator. This retrospective study was designed to examine the necessity of the placement of an overtube during elective endoscopic variceal ligation. Thirty-one sessions in 18 patients were analyzed. An overtube was inserted using an over-the-scope technique in 11 sessions (group 1) but was omitted in 20 sessions (group II). The complications, technical difficulties, and operating time were analyzed. Child's grading, the size of the esophageal varices, and the number of rubber bands deployed were comparable in both groups. There was a significantly longer operating time (p < 0.01) and more oropharyngeal injury (p = 0.03) in group I than in group II. Mid esophageal injury, which was associated with resistance in withdrawing the gastroscope from the overtube, occurred in 55% of sessions in group I but in 0% of session in group II. In conclusion, the use of an overtube is associated with more complications, and it can be omitted during elective endoscopic variceal ligation.

  8. THE PECULIARITIES OF TREATMENT OF UNCOMPLICATED AND COMPLICATED DENTAL INJURIES CAUSED BY TRAUMA.

    Science.gov (United States)

    Mamaladze, M; Nizharadze, N; Vadachkoria, O

    2017-01-01

    Trauma related injuries of permanent teeth occur frequently and are the most pressing issue the dentists are facing today. In different age groups the same type of trauma affects the teeth with different frequencies. For instance, accident related dental trauma in children and adults affected permanent teeth in 30% and deciduous teeth in 20%, respectively. It should also be noted that front teeth are more susceptible to traumatic injuries compared to the incisors. Upper front teeth were injured in 72% of cases, while lower central, upper lateral incisors, canines and premolars only in 6-8%. The severity of dental injury depends on the type and extent of the trauma. Dental injury can be result of either direct or indirect trauma. A strong, «fast as lightning» impact most often affects the dental crown. A weak and dull impact (thump) extends toward the root apical direction resulting in avulsion of the tooth and root fracture. Dental injury caused by trauma has been always considered as an emergency condition. It requires prompt complex treatment methods from maintaining pulp vitality to tooth extraction option. Treatment plan always depends on the type and severity of the injury and on current clinical condition of tooth. In all cases, the combined treatment includes: care of visible wound, fixation of teeth, performance of surgical manipulations, determining of the need of endodontic treatment, restorations and orthodontic consultation. The recorded clinical cases include descriptions of dental injuries of various types, as well as performed diagnostic and treatment procedures. In both cases root was fractured by impact. In Clinical Case 1 the tooth 2.1 vertical partial displacement of the tooth (extrusion) with root fracture in the apical third was observed; Clinical Case 2 - 1.1 dental root fracture in its middle third and vertical extrusion. Treatment strategy is dictated by pulp condition (Assessment of pulp vitality and status). In both cases, the

  9. [Esophageal atresia in the Goldenhar syndrome].

    Science.gov (United States)

    Ayuso Velasco, R; Torres Aguirre, A; Enríquez Zarabozo, E; Galán Gómez, E; Blesa Sánchez, E

    2010-01-01

    Among the multiple congenital defects associated to esophagueal atresia, the characteristic ones of the Goldenhar syndrome usually are not included. The high incidence has been reported, about 5% of esophagueal atresia in patients with Goldenhar syndrome. Our experience includes two patients with this association who presented anesthetic problems and surgical complications associated with gastroesophageal reflux and esophageal anastomosis.

  10. Gastrointestinal Complications of Obesity

    Science.gov (United States)

    Camilleri, Michael; Malhi, Harmeet; Acosta, Andres

    2017-01-01

    Obesity usually is associated with morbidity related to diabetes mellitus and cardiovascular diseases. However, there are many gastrointestinal and hepatic diseases for which obesity is the direct cause (eg, nonalcoholic fatty liver disease) or is a significant risk factor, such as reflux esophagitis and gallstones. When obesity is a risk factor, it may interact with other mechanisms and result in earlier presentation or complicated diseases. There are increased odds ratios or relative risks of several gastrointestinal complications of obesity: gastroesophageal reflux disease, erosive esophagitis, Barrett’s esophagus, esophageal adenocarcinoma, erosive gastritis, gastric cancer, diarrhea, colonic diverticular disease, polyps, cancer, liver disease including nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, gallstones, acute pancreatitis, and pancreatic cancer. Gastroenterologists are uniquely poised to participate in the multidisciplinary management of obesity as physicians caring for people with obesity-related diseases, in addition to their expertise in nutrition and endoscopic interventions. PMID:28192107

  11. Gastrointestinal Complications of Obesity.

    Science.gov (United States)

    Camilleri, Michael; Malhi, Harmeet; Acosta, Andres

    2017-05-01

    Obesity usually is associated with morbidity related to diabetes mellitus and cardiovascular diseases. However, there are many gastrointestinal and hepatic diseases for which obesity is the direct cause (eg, nonalcoholic fatty liver disease) or is a significant risk factor, such as reflux esophagitis and gallstones. When obesity is a risk factor, it may interact with other mechanisms and result in earlier presentation or complicated diseases. There are increased odds ratios or relative risks of several gastrointestinal complications of obesity: gastroesophageal reflux disease, erosive esophagitis, Barrett's esophagus, esophageal adenocarcinoma, erosive gastritis, gastric cancer, diarrhea, colonic diverticular disease, polyps, cancer, liver disease including nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, gallstones, acute pancreatitis, and pancreatic cancer. Gastroenterologists are uniquely poised to participate in the multidisciplinary management of obesity as physicians caring for people with obesity-related diseases, in addition to their expertise in nutrition and endoscopic interventions. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  12. Treatment Option Overview (Esophageal Cancer)

    Science.gov (United States)

    ... Cancer Prevention Esophageal Cancer Screening Research Esophageal Cancer Treatment (PDQ®)–Patient Version General Information About Esophageal Cancer ... Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment ...

  13. High-dose ambroxol reduces pulmonary complications in patients with acute cervical spinal cord injury after surgery.

    Science.gov (United States)

    Li, Qiang; Yao, Gaiqi; Zhu, Xi

    2012-04-01

    Ambroxol has a very high affinity for lung tissues; its concentration is approximately 20 times higher in the lung than in the serum. We aimed to evaluate the effectiveness of high-dose ambroxol (990 mg/day) in the improvement of oxygenation and prevention of postoperative respiratory complications in the patients with acute cervical spinal cord injury (CSCI). A total of 61 acute CSCI patients admitted to the Intensive Care Unit (ICU) of our hospital between January 2009 and June 2011 were included in the study. They were graded as ASIA A and ASIA B according to the classification of the American Spinal Injury Association (ASIA) and were randomly divided into two groups: one group received intravenous ambroxol at 990 mg/day for 5 consecutive days after operation; the other group treated without ambroxol served as control. The results of arterial blood gas analysis on postoperative day 3 and 5 and occurrence of pulmonary complications within 5 days after operation were evaluated. The group treated with high-dose ambroxol showed a lower rate of postoperative pneumonia and hypoxemia within 5 days after operation. On the 3rd and 5th days, the oxygenation index in the high-dose ambroxol group (291.02 ± 34.96 and 301.28 ± 37.69) was significantly higher than in the control group (230.08 ± 26.25 and 253.82 ± 26.26), with significant differences between the two groups (P = 0.045 and 0.041). Administration of high-dose ambroxol should be considered as an alternative and effective approach to reduce the postoperative respiratory complications and improve the oxygenation status in acute CSCI patients.

  14. Dysregulated Complement Activation as a Common Pathway of Injury in Preeclampsia and Other Pregnancy Complications

    OpenAIRE

    Lynch, Anne M.; Salmon, Jane E.

    2010-01-01

    The complement system protects the host against invading organisms, initiates inflammation and dispose of immune complexes and the products of inflammatory injury. The complement system provides an important link between the innate and adaptive immune systems. Experimental observations suggest that increased complement activation causes and/or perpetuates inflammation during pregnancy. Recent studies suggest a link between complement activation and preeclampsia. Excessive activation or insuff...

  15. Surgical treatment analysis of idiopathic esophageal achalasia.

    Science.gov (United States)

    Aquino, José Luis Braga de; Said, Marcelo Manzano; Pereira, Douglas Rizzanti; Amaral, Paula Casals do; Lima, Juliana Carolina Alves; Leandro-Merhi, Vânia Aparecida

    2015-01-01

    Idiopathic esophageal achalasia is an inflammatory disease of unknown origin, characterized by aperistalsis of the esophageal body and failure of the lower esophageal sphincter in response to swallowing, with consequent dysphagia. To demonstrate the results of surgical therapy in these patients, evaluating the occurred local and systemic complications. Were studied retrospectively 32 patients, 22 of whom presented non-advanced stage of the disease (Stage I/II) and 10 with advanced disease (Stage III/IV). All of them had the clinical conditions to be submitted to surgery. The diagnoses were done by clinical, endoscopic, cardiological, radiological and esophageal manometry analysis. Pre-surgical evaluation was done with a questionnaire based on the most predisposing factors in the development of the disease and the surgical indication was based on the stage of the disease. The patients with non-advanced stages were submitted to cardiomyotomy with fundoplication, wherein in the post-surgical early assessment, only one (4,4%) presented pulmonary infection, but had a good outcome. In patients with advanced disease, seven were submitted to esophageal mucosectomy preserving the muscular layer, wherein one patient (14,2%) presented dehiscence of gastric cervical esophagus anastomosis as well as pulmonary infection; all of these complications were resolved with proper specific treatment; the other three patients with advanced stage were submitted to transmediastinal esophagectomy; two of them presented hydropneumothorax with good evolution, and one of them also presented fistula of the cervical esophagogastric anastomosis, but with spontaneous healing after conservative treatment and nutritional support. The two patients with fistula of the cervical anastomosis progressed to stenosis, with good results after endoscopic dilations. In the medium and long term assessment done in 23 patients, all of them reported improvement in life quality, with return to swallowing. The

  16. Two-Stage Explantation of a Magnetic Lower Esophageal Sphincter Augmentation Device Due to Esophageal Erosion.

    Science.gov (United States)

    Parmar, Abhishek D; Tessler, Robert A; Chang, Howard Y; Svahn, Jonathan D

    2017-08-01

    Implanting a magnetic lower esophageal sphincter augmentation device (LINX, Torax Medical) has become an increasingly common option in the surgical management of gastroesophageal reflux disease. As the enthusiasm for placing this device increases, experience in the management of device-related complications-including erosion-is necessary. We report a staged approach to LINX removal in a 64-year-old female with symptoms of odynophagia secondary to partial erosion of a LINX device into the esophagus. The patient had a 12-bead LINX device placed in 2011 at an outside, international facility. In late 2013, she began experiencing symptoms of odynophagia. An esophagogastroduodenoscopy at our institution in October 2015 demonstrated two metallic beads eroding through the distal esophageal lumen. An elective endoscopic removal of the two visible beads was performed. A postoperative esophagram confirmed that there was no resulting esophageal perforation. The patient noted mild improvement in her symptoms. After a 12-week period to allow for complete healing, the remaining 10 beads of the LINX device were explanted laparoscopically without complication. No further procedures were undertaken. At 2 months' follow-up, the patient noted complete resolution of her symptoms. Transmural erosion of the LINX device into the esophageal lumen is a rare occurrence, with only five such complications reported in the published literature. We present the first account of LINX explantation for esophageal erosion in the United States. We demonstrated that a staged laparoendoscopic approach to LINX removal in these cases is feasible with minimal morbidity.

  17. Technological advances in radiotherapy for esophageal cancer

    Science.gov (United States)

    Vosmik, Milan; Petera, Jiri; Sirak, Igor; Hodek, Miroslav; Paluska, Petr; Dolezal, Jiri; Kopacova, Marcela

    2010-01-01

    Radiotherapy with concurrent chemotherapy and surgery represent the main treatment modalities in esophageal cancer. The goal of modern radiotherapy approaches, based on recent technological advances, is to minimize post-treatment complications by improving the gross tumor volume definition (positron emission tomography-based planning), reducing interfraction motion (image-guided radiotherapy) and intrafraction motion (respiratory-gated radiotherapy), and by better dose delivery to the precisely defined planning target volume (intensity-modulated radiotherapy and proton therapy). Reduction of radiotherapy-related toxicity is fundamental to the improvement of clinical results in esophageal cancer, although the dose escalation concept is controversial. PMID:21105188

  18. Esophageal lichen planus.

    Science.gov (United States)

    Oliveira, Janine Pichler de; Uribe, Natalia Caballero; Abulafia, Luna Azulay; Quintella, Leonardo Pereira

    2015-01-01

    Lichen planus is a chronic inflammatory disease that affects the skin, mucous membranes, nails and scalp. Esophageal lichen planus is a rarely reported manifestation of lichen planus, presenting itself commonly in middle-aged women, with symptoms such as dysphagia. We report a case of esophageal lichen planus in a 54-year-old woman associated with oral, cutaneous and ungual lichen planus. Although lichen planus is a disorder well known by dermatologists, reports of esophageal lichen planus are rare in dermatologic literature. The esophageal lichen planus is little known and underdiagnosed, with a significant delay between the onset of symptoms and diagnosis.

  19. Mediastinal abscess and esophageal stricture following voice prosthesis insertion.

    Science.gov (United States)

    Bozzo, Corrado; Meloni, Francesco; Trignano, Mario; Profili, Stefano

    2014-04-01

    The use of a tracheo-esophageal voice prosthesis is a well-established procedure to restore the voice in total laryngectomees. The insertion of the prosthesis is not a risk-free procedure, various complications having been reported especially in irradiated patients. Here described is a case of an esophageal rupture after secondary tracheo-esophageal puncture with mediastinal abscess in a patient previously treated with pharyngo-laryngectomy and subsequent radiotherapy for a left pyriform sinus carcinoma, which required immediate surgical drainage through a left cervical approach. Few weeks after surgical drainage an esophageal stricture at the site of the rupture developed, which was only temporarily resolved after the insertion of biodegradable esophageal stents, followed by re-stenosis once the reabsorption of the stent took place. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. Chemical Burn Injury in Kumasi: The Trend and Complications following and Their Management.

    Science.gov (United States)

    Agbenorku, Pius; Akpaloo, Joseph; Chirurgie, Facharzt; Aboah, Ken; Klutsey, Ellen; Hoyte-Williams, Paa Ekow; Farhat, Boutros; Turkson, Edmund; Yorke, Joseph; Chirurgie, Facharzt; Ametih, Richard; Hussey, Romeo

    2015-10-01

    A chemical burn refers to irritation and destruction of human tissue caused by exposure to a chemical, usually by direct contact with the chemical or its fumes. The study investigated the trend and complications following chemical burns and their management. The study involved a retrospective review of Burns Registry at the Burns Intensive Care Unit of the Komfo Anokye Teaching Hospital on patients who were admitted for burns from May 1, 2009 to April 30, 2013. Chemical burns admissions accounted for 3.5% (n = 17) out of the total 487 burns cases, consisting of 12 males (70.6%) and 5 females (29.4%). Mean total burns surface area was 21.9%; mean length of stay in Burns Intensive Care Unit was 9.5 days. The etiological agents for the chemical burns included the following: hot caustic soda 1 (5.9%); acid 9 (53.9%)-the most common; hot ethanol 3 (17.6%); and other chemicals such as other bases, oxidizers, solvents, etc. accounted for 4 (23.5%) etiological agents. Outcome included 11 discharges (64.7%), 6 transferred out to other wards (35.3%), and 0 deaths (0.0%). The complications included severe scar contractures in 5 patients (29.4%), loss of vision: partial/total = 2 (11.8%), gross keloidal/hypertrophic scars = 10 (58.8%). Chemical burns are severe and often cause severe debilitating sequelae including partial/total loss of vision. But the current study showed that only a small population (3.5%) were affected by chemical burns and no death was recorded; society has to be continually conscious of chemicals, especially caustic agents, and hence take the necessary precautions so as to prevent these avoidable complications.

  1. Chemical Burn Injury in Kumasi: The Trend and Complications following and Their Management

    Science.gov (United States)

    Akpaloo, Joseph; Chirurgie, Facharzt; Aboah, Ken; Klutsey, Ellen; Hoyte-Williams, Paa Ekow; Farhat, Boutros; Turkson, Edmund; Yorke, Joseph; Chirurgie, Facharzt; Ametih, Richard; Hussey, Romeo

    2015-01-01

    Background: A chemical burn refers to irritation and destruction of human tissue caused by exposure to a chemical, usually by direct contact with the chemical or its fumes. The study investigated the trend and complications following chemical burns and their management. Methods: The study involved a retrospective review of Burns Registry at the Burns Intensive Care Unit of the Komfo Anokye Teaching Hospital on patients who were admitted for burns from May 1, 2009 to April 30, 2013. Results: Chemical burns admissions accounted for 3.5% (n = 17) out of the total 487 burns cases, consisting of 12 males (70.6%) and 5 females (29.4%). Mean total burns surface area was 21.9%; mean length of stay in Burns Intensive Care Unit was 9.5 days. The etiological agents for the chemical burns included the following: hot caustic soda 1 (5.9%); acid 9 (53.9%)—the most common; hot ethanol 3 (17.6%); and other chemicals such as other bases, oxidizers, solvents, etc. accounted for 4 (23.5%) etiological agents. Outcome included 11 discharges (64.7%), 6 transferred out to other wards (35.3%), and 0 deaths (0.0%). The complications included severe scar contractures in 5 patients (29.4%), loss of vision: partial/total = 2 (11.8%), gross keloidal/hypertrophic scars = 10 (58.8%). Conclusions: Chemical burns are severe and often cause severe debilitating sequelae including partial/total loss of vision. But the current study showed that only a small population (3.5%) were affected by chemical burns and no death was recorded; society has to be continually conscious of chemicals, especially caustic agents, and hence take the necessary precautions so as to prevent these avoidable complications. PMID:26579354

  2. Clinical and statistical analysis of traumatic injuries of the maxillofacial region and its complications on materials of the Department of Maxillofacial Surgery from 2008 till 2012

    Directory of Open Access Journals (Sweden)

    Lepilin A.V. Bakhteeva G.R.

    2013-09-01

    The ratio of male and female patients during the study period did not change (men 89%, women — 11 %. Single fractures that do not require surgical treatment were dominated. Operating activities during the study period of fracture increased. For 5 years, the number of complications of traumatic injuries remained the same. Conclusion. Statistical analysis of traumatic injuries of the maxillofacial region shows that the average age of the patients decreased by almost 5 years, reduced average hospital stay. Most of the patients were admitted to the profile department in the early period (up to 3 days after preparation, but 21.6% of the patients were received only with the development of complications. The article concludes that there is a need to find new methods of diagnosis, treatment and prevention of complications of traumatic injuries.

  3. [Complicated course of eosinophilic gastroenteritis: a case report and literature review].

    Science.gov (United States)

    Mais, L; Galoo, E; Nibaud, A; Barba, T; Pasquet, F; Pavic, M

    2014-10-01

    Eosinophilic gastroenteritis is an unusual disease characterized by an eosinophilic infiltration of the gastrointestinal tract. The esophageal location of this disorder is uncommon and is usually revealed by dysphagia. Diagnosis is obtained by histology during endoscopy after exclusion of differential diagnosis. Treatment is based on systemic corticosteroids, which improve dramatically symptoms and endoscopic lesions. We report an 88-year-old man who presented eosinophilic gastroenteritis with esophageal injury complicated by gastrointestinal haemorrhage and fistule. Eosinophilic gastroenteritis may have a potentially unfavourable outcome. The treatment of complicated forms is not codified and often empirical. Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  4. Computed tomography and upper gastrointestinal series findings of esophageal bronchi in infants

    Energy Technology Data Exchange (ETDEWEB)

    Colleran, Gabrielle C. [Boston Children' s Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Our Lady' s Children' s Hospital Crumlin, Department of Radiology, Dublin (Ireland); Ryan, Ciara E. [Our Lady' s Children' s Hospital Crumlin, Department of Pathology, Dublin (Ireland); Lee, Edward Y. [Boston Children' s Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Sweeney, Brian [Our Lady' s Children' s Hospital Crumlin, Department of Surgery, Dublin (Ireland); Rea, David; Brenner, Clare [Our Lady' s Children' s Hospital Crumlin, Department of Radiology, Dublin (Ireland)

    2017-02-15

    Esophageal bronchus is a rare form of communicating bronchopulmonary foregut malformation and a rare but important cause of an opaque hemithorax on chest radiography. A higher incidence of esophageal bronchus is associated with esophageal atresia, tracheo-esophageal fistula (TEF) and VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) association. In the presence of these conditions, the pediatric radiologist may be the first to consider the diagnosis of esophageal bronchus or esophageal lung. To describe the imaging features in five children with esophageal bronchus. We reviewed hospital records and teaching files at two large pediatric tertiary referral centers over the 24-year period from January 1992 to January 2016. We reviewed all imaging studies and tabulated findings on radiography, fluoroscopic upper gastrointestinal (GI) series and CT. We then described the imaging features of esophageal bronchi with emphasis on CT and upper GI findings in four infants and one toddler. Three cases were identified from one institution (cases 2, 3, 4) and two from another (cases 1, 5). All five cases occurred in association with other midline malformations: four of the five had VACTERL association and three of the five had esophageal atresia and TEF. Lung opacification, ipsilateral mediastinal shift, and an abnormal carina and anomalous vascular anatomy suggest an esophageal bronchus or an esophageal lung on CT. While esophageal bronchus is a rare cause of an opaque hemithorax, CT and upper GI imaging play key roles in its diagnosis. Associations with esophageal atresia with tracheo-esophageal fistula and VACTERL association are particularly pertinent. Early diagnosis of esophageal bronchus might prevent complications such as aspiration and infection, which can allow for parenchymal sparing surgery as opposed to pneumonectomy. (orig.)

  5. Pharmacological Management of Esophageal Food Bolus Impaction

    Directory of Open Access Journals (Sweden)

    Yasir Mohammed Khayyat

    2013-01-01

    Full Text Available Background. Soft esophageal bolus impaction is an emergency that requires skilled endoscopic removal if persistent obstructive symptoms do not resolve spontaneously after careful observation. Expedited care of these patients is crucial to avoid respiratory and mechanical complications. Other possible options for management include medical agents used to manage it prior to performing endoscopy if access to endoscopy was not available or declined by the patient. Aim. To review the available pharmacological and other nonmedicinal options and their mechanism of relief for soft esophageal impaction. Method. Pubmed, Medline and Ovid were used for search of MESH terms pertinent including “foreign body, esophageal, esophageal bolus and medical” for pharmacological and non medicinial agents used for management of esophageal soft bolus impaction as well as manual review of the cross-references. Results. Several agents were identified including Buscopan, Glucagon, nitrates, calcium channel blockers, and papaveretum. Non medicinal agents are water, effervescent agents, and papain. No evidence was found to suggest preference or effectiveness of use of a certain pharmacological agent compared to others. Buscopan, Glucagon, benzodiazepines, and nitrates were studied extensively and may be used in selected patients with caution. Use of papain is obsolete in management of soft bolus impaction.

  6. Preventable long-term complications of suprapubic cystostomy after spinal cord injury: Root cause analysis in a representative case report

    Directory of Open Access Journals (Sweden)

    Singh Gurpreet

    2011-10-01

    Full Text Available Abstract Background Although complications related to suprapubic cystostomies are well documented, there is scarcity of literature on safety issues involved in long-term care of suprapubic cystostomy in spinal cord injury patients. Case Presentation A 23-year-old female patient with tetraplegia underwent suprapubic cystostomy. During the next decade, this patient developed several catheter-related complications, as listed below: (1 Suprapubic catheter came out requiring reoperation. (2 The suprapubic catheter migrated to urethra through a patulous bladder neck, which led to leakage of urine per urethra. (3 Following change of catheter, the balloon of suprapubic catheter was found to be lying under the skin on two separate occasions. (4 Subsequently, this patient developed persistent, seropurulent discharge from suprapubic cystostomy site as well as from under-surface of pubis. (5 Repeated misplacement of catheter outside the bladder led to chronic leakage of urine along suprapubic tract, which in turn predisposed to inflammation and infection of suprapubic tract, abdominal wall fat, osteomyelitis of pubis, and abscess at the insertion of adductor longus muscle Conclusion Suprapubic catheter should be anchored securely to prevent migration of the tip of catheter into urethra and accidental dislodgment of catheter. While changing the suprapubic catheter, correct placement of Foley catheter inside the urinary bladder must be ensured. In case of difficulty, it is advisable to perform exchange of catheter over a guide wire. Ultrasound examination of urinary bladder is useful to check the position of the balloon of Foley catheter.

  7. Role of character strengths in outcome after mild complicated to severe traumatic brain injury: a positive psychology study.

    Science.gov (United States)

    Hanks, Robin A; Rapport, Lisa J; Waldron-Perrine, Brigid; Millis, Scott R

    2014-11-01

    To examine the effects of character strengths on psychosocial outcomes after mild complicated to severe traumatic brain injury (TBI). Prospective study with consecutive enrollment. A Midwestern rehabilitation hospital. Persons with mild complicated to severe TBI (N=65). Not applicable. Community Integration Measure, Disability Rating Scale, Modified Cumulative Illness Rating Scale, Positive and Negative Affect Schedule, Satisfaction with Life Scale, Values in Action Inventory of Strengths, and Wechsler Test of Adult Reading. Character virtues and strengths were moderately associated with subjective outcomes, such that there were fewer and less strong associations between character virtues/strengths and objective outcomes than subjective outcomes. Specifically, positive attributes were associated with greater life satisfaction and perceived community integration. Fewer and less strong associations were observed for objective well-being; however, character strengths and virtues showed unique value in predicting physical health and disability. Positive affectivity was not meaningfully related to objective outcomes, but it was significantly related to subjective outcomes. In contrast, negative affectivity was related to objective but not subjective outcomes. Given the strength of the associations between positive aspects of character or ways of perceiving the world and positive feelings about one's current life situation, treatments focused on facilitating these virtues and strengths in persons who have experienced TBI may result in better perceived outcomes and potentially subsequently lower comorbidities. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  8. Effectiveness of an Educational Intervention on Reducing Misconceptions Among Ethnic Minorities With Complicated Mild to Severe Traumatic Brain Injury.

    Science.gov (United States)

    Pappadis, Monique R; Sander, Angelle M; Łukaszewska, Beata; Struchen, Margaret A; Leung, Patrick; Smith, Dennis W

    2017-04-01

    To evaluate the effectiveness of an educational intervention designed to reduce traumatic brain injury (TBI)-related misconceptions among blacks and Latinos with complicated mild to severe TBI. Randomized controlled trial with masked 1-month follow-up. Community. Persons (N=52) with complicated mild to severe TBI (mean best day 1 Glasgow Coma Scale score, 11.27±3.89) were randomly recruited from 141 eligible participants (mean age, 37.71±13.88y; age range, 19-66y; mean months postinjury, 24.69±11.50); 25 participants (48.1%) of participants were black and 27 (51.9%) were Hispanic/Latino. Of the Hispanic/Latino participants, 18 (66.7%) were non-U.S. born and 12 (44.4%) spoke Spanish as their primary language. Twenty-seven individuals were randomized to the educational intervention group and 25 were randomized to the wait-list control group. Single-session educational intervention with written materials provided in English or Spanish. Forty-item Common Misconceptions about Traumatic Brain Injury Questionnaire administered at baseline and 1-month follow-up. After controlling for ethnic and language differences, a significant between-group main effect (P=.010) and a significant time-group interaction for the Common Misconceptions about Traumatic Brain Injury Questionnaire were noted (Wilks Λ=.89; F1,46=6.00; P=.02). The intervention group showed a decrease in TBI misconception percentages, whereas the wait-list control group maintained similar percentages. At 1-month follow-up, the wait-list control group reported more misconceptions than did the intervention group (P=.019). An educational intervention developed to address the recovery process, common symptoms, and ways to handle the symptoms provides promise as a tool to decrease TBI misconceptions among persons from ethnically and educationally diverse backgrounds. The effects of therapist characteristics and the client-therapist relation on outcomes should be further explored. Copyright © 2016 American Congress

  9. Esophageal infections: an update.

    Science.gov (United States)

    Patel, Niraj C; Caicedo, Ricardo A

    2015-10-01

    Infectious esophagitis generally occurs in patients with impaired immunity. Although methods to suppress the immune system evolve, the potential infectious consequences are poorly understood. The purpose of this article is to review the risk factors, diagnosis, and treatment of infectious esophagitis. Minimal pediatric data, including a few case reports and series, involve infectious esophagitis. Esophageal infections are usually caused by the following microbes, in order starting with the most common: Candida albicans, herpes simplex virus, and cytomegalovirus. Uncommon risk factors in these and other reports include epidural triamcinolone and oral budesonide in addition to more common risk factors such as HIV infection, chemotherapeutic agents, and transplant immunosuppressive medications. Rare reports involve immunocompetent patients and treatment of these patients is controversial. Understanding of infectious esophagitis is growing, and risk factors, diagnosis, and treatments are evolving.

  10. Complication following primary repair of a penetrating bull horn injury to the trachea

    Directory of Open Access Journals (Sweden)

    Khan Mozaffar

    2008-01-01

    Full Text Available A 22-year-old male patient was admitted to the casualty with a bull horn injury in the lower zone of the neck in the midline. The patient was conscious and distressed but hemodynamically stable. Local examination revealed a lacerated wound. He underwent emergency primary repair of the wound under halothane anesthesia; intubation was done keeping in readiness all preparations for difficult airway management. Postoperatively, elective controlled ventilation was performed with continuous infusion of muscle relaxant. After approximately 8 hours of controlled ventilation, the syringe pump failed; this initially went unnoticed and made the patient cough and buck on the tube. Infusion was restarted after a bolus dose of vecuronium bromide intravenously but, meanwhile, the patient developed subcutaneous emphysema in the neck. He was immediately transferred to the operating room, where exploration of the surgical site revealed dehiscence of the tracheal wound; this had led to the subcutaneous emphysema. Repair of the tracheal wound dehiscence was not possible due to both lack of space and lack of tissue for apposition. Hence, a tracheostomy tube was inserted through the tracheal wound and the patient was transferred to the intensive care unit for elective controlled ventilation. The patient was weaned off the ventilator within 24 h and transferred to the surgical ward on spontaneous ventilation with the tracheostomy tube in situ. The size of the patient′s tracheostomy tube was reduced gradually by the serial exchange method. The wound ultimately healed with minimal scarring.

  11. Executive functioning of complicated-mild to moderate traumatic brain injury patients with frontal contusions.

    Science.gov (United States)

    Ghawami, Heshmatollah; Sadeghi, Sadegh; Raghibi, Mahvash; Rahimi-Movaghar, Vafa

    2017-01-01

    Executive dysfunctions are among the most prevalent neurobehavioral sequelae of traumatic brain injuries (TBIs). Using culturally validated tests from the Delis-Kaplan Executive Function System (D-KEFS: Trail Making, Verbal Fluency, Design Fluency, Sorting, Twenty Questions, and Tower) and the Behavioural Assessment of the Dysexecutive Syndrome (BADS: Rule Shift Cards, Key Search, and Modified Six Elements), the current study was the first to examine executive functioning in a group of Iranian TBI patients with focal frontal contusions. Compared with a demographically matched normative sample, the frontal contusion patients showed substantial impairments, with very large effect sizes (p ≤ .003, 1.56 executive measures. Controlling for respective lower-level/fundamental conditions, the differences on the highest-level executive (cognitive switching) conditions were still significant. The frontal patients also committed more errors. Patients with lateral prefrontal (LPFC) contusions were qualitatively worst. For example, only the LPFC patients committed perseverative repetition errors. Altogether, our results support the notion that the frontal lobes, specifically the lateral prefrontal regions, play a critical role in cognitive executive functioning, over and above the contributions of respective lower-level cognitive abilities. The results provide clinical evidence for validity of the cross-culturally adapted versions of the tests.

  12. [Endoscopic implantation of endoprostheses in incurable esophageal and cardia cancer].

    Science.gov (United States)

    Wiesenhaken, U; Rogos, R

    1990-03-01

    The palliative treatment of tumorous stenosis of the esophagus and cardio-esophageal region by intubation with an endoprosthesis leads to an improved quality of life. The used endoscopic positioning provides better results than the surgical procedure. This method is easy in handling and has only few complications. The endoscopic positioning of endoprosthesis is also a really alternative of alimentary fistula. The positioning of plastic prosthesis under endoscopic control should be given preference in the palliative treatment of obstructing cardio-esophageal malignancy.

  13. Retropharyngeal abscess with secondary osteomyelitis and epidural abscess: proposed pathophysiological mechanism of an underrecognized complication of unstable craniocervical injuries: case report.

    Science.gov (United States)

    Goulart, Carlos R; Mattei, Tobias A; Fiore, Mariano E; Thoman, William J; Mendel, Ehud

    2016-01-01

    Because of the proximity of the oropharynx (a naturally contaminated region) to the spinal structures of the craniocervical junction, it is possible that small mucosal lacerations in the oropharynx caused by unstable traumatic craniocervical injuries may become contaminated and lead to secondary infection and osteomyelitis. In this report, the authors describe the case of a previously healthy and immunocompetent patient who developed a large retropharyngeal abscess with spinal osteomyelitis after a high-energy craniocervical injury. This unusual report of osteomyelitis with a delayed presentation after a high-energy traumatic injury of the craniocervical junction highlights the possibility of direct injury to a specific area in the oropharyngeal mucosa adjacent to the osteoligamentous structures of the craniocervical junction, an overall underrecognized complication of unstable craniocervical injuries.

  14. Mediastinitis and pneumomediastinum in a preterm infant with iatrogenic esophageal perforation: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Ji; Kim, Ok Hwa [College of Medicine, Ajou University, Suwon (Korea, Republic of)

    2006-06-15

    Introgenic esophageal perforation is very rare in pediatric patients. Preterm infants or low birth weight babies are more susceptible to esophageal perforation due to performing frequent tracheal intubation and/or gastric tube installation. When perforation occurs, it may present as pneumothorax and pulmonary interstitial emphysema. However, isolated pneumomediastinum without pneumothorax is a rare finding. Furthermore, the mediastinitis after esophageal perforation is rare complication, but it can be a critical complication. Therefore, making an immediate and precise diagnosis as well as instituting proper treatment of esophageal perforation and mediastinitis are important. To the best of our kowledge, few reports have described mediastinitis after pneumomediastinum that was secondary to esophageal perforation. We describe here the radiologic findings of a rare case of mediastinitis after pneumomediastinum is a preterm infant with esophageal perforation.

  15. Common bile duct injury by fibrin glue: report of a rare complication.

    Science.gov (United States)

    Yang, Yu-Long; Zhang, Cheng; Zhang, Hong-Wei; Wu, Ping; Ma, Yue-Feng; Lin, Mei-Ju; Shi, Li-Jun; Li, Jing-Yi; Zhao, Mu

    2015-03-07

    Fibrin glue is widely used in clinical practice and plays an important role in reducing postoperative complications. We report a case of a 65-year-old man, whose common bile duct was injured by fibrin glue, with a history of failed laparoscopic cholecystectomy and open operation for uncontrolled laparoscopic bleeding. In view of the persistent liver dysfunction, xanthochromia and skin itching, the patient was admitted to us for further management. Ultrasound, computed tomography, and magnetic resonance cholangiopancreatography (MRCP) revealed multiple stones in the common bile duct, and liver function tests confirmed the presence of obstructive jaundice and liver damage. Endoscopic retrograde cholangiopancreatography was unsuccessfully performed to remove choledocholithiasis, but a small amount of tissue was removed and pathologically confirmed as calcified biliary mucosa. This was followed by open surgery for suspicious cholangiocarcinoma. There was no evidence of cholangiocarcinoma, but the common bile duct wall had a defect of 8 mm × 10 mm at Calot's triangle. A hard, grid-like foreign body was removed, which proved to be solid fibrin glue. Subsequently, the residual choledocholithiasis was removed by a choledochoscopic procedure, and the common bile duct deletion was repaired by liver round ligament with T-tube drainage. Six months later, endoscopy was performed through the T-tube fistula and showed a well-repaired bile duct wall. Eight months later, MRCP confirmed no bile duct stenosis. A review of reported cases showed that fibrin glue is widely used in surgery, but it can also cause organ damage. Its mechanism may be related to discharge reactions.

  16. Hiatal Hernia as a Total Gastrectomy Complication

    National Research Council Canada - National Science Library

    Santos, Bruna do Nascimento; de Oliveira, Marcos Belotto; Peixoto, Renata D'Alpino

    2016-01-01

    .... Hiatal hernia refers to herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm, though this occurrence is rarely reported as a complication in gastrectomy...

  17. The effect of pre-injury anti-platelet therapy on the development of complications in isolated blunt chest wall trauma: a retrospective study.

    Directory of Open Access Journals (Sweden)

    Ceri Battle

    Full Text Available INTRODUCTION: The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature. Pre-injury anti-platelet therapy has been previously investigated as a risk factor for poor outcomes following traumatic head injury, but not in the blunt chest wall trauma patient cohort. The aim of this study was to investigate pre-injury anti-platelet therapy as a risk factor for the development of complications in the recovery phase following blunt chest wall trauma. METHODS: A retrospective study was completed in which the medical notes were analysed of all blunt chest wall trauma patients presenting to a large trauma centre in Wales in 2012 and 2013. Using univariate and multivariable logistic regression analysis, pre-injury platelet therapy was investigated as a risk factor for the development of complications following blunt chest wall trauma. Previously identified risk factors were included in the analysis to address the influence of confounding. RESULTS: A total of 1303 isolated blunt chest wall trauma patients presented to the ED in Morriston Hospital in 2012 and 2013 with complications recorded in 144 patients (11%. On multi-variable analysis, pre-injury anti-platelet therapy was found to be a significant risk factor for the development of complications following isolated blunt chest wall trauma (odds ratio: 16.9; 95% confidence intervals: 8.2-35.2. As in previous studies patient age, number of rib fractures, chronic lung disease and pre-injury anti-coagulant use were also found to be significant risk factors. CONCLUSIONS: Pre-injury anti-platelet therapy is being increasingly used as a first line treatment for a number of conditions and there is a concurrent increase in trauma in the elderly population. Pre-injury anti-platelet therapy should be considered as a risk factor for the development of complications by clinicians managing

  18. Frequency and impact of intensive care unit complications on moderate-severe traumatic brain injury: early results of the Outcome Prognostication in Traumatic Brain Injury (OPTIMISM) Study.

    Science.gov (United States)

    Muehlschlegel, Susanne; Carandang, Raphael; Ouillette, Cynthia; Hall, Wiley; Anderson, Fred; Goldberg, Robert

    2013-06-01

    Known predictors of adverse outcomes in patients with moderate-severe TBI (msTBI) explain only a relatively small proportion of patient-related outcomes. The frequency and impact of intensive care unit complications (ICU-COMPL) on msTBI-associated outcomes are poorly understood. In 213 consecutive msTBI patients admitted to a Level I Trauma Center neuro trauma ICU, twenty-eight ICU-COMPL (21 medical and 7 neurological) were prospectively collected and adjudicated by group consensus, using pre-defined criteria. We determined frequencies, and explored associations of ICU-COMPL and hospital discharge outcomes using multivariable logistic regression. The average age of the study sample was 53 years, and the median presenting Glasgow Coma Scale and Injury Severity Scores were 5 and 27, respectively. Hyperglycemia (79%), fever (62%), systemic inflammatory response syndrome (60%), and hypotension requiring vasopressors (42%) were the four most common medical ICU-COMPL. Herniation (39%), intracranial rebleed (39%), and brain edema requiring osmotherapy (37%) were the three most common neurological ICU-COMPL. After adjusting for admission variables, duration of ventilation, and ICU length-of-stay, patients with brain edema (OR 5.8; 95% CI 2, 16.7) had a significantly increased odds for dying during hospitalization whereas patients with hospital-acquired urinary tract infection (UTI) had a decreased odds (OR 0.05; 95% CI 0.005, 0.6). Sensitivity analysis revealed that UTI occurred later, suggesting a non-causal association with survival. Brain herniation (OR 15.7; 95% CI 2.6, 95.4) was associated with an unfavorable functional status (GOS 1-3). ICU-COMPL are very common after msTBI, have a considerable impact on short-term outcomes, and should be considered in the prognostication of these high risk patients. Survival associations of time-dependent complications warrant cautious interpretation.

  19. Comparative study of esophageal stent and feeding gastrostomy/jejunostomy for tracheoesophageal fistula caused by esophageal squamous cell carcinoma.

    Science.gov (United States)

    Chen, Yen-Hao; Li, Shau-Hsuan; Chiu, Yi-Chun; Lu, Hung-I; Huang, Cheng-Hua; Rau, Kun-Ming; Liu, Chien-Ting

    2012-01-01

    A malignant tracheoesophageal/bronchoesophageal fistula (TEF) is a life-threatening complication of esophageal squamous cell carcinoma. A feeding gastrostomy/jejunostomy had been the most common treatment method for patients with TEF before the era of stenting. The aim of this retrospective study is to compare the prognosis of esophageal squamous cell carcinoma patients with TEF treated with an esophageal metallic stent to those treated with a feeding gastrostomy/jejunostomy. We retrospectively reviewed a total of 1011 patients with esophageal squamous cell carcinoma between 1996 and 2011 at Kaohsiung Chang Gung Memorial Hospital, and 86 patients with TEF (8.5%) were identified. The overall survival and other clinical data were compared between 30 patients treated with an esophageal metallic stent and 35 patients treated with a feeding gastrostomy/jejunostomy. Among the 65 patients receiving either an esophageal metallic stent or a feeding gastrostomy/jejunostomy, univariate analysis showed that treatment modality with an esophageal metallic stent (P = 0.007) and radiotherapy treatment after fistula diagnosis (P = 0.04) were predictive of superior overall survival. In the multivariate comparison, treatment modality with an esophageal metallic stent (P = 0.026, odds ratio: 1.859) represented the independent predictive factor of superior overall survival. There were no significant differences between groups in mean decrease in serum albumin or mean body weight loss. Compared to the feeding gastrostomy/jejunostomy group, a significantly higher proportion of patients in the stenting group (53% versus 14%, P = 0.001) were able to receive chemotherapy within 30 days after fistula diagnosis, indicating better infection control in the stenting group. Compared with a feeding gastrostomy/jejunostomy, an esophageal metallic stent significantly improves overall survival in patients with malignant TEF in our retrospective analysis. Esophageal metallic stent placement may be

  20. Comparative study of esophageal stent and feeding gastrostomy/jejunostomy for tracheoesophageal fistula caused by esophageal squamous cell carcinoma.

    Directory of Open Access Journals (Sweden)

    Yen-Hao Chen

    Full Text Available BACKGROUND: A malignant tracheoesophageal/bronchoesophageal fistula (TEF is a life-threatening complication of esophageal squamous cell carcinoma. A feeding gastrostomy/jejunostomy had been the most common treatment method for patients with TEF before the era of stenting. The aim of this retrospective study is to compare the prognosis of esophageal squamous cell carcinoma patients with TEF treated with an esophageal metallic stent to those treated with a feeding gastrostomy/jejunostomy. METHODS: We retrospectively reviewed a total of 1011 patients with esophageal squamous cell carcinoma between 1996 and 2011 at Kaohsiung Chang Gung Memorial Hospital, and 86 patients with TEF (8.5% were identified. The overall survival and other clinical data were compared between 30 patients treated with an esophageal metallic stent and 35 patients treated with a feeding gastrostomy/jejunostomy. RESULTS: Among the 65 patients receiving either an esophageal metallic stent or a feeding gastrostomy/jejunostomy, univariate analysis showed that treatment modality with an esophageal metallic stent (P = 0.007 and radiotherapy treatment after fistula diagnosis (P = 0.04 were predictive of superior overall survival. In the multivariate comparison, treatment modality with an esophageal metallic stent (P = 0.026, odds ratio: 1.859 represented the independent predictive factor of superior overall survival. There were no significant differences between groups in mean decrease in serum albumin or mean body weight loss. Compared to the feeding gastrostomy/jejunostomy group, a significantly higher proportion of patients in the stenting group (53% versus 14%, P = 0.001 were able to receive chemotherapy within 30 days after fistula diagnosis, indicating better infection control in the stenting group. CONCLUSIONS: Compared with a feeding gastrostomy/jejunostomy, an esophageal metallic stent significantly improves overall survival in patients with malignant TEF in our retrospective

  1. Esophageal foreign bodies in dogs: 34 cases (2004-2009).

    Science.gov (United States)

    Thompson, Holly C; Cortes, Yonaira; Gannon, Kristi; Bailey, Dennis; Freer, Sean

    2012-04-01

    To characterize the clinical and radiographic signs, endoscopic findings, treatment, and outcome for dogs that present with esophageal foreign bodies (EFBs), and to identify factors associated with the severity of secondary esophagitis and length of hospitalization (LOH). Retrospective case series. Private referral veterinary center. Client-owned dogs. None. Medical records for 34 client-owned dogs with EFBs that had esophageal radiographs and that had undergone esophagoscopy were evaluated retrospectively. Information regarding clinical history, radiographic signs, findings at esophagoscopy, and outcome were recorded. The most common EFBs were bone (29.7%) and rawhides (29.7%). The median duration of clinical signs prior to initial presentation was 2.75 hours. Radiographically, EFBs were identified definitively in 30 dogs and questionably in 1. The most common location was in the caudal esophagus (59.3%). Esophagitis was not identified in 6 dogs; and was assessed as mild in 14, moderate in 9, and severe in 4. In 1 dog the degree of esophagitis could not be determined due to the presence of contrast agent. Dogs with longer duration of clinical signs and longer anesthesia times were more likely to have moderate or severe esophagitis. Median LOH was 19 hours. Dogs with longer duration of clinical signs, EFBs located in the caudal esophagus, and moderate or severe esophagitis had longer hospital stays. No dogs experienced long-term complications. Complication rate was 82.5% with 8 patients having more than 1 complication. While long-term prognosis is excellent, early intervention helps reduce short-term esophagitis and LOH. © Veterinary Emergency and Critical Care Society 2012.

  2. High-Resolution Infrared Thermography of Esophageal Temperature During Radiofrequency Ablation of Atrial Fibrillation.

    Science.gov (United States)

    Daly, Matthew G; Melton, Iain; Roper, Graham; Lim, Gary; Crozier, Ian G

    2018-02-01

    Catheter ablation for atrial fibrillation has potential to cause esophageal thermal injury. Esophageal temperature monitoring during ablation is commonly used; however, it has not eliminated thermal injuries, possibly because conventional sensors have poor spatial sampling and response characteristics. To enhance understanding of temperature dynamics that may underlie esophageal injury, we tested a high-resolution, intrabody, infrared thermography catheter to continuously image esophageal temperatures during ablation. Atrial fibrillation ablation patients were instrumented with a flexible, 9F infrared temperature catheter inserted nasally (n=8) or orally (n=8) into the esophagus adjacent to the left atrium. Ablation was performed while the infrared catheter continuously recorded surface temperatures from 7680 points per second circumferentially over a 6-cm length of esophagus. Physicians were blinded to temperature data. Endoscopy was performed within 24 hours to document esophageal injury. Thermal imaging showed that most patients (10/16) experienced ≥1 events where peak esophageal temperature was >40°C. Three patients experienced temperatures >50°C; and 1 experienced >60°C. Analysis of temperature data for each subject's maximum thermal event revealed high gradients (2.3±1.4°C/mm) and rates of change (1.5±1.3°C/s) with an average length of esophageal involvement of 11.0±5.4 mm. Endoscopy identified 3 distinct thermal lesions, all in patients with temperatures >50°C; all resolved within 2 weeks. Infrared thermography provided dynamic, high-resolution mapping of esophageal temperatures during cardiac ablation. Esophageal thermal injury occurred with temperatures >50°C and was associated with large spatiotemporal gradients. Additional studies are warranted to determine the relationships between thermal parameters and esophageal injury. © 2018 American Heart Association, Inc.

  3. Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting

    Directory of Open Access Journals (Sweden)

    Ana Grilo

    2012-09-01

    Full Text Available CONTEXT: Esophageal cancer is often diagnosed at an advanced stage and has a poor prognosis. Most patients with advanced esophageal cancer have significant dysphagia that contributes to weight loss and malnutrition. Esophageal stenting is a widespread palliation approach, but unsuitable for cancers near the upper esophageal sphincter, were stents are poorly tolerated. Generally, guidelines do not support endoscopic gastrostomy in this clinical setting, but it may be the best option for nutritional support. OBJECTIVE: Retrospective evaluation of patients with dysphagia caused advanced esophageal cancer, no expectation of resuming oral intake and with percutaneous endoscopic gastrostomy for comfort palliative nutrition. METHOD: We selected adult patients with unresecable esophageal cancer histological confirmed, in whom stenting was impossible due to proximal location, and chemotherapy or radiotherapy were palliative, using gastrostomy for enteral nutrition. Clinical and nutritional data were evaluated, including success of gastrostomy, procedure complications and survival after percutaneous endoscopic gastrostomy, and evolution of body mass index, albumin, transferrin and cholesterol. RESULTS: Seventeen males with stage III or IV squamous cell carcinoma fulfilled the inclusion criteria. Mean age was 60.9 years. Most of the patients had toxic habits. All underwent palliative chemotherapy or radiotherapy. Gastrostomy was successfully performed in all, but nine required prior dilatation. Most had the gastrostomy within 2 months after diagnosis. There was a buried bumper syndrome treated with tube replacement and four minor complications. There were no cases of implantation metastases or procedure related mortality. Two patients were lost and 12 died. Mean survival of deceased patients was 5.9 months. Three patients are alive 6, 14 and 17 months after the gastrostomy procedure, still increasing the mean survival. Mean body mass index and laboratory

  4. Esophageal ulcer and alendronate

    Directory of Open Access Journals (Sweden)

    Angelo Paulo Ferrari Junior

    Full Text Available OBJECTIVE: To describe a case of esophageal ulcer associated with the use of alendronate. CASE REPORT: This is the fifth case ever described in the literature according to our bibliographic review. In our patient, the association between the drug and the esophageal lesions was masked by the presence of a hiatal hernia, potentially a cause of the esophageal lesion. The persistence of the lesions despite high doses of anti-reflux therapy called attention to the possibility of the relationship. The esophageal lesion healed soon after suspension of alendronate. DISCUSSION: The authors present a review of the literature and point to the need for diagnostic investigation, to suspend such a drug from patients who experience dyspeptic symptoms while using it.

  5. Lower esophageal ring (Schatzki)

    Science.gov (United States)

    ... Upper gastrointestinal system References Devault KR. Symptoms of esophageal disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease . 10th ed. ... anomalies of the esophagus. In: Feldman M, Friedman LS, Brandt LJ, eds. ...

  6. Pulmonary hypertension secondary to pulmonary veno-occlusive disease complicated by right heart failure, hypotension and acute kidney injury

    Directory of Open Access Journals (Sweden)

    Nima Golzy

    2017-01-01

    Full Text Available Pulmonary veno-occlusive disease (PVOD is rare condition which can lead to severe pulmonary hypertension, right ventricular dysfunction, and cardiopulmonary failure. The diagnosis of PVOD can be challenging due to its nonspecific symptoms and its similarity to idiopathic pulmonary arterial hypertension and interstitial lung disease in terms of diagnostic findings. This case describes a 57 year old female patient who presented with a 5-month history of progressive dyspnea on exertion and nonproductive cough. Workup at another hospital was nonspecific and the patient underwent surgical lung biopsy due to concern for interstitial lung disease. She subsequently became hemodynamically unstable and was transferred to our hospital where she presented with severe hypoxemia, hypotension, and suprasystemic pulmonary artery pressures. Preliminary lung biopsy results suggested idiopathic pulmonary arterial hypertension and the patient was started on vasodilating agents, including continuous epoprostenol infusion. Pulmonary artery pressures decreased but remained suprasystemic and the patient did not improve. Final review of the biopsy by a specialized laboratory revealed a diagnosis of PVOD after which vasodilating therapy was immediately weaned off. Evaluation for dual heart-lung transplantation was begun. The patient's hospital course was complicated by hypotension requiring vasopressors, worsening right ventricular dysfunction, and acute kidney injury. During the transplantation evaluation, the patient decided that she did not want to undergo continued attempts at stabilization of her progressive multi-organ dysfunction and she was transitioned to comfort care. She expired hours after removing inotropic support.

  7. A bridging stent to surgery in patients with esophageal and gastroesophageal junction cancer has a dramatic negative impact on patient survival

    DEFF Research Database (Denmark)

    Nassar, M; Kjaer, D W; Jensen, Lone Susanne

    2017-01-01

    This study aimed to assess the impact of esophageal stenting on postoperative complications and survival in patients with obstructing esophageal and gastroesophageal junction (GEJ) cancer. All patients treated without neoadjuvant therapy that had an R0-resection performed for esophageal and GEJ c...

  8. [Esophageal motility disorders].

    Science.gov (United States)

    Hannig, C; Wuttge-Hannig, A; Rummeny, E

    2007-02-01

    For the better understanding of esophageal motility, the muscle texture and the distribution of skeletal and smooth muscle fibers in the esophagus are of crucial importance. Esophageal physiology will be shortly mentioned as far as necessary for a comprehensive understanding of peristaltic disturbances. Besides the pure depiction of morphologic criteria, a complete esophageal study has to include an analysis of the motility. New diagnostic tools with reduced radiation for dynamic imaging (digital fluoroscopy, videofluoroscopy) at 4-30 frames/s are available. Radiomanometry is a combination of a functional pressure measurement and a simultaneous dynamic morphologic analysis. Esophageal motility disorders are subdivided by radiologic and manometric criteria into primary, secondary, and nonclassifiable forms. Primary motility disorders of the esophagus are achalasia, diffuse esophageal spasm, nutcracker esophagus, and the hypertonic lower esophageal sphincter. The secondary motility disorders include pseudoachalasia, reflux-associated motility disorders, functionally caused impactions, Boerhaave's syndrome, Chagas'disease, scleroderma, and presbyesophagus. The nonclassificable motility disorders (NEMD) are a very heterogeneous collective.

  9. Drug-induced acute esophageal lesions and use of ciprofloxacin.

    Science.gov (United States)

    Santos, V M; Carneiro, M V; Cruz, L R; Paixao, G T G

    2012-01-01

    We report the case of a 95-year-old woman who had acute esophageal lesions while being treated with oral ciprofloxacin for an acute cystitis. On day 2 of treatment, she reported retroesternal pain with a globus sensation, and presented hematemesis and melena. There was no history of gastric or esophageal disturbances. An upper digestive endoscopy showed bleeding lesions on the middle third of the esophagus. Ciprofloxacin was discontinued and a proton pump inhibitor was administered. One week later, the endoscopic aspect of the esophagus was normal. Only two cases of ciprofloxacin-induced esophageal lesions have been reported previously. A short review of this kind of esophageal injuries is presented, focusing on the main risk factors and preventive measures.

  10. Lung Atelectasis Secondary to Massive Esophageal Dilation in a Patient With Scleroderma

    Directory of Open Access Journals (Sweden)

    Charles St-Arnaud

    2010-01-01

    Full Text Available Esophageal dilation is a rare complication of scleroderma and CREST syndrome. A case of atelectasis secondary to right inferior bronchus compression by a massively dilated esophagus is described. The authors are unaware of any previous cases of atelectasis secondary to esophageal dilation in scleroderma.

  11. Successful primary repair of late diagnosed spontaneous esophageal rupture: A case report

    Directory of Open Access Journals (Sweden)

    Diana Y. Kircheva

    2017-01-01

    Conclusion: Primary closure of late diagnosed spontaneous esophageal rupture can be successful, even when it is complicated by a prolonged delay in treatment and failed endoscopic procedures. We conclude that primary surgical repair should be attempted in patients with spontaneous esophageal rupture if tissues are viable.

  12. Esophageal adenocarcinoma five years after laparoscopic sleeve gastrectomy. A case report

    Directory of Open Access Journals (Sweden)

    Fernando Gabriel Wright

    2017-01-01

    Conclusion: We present a case of an esophageal adenocarcinoma five years after a laparoscopic sleeve gastrectomy for morbid obesity. There is need to better determine the relationship between sleeve gastrectomy and gastroesophageal reflux disease in order to prevent its related complications, such as esophageal adenocarcinoma.

  13. Esophageal lesions following button-battery ingestion in children: Analysis of causes and proposals for preventive measures.

    Science.gov (United States)

    Lahmar, J; Célérier, C; Garabédian, E N; Couloigner, V; Leboulanger, N; Denoyelle, F

    2017-10-17

    To study recent cases of esophageal injury due to button-battery ingestion in children presenting in pediatric ENT emergency departments of the Paris area of France (Île-de-France region), in order to propose appropriate preventive measures. A retrospective descriptive single-center study included all children under 15 years of age, presenting in pediatric ENT emergency departments between January 2008 and April 2014 for button-battery ingestion with esophageal impaction requiring emergency removal. Twenty-two boys and 4 girls, with a median age of 25 months, were included. Twenty-five of the 26 batteries had diameters of 20mm or more. Median esophageal impaction time was 7 hours 30 minutes (range, 2 to 72 hours). The complications rate was 23%. Mean hospital stay cost was €38,751 (range, €5130-119,737). The origin of the battery was known in 23 of the 26 cases: remote control without screw-secured compartment (42.3%), open battery pack (15.4%), children's toy (15.3%), camera (7.7%), watch (1 case) and hearing aid without screw-secured compartment (1 case). Esophageal lesions due to ingestion of button-batteries in children are almost always due to batteries larger than 20mm in diameter, mostly from devices with a poorly protected compartment, or batteries that are not individually packaged. These lesions cause serious complications in a quarter of cases and their management entails high health costs. Legislation requiring screw-secured compartments and individual blisters for batteries could have prevented 69.2% of the ingestions. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. [Endosurgery of benign diseases and injuries of esophagus].

    Science.gov (United States)

    Oskretkov, V I; Gur'yanov, A A; Gankov, V A; Klimova, G I; Andreasyan, A R; Balatsky, D V; Fedorov, V V; Maslikova, S A

    2016-01-01

    To analyze the results of endoscopic interventions for benign diseases and injuries of the esophagus. 159 patients with benign diseases and perforation of the esophagus were operated. There were 72 (45.3%) cases of achalasia, 56 (35.2%) with post-ambustial stenosis of esophagus, 14 (8.8%) with esophageal perforation, 13 (8.2%) with leuomyoma of esophagus and 4 (2.5%) with diverticulum of thoracic esophagus. In long-term period 56 patients with achalasia were followed-up after laparoscopic Heller cardiomyotomy with Dor fundoplication. Good results were observed in all cases. Three patients died in early postoperative period after thoracoscopic extirpation of esophagus with esophagoplasty via laparotomy at the stage of development of the technique. There were no deaths after thoracoscopic extirpation of esophagus with simultaneous laparoscopic gastroplasty. Postoperative period was significantly less after thoracoscopic extirpation of esophagus with simultaneous laparoscopic esophagogastroplasty using whole stomach compared with esophagogastroplasty and esophagocoloplasty via laparotomy. In long-term postoperative period different complications occurred in 17 cases. Two patients with esophageal perforation died after video-assisted laparotranshiatal drainage of posterior mediastinum. Scarring of esophageal defect was observed in others. Seam failure after esophageal leuomyoma removal was diagnosed in 2 patients that required video-assisted laparotranshiatal drainage of posterior mediastinum and Maydl jejunostomy. Seam failure in thoracic esophagus after thoracoscopic removal of diverticulum was observed in 1 case. The complication was cured by video-assisted laparotranshiatal drainage of posterior mediastinum.

  15. Development of Therapeutic Modality of Esophageal Cancer Using Ho-166 Stent

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Doo; Park, Kwang Kyun; Lee, Min Geol [Yonsei University Medical College, Seoul (Korea, Republic of); Park, Kyung Bae [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)

    1997-09-01

    The prognosis of esophageal cancer is poor due absence of serosa which prevent local invasion to the surrounding organs such as aorta, mediastinum, trachea, and bronchi. We developed a Ho-166 Coated Radioactive Self-Expandable Metallic Stent which is a new herapeutic device in the treatment of esophageal cancer and underwent an animal experiment in mongrel dogs. We observed mucosal destruction by 4-6 mCi of Ho-166 without serious complications such as perforation of esophageal wall. Therefore, Ho-166 coated self-expandable stent appears to be an effective therapeutic device in the palliative treatment of esophageal cancer. 17 refs., 4 figs. (author)

  16. Esophageal Replacement for Long-Gap Esophageal Atresia in a ...

    African Journals Online (AJOL)

    The management of esophageal atresia in a resourcelimited environment is plagued with challenges that often lead to poor outcome. The diagnosis and management of babies with long-gap esophageal atresia adds a new dimension to these challenges. We report the success of esophageal replacement surgery for a ...

  17. Use of endoanal ultrasound for reducing the risk of complications related to anal sphincter injury after vaginal birth.

    Science.gov (United States)

    Walsh, Kate A; Grivell, Rosalie M

    2015-10-29

    During childbirth, many women sustain trauma to the perineum, which is the area between the vaginal opening and the anus. These tears can involve the perineal skin, the pelvic floor muscles, the external and internal anal sphincter muscles as well as the rectal mucosa (lining of the bowel). When these tears extend beyond the external anal sphincter they are called 'obstetric anal sphincter injuries' (OASIS). When women sustain an OASIS, they are at increased risk of developing anal incontinence either immediately following birth or later in life. Anal incontinence is associated with significant medical, hygiene and social problems. Endoanal ultrasound (EAUS) can be performed with a bedside scanner by inserting a small probe into the anus and the structures of the anal canal and perineum can be reviewed in real-time. We proposed that by examining the perineum with EAUS after the birth of the baby and before the tear has been repaired, there would be an increase in detection of OASIS. This increased detection could lead to improved primary repair of the external and internal anal sphincter resulting in reduced rates of anal incontinence and improved quality of life for women. EAUS may also have a role after perineal repair in the evaluation of residual injury and may help guide a woman's management in subsequent pregnancies and allow for early referral to specialised units, minimising long-term complications. To evaluate the effectiveness of EAUS in the detection of OASIS following vaginal birth and in reducing the risk of anal sphincter complications related to OASIS. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2015) and reference list of the one retrieved study. Randomised control trials (RCTs) comparing EAUS versus no ultrasound in women prior to repair of perineal trauma and EAUS performed after perineal repair. RCTs published in abstract form only and trials using a cluster-randomised design were eligible for inclusion

  18. The Efficacy of Mesenchymal Stem Cell Transplantation in Caustic Esophagus Injury: An Experimental Study

    Directory of Open Access Journals (Sweden)

    Murat Kantarcioglu

    2014-01-01

    Full Text Available Introduction. Ingestion of corrosive substances may lead to stricture formation in esophagus as a late complication. Full thickness injury seems to exterminate tissue stem cells of esophagus. Mesenchymal stem cells (MSCs can differentiate into specific cell lineages and have the capacity of homing in sites of injury. Aim and Methods. We aimed to investigate the efficacy of MSC transplantation, on prevention of esophageal damage and stricture formation after caustic esophagus injury in rats. 54 rats were allocated into four groups; 4 rats were sacrificed for MSC production. Group 1, untreated controls (n: 10. Group 2, membrane labeled MSCs-treated rats (n: 20. Group 3, biodistribution of fluorodeoxyglucose labeled MSCs via positron emission tomography (PET imaging (n: 10. Group 4, sham operated (n: 10. Standard caustic esophageal burns were created and MSCs were transplanted 24 hours after. All rats were sacrificed at the 21st days. Results. PET scan images revealed the homing behavior of MSCs to the injury site. The histopathology damage score was not significantly different from controls. However, we demonstrated Dil labeled epithelial and muscle cells which were originating from transplanted MSCs. Conclusion. MSC transplantation after caustic esophageal injury may be a helpful treatment modality; however, probably repeated infusions are needed.

  19. Conservative management of esophageal perforation after a fall.

    Science.gov (United States)

    Delos Reyes, Arthur P; Clancy, Christopher; Lach, Joseph; Olorunto, William A; Williams, Mallory

    2013-01-01

    Esophageal perforation in the setting of blunt trauma is rare, and diagnosis can be difficult due to atypical signs and symptoms accompanied by distracting injury. We present a case of esophageal perforation resulting from a fall from height. Unexplained air in the soft tissues planes posterior to the esophagus as well as subcutaneous emphysema in the absence of a pneumothorax on CT aroused clinical suspicions of an injury to the aerodigestive tract. The patient suffered multiple injuries including bilateral first rib fractures, C6 lamina fractures, C4-C6 spinous process fractures, a C7 right transverse process fracture with associated ligamentous injury and cord contusion, multiple comminuted nasal bone fractures, and a right verterbral artery dissection. Esophageal injury was localized using a gastrograffin esophagram to the cervical esophagus and was most likely secondary to cervical spine fractures. Because there were no clinical signs of sepsis and the esophagram demonstrated a contained rupture, the patient was thought to be a good candidate for a trial of conservative management consisting of broad spectrum intravenous antibiotics, oral care with chlorhexadine gluconate, NPO, and total parenteral nutrition. No cervical spine fixation or procedure was performed during this trial of conservative management. The patient was received another gastrograffin esophagram on hospital day 14 and demonstrated no evidence of contrast extravasation. Early diagnosis and control of the infectious source are the cornerstones to successful management of esophageal perforation from all etiologies. Traditionally, esophageal perforation relied on a high index of clinical suspicion for early diagnosis, but the use of CT scan for has proved to be highly effective in diagnosing esophageal perforation especially in patients with atypical presentations. While aggressive surgical infection control is paramount in the majority of esophageal perforations, a select subset of patients can

  20. Nutrition in peri-operative esophageal cancer management.

    Science.gov (United States)

    Steenhagen, Elles; van Vulpen, Jonna K; van Hillegersberg, Richard; May, Anne M; Siersema, Peter D

    2017-07-01

    Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review encompasses the current literature on nutrition in the pre-operative, peri-operative, and post-operative phases of esophageal cancer. Both established interventions and potential novel targets for nutritional management are discussed. Expert commentary: To ensure an optimal pre-operative status and to reduce peri-operative complications, it is key to assess nutritional status in all pre-operative esophageal cancer patients and to apply nutritional interventions accordingly. Since esophagectomy results in a permanent anatomical change, a special focus on nutritional strategies is needed in the post-operative phase, including early initiation of enteral feeding, nutritional interventions for post-operative complications, and attention to long-term nutritional intake and status. Nutritional aspects of pre-optimization and peri-operative management should be incorporated in novel Enhanced Recovery After Surgery programs for esophageal cancer.

  1. Right colon interposition in corrosive esophageal long segment ...

    African Journals Online (AJOL)

    2013-09-20

    Sep 20, 2013 ... complications. The ascending colon and part of transverse colon form the graft island pedicle. Maintenance of adequate nutrition during all the stages of treatment does help. Paying heed to technical details during the colon interposition for esophageal replacement gives the. Right colon interposition in ...

  2. Treatment Options by Stage (Esophageal Cancer)

    Science.gov (United States)

    ... Cancer Prevention Esophageal Cancer Screening Research Esophageal Cancer Treatment (PDQ®)–Patient Version General Information About Esophageal Cancer ... Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment ...

  3. [Video-assisted thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in thoracic cavity: analysis of 60 cases].

    Science.gov (United States)

    Sun, Xiang-xiang; Xu, Mei-qing; Guo, Ming-fa; Liu, Chang-qing; Xu, Shi-bin; Mei, Xin-yu; Tian, Jie-yong; Zhang, Zheng-hua; Wei, Da-zhong

    2013-04-01

    To investigate the feasibility and safety of video-assisted thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity. The clinical data of 120 patients who underwent esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity from March to December 2011 was analyzed retrospectively. In the video-assisted thoracoscopic surgery group, there were 60 patients [41 male and 19 female patients with aver age of (62 ± 7) years old] who underwent video-assisted thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity. In the routine thoracotomy group, there were 60 patients [39 male and 21 female patients with aver age of (62 ± 9) years old] who underwent routine thoracotomy esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity. Operation time, intra-operative blood loss, postoperative total thoracic drainage in 3 days, total number of harvested lymph nodes, hospitalization, cost of hospitalization and complications were compared between the two groups. The operations were carried out successfully in two groups. There was no perioperative death in all patients. There was no statistical difference in intra-operative blood loss, postoperative total thoracic drainage and cost of hospitalization between the two groups. Operation time of rideo-assisted thoracoscopic surgery group was significantly longer than that of thoracotomy group ((188 ± 38) minutes vs. (138 ± 50) minutes, t = 6.171, P = 0.000), but postoperative hospitalization was significantly lower ((14 ± 3) d vs. (18 ± 6) d, t = -4.093, P = 0.000) and total number of harvested lymph nodes was lower (17 ± 9 vs. 21 ± 11, t = -2.058, P = 0.042). There was significantly statistical difference in total postoperative main complication (25.0% vs. 48.3%, χ(2) = 7.033, P = 0.008). And postoperative incisional infection of VATE

  4. Cognitive reserve as a moderator of postconcussive symptoms in children with complicated and uncomplicated mild traumatic brain injury

    OpenAIRE

    Fay, Taryn B.; Yeates, Keith Owen; Taylor, H. Gerry; Bangert, Barbara; Dietrich, Ann; NUSS, KATHRYN E.; Rusin, Jerome; Wright, Martha

    2009-01-01

    The occurrenceof postconcussive symptoms (PCS) following mild traumatic brain injury (TBI) in children may depend on cognitive reserve capacity. This prospective, longitudinal study examined whether the relationship between mild TBI and PCS is moderated by cognitive ability, which served as a proxy for cognitive reserve. Participants included 182 children with mild TBI and 99 children with orthopedic injuries (OI), ranging from 8 to 15 years of age when injured. Mild TBI were classified as co...

  5. Perioperative morbidity and outcome of esophageal surgery in dogs and cats: 72 cases (1993-2013).

    Science.gov (United States)

    Sutton, Jessie S; Culp, William T N; Scotti, Katherine; Seibert, Rachel L; Lux, Cassie N; Singh, Ameet; Wormser, Chloe; Runge, Jeffrey J; Schmiedt, Chad W; Corrie, Jessica; Phillips, Heidi; Selmic, Laura E; Nucci, Daniel J; Mayhew, Philipp D; Kass, Philip H

    2016-10-01

    OBJECTIVE To evaluate perioperative morbidity and outcome in dogs and cats undergoing esophageal surgery. DESIGN Retrospective case series. ANIMALS 63 client-owned dogs and 9 client-owned cats. PROCEDURES Medical records of dogs and cats that underwent esophageal surgery were reviewed for information on signalment, history, results of preoperative diagnostic testing, condition treated, details of surgery, intraoperative complications, and postoperative complications. Long-term follow-up data were obtained via veterinarian and client telephone conversations. The relationship between complications and survival to hospital discharge was evaluated by means of regression analysis. RESULTS The most common indication for surgical intervention was an esophageal foreign body in dogs (50/63 [79%]) and esophageal stricture in cats (3/9). Complications were documented in 54% (34/63) of dogs and 3 of 9 cats. The most common immediate postoperative complications were respiratory in nature (9 dogs, 1 cat). Partial esophagectomy and resection with anastomosis were significantly associated with the development of immediate postoperative complications in dogs. The most common delayed postoperative complications were persistent regurgitation (7 dogs) and esophageal stricture formation (3 dogs, 1 cat). For dogs, a mass lesion and increasing lesion size were significantly associated with the development of delayed postoperative complications. Six dogs (10%) and 1 cat died or were euthanized prior to discharge, and pneumomediastinum and leukopenia were negative prognostic factors for dogs being discharged from the hospital. CONCLUSIONS AND CLINICAL RELEVANCE Results of this study suggested that the short-term prognosis for dogs and cats that survive surgery for treatment of esophageal lesions is favorable, with 90% of patients discharged from the hospital (57/63 dogs; 8/9 cats). However, dogs treated for more extensive esophageal lesions as well as those undergoing esophagectomy or

  6. Peroral endoscopic myotomy (POEM) for esophageal achalasia.

    Science.gov (United States)

    Inoue, H; Minami, H; Kobayashi, Y; Sato, Y; Kaga, M; Suzuki, M; Satodate, H; Odaka, N; Itoh, H; Kudo, S

    2010-04-01

    Peroral endoscopic myotomy (POEM) was developed by our group to provide a less invasive permanent treatment for esophageal achalasia. POEM was performed in 17 consecutive patients with achalasia (10 men, 7 women; mean age 41.4 years). A long submucosal tunnel was created (mean length 12.4 cm), followed by endoscopic myotomy of circular muscle bundles of a mean total length of 8.1 cm (6.1 cm in distal esophagus and 2.0 cm in cardia). Smooth passage of an endoscope through the gastroesophageal junction was confirmed at the end of the procedure. In all cases POEM significantly reduced the dysphagia symptom score (from mean 10 to 1.3; P = 0.0003) and the resting lower esophageal sphincter (LES) pressure (from mean 52.4 mmHg to 19.9 mmHg; P = 0.0001). No serious complications related to POEM were encountered. During follow-up (mean 5 months), additional treatment or medication was necessary in only one patient (case 17) who developed reflux esophagitis (Los Angeles classification B); this was well controlled with regular intake of protein pump inhibitors (PPIs). The short-term outcome of POEM for achalasia was excellent; further studies on long-term efficacy and on comparison of POEM with other interventional therapies are awaited. Georg Thieme Verlag KG Stuttgart. New York.

  7. Esophagitis Induced by Doxycycline Treatment

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    Engin Şenel

    2016-09-01

    Full Text Available Esophagitis is the most common disease of the esophagus. Drug use is one of the reasons of chemical esophagitis. Herein, we report two male patients of 17 and 18 years of age who developed esophagitis in acne treatment with doxycycline. Both patients took doxycycline capsules for approximately one week. Ulcerations were detected at upper and mid-esophagus of the 17-year-old patient. Circular ulcerations were found at mid-esophagus of the 18-year-old case. Doxycycline induced esophagitis is a preventable disease with the physician giving appropriate medication ingestion advice to the patient.

  8. Advances in Clinical Management of Eosinophilic Esophagitis

    Science.gov (United States)

    Dellon, Evan S.; Liacouras, Chris A.

    2014-01-01

    EoE is a chronic immune/antigen-mediated clinicopathologic condition that has become an increasingly important cause of upper gastrointestinal morbidity in adults and children over the past 2 decades. It is diagnosed based on symptoms of esophageal dysfunction, the presence of at least 15 eosinophils/high-power field in esophageal biopsies, and exclusion of competing causes of esophageal eosinophilia, including proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE). We review what we have recently learned about the clinical aspects of EoE, discussing the clinical, endoscopic, and histologic features of EoE in adults and children. We explain the current diagnostic criteria and challenges to diagnosis, including the role of gastroesophageal reflux disease and PPI-REE. It is also important to consider the epidemiology of EoE (current incidence of 1/10,000 new cases per year and prevalence of 0.5-1/1,000 cases per year) and disease progression. We review the main treatment approaches and new treatment options; EoE can be treated with topical corticosteroids such as fluticasone and budesonide, or dietary strategies, such as amino acid-based formulas, allergy test-directed elimination diets, and non-directed empiric elimination diets. Endoscopic dilation has also become an important tool for treatment of fibrostenostic complications of EoE. There are number of unresolved issues in EoE, including phenotypes, optimal treatment endpoints, the role of maintenance therapy, and treatment of refractory EoE. The care of patients with EoE and the study of the disease span many disciplines—EoE is ideally managed by a multidisciplinary team of gastroenterologists, allergists, pathologists, and dieticians. PMID:25109885

  9. Conservative therapy for missed esophageal perforation after blunt trauma.

    Science.gov (United States)

    Lucas, C E; Splittgerber, F; Ledgerwood, A M

    1986-11-01

    An 80-year-old man was treated, non-operatively, for a distal esophageal perforation, diagnosed nine days after blunt thoracic trauma. Emergency department diagnosis was impeded by absence of mediastinal air; right chest-wall emphysema was thought to result from associated rib fractures. Conservative therapy consisting of nasogastric suction, intravenous antibiotics, right-chest tube drainage of a large communicating empyema cavity, temporary nasotracheal intubation with ventilatory support, total parenteral nutrition, and, finally, nasoduodenal intubation for elemental feeding were employed. This mode of therapy may be best in comparable elderly patients with esophageal perforation that is overlooked during the initial 24 hours after injury. Possibly, routine barium swallow in all patients with chest-wall emphysema and rib fractures would circumvent missed esophageal rupture after blunt trauma.

  10. Two cases of esophageal eosinophilia: eosinophilic esophagitis or gastro-esophageal reflux disease?

    Directory of Open Access Journals (Sweden)

    Ozlem Yilmaz

    2014-06-01

    Full Text Available Eosinophilic esophagitis (EoE and gastro-esophageal reflux disease are among the major causes of isolated esophageal eosinophilia. Isolated esophageal eosinophilia meeting criteria for EoE may respond to proton pump inhibitor (PPI treatment. This entity is termed proton pumps inhibitor responsive esophageal eosinophilia (PPI-REE. Gastro-esophageal reflux is thought to comprise a subgroup of patients with PPI-REE. According to the latest guidelines, PPI responsiveness distinguishes people with PPI-REE from patients having EoE (non-responders. In this report, two unusual cases with findings belonging to both EoE and PPI-REE are discussed with known and unknown facts.

  11. Dickkopf-1, the Wnt antagonist, is induced by acidic pH and mediates epithelial cellular senescence in human reflux esophagitis.

    Science.gov (United States)

    Lyros, Orestis; Rafiee, Parvaneh; Nie, Linghui; Medda, Rituparna; Jovanovic, Nebojsa; Schmidt, Jamie; Mackinnon, Alexander; Venu, Nanda; Shaker, Reza

    2014-04-01

    Squamous esophageal epithelium adapts to acid reflux-mediated injury by proliferation and differentiation via signal transduction pathways. Induction of the Wnt antagonist Dickkopf-1 (Dkk1) is involved in tissue repair during inflammation and cellular injury. In this study, we aimed to identify the biological role of Dkk1 in human reflux esophagitis with respect to cell growth and regulation of Wnt signaling. Esophageal biopsies from reflux-esophagitis patients (n = 15) and healthy individuals (n = 10) were characterized in terms of Dkk1 expression. The role of Dkk1 in response to acid-mediated epithelial injury was analyzed by cellular assays in vitro utilizing squamous esophageal epithelial cell lines (EPC1-hTERT, EPC2-hTERT, and HEEC). Dkk1 was significantly overexpressed in human reflux-esophagitis tissue compared with healthy esophageal mucosa at transcriptional and translational levels. After acute and chronic acid (pH 4) exposure, esophageal squamous epithelial cell lines expressed and secreted high levels of Dkk1 in response to stress-associated DNA injury. High extracellular levels of human recombinant Dkk1 inhibited epithelial cell growth and induced cellular senescence in vitro, as demonstrated by reduced cell proliferation, G0/G1 cell cycle arrest, elevated senescence-associated β-galactosidase activity, and upregulation of p16. Acid pulsing induced Dkk1-mediated senescence, which was directly linked to the ability of Dkk1 to antagonize the canonical Wnt/β-catenin signaling. In healthy esophageal mucosa, Dkk1 expression was associated with low expression of transcriptionally active β-catenin, while in reflux-esophagitis tissue, Dkk1 overexpression correlated with increased senescence-associated β-galactosidase activity and p16 upregulation. The data indicate that, in human reflux esophagitis, Dkk1 functions as a secreted growth inhibitor by suppressing Wnt/β-catenin signaling and promoting cellular senescence. These findings suggest a significant

  12. Urinary retention and acute kidney injury in a tetraplegic patient using condom catheter after partying: a preventable complication

    Directory of Open Access Journals (Sweden)

    Vaidyanathan S

    2015-10-01

    Full Text Available Subramanian Vaidyanathan,1 Fahed Selmi,1 Peter L Hughes,2 Gurpreet Singh,3 Bakul M Soni11Regional Spinal Injuries Centre, 2Department of Radiology, 3Department of Urology, Southport and Formby District General Hospital, Town Lane, Southport, UKBackground: Spinal cord injury patients, who manage their bladder using a condom catheter, are at risk of developing urine retention when they consume large volumes of alcoholic drinks within a short period of time.Case presentation: A male tetraplegic patient had been managing satisfactorily penile sheath drainage for 8 years. He went out socializing during which he consumed large volumes of alcohol but did not take any recreational drugs. The following morning, he noticed distension of the lower abdomen and passed urine in dribbles. He then developed a temperature and became unwell. He was seen by district nurses and a doctor, who prescribed antibiotics. He continued to feel unwell. After 8 days, he referred himself to a spinal unit at Regional Spinal Injuries Centre, Southport. The blood test results showed the following: blood urea: 19.8 mmol/L; creatinine: 172 µmol/L; and C-reactive protein: 336.4 mg/L. Urethral catheterization led to immediate drainage of 1,400 mL of urine. A computed tomography scan revealed an enlarged, swollen left kidney, indicating acute bacterial nephritis. He was prescribed intravenous fluids and Meropenem. Creatinine decreased to 46 µmol/L.Conclusion: Spinal cord injury patients using condom catheters should be made aware of the risk of urine retention when they consume large amounts of alcoholic drinks in a short period of time. Patients and caregivers should be informed to consider intermittent catheterizations for 24–48 hours or insert indwelling urethral catheter when planning for an evening out.Keywords: spinal cord injury, tetraplegia, neuropathic urinary bladder, acute kidney injury 

  13. Hypnotherapy for Esophageal Disorders.

    Science.gov (United States)

    Riehl, Megan E; Keefer, Laurie

    2015-07-01

    Hypnotherapy is an evidence based intervention for the treatment of functional bowel disorders, particularly irritable bowel syndrome. While similar in pathophysiology, less is known about the utility of hypnotherapy in the upper gastrointestinal tract. Esophageal disorders, most of which are functional in nature, cause painful and uncomfortable symptoms that impact patient quality of life and are difficult to treat from a medical perspective. After a thorough medical workup and a failed trial of proton pump inhibitor therapy, options for treatment are significantly limited. While the pathophysiology is likely multifactorial, two critical factors are believed to drive esophageal symptoms--visceral hypersensitivity and symptom hypervigilance. The goal of esophageal directed hypnotherapy is to promote a deep state of relaxation with focused attention allowing the patient to learn to modulate physiological sensations and symptoms that are not easily addressed with conventional medical intervention. Currently, the use of hypnosis is suitable for dysphagia, globus, functional chest pain/non-cardiac chest pain, dyspepsia, and functional heartburn. In this article the authors will provide a rationale for the use of hypnosis in these disorders, presenting the science whenever available, describing their approach with these patients, and sharing a case study representing a successful outcome.

  14. esophageal cancer: preliminary results

    Directory of Open Access Journals (Sweden)

    Afsaneh Maddah Safaei

    2017-01-01

    Full Text Available Purpose: Dysphagia is a common initial presentation in locally advanced esophageal cancer and negatively impacts patient quality of life and treatment compliance. To induce fast relief of dysphagia in patients with potentially operable esophageal cancer high-dose-rate (HDR brachytherapy was applied prior to definitive radiochemotherapy. Material and methods : In this single arm phase II clinical trial between 2013 to 2014 twenty patients with locally advanced esophageal cancer (17 squamous cell and 3 adenocarcinoma were treated with upfront 10 Gy HDR brachytherapy, followed by 50.4 Gy external beam radiotherapy (EBRT and concurrent chemotherapy with cisplatin/5-fluorouracil. Results : Tumor response, as measured by endoscopy and/or computed tomography scan, revealed complete remission in 16 and partial response in 4 patients (overall response rate 100%. Improvement of dysphagia was induced by brachytherapy within a few days and maintained up to the end of treatment in 80% of patients. No differences in either response rate or dysphagia resolution were found between squamous cell and adenocarcinoma histology. The grade 2 and 3 acute pancytopenia or bicytopenia reported in 4 patients, while sub-acute adverse effects with painful ulceration was seen in five patients, occurring after a median of 2 months. A perforation developed in one patient during the procedure of brachytherapy that resolved successfully with immediate surgery. Conclusions : Brachytherapy before EBRT was a safe and effective procedure to induce rapid and durable relief from dysphagia, especially when combined with EBRT.

  15. Radiation-Induced Esophagitis is Mitigated by Soy Isoflavones

    Directory of Open Access Journals (Sweden)

    Matthew D Fountain

    2016-11-01

    Full Text Available Introduction: Lung cancer patients receiving radiotherapy present with acute esophagitis and chronic fibrosis, as a result of radiation injury to esophageal tissues. We have shown that soy isoflavones alleviate pneumonitis and fibrosis caused by radiation toxicity to normal lung. The effect of soy isoflavones on esophagitis histopathological changes induced by radiation was investigated. Methods: C57BL/6 mice were treated with 10 Gy or 25 Gy single thoracic irradiation and soy isoflavones for up to 16 weeks. Damage to esophageal tissues was assessed by H&E, Masson’s Trichrome and Ki-67 staining at 1, 4, 10, 16 weeks after radiation. The effects on smooth muscle cells and leukocyte infiltration were determined by immunohistochemistry using anti-αSMA and anti-CD45 respectively. Results: Radiation caused thickening of esophageal tissue layers that was significantly reduced by soy isoflavones. Major radiation alterations included hypertrophy of basal cells in mucosal epithelium and damage to smooth muscle cells in muscularis mucosae as well as disruption of collagen fibers in lamina propria connective tissue with leukocyte infiltration. These effects were observed as early as one week after radiation and were more pronounced with a higher dose of 25 Gy. Soy isoflavones limited the extent of tissue damage induced by radiation both at 10 and 25 Gy.Conclusions: Soy isoflavones have a radioprotective effect on the esophagus, mitigating the early and late effects of radiation injury in several esophagus tissue layers. Soy could be administered with radiotherapy to decrease the incidence and severity of esophagitis in lung cancer patients receiving thoracic radiation therapy.

  16. The efficacy of ozone therapy in experimental caustic esophageal burn.

    Science.gov (United States)

    Guven, Ahmet; Gundogdu, Gokhan; Sadir, Serdar; Topal, Turgut; Erdogan, Esra; Korkmaz, Ahmet; Surer, Ilhami; Ozturk, Haluk

    2008-09-01

    Ozone has been proposed as an antioxidant enzyme activator, immunomodulator and cellular metabolic activator. This study was designed to investigate the efficacy of ozone therapy in the prevention of esophageal damage and stricture formation developed after esophageal caustic injuries in the rat. Forty-five rats were allocated into three groups; sham-operated, un-treatment and treatment groups. Caustic esophageal burn was created by instilling 15% NaOH in the distal esophagus. The rats were left untreated or treated with 1 mg/kg/day ozone intraperitoneally. All rats were sacrificed at 28 days. Efficacy of the treatment was assessed by measuring the stenosis index (SI) and histopathologic damage score, and biochemically by determining tissue hydroxyproline content (HP), superoxide dismutase (SOD), glutathione peroxidase (GPx), malondialdehyde (MDA) and protein carbonyl content (PCC) in esophageal homogenates. Whereas seven (47%) rats died in the un-treatment group, all rats in the sham-operated and the treatment group survived during the study. SI, the histopathologic damage score, was significantly lower in the ozone-therapy group than the un-treatment group. HP levels were significantly higher in the un-treatment group than the group treated with ozone. Caustic esophageal burn increased MDA and PCC levels and also decreased SOD and GPx enzyme activities. In contrast, ozone therapy decreased the elevated MDA and PCC levels and also increased the reduced SOD and GPx enzyme activities. Ozone has a preventive effect in the development of fibrosis by decreasing tissue damage and increasing the antioxidant enzyme activity in an experimental model of corrosive esophageal injury.

  17. Two-Stage Thoracoscopic Repair of Long-Gap Esophageal Atresia Using Internal Traction Is Safe and Feasible.

    Science.gov (United States)

    Tainaka, Takahisa; Uchida, Hiroo; Tanano, Akihide; Shirota, Chiyoe; Hinoki, Akinari; Murase, Naruhiko; Yokota, Kazuki; Oshima, Kazuo; Shirotsuki, Ryo; Chiba, Kosuke; Amano, Hizuru; Kawashima, Hiroshi; Tanaka, Yujiro

    2017-01-01

    The treatment of long-gap esophageal atresia remains an issue for pediatric surgeons. Many techniques for treating long-gap esophageal atresia have been proposed, but the optimal method has not been established. The thoracoscopic esophageal elongation technique has recently been developed. We previously reported a case in which two-stage thoracoscopic repair was performed using internal esophageal traction without esophageal tearing, and we retrospectively reviewed the outcomes of this procedure in this study. Five patients underwent thoracoscopic treatment involving internal esophageal traction for esophageal atresia involving a long gap or vascular ring over a 5-year period. Between November 2010 and November 2015, 5 patients were treated with thoracoscopic traction. All of these patients successfully underwent thoracoscopic-delayed primary anastomosis. Conversion to open thoracotomy was not required in any case. The postoperative complications experienced by the patients included minor anastomotic leakage in 2 cases, anastomotic stenosis in 1 case, gastroesophageal reflux (GER) in 4 cases, and a hiatal hernia in 1 case. None of the patients died. Two-stage thoracoscopic repair for esophageal atresia involving a long gap or vascular ring is a safe and feasible procedure; however, we must develop methods for treating minor anastomotic complications and GER due to esophageal traction in future.

  18. Endoscopic submucosal tunnel dissection for large esophageal neoplastic lesions.

    Science.gov (United States)

    Pioche, Mathieu; Mais, Laetitia; Guillaud, Olivier; Hervieu, Valérie; Saurin, Jean-Christophe; Ponchon, Thierry; Lepilliez, Vincent

    2013-12-01

    Endoscopic submucosal dissection (ESD) is recommended for en bloc R0 resection of superficial esophageal neoplasms larger than 20  mm, but is high risk and time-consuming. In the tunnel technique, incisions at the lower and upper lesion edges are joined by a submucosal tunnel and then lateral incisions are made. The mucosa is thereby easily separated from the muscular layer. We report our experience of esophageal tunnel ESD. We retrospectively reviewed all consecutive esophageal tunnel ESDs performed at our unit between January 1 2010 and January 11 2013. Lesions were superficial esophageal neoplasms, UT1N0 at EUS.  11 patients underwent tunnel ESD (nine squamous cell carcinomas, two adenocarcinomas). Mean dissected surface area was 13.25 cm(2). Mean procedure duration was 76.7 minutes. All 11 resections were en bloc and 9/11 were R0. Complications were one subcutaneous emphysema with spontaneous resolution, and stenosis in 4/11 patients (36.4%) with resolution after 1-5 dilations. Tunnel ESD of superficial esophageal neoplasms is an interesting option, seeming to be faster and more effective than standard ESD, without higher morbidity. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Esophageal candidiasis--an adverse effect of inhaled corticosteroids therapy.

    Science.gov (United States)

    Aun, Marcelo Vivolo; Ribeiro, Marisa Rosimeire; Costa Garcia, Cláudia Leite; Agondi, Rosana Câmara; Kalil, Jorge; Giavina-Bianchi, Pedro

    2009-05-01

    Over the last few decades, inhaled corticosteroids (ICs) became the cornerstone in the treatment of persistent asthma. Their use improved asthma control, decreased mortality and also minimized adverse reactions associated with systemic steroid. Esophageal candidiasis is a rare complication resulting from the use of ICs. Although, in recent years, as their prescriptions has increased, more cases have been reported, especially in Japan. Listed are 4 case reports regarding esophageal candidiasis in asthmatic patients associated with inhaled budesonide administration. In the cases reported herein, the use of a different device of dry powder budesonide might have favored esophageal drug deposition and Candida infection. Patients denied using systemic corticosteroids in the previous 6 months. Furthermore, none of the patients presented Diabetes mellitus, malignant disease, HIV infection, or other immunosuppressive conditions. We conclude that patients treated with high doses of ICs are at higher risk of developing esophageal candidiasis. These patients should undergo upper gastrointestinal endoscopy whenever they present symptoms. Nevertheless, we must keep in mind that infection might also be asymptomatic and esophageal candidiasis prevalence may be higher than that reported thus far.

  20. A case of progressive hypertension preceding gemcitabine-associated thrombotic microangiopathy complicated by acute kidney injury and stroke.

    LENUS (Irish Health Repository)

    Phelan, Paul J

    2009-01-01

    Gemcitabine-associated thrombotic microangiopathy is being increasingly recognized as a serious complication of treatment. We report a normotensive patient who developed progressive hypertension after commencing gemcitabine therapy. She also developed subtle changes in her platelet count and serum creatinine months before her emergent presentation. Clinicians should be aware of new onset or worsening hypertension and \\'mild\\' biochemical changes in gemcitabine-treated patients.

  1. Predicting complicated outcomes in spinal cord injury patients with urinary tract infection: Development and internal validation of a risk model.

    Science.gov (United States)

    Si, Sheng; Yan, Yan; Fuller, Brian M; Liang, Stephen Y

    2018-02-21

    Patients with chronic SCI hospitalized for UTI can have significant morbidity. It is unclear whether SIRS criteria, SOFA score, or quick SOFA score can be used to predict complicated outcome. Retrospective cohort study. A risk prediction model was developed and internally validated using bootstrapping methodology. Urban, academic hospital in St. Louis, Missouri. 402 hospitalizations for UTI between October 1, 2010 and September 30, 2015, arising from 164 patients with chronic SCI, were included in the final analysis. Outcome/measures: An a priori composite complicated outcome defined as: 30-day hospital mortality, length of hospital stay >4 days, intensive care unit (ICU) admission, and hospital revisit within 30 days of discharge. Mean age of patients was 46.4 ± 12.3 years; 83.6% of patient-visits involved males. The primary outcome occurred in 278 (69.2%) hospitalizations. In multivariate analysis, male sex was protective (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.18-0.99; P = 0.048) while Gram-positive urine culture (OR 3.07; 95% CI, 1.05-9.01; P = 0.041), urine culture with no growth (OR, 1.69; 95% CI, 1.02-2.80; P = 0.041), and greater SOFA score (for one-point increments, OR, 1.41; 95% CI, 1.18-1.69; P complicated outcome. SIRS criteria and qSOFA score were not associated with complicated outcome. Our risk prediction model demonstrated good overall performance (Brier score, 0.19), fair discriminatory power (c-index, 0.72), and good calibration during internal validation. Clinical variables present on hospital admission with UTI may help identify SCI patients at risk for complicated outcomes and inform future clinical decision-making.

  2. [Experimental study on a novel esophageal prosthesis made of composite biomaterials].

    Science.gov (United States)

    Qin, Xiong; Xu, Zhi-fei; Shi, Hong-can; Zhao, Xue-wei; Sun, Kang; Gao, Xiang-yang

    2003-07-01

    To design and develop a novel esophageal prosthesis by selecting appropriate biomaterials, developing special manufacturing techniques, and investigating the feasibility of replacement of cervical esophagus in mongrel dogs. In accordance with the requirements of ideal esophageal substitutes, we designed a new type of esophageal prostheses. The inner stent were made with polyurethane of medical grade, and the outer surface of the prosthesis was coated with collagen-chitosan sponge. The silicone tube was used as a control. Thirteen adult mongrel dogs that were divided into two groups were used to establish the experimental models. In the experimental group (n = 8), the esophageal prostheses were completely incorporated with the native esophagus and adherent to the surrounding host connective tissues. Epithelial linings of varying degrees were formed on the luminal surface, and complete epithelization was seen in 1 month postoperatively. The granulation at the sites of the anastomosis in this group was less significant than that of the control group. One dog has been surviving for 12 months up to now without any complications. In the control group (n = 5), esophageal epithelial was not observed on the luminal surface, constriction of the regenerated esophagus progressed and all the dogs died within 2 months after operation. These observations suggest that this esophageal prosthesis made of composite biomaterials has high biocompatibility and potential for long-segment esophageal reconstruction, which is promising for the clinical repair of esophageal defects.

  3. Esophageal Replacement in Children: Presentation of 18 Cases and Results of Their Surgical Procedure

    Directory of Open Access Journals (Sweden)

    S. Delshad

    2007-11-01

    Full Text Available Background:Esophageal replacement is indicated in certain circumstances including long gap esophageal atresia,severe strictures due to gastro-esophageal reflux (GER and caustic burns. We analyzed our results of 18 patients who underwent esophageal replacement in our university hospital. Methods:We reviewed esophageal replacements carried out in our department between June 1996 and August 2004.We report 18 patients(4 girls and 14 boys with ages ranging from 3.5 until 30 months.Fifteen patients had long gap atresia,two had strictures due to GER,and one case had caustic burn. Esophageal replacement was performed through an abdominal midline incision by one of three methods, namely: colon transposition in 15, gastric replacement in 2, and gastric tube in 1 case. Results: Leakage and stricture were the most common complications of esophageal replacement.Most deaths were due to aspiration pneumonia and congenital cardiac disease.Conclusion:Esophageal replacement has limited indications.It allows a good functional result,with adequate oral feeding and normal growth.

  4. Risk factors for esophageal candidiasis.

    Science.gov (United States)

    Chocarro Martínez, A; Galindo Tobal, F; Ruiz-Irastorza, G; González López, A; Alvarez Navia, F; Ochoa Sangrador, C; Martín Arribas, M I

    2000-02-01

    The role of gastric acid inhibitors as predisposing factors for Candida esophagitis is unknown. A retrospective case-control study of esophageal candidiasis was conducted in human immunodeficiency virus (HIV)-negative patients diagnosed from January 1991 to December 1997. The diagnosis of esophageal candidiasis was always made on the basis of endoscopic and histological criteria. Fifty-one patients were diagnosed with esophageal candidiasis, 15 of whom had esophageal complaints and 48 of whom suffered from another previous chronic disease (17 had cancer). In addition, 20 patients had previously been treated with antibiotics, 13 with steroids and 14 with omeprazole. In the multivariate analysis, neoplasm (odds ratio, 5.50; 95% confidence interval, 1.94-15.56) and therapy with antibiotics (odds ratio, 11.97; 95% confidence interval, 3.82-37.45), steroids (odds ratio, 35.52; 95% confidence interval, 3.90-324.01) or omeprazole (odds ratio, 18.23; 95% confidence interval, 4.67-71.03) were all associated with esophageal candidiasis. These data suggest that Candida esophagitis tends to occur in patients with chronic diseases, most of whom have been previously treated with antibiotics, steroids or omeprazole. The findings support the hypothesis that treatment with omeprazole favors the development of esophageal candidiasis.

  5. [Traumatic esophageal pseudodiverticulum (author's transl)].

    Science.gov (United States)

    Blesa, E; Olivares, P; Morales, C; Díez Pardo, J A; Monereo, J

    1975-01-01

    Hypoharyngeal perforation with production of an esophageal pseudodiverticulum in the newborn is reviewed. Two new cases are reported and the clinical signs, very similar to those of tracheoesophageal fistula with esophageal artresia, commented upon. The radiological findings of the lesion are discussed, and hints on conservative treatment, advanced.

  6. Hydronephrosis and renal failure following inadequate management of neuropathic bladder in a patient with spinal cord injury: Case report of a preventable complication

    Directory of Open Access Journals (Sweden)

    Vaidyanathan Subramanian

    2012-09-01

    Full Text Available Abstract Background Condom catheters are indicated in spinal cord injury patients in whom intravesical pressures during storage and voiding are safe. Unmonitored use of penile sheath drainage can lead to serious complications. Case report A 32-year old, male person, sustained complete paraplegia at T-11 level in 1985. He had been using condom catheter. Eleven years after sustaining spinal injury, intravenous urography showed no radio-opaque calculus, normal appearances of kidneys, ureters and bladder. Blood urea and Creatinine were within reference range. A year later, urodynamics revealed detrusor pressure of 100 cm water when detrusor contraction was initiated by suprapubic tapping. This patient was advised intermittent catheterisation and take anti-cholinergic drug orally; but, he wished to continue penile sheath drainage. Nine years later, this patient developed bilateral hydronephrosis and renal failure. Indwelling urethral catheter drainage was established. Five months later, ultrasound examination of urinary tract revealed normal kidneys with no evidence of hydronephrosis. Conclusion Spinal cord injury patients with high intravesical pressure should not have penile sheath drainage as these patients are at risk for developing hydronephrosis and renal failure. Intermittent catheterisation along with antimuscarinic drug should be the preferred option for managing neuropathic bladder.

  7. Invisible Threat In Sport Bag: Esophageal Obstruction Due To Aminoacid Tablets

    Directory of Open Access Journals (Sweden)

    Erhan Dedeoglu

    2013-10-01

    Full Text Available Although esophageal foreign bodies are mostly encountered in children, they also continue to constitute a life threatening problem in adults. Because of severe complications possibly to occur, esophageal foreign bodies should be extracted as soon as the diagnosis is made. A 30 year-old male patient who had a sense of blockage in the throat after taking two amino acid tablets and who was admitted to our emergency room and was discussed in this case report. In endoscopy performed with the initial diagnosis of esophageal foreign body, two attached tablets which completely obstruct lower lumen were removed immediately below the upper esophageal sphincter. In recent years, we wanted to share this case in order to express that increasing amino acid tablet usage will lead to serious complications.

  8. Gender effects on esophageal motility

    Directory of Open Access Journals (Sweden)

    Dantas R.O.

    1998-01-01

    Full Text Available It has been suggested that there are no gender effects on esophageal motility. However, in previous studies the subjects did not perform multiple swallows and the quantitative features of esophageal contractions were not evaluated. In order to investigate the gender effects on esophageal motility we studied 40 healthy normal volunteers, 20 men aged 37 ± 15 years (mean ± SD, and 20 women aged 38 ± 14 years. We used the manometric method with an eight-lumen polyvinyl catheter and continuous perfusion. The upper and lower esophageal sphincter pressures were measured by the rapid pull-through method. With the catheter positioned with one lumen opening in the lower esophageal sphincter, and the others at 5, 10 and 15 cm above the sphincter, ten swallows of a 5-ml water bolus alternated with ten dry swallows were performed. Statistical analysis was done by the Student t-test and Mann-Whitney test. Gender differences (P<0.05 were observed for wet swallows in the duration of contractions 5 cm above the lower esophageal sphincter (men: 3.7 ± 0.2 s, women: 4.5 ± 0.3 s, mean ± SEM, and in the velocity of contractions from 15 to 10 cm above the lower esophageal sphincter (men: 4.7 ± 0.3 cm/s, women: 3.5 ± 0.2 cm/s. There was no difference (P>0.05 in sphincter pressure, duration and percentage of complete lower esophageal sphincter relaxation, amplitude of contractions, or in the number of failed, multipeaked and synchronous contractions. We conclude that gender may cause some differences in esophageal motility which, though of no clinical significance, should be taken into consideration when interpreting esophageal motility tests.

  9. Amniotic fluid insulin and C-peptide as predictive markers for fetal macrosomia, birth injuries, and delivery complications?

    OpenAIRE

    Stein, Roland Gregor; Meinusch, Malgorzata; Diessner, Joachim; Dietl, Johannes; Hönig, Arnd; Zollner, Ursula

    2014-01-01

    Background Gestational diabetes mellitus (GDM) occurs in 3–5% of all pregnancies. GDM increases both maternal and fetal risks, causes fetal macrosomia, and hence increases the rates of caesarean sections and delivery complications such as shoulder dystocia. An early predictive marker and consequent early treatment could be beneficial, so amniotic fluid insulin and C-peptide have been examined in several studies. Increased amniotic fluid insulin in early amniocentesis between the 14th and 20th...

  10. Utility of esophageal gastroduodenoscopy at the time of percutaneous endoscopic gastrostomy in trauma patients

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    Scalea Thomas M

    2007-07-01

    Full Text Available Abstract Background The utility of esophagogastroduodenoscopy (EGD performed at the time of percutaneous endoscopic gastrostomy (PEG is unclear. We examined whether EGD at time of PEG yielded clinically useful information important in patient care. We also reviewed the outcome and complication rates of EGD-PEG performed by trauma surgeons. Methods Retrospective review of all trauma patients undergoing EGD with PEG at a level I trauma center from 1/01–6/03. Results 210 patients underwent combined EGD with PEG by the trauma team. A total of 37% of patients had unsuspected upper gastrointestinal lesions seen on EGD. Of these, 35% had traumatic brain injury, 10% suffered multisystem injury, and 47% had spinal cord injury. These included 15 esophageal, 61 gastric, and six duodenal lesions, mucosal or hemorrhagic findings on EGD. This finding led to a change in therapy in 90% of patients; either resumption/continuation of H2 -blockers or conversion to proton-pump inhibitors. One patient suffered an upper gastrointestinal bleed while on H2-blocker. It was treated endoscopically. Complication rates were low. There were no iatrogenic visceral perforations seen. Three PEGs were inadvertently removed by the patient (1.5%; one was replaced with a Foley, one replaced endoscopically, and one patient underwent gastric repair and open jejunostomy tube. One PEG leak was repaired during exploration for unrelated hemorrhage. Six patients had significant site infections (3%; four treated with local drainage and antibiotics, one requiring operative debridement and later closure, and one with antibiotics alone. Conclusion EGD at the time of PEG may add clinically useful data in the management of trauma patients. Only one patient treated with acid suppression therapy for EGD diagnosed lesions suffered delayed gastrointestinal bleeding. Trauma surgeons can perform EGD and PEG with acceptable outcomes and complication rates.

  11. Utility of esophageal gastroduodenoscopy at the time of percutaneous endoscopic gastrostomy in trauma patients

    Science.gov (United States)

    Haan, James M; Bochicchio, Grant V; Scalea, Thomas M

    2007-01-01

    Background The utility of esophagogastroduodenoscopy (EGD) performed at the time of percutaneous endoscopic gastrostomy (PEG) is unclear. We examined whether EGD at time of PEG yielded clinically useful information important in patient care. We also reviewed the outcome and complication rates of EGD-PEG performed by trauma surgeons. Methods Retrospective review of all trauma patients undergoing EGD with PEG at a level I trauma center from 1/01–6/03. Results 210 patients underwent combined EGD with PEG by the trauma team. A total of 37% of patients had unsuspected upper gastrointestinal lesions seen on EGD. Of these, 35% had traumatic brain injury, 10% suffered multisystem injury, and 47% had spinal cord injury. These included 15 esophageal, 61 gastric, and six duodenal lesions, mucosal or hemorrhagic findings on EGD. This finding led to a change in therapy in 90% of patients; either resumption/continuation of H2 -blockers or conversion to proton-pump inhibitors. One patient suffered an upper gastrointestinal bleed while on H2-blocker. It was treated endoscopically. Complication rates were low. There were no iatrogenic visceral perforations seen. Three PEGs were inadvertently removed by the patient (1.5%); one was replaced with a Foley, one replaced endoscopically, and one patient underwent gastric repair and open jejunostomy tube. One PEG leak was repaired during exploration for unrelated hemorrhage. Six patients had significant site infections (3%); four treated with local drainage and antibiotics, one requiring operative debridement and later closure, and one with antibiotics alone. Conclusion EGD at the time of PEG may add clinically useful data in the management of trauma patients. Only one patient treated with acid suppression therapy for EGD diagnosed lesions suffered delayed gastrointestinal bleeding. Trauma surgeons can perform EGD and PEG with acceptable outcomes and complication rates. PMID:17615081

  12. Rare cause of odynophagia: Giant esophageal ulcer.

    Science.gov (United States)

    Veroux, Massimiliano; Aprile, Giuseppe; Amore, Francesca F; Corona, Daniela; Giaquinta, Alessia; Veroux, Pierfrancesco

    2016-04-14

    Gastrointestinal complications are a frequent cause of morbidity after transplantation and may affect up to 40% of kidney transplant recipients. Here we report a rare case of idiopathic giant esophageal ulcer in a kidney transplant recipient. A 37-year-old female presented with a one-week history of odynophagia and weight loss. Upon admission, the patient presented cold sores, and a quantitative cytomegalovirus polymerase chain reaction was positive (10(5) copies/mL). An upper endoscopy demonstrated the presence of a giant ulcer. Serological test and tissue biopsies were unable to demonstrate an infectious origin of the ulcer. Immunosuppression was reduced and everolimus was introduced. An empirical i.v. therapy with acyclovir was started, resulting in a dramatic improvement in symptoms and complete healing of the ulcer. Only two cases of idiopathic giant esophageal ulcer in kidney transplant recipients have been reported in the literature; in both cases, steroid therapy was successful without recurrence of symptoms or endoscopic findings. However, this report suggests that correction of immune imbalance is mandatory to treat such a rare complication.

  13. Urethral Injuries

    Science.gov (United States)

    ... include pelvic fractures and straddle injuries to the perineum. The perineum is the area between the anus and the ... tissues of the penis, scrotum, abdominal wall, or perineum. Complications that can result from urethral injuries include ...

  14. Fulminant Epstein-Barr virus - infectious mononucleosis in an adult with liver failure, splenic rupture, and spontaneous esophageal bleeding with ensuing esophageal necrosis: a case report.

    Science.gov (United States)

    Busch, Daniel; Hilswicht, Sarah; Schöb, Dominik S; von Trotha, Klaus T; Junge, Karsten; Gassler, Nikolaus; Truong, Son; Neumann, Ulf P; Binnebösel, Marcel

    2014-02-05

    Infectious mononucleosis is a clinical syndrome most commonly associated with primary Epstein-Barr virus infection. The majority of patients with infectious mononucleosis recovers without apparent sequelae. However, infectious mononucleosis may be associated with several acute complications. In this report we present a rare case of esophageal rupture that has never been described in the literature before. We present the case of an 18-year-old Caucasian man affected by severe infectious mononucleosis complicated by fulminant hepatic failure, splenic rupture and esophageal necrosis. Although primary Epstein-Barr virus infection is rarely fatal, fulminant infection may occur - in this case leading to hepatic failure, splenic rupture and esophageal necrosis, subsequently making several surgical interventions necessary. We show here that infectious mononucleosis is not only a strictly medical condition, but can also lead to severe surgical complications.

  15. Imaging of Esophageal Tuberculosis

    Energy Technology Data Exchange (ETDEWEB)

    Nagi, B.; Kochhar, R.; Bhasin, D.K.; Singh, K. [PGIMER, Chandigarh (India). Dept. of Gastroenterology; Lal, A.; Gulati, M.; Suri, S. [PGIMER, Chandigarh (India). Dept. of Radiodiagnosis

    2003-05-01

    Purpose: To evaluate the various radiological abnormalities in patients with proven esophageal tuberculosis. Material and Methods: The case records of 23 patients with proven esophageal tuberculosis were evaluated retrospectively for various radiological abnormalities. Twenty-two patients had secondary involvement of esophagus in the form of direct extension of mediastinal and pulmonary tuberculosis or spinal tuberculosis. Only 1 patient had primary involvement of the esophagus with no evidence of disease elsewhere. The diagnosis was confirmed by endoscopic and CT-guided biopsy/aspiration cytology in 7 and 6 cases, respectively. Diagnosis was made on the basis of surgical biopsy of lymph node and autopsy in 1 patient each. In the remaining 8 patients the diagnosis was based on radiological and endoscopic findings and the response to antituberculous treatment. Results: Chest radiography (CXR) was abnormal in 65% patients. While the findings were non-conclusive for esophageal tuberculosis, characteristic lesions of tuberculosis in lungs or spine were suggestive of tuberculous etiology. In 15 patients, CT of the chest confirmed the corresponding CXR findings and also showed additional findings of mediastinal lymphadenopathy when CXR was normal. Fourteen patients showed mediastinal lymphadenopathy on CT of the chest. In all these patients, more than one group of lymph nodes was involved. The characteristic hypodense center of lymph nodes suggestive of tuberculosis was seen in 12 patients. Radiological abnormalities seen in barium swallow examination were extrinsic compression, traction diverticula, strictures, sinus/fistulous tracts, kinking and pseudotumor mass of esophagus in decreasing order of frequency. The middle third of the esophagus was found to be the most frequent site of involvement.

  16. Laparoscopic surgery of esophageal hiatus hernia - single center experience.

    Science.gov (United States)

    Piątkowski, Jacek; Jackowski, Marek; Szeliga, Jacek

    2014-03-01

    Esophageal hiatal hernias are the most frequent types of internal hernias. This condition involves disturbance of normal functioning of the stomach cardiac mechanism and reflux of the gastric contents to the esophagus. To evaluate postoperative results in our Clinic and the comparison of these results to data from the literature. One hundred and seventy-eight patients underwent surgery due to esophageal hiatal hernia at the Clinic of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland, from 2006 to 2011. All operations were performed using laparoscopy. Fundoplication by means of the Nissen-Rossetti method was carried out in 172 patients while Toupet's and Dor's methods were applied in 4 and 2 patients, respectively. Average time of the surgery was 82 min (55-140 min). Conversion was performed in 4 cases. No serious intraoperative complications were noted. In the postoperative period, dysphagia was reported in 20 patients (11.2%). Postoperative wound infection was observed in 1 patient (0.56%). Hernias in the trocar insertion area were reported in 3 patients (1.68%). Ailments recurred in 6 patients. The recurrence of esophageal hiatal hernia was confirmed in 2 patients. Patients with recurrent hernia were re-operated using a laparoscopic approach. Laparoscopic surgery is a simple and effective approach for patients with gastroesophageal reflux symptoms due to diaphragmatic esophageal hiatus hernia. The number of complications is lower after laparoscopic procedures than after "open" operations.

  17. Long Standing Esophageal Perforation due to Foreign Body Impaction in Children: A Therapeutic Challenge in a Resource Limited Setting

    Directory of Open Access Journals (Sweden)

    Ngo Nonga Bernadette

    2017-01-01

    Full Text Available Late presentation of foreign body impaction in the esophagus, complicated by perforation in children, has rarely been reported in the literature. Esophageal surgery is very difficult and challenging in Cameroon (a resource limited setting. We are reporting herein 2 cases of esophageal perforation in children seen very late (12 days and 40 days after foreign body impaction, complicated with severe sepsis, who were successfully operated upon with very good results.

  18. Fungal urinary tract infection complicated by acute kidney injury in an infant with intestino-vesical fistula

    Directory of Open Access Journals (Sweden)

    Anna Jakubowska

    2013-08-01

    Full Text Available We report one infant, who in the course of therapy of bacterial urinary tract infection developed fungal UTI and acute kidney injury. It was caused by coexistence of well-known risk factors and additionally intestino-vesical fistula. Appropriate and timely introduced treatment with intravenous fluconazole proved to be therapeutic in the patient. Our report shows that in every case detailed analysis of predisposing factors should be performed and appropriate diagnostic studies ordered, including the possible presence of other – less common – factors, e.g. defects in the gastrointestinal tract.

  19. Fungal urinary tract infection complicated by acute kidney injury in an infant with intestino-vesical fistula.

    Science.gov (United States)

    Jakubowska, Anna; Kiliś-Pstrusińska, Katarzyna; Pukajło-Marczyk, Agnieszka; Samir, Sandra; Bagłaj, Maciej; Zwolińska, Danuta

    2013-08-02

    We report one infant, who in the course of therapy of bacterial urinary tract infection developed fungal UTI and acute kidney injury. It was caused by coexistence of well-known risk factors and additionally intestino-vesical fistula. Appropriate and timely introduced treatment with intravenous fluconazole proved to be therapeutic in the patient. Our report shows that in every case detailed analysis of predisposing factors should be performed and appropriate diagnostic studies ordered, including the possible presence of other - less common - factors, e.g. defects in the gastrointestinal tract.

  20. Pancolitis with Ischemic Injury as a Complication of Immunosuppressive Treatment in a Patient with Autoimmune Hepatitis: A Case Report

    Directory of Open Access Journals (Sweden)

    A. Dalbeni

    2012-01-01

    Full Text Available Ischemic colitis is a serious drug-induced adverse event. There are only few cases of immunosuppression-associated ischemic colitis described in the literature, but none with a pancolitis-like manifestation. We report the case of a 72-year-old female patient who developed a pancolitis with ischemic injury on immunosuppressive treatment with steroids and azathioprine for autoimmune hepatitis. The patient presented with massive rectal bleeding. Colonoscopy confirmed the diagnosis of pancolitis. The results of histological examination indicated drug-induced ischemic colitis involving the entire colon. This is the first case of ischemic pancolitis mimicking an inflammatory bowel disease (IBD in a patient with immunosuppressive therapy.

  1. [Effect of aluminum phosphate gel and Kangfuxin on esophageal pathology and IL-8 and PGE2 expressions in a rat model of reflux esophagitis].

    Science.gov (United States)

    Lin, Hai-Ling; Li, Guo-Jian; Wu, Ji-Zhou

    2015-04-01

    To explore the effect of aluminum phosphate gel and Kangfuxin on esophageal pathology and expressions of interleukin-8 (IL-8) and prostaglandin E2 (PGE2) in rats with reflux esophagitis and explore the possible mechanisms. Sixty SD rats were randomized into aluminum phosphate gel group (n=10), Kangfuxin group (n=10), aluminum phosphate gel+Kangfuxin group (n=10), model group (n=20), and control group (n=10). Except for those in the control group, all the rats were subjected to infusion of diluted lysolecithin with hydrochloric acid in the esophagus for 14 days. Ten rats in the model group and those in the control group were sacrificed to examine the pathological changes and contents of IL-8 and PGE2 in the esophagus using optical and electron microscopes and radioimmunoassay. The next day the rest rats were given corresponding treatments (saline in model group) administered into the esophagus on a daily basis for 14 days, after which esophageal pathologies and IL-8 and PGE2 contents were examined. The model rats showed obvious esophageal pathologies including inflammatory cell infiltration, vacuolar degeneration of the epithelial cells, esophageal erosion and even ulceration, with severe detachment of the epithelial cells. The rats in all the intervention groups showed lessened esophageal pathologies and lowered esophageal IL-8 and PGE2 contents compared with those in the model group. Esophageal mucosal injury index and IL-8 and PGE2 contents were all significantly lower in rats receiving combined treatment with aluminum phosphate and Kangfuxin than in those receiving either of the treatments (Paluminum phosphate gel are effective in the treatment for reflux esophagitis induced by lysolecithin and hydrochloric acid, and their therapeutic effects are achieved possibly by reducing IL-8 and PGE2 levels in the esophagus.

  2. Esophageal Ulcer as a Cause of Death: A Population-Based Study. Mortality of Esophageal Ulcer Disease.

    Science.gov (United States)

    Rantanen, Tuomo K; Sihvo, Eero I T; Räsänen, Jari V; Hynninen, Marja; Salo, Jarmo A

    2015-01-01

    This study aimed at defining the mortality and the nature of fatal complications that arise out of esophageal ulcer for one clearly defined geographical area. In this national, population-based study, the occurrence of fatal esophageal ulcer or ulcer requiring hospital treatment between January 1987 and December 2000 was assessed by the use of Finland's administrative databases. Medical records provided etiology of fatal ulcer and agonal symptoms. Due to an esophageal ulcer, 2,242 patients received treatment in Finnish hospitals, at an annual frequency of 3.2/100,000. Ulcer with hemorrhage (53.5%), perforation (38.4%), or aspiration pneumonia (2.3%) was the cause of death in 86 patients for an annual mortality of 0.12/100,000. Based on the number of ulcers treated, 3.8% cases ended fatally. Gastroesophageal reflux disease (GERD) seemed to be the etiologic factor for ulcer in 68 (79.0%) patients. The most common agonal symptoms were hematemesis (41.8%), abdominal pain (25.6%), melaena (22.1%), and dyspnea (17.4%). Twenty (23.3%) patients were found dead at home. The rarity of the disease, related disorders, and the diversity of symptoms make the complicated esophageal ulcer a diagnostic challenge. Effective monitored treatment for severe GERD may be an important step to prevent fatal outcome.

  3. Esophageal cancer: a historical perspective.

    Science.gov (United States)

    Eslick, Guy D

    2009-03-01

    The history of esophageal cancer dates back to ancient Egyptian times, circa 3000 bc. Since then, the progress in the diagnosis and treatment of esophageal cancer has been steady. Over the last few centuries there have been advancements in the visualization and removal of these lesions, but with no real overall impact on survival rates. The twenty-first century is the time to make major progress in not only improving survival rates, but also in diagnosing esophageal cancer in the very early stages.

  4. Safety of dilation in adults with eosinophilic esophagitis.

    Science.gov (United States)

    Ally, M R; Dias, J; Veerappan, G R; Maydonovitch, C L; Wong, R K; Moawad, F J

    2013-04-01

    Esophageal dilation is an effective therapy for dysphagia in patients with stenosing eosinophilic esophagitis (EoE). Historically, there have been significant concerns of increased perforation rates when dilating EoE patients. More recent studies suggest that improved techniques and increased awareness have decreased complication rates. The aim of this study was to explore the safety of dilation in our population of EoE patients. A retrospective review of all adult EoE patients enrolled in a registry from 2006 to 2010 was performed. All patients who underwent esophageal dilation during this time period were identified and included in the analysis. Our hospital inpatient/outpatient medical records, radiology reports, and endoscopy reports were searched for evidence of any complication following dilation. Perforation, hemorrhage, and hospitalization were identified as a major complication, and chest pain was considered a minor complication. One hundred and ninety-six patients (41 years [12]; mean age [standard deviation], 80% white, 85% male) were identified. In this cohort, 54 patients (28%) underwent 66 total dilations (seven patients underwent two dilations, one patient underwent three dilations, and one patient underwent four dilations). Three dilation techniques were used (Maloney [24], Savary [29] and through-the-scope [13]). There were no major complications encountered. Chest pain was noted in two patients (4%). There were no endoscopic features (rings, furrows, plaques) associated with any complication. Type of dilator, size of dilator, number of prior dilations, and age of patient were also not associated with complications. Endoscopic dilation using a variety of dilators can be safely performed with minimal complications in patients with EoE. Published 2012. This article is a U.S. Government work and is in the public domain in the USA.

  5. Esophageal Motility Disorders: Current Concepts of Pathogenesis and Treatment

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    Peter J Kahrilas

    2000-01-01

    Full Text Available Current concepts of esophageal motility disorders are summarized. Primary data sources were located via MEDLINE or cross-citation. No attempt was made to be comprehensive or inclusive of the literature because fewer than 10% of citations are discussed. Instead, emphasis was placed on new developments in diagnosis, therapeutics, and practice patterns. Controlled therapeutic trials and pathophysiological observations are emphasized. Achalasia is a rare disease of failed lower sphincter relaxation and aperistalsis. Diffuse esophageal spasm (DES, an equally rare disease, is defined by non-propagated esophageal contractions. Nonspecific motility disorders, including nutcracker esophagus and hypertensive lower esophageal sphincter, are identified only by manometry and are ten times as prevalent. Neuromuscular pathology is evident only with achalasia (myenteric plexus neurons destruction. Pharmacological therapies have limited efficacy with achalasia; more limited with DES; and none with the nonspecific motility disorders. More efficacious therapies for the nonspecific disorders are directed at associated reflux disease or psychiatric disorders. Pneumatic dilation is effective therapy for achalasia 72% of instances, but frequently requires repeat dilation and is complicated by a 3% perforation rate. Surgical myotomy is effective in 88% of achalasics; morbidity from thoracotomy has been the major limitation but this has been sharply reduced with a laparoscopic approach. In conclusion, although it has been suggested that esophageal motility disorders are distinct clinical entities, critical review of the literature supports this only in the case of achalasia, a disease of well defined pathophysiology, functional disturbance, and therapies. This clarity diminishes progressively for DES and non-specific esophageal motility disorders.

  6. Esophageal dysmotility in children with eosinophilic esophagitis: a study using prolonged esophageal manometry.

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    Nurko, Samuel; Rosen, Rachel; Furuta, Glenn T

    2009-12-01

    The pathophysiology of dysphagia in patients with eosinophilic esophagitis (EoE) is unknown but may be related to abnormal esophageal motor function. Symptoms rarely occur during stationary esophageal manometry, so it has been difficult to establish an association between symptoms and motor events. Our aim was to evaluate esophageal motor function in children with EoE with the use of stationary manometry and ambulatory prolonged esophageal manometry and pH-metry (PEMP). PEMP was performed in children with EoE and compared with controls and children with gastroesophageal reflux disease (GERD). Peristalsis was considered effective when the esophageal contractions had a normal amplitude and propagation. Results are expressed as mean+/-s.e. Seventeen patients with EoE, 13 with GERD, and 11 controls were studied. Values are expressed as mean+/-s.e. Stationary manometry identified abnormal peristalsis in 41% of children with EoE. During PEMP, children with EoE had an increased number of isolated (16.7+/-3.8 vs. 9.5+/-1.6 vs. 6.5+/-1.1; Pchildren with GERD and controls. Thirteen patients with EoE experienced 21 episodes of dysphagia, and all correlated with simultaneous abnormal motor function. PEMP allowed the detection of ineffective peristalsis in children with EoE. Symptoms observed in children with EoE may be related to esophageal motor dysfunction.

  7. ESOPHAGEAL DYSMOTILITY IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS. A STUDY USING PROLONGED ESOPHAGEAL MANOMETRY

    Science.gov (United States)

    Nurko, Samuel; Rosen, Rachel; Furuta, Glenn T.

    2010-01-01

    Background The pathophysiology of dysphagia in patients with eosinophilic esophagitis (EoE) is unknown, but may be related to abnormal esophageal motor function. Symptoms rarely occur during stationary esophageal manometry so it has been difficult to establish an association between symptoms and motor events. Aim To evaluate esophageal motor function in children with EoE with the use of stationary manometry and ambulatory prolonged esophageal manometry and pH-metry (PEMP) Methods PEMP was performed in children with EoE, compared with controls and children with GERD. Effective peristalsis was considered when the esophageal contractions had a normal amplitude and propagation. Results expressed as mean ± S.E. Results Seventeen patients with EoE, 13 with GERD and 11 controls were studied. Values are expressed as mean ± se. Stationary manometry identified abnormal peristalsis in 41% of children with EoE. During PEMP, children with EoE had an increased number of isolated (16.7 ± 3.8 vs 9.5 ± 1.6 vs 6.5 ± 1.1 ; pchildren with GERD and controls. Thirteen patients with EoE experienced 21 episodes of dysphagia and all correlated with simultaneous abnormal motor function. Conclusions PEMP allowed the detection of ineffective peristalsis in children with EoE. Symptoms observed in children with EoE may be related to esophageal motor dysfunction. PMID:19755968

  8. Esophageal cancer in esophageal diverticula associated with achalasia.

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    Choi, Ah Ran; Chon, Nu Ri; Youn, Young Hoon; Paik, Hyo Chae; Kim, Yon Hee; Park, Hyojin

    2015-01-01

    The simultaneous occurrence of achalasia and esophageal diverticula is rare. Here, we report the case of a 68-year-old man with multiple esophageal diverticula associated with achalasia who was later diagnosed with early esophageal cancer. He initially presented with dysphagia and dyspepsia, and injection of botulinum toxin to the lower esophageal sphincter relieved his symptoms. Five years later, however, the patient presented with worsening of symptoms, and esophagogastroduodenoscopy (EGD) was performed. The endoscopic findings showed multifocal lugol-voiding lesions identified as moderate dysplasia. We decided to use photodynamic therapy to treat the multifocal dysplastic lesions. At follow-up EGD 2 months after photodynamic therapy, more lugol-voiding lesions representing a squamous cell carcinoma in situ were found. The patient ultimately underwent surgery for the treatment of recurrent esophageal multifocal neoplasia. After a follow-up period of 3 years, the patient showed a good outcome without symptoms. To manage premalignant lesions such as achalasia with esophageal diverticula, clinicians should be cautious, but have an aggressive approach regarding endoscopic surveillance.

  9. Correlation Between Esophageal Varices and Lok Score as a Non-invasive Parameter in Liver Cirrhosis Patients

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    Iqbal Sungkar

    2016-09-01

    Full Text Available Bleeding from gastro-esophageal varices is the most serious and life-threatening complication of cirrhosis. Endoscopic surveillance of esophageal varices in cirrhotic patients is expensive and uncomfortable for the patients. Therefore, there is a particular need for non-invasive predictors for esophageal varices. The aim of the present study was to evaluate association of esophageal varices and Lok Score as non-invasive parameter in liver cirrhosis patients. This is a cross-sectional study of patients admitted at the Adam Malik hospital Medan between September to December 2014 with a diagnosis of cirrhosis based on clinical, biochemical examination, ultrasound, and gastroscopy. Lok Score was calculated for all patients, tabulated and analyzed. Among 76 patients with esophageal varices, 55.3% was due to hepatitis B virus (HBV. The majority of patients were Child C with only 13,2% being Child Pugh class A. Majority of the population had F2 esophageal varices (42.1%, F1 (32.9%, and F3 (25%. There is significance difference between Lok Score and grading of esophageal varices, in which Lok Score is higher in large esophageal varices compared with small esophageal varises (0.92 ± 0.14 vs. 0.70 ± 0.29; p = 0.001. Lok Score with cut-off point of > 0.9141 was highly predictive in the diagnosis large esophageal varices with a sensitivity of 74.5%, specificity of 72%, positive predictive value of 84%, negative predictive value 58%, and accuracy was 73.7%. Lok Score was significantly associated with esophageal varices. Lok Score is a good non-invasive predictor of large esophageal varices in cirrhotic patients.

  10. Hedgehog signaling regulates FOXA2 in esophageal embryogenesis and Barrett’s metaplasia

    Science.gov (United States)

    Wang, David H.; Tiwari, Anjana; Kim, Monica E.; Clemons, Nicholas J.; Regmi, Nanda L.; Hodges, William A.; Berman, David M.; Montgomery, Elizabeth A.; Watkins, D. Neil; Zhang, Xi; Zhang, Qiuyang; Jie, Chunfa; Spechler, Stuart J.; Souza, Rhonda F.

    2014-01-01

    Metaplasia can result when injury reactivates latent developmental signaling pathways that determine cell phenotype. Barrett’s esophagus is a squamous-to-columnar epithelial metaplasia caused by reflux esophagitis. Hedgehog (Hh) signaling is active in columnar-lined, embryonic esophagus and inactive in squamous-lined, adult esophagus. We showed previously that Hh signaling is reactivated in Barrett’s metaplasia and overexpression of Sonic hedgehog (SHH) in mouse esophageal squamous epithelium leads to a columnar phenotype. Here, our objective was to identify Hh target genes involved in Barrett’s pathogenesis. By microarray analysis, we found that the transcription factor Foxa2 is more highly expressed in murine embryonic esophagus compared with postnatal esophagus. Conditional activation of Shh in mouse esophageal epithelium induced FOXA2, while FOXA2 expression was reduced in Shh knockout embryos, establishing Foxa2 as an esophageal Hh target gene. Evaluation of patient samples revealed FOXA2 expression in Barrett’s metaplasia, dysplasia, and adenocarcinoma but not in esophageal squamous epithelium or squamous cell carcinoma. In esophageal squamous cell lines, Hh signaling upregulated FOXA2, which induced expression of MUC2, an intestinal mucin found in Barrett’s esophagus, and the MUC2-processing protein AGR2. Together, these data indicate that Hh signaling induces expression of genes that determine an intestinal phenotype in esophageal squamous epithelial cells and may contribute to the development of Barrett’s metaplasia. PMID:25083987

  11. Drugs Approved for Esophageal Cancer

    Science.gov (United States)

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) for esophageal cancer. The list includes generic names and brand names. The drug names link to NCI's Cancer Drug Information summaries.

  12. Definitive management of isolated esophageal atresia: Experience at NICH Karachi

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    Jan Iftikhar

    2006-01-01

    Full Text Available Background: Definitive treatment of isolated esophageal atresia (IEA is still controversial. A study was conducted to review cases of IEA in our department with a view to evaluate the long term results of definitive surgery in these patients. Materials and Methods: Nine consecutive patients with IEA were included in the study. All babies initially underwent cervical esophagostomy and feeding gastrostomy. One baby also had anorectal atresia and needed a colostomy. In 6 babies, end esophagostomy was performed while in 3 babies, lateral esophagostomy was performed. Of the 6 babies with end esophagostomy, two underwent jejunal Interpositioning, two had serial extra-thoracic lengthening and two reverse gastric tube interpositiong. Three babies with lateral esophagostomy were planned for delayed primary repair. Results: Both babies with jejunal interpositiong initially did well; serious gastro-esophageal reflux occurred in one baby who needed antireflux surgery. At 6 years follow-up both children had redundant Jejunum. Recurrent Respiratory tract infection remained a problem in one child while other is doing well. Of the two babies with extrathoracic lengthening it was possible to perform end to end anastomosis in one baby but in the other extrathoracic lengthening did not work and gastric transpositioning was performed. Of the two babies with reverse gastric tube interpositioning one developed esophageal stenosis at the site of anastomosis and is on serial dilatations. Other died due to anastomotic leak and mediastinitis. In all the three babies with lateral esophagostomy spontaneous lengthening of esophagus was noted. End to end anastomosis was possible in two of these babies who are doing well. One is waiting definitive surgery. Number of complications, hospital stay and cost of surgery was least in patients with lateral esophagostomy. Conclusion: Various methods of definitive treatment have been proposed for isolated esophageal atresia but each

  13. Treatment of Metformin Intoxication Complicated by Lactic Acidosis and Acute Kidney Injury: The Role of Prolonged Intermittent Hemodialysis.

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    Regolisti, Giuseppe; Antoniotti, Riccardo; Fani, Filippo; Greco, Paolo; Fiaccadori, Enrico

    2017-08-01

    Metformin intoxication with lactic acidosis, a potentially lethal condition, may develop in diabetic patients when the drug dose is inappropriate and/or its clearance is reduced. Diagnosis and therapy may be delayed due to nonspecific symptoms at presentation, with severe anion gap metabolic acidosis and elevated serum creatinine values being the most prominent laboratory findings. Confirmation requires measurement of serum metformin by high-performance liquid chromatography-tandem mass spectrometry, but this technique is available only at specialized institutions and cannot be relied on as a guide to immediate treatment. Thus, based on strong clinical suspicion, renal replacement therapy must be started promptly to achieve efficient drug clearance and correct the metabolic acidosis. However, because metformin accumulates in the intracellular compartment with prolonged treatment, a rebound in serum concentrations due to redistribution is expected at the end of dialysis. We report a case of metformin intoxication, severe lactic acidosis, and acute kidney injury in a diabetic patient with pre-existing chronic kidney disease stage 3, treated effectively with sustained low-efficiency dialysis. We discuss the pathophysiology, differential diagnosis, and treatment options and highlight specific pharmacokinetic issues that should be considered in selecting the appropriate modality of renal replacement therapy. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  14. Radiation-induced esophagitis in lung cancer

    Science.gov (United States)

    Baker, Sarah; Fairchild, Alysa

    2016-01-01

    Radiation-induced esophagitis is the most common local acute toxicity of radiotherapy (RT) delivered for the curative or palliative intent treatment of lung cancer. Although concurrent chemotherapy and higher RT dose are associated with increased esophagitis risk, advancements in RT techniques as well as adherence to esophageal dosimetric constraints may reduce the incidence and severity. Mild acute esophagitis symptoms are generally self-limited, and supportive management options include analgesics, acid suppression, diet modification, treatment for candidiasis, and maintenance of adequate nutrition. Esophageal stricture is the most common late sequela from esophageal irradiation and can be addressed with endoscopic dilatation. Approaches to prevent or mitigate these toxicities are also discussed. PMID:28210168

  15. Sucralfate versus cimetidine in the treatment of reflux esophagitis in children.

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    Argüelles-Martin, F; Gonzalez-Fernandez, F; Gentles, M G

    1989-06-09

    Peptic esophagitis is a common complication of gastroesophageal reflux. Therapeutic measures aimed at reinforcing the anti-gastroesophageal reflux barrier, reducing acid secretion, or increasing the defense mechanisms of the esophageal mucosa are used to treat this form of esophagitis. The purpose of this study was to determine the efficacy of sucralfate in the treatment of peptic esophagitis in children. We studied 75 patients diagnosed endoscopically as suffering from esophagitis. The age of the patients ranged from three months to 13 years. Gastroesophageal reflux was diagnosed by isotopic investigation and/or radiologically. None of the patients had kidney disease or had received anti-inflammatory drugs, sucralfate, or cimetidine during the preceding two weeks. The patients were divided into three groups of 25. Patients were homogeneous in age, sex, nutritional status, symptoms, and grade of esophagitis. All patients in each group were treated with cimetidine, sucralfate tablets, or sucralfate suspension. No other dietary or postural measures were prescribed. Clinical examinations were carried out on Days 14, 28, 42, and 56, with an endoscopic examination on Day 28. Endoscopy was repeated on Day 56 if the course was unsatisfactory. Statistical examination of the data showed that there were no differences between the three groups. Sucralfate is a useful drug for the treatment of peptic esophagitis in children.

  16. Genetics of Eosinophilic Esophagitis

    Science.gov (United States)

    2012-03-01

    in Table 2. SNP CHR BP Alleles Gene Location Left gene Right gene P -values OR rs12642902 4 123727951 A/G NA NA IL2 IL21 0.02 1.27 rs6835745 4...123730462 G/T NA NA IL2 IL21 0.04 1.25 rs975405 4 123740630 C/T IL21 intron IL2 LOC729338 0.04 1.23 CCHMC EE (n=226) vs. CHOP controls (n=316) Table 2...variants for celiac disease in the IL2 /IL21 locus are associated with eosinophilic esophagitis. J Allergy Clin Immunol. Feb2010;125(2)Supplement 1:AB160

  17. High-resolution esophageal pressure topography for esophageal motility disorders

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    Hashem Fakhre Yaseri

    2016-04-01

    Full Text Available Background: High-resolution manometer (HRM of the esophagus has become the main diagnostic test in the evaluation of esophageal motility disorders. The development of high-resolution manometry catheters and software displays of manometry recordings in color-coded pressure plots have changed the diagnostic assessment of esophageal disease. The first step of the Chicago classification described abnormal esophagogastric junction deglutitive relaxation. The latest classification system, proposed by Pandolfino et al, includes contraction patterns and peristalsis integrity based on integrated relaxation pressure 4 (IRP4. It can be discriminating the achalasia from non-achalasia esophageal motility disorders. The aim of this study was to assessment of clinical findings in non-achalasia esophageal motility disorders based on the most recent Chicago classification. Methods: We conducted a prospective cross-sectional study of 963 patients that had been referred to manometry department of Gastrointestinal and Liver Research Center, Firozgar Hospital, Tehran, Iran, from April, 2012 to April, 2015. They had upper GI disorder (Dysphasia, non-cardiac chest pain, regurgitation, heartburn, vomiting and asthma and weight loss. Data were collected from clinical examinations as well as patient questionnaires. Manometry, water-perfused, was done for all patients. Manometry criteria of the patients who had integrated relaxation pressure 4 (IRP4 ≤ 15 mmHg were studied. Results: Our finding showed that the non-achalasia esophageal motility disorders (58% was more common than the achalasia (18.2%. Heartburn (68.5%, regurgitation (65.4% and non-cardiac chest pain (60.6% were the most common clinical symptoms. Although, vomiting (91.7% and weight loss (63% were the most common symptoms in referring patients but did not discriminate this disorders from each other’s. Borderline motor function (67.2% was the most common, absent peristalsis (97% and the hyper

  18. Cloxacillin: A New Cause of Pill-Induced Esophagitis

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    Petros Zezos

    2016-01-01

    Full Text Available A large variety of medications can cause pill-induced esophagitis. Herein we present a case of cloxacillin-induced esophagitis. A 66-year-old male presented with an acute onset of epigastric and retrosternal pain on the 5th day of a course of oral cloxacillin prescribed for erysipelas. Initial clinical and imaging assessment was negative and he was sent home. A few days later, he returned with persistent severe retrosternal pain; endoscopy at the same day revealed a normal upper esophagus, several small stellate erosions in the midesophagus, and a normal squamocolumnar junction with a small hiatus hernia. Treatment with esomeprazole 40 mg bid and MucaineR suspension resulted in complete resolution of his symptoms. Pill-induced esophagitis may be underreported by patients, when symptoms are mild and unrecognized and/or underdiagnosed by the clinicians as a cause of retrosternal pain, odynophagia, or dysphagia. Failure of early recognition may result in unnecessary diagnostic investigations and prolongation of the patient’s discomfort. This case signifies the importance of enhancing clinician awareness for drug-associated esophageal injury when assessing patients with retrosternal pain, as well as the value of prophylaxis against this unpleasant condition by universally recommending drinking enough water in an upright position during ingestion of any oral medication.

  19. Cloxacillin: A New Cause of Pill-Induced Esophagitis.

    Science.gov (United States)

    Zezos, Petros; Harel, Ziv; Saibil, Fred

    2016-01-01

    A large variety of medications can cause pill-induced esophagitis. Herein we present a case of cloxacillin-induced esophagitis. A 66-year-old male presented with an acute onset of epigastric and retrosternal pain on the 5th day of a course of oral cloxacillin prescribed for erysipelas. Initial clinical and imaging assessment was negative and he was sent home. A few days later, he returned with persistent severe retrosternal pain; endoscopy at the same day revealed a normal upper esophagus, several small stellate erosions in the midesophagus, and a normal squamocolumnar junction with a small hiatus hernia. Treatment with esomeprazole 40 mg bid and Mucaine(R) suspension resulted in complete resolution of his symptoms. Pill-induced esophagitis may be underreported by patients, when symptoms are mild and unrecognized and/or underdiagnosed by the clinicians as a cause of retrosternal pain, odynophagia, or dysphagia. Failure of early recognition may result in unnecessary diagnostic investigations and prolongation of the patient's discomfort. This case signifies the importance of enhancing clinician awareness for drug-associated esophageal injury when assessing patients with retrosternal pain, as well as the value of prophylaxis against this unpleasant condition by universally recommending drinking enough water in an upright position during ingestion of any oral medication.

  20. Urological complications of coitus.

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    Eke, N

    2002-02-01

    To ascertain the urological complications of coitus, as the proximity of the lower urinary tract to the organs of coitus exposes the tract to coital trauma. Medline was searched from 1966 to 2000 to identify reports on coital injuries. Publications and relevant references were retrieved. Those reporting urological complications were selected for analysis. In all, 1454 cases of reported coital injuries were reviewed; 790 occurred in men while 664 occurred in women, mainly in the genital area. Physical urological complications were more common in men than in women. The injuries were often sustained during voluntary coitus, but one penile fracture was sustained during an attempted rape. The presentations included penile swellings and deviations, haemorrhage, erectile dysfunction and urinary incontinence. Complications included vesicovaginal fistulae, bladder and cavernosal ruptures, and urinary tract infections. Rare complications included isolated rupture of the penile vasculature. Major risk factors included penovaginal disproportion, excessive force at coitus, urethral coitus, fellatio and anal intercourse. Urethral injuries were the commonest complications; in men these were associated with 10-38% of penile fractures. The treatments included cold compress and anti-inflammatory agents in contusions, repairs of lacerations, closure of fistulae and urethral and vaginal reconstruction. The results of treatment were essentially good. Recurrent penile fractures were reported. Coitus, although pleasurable, may be risky. The complications have been termed 'faux pas' implying that they are preventable. While the ultimate prevention is abstinence, this is an unrealistic prescription. Therefore, efforts are necessary to identify risk factors to enable preventive strategies.

  1. Primary esophageal melanoma: report of a case

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    Laura Granel-Villach

    Full Text Available Introduction: Primary malignant melanoma of the esophagus is a rare tumor representing only 0.1-0.2% of esophageal malignancies. The goal of the study was to report on the management of a new case diagnosed and treated in our site. Case report: A 67-year-old patient presented with dysphagia to solids with no other remarkable history or associated skin lesions. He underwent gastroscopy, which revealed a polypoid mass suggestive of neoplasm in the distal third of the esophagus. Biopsy indicated melanoma with positive immunohistochemical markers S100 and HMB45, and negative cytokeratins and CEA. Computerized tomography (CT and positron-emission tomography (PET scans showed no local infiltration or distant metastases. An Ivor-Lewis esophagectomy procedure was performed with regional lymphadenectomy. Postoperative stay lasted for three weeks, and no remarkable postsurgical complications arose. The pathological study of the specimen confirmed the diagnosis of primary esophageal melanoma. Discussion: Primary malignant melanoma of the esophagus has an unfortunate prognosis as it is an aggressive tumor usually diagnosed at an advanced stage, with local invasion and metastatic disease. Currently, surgery is the treatment of choice, with the remaining adjuvant therapies obtaining limited results.

  2. Partial esophagectomy with single layer closure for treatment of esophageal sarcomas in 6 dogs.

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    Ranen, Eyal; Shamir, Merav H; Shahar, Ron; Johnston, Dudley E

    2004-01-01

    To report partial esophagectomy (PE) as a treatment for esophageal sarcoma in dogs. Retrospective study (2000-2002). Six dogs with caudal thoracic esophageal tumors. Medical records of 6 dogs that had surgical removal of esophageal tumors were reviewed. Signalment, medical history, physical examination results, complete blood count, surgical procedure, tumor classification, postoperative treatment, and complications were retrieved. Esophageal masses were approached by thoracotomy and esophagotomy on the side opposite the mass, removed with 1 cm margins by full thickness excision, and the defects closed with a single layer of interrupted sutures. All dogs recovered rapidly without major complications. Tumors were fibrosarcoma (3 dogs), undifferentiated sarcoma (1), and osteosarcoma (2). Five dogs were administered doxorubicin chemotherapy after surgery. Good quality of life was observed postoperatively in 5 dogs until deterioration necessitated euthanasia; survival ranged from 2-16 months. The remaining dog was alive, 20 months after surgery. Partial esophagectomy and closure using 1 suture layer, was an effective, simple, and safe technique for removal of sarcomas of the distal thoracic esophagus. Removal of esophageal masses by partial esophagectomy can be used reliably as a method of esophageal surgery.

  3. Esophageal dysfunction in four alpaca crias and a llama cria with vascular ring anomalies.

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    McKenzie, Erica C; Seguin, Bernard; Cebra, Christopher K; Margiocco, Marco L; Anderson, David E; Löhr, Christiane V

    2010-08-01

    3 alpaca crias and cadavers of an alpaca cria and a llama cria were evaluated for evidence of esophageal dysfunction. All 5 crias were between 3 and 5 months of age when clinical signs developed, and all had a thin body condition when examined. Clinical signs included coughing, regurgitation, and grossly visible esophageal peristaltic waves. A barium esophagram was used to diagnose esophageal obstruction, megaesophagus, and a vascular ring anomaly (VRA). Fluoroscopy was used to evaluate deglutition, esophageal peristalsis, and the extent of esophageal dilation in 1 alpaca cria. A persistent right aortic arch was identified in 1 alpaca cria, and a left aortic arch with right ductus arteriosus or ligamentum arteriosum and an aberrant right subclavian artery were identified in the 4 remaining crias. Surgical correction of the VRA was attempted in the 3 live alpaca crias. It was complicated by the conformation and location of each VRA and inaccurate anatomic diagnosis of the VRAs before surgery. Treatment was universally unsuccessful because of intraoperative complications and the persistence of clinical signs after surgery. Megaesophagus is typically an idiopathic condition in camelids. However, these findings suggested that camelids with esophageal dysfunction during the neonatal period may have a VRA. The prognosis is grave for camelids with VRA, and accurate anatomic diagnosis of the VRA via the use of advanced imaging techniques (eg, angiography, computed tomography, or magnetic resonance imaging) may improve the success of surgical intervention.

  4. High-dose omeprazole in esophagitis with stenosis after surgical treatment of esophageal atresia.

    Science.gov (United States)

    Van Biervliet, S; Van Winckel, M; Robberecht, E; Kerremans, I

    2001-09-01

    The authors describe 4 children with recurrent stenosis and persistent esophagitis after secondary repair of a long gap esophageal atresia. They underwent an esophageal reconstruction by elongation of the lesser gastric curvature according to Schärli at the age of 11 to 14 months. All had esophagitis grade III to IV (Savary-Miller classification), esophageal stenosis, and failure to thrive. Effective treatment of the esophagitis and prevention of stenosis consisted in high doses of omeprazole (1.9 to 2.5 mg/kg/d). After this treatment, the need for esophageal dilatation disappeared, and nutritional status normalized. Copyright 2001 by W.B. Saunders Company.

  5. Pulmonary Complications due to Esophagectomy.

    Science.gov (United States)

    Shirinzadeh, Abulfazl; Talebi, Yashar

    2011-01-01

    Esophageal carcinoma is the scourge of human beings. Pulmonary complications in patients who have undergone operation are common (20-30% of cases) and there are no suitable tools and ways to predict these complications. During a period of 10 years, from March 1998 to February 2007, 200 patients (150 male and 50 female) underwent Esophagectomy due to esophageal carcinoma in thoracic surgery ward retrospectively. Complications include the length of hospitalization, mechanical ventilation, morbidity and mortality. Patients' risk factors include age, preoperative chemo-radiotherapy, stage of the disease and preoperative spirometry condition. WE GROUPED OUR PATIENTS INTO THREE CATEGORIES: Normal (FEV1 ≥ 80% predicted), mildly impaired (FEV1 65% to 79% predicted), more severely impaired (FEV1 atelectasia in 160 patients (80%). 24 patients needed chest-tube insertion. 20 patients (10%) developed ARDS. 14 patients (7%) developed chylothorax. 20 patients (10%) of patients died during their postoperative hospital stay. 30 patients (15%) required mechanical ventilation for greater than 48 hours. We reviewed a number of preoperative clinical variables to determine whether they contributed to postoperative pulmonary complications as well as other outcomes. In general, age, impaired pulmonary function especially in those patients with FEV1 less than 65% predicted was associated with prolonged hospital length of stay (LOS). In fact pulmonary complications rate after Esophagectomy are high and there was associated mortality and morbidity.

  6. Utility of removable esophageal covered self-expanding metal stents for leak and fistula management.

    Science.gov (United States)

    Blackmon, Shanda H; Santora, Rachel; Schwarz, Peter; Barroso, Alberto; Dunkin, Brian J

    2010-03-01

    Esophageal or gastric leakage from anastomotic wound dehiscence, perforation, staple line dehiscence, or trauma can be a devastating event. Traditional therapy has often consisted of either surgical repair for rapidly diagnosed leaks or diversion for more complicated cases, commonly associated with a delayed diagnosis. This study summarizes our experience treating leaks or fistulas with novel, covered self-expanding metal stents (cSEMS). The primary objective of this study was to determine the efficacy and safety of covered self-expanding metal stents when used to treat complicated leaks and fistulas. Over 15 months, 25 patients with esophageal or gastric leaks were evaluated for stenting as primary treatment. A prospective database was used to collect data. Stents were placed endoscopically, with contrast evaluation used for leak evaluation. Patients who did not improve clinically after stenting or whose leak could not be sealed underwent operative management. During a mean follow-up of 15 months, 23 of the 25 patients with esophageal or gastric leaks during a 15-month period were managed with endoscopic stenting as primary treatment. Healing occurred in patients who were stented for anastomotic leakage after gastric bypass or sleeve gastrectomy (n = 10). One patient with three esophageal iatrogenic perforations healed with stenting. Eight patients successfully avoided esophageal diversion and healed with stenting and adjunctive therapy. Two of the 4 patients with tracheoesophageal fistulas sealed with the assistance of a new pexy technique to prevent stent migration; 1 additional patient had this same technique used to successfully heal an upper esophageal perforation. Esophageal leaks and fistulas can be effectively managed with cSEMS as a primary modality. The potential benefits of esophageal stenting are healing without diversion or reconstruction and early return to an oral diet. 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights

  7. Gallium-67 imaging in candidal esophagitis

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    Rundback, J.H.; Goldfarb, C.R.; Ongseng, F. (Beth Israel Medical Center, New York, NY (USA))

    1990-01-01

    Ga-67 scanning has been used to evaluate esophageal carcinoma. It has demonstrated candidal infection in other body sites and, in one previous case, in the esophagus. The authors present a case of diffuse esophageal uptake of Ga-67 in esophageal candidiasis.

  8. Respiratory function after esophageal replacement in children

    NARCIS (Netherlands)

    Gallo, Gabriele; Vrijlandt, Elianne J. L. E.; Arets, Hubertus G. M.; Koppelman, Gerard H.; Van der Zee, David C.; Hulscher, Jan B. F.; Zwaveling, Sander

    2017-01-01

    Background: Children born with esophageal atresia require an anastomosis between the proximal and distal esophagus. When this distance is too wide (long gap esophageal atresia, LGEA) esophageal replacement strategies have to be deployed. The aim of this study was to assess long-term respiratory

  9. Planejamento tridimensional para radioterapia de tumores de esôfago: comparação de técnicas de tratamento e análise de probabilidade de complicações Three-dimensional radiotherapy planning system for esophageal tumors: comparison of treatment techniques and analysis of probability of complications

    Directory of Open Access Journals (Sweden)

    Pitágoras Báskara Justino

    2003-06-01

    Full Text Available Para comparar diversas técnicas de irradiação para o câncer de esôfago, foi utilizado sistema de planejamento tridimensional. Em um paciente com carcinoma espinocelular de esôfago médio, foram estudadas as seguintes técnicas de tratamento: dois campos ântero-posteriores e dois campos látero-laterais paralelos e opostos, três campos em "Y" e em "T" e quatro campos em "X". Foram obtidos os histogramas dose-volume, considerando como órgãos de risco medula espinhal e pulmões. Os resultados foram analisados de acordo com as recomendações da Normal Tissue Complication Probability (NTCP e Tumor Control Probability (TCP. Quanto às doses de irradiação em pulmão, a melhor opção foi a técnica em dois campos ântero-posteriores paralelos e opostos. A medula foi mais poupada quando se utilizaram campos látero-laterais. Sugerimos a combinação de pelo menos duas técnicas de tratamento: ântero-posterior e as técnicas com campos em "Y", "T" ou látero-laterais, para o balanceamento das doses em pulmões e medula espinhal. Ou, ainda, a utilização de técnicas de três campos durante todo o tratamento.Radiotherapy techniques for esophageal cancer were compared using a three-dimensional planning system. We studied the following treatment techniques used for a patient with squamous cell carcinoma of the middle third of the esophagus: two antero-posterior and two latero-lateral parallel opposed fields, three fields ("Y" and "T", and four fields ("X". Dose-volume histograms were obtained considering spinal cord and lungs as organs at risk. Analysis was performed comparing doses in these organs as recommended by the Normal Tissue Complication Probability (NTCP and Tumor Control Probability (TCP. When only the lungs were considered the best technique was two antero-posterior parallel opposed fields. The spinal cord was best protected using latero-lateral fields. We suggest the combination of at least two treatment techniques: antero

  10. Complications of electrosurgery in laparoscopy

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    Hui-Yu Huang

    2014-05-01

    Full Text Available Electrosurgery is widely used in laparoscopic surgeries. It is essential to understand the principles of using appropriate electric currents and techniques to achieve the desired tissue effect and avoid complications. We reviewed the literature concerning the incidence of electrosurgical injuries, the mechanisms of injury, and recognition and management of electrosurgical complications. Alertness to postoperative warning signs, patient education prior to discharge, and the detection of delayed manifestations with salvage maneuvers may minimize catastrophic complications.

  11. The Pathophysiology of Eosinophilic Esophagitis

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    Daniel Avi Lemberg

    2014-05-01

    Full Text Available Eosinophilic Esophagitis (EoE is an emerging disease characterised by esophageal eosinophilia (>15eos/hpf, lack of responsiveness to acid-suppressive medication and is managed by allergen elimination and anti-allergy therapy. Although the pathophysiology of EoE is currently unsubstantiated, evidence implicates food and aeroallergen hypersensitivity in genetically predisposed individuals as contributory factors. Genome-wide expression analyses have isolated a remarkably conserved gene-expression profile irrespective of age and gender, suggesting a genetic contribution. EoE has characteristics of mainly TH2 type immune responses but also some TH1 cytokines, which appear to strongly contribute to tissue fibrosis, with esophageal epithelial cells providing a hospitable environment for this inflammatory process. Eosinophil-degranulation products appear to play a central role in tissue remodeling in EoE. This remodeling and dysregulation predisposes to fibrosis. Mast cell-derived molecules such as histamine may have an effect on enteric nerves and may also act in concert with TGF-β to interfere with esophageal musculature. Additionally, the esophageal epithelium may facilitate the inflammatory process under pathogenic contexts such as in EoE. This article aims to discuss the contributory factors in the pathophysiology of EoE.

  12. Esophageal cancer in Yemen.

    Science.gov (United States)

    Al-Samawi, Abdullah S; Aulaqi, Saleh M

    2014-03-01

    To document the age and gender distribution, histopathologic type as well as grading characteristics of Esophageal Cancer (EC) in Yemen. A case series. Department of Pathology, Sana'a University, Sana'a, Yemen, from January 2005 to December 2011. Three hundred twenty five cases of EC were included for review. The diagnoses were made on hematoxylin and eosin stained sections and the cases were categorized into Squamous Cell Carcinoma (SCC) and adenocarcinoma (ADC). Out of the 325 EC cases, 163 (50%) were SCC (females 67%, males 33%) and 158 (49%) were ADC (females 30%, males 70%). The rest of the cases were 2 adenosquamous carcinoma and 2 non-Hodgkin's lymphoma. The mean age, for SCC was 60 years while the mean age for ADC was 65 years. The peak incidence for SCC was found in the age groups of fifth and sixth decades for females and in fifth and seventh decades for males. The maximum number of patients with ADC was seen in sixth and seventh decades for both gender. Well-differentiated histological grading accounted for 247 (77%) for both genders and types. The moderately differentiated and poorly differentiated accounted, for 17% and 6% respectively. The EC in Yemen had a predominance of SCC in female patients and predominance of ADC in male patients which was usually of a well-differentiated grade.

  13. Photodynamic therapy for esophageal cancer. Update.

    Science.gov (United States)

    Greenwald, B D

    2000-08-01

    Although clinical studies with photodynamic therapy have been conducted for over 25 years, only recently has this technique become widely available for the treatment of esophageal cancer. Studies have demonstrated that it is as effective as Nd:YAG therapy for advanced esophageal malignancies while technically being somewhat easier to perform. Preliminary studies in early esophageal cancer also show effectiveness. In many ways, PDT is still in its infancy, and its exact role compared to other endoscopic treatments of esophageal cancer remains to be defined. It is expected that the development of new photosensitizers and light delivery systems will further expand the role of PDT in the diagnosis and management of esophageal neoplasms.

  14. Advances in dosimetry and biological predictors of radiation-induced esophagitis

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    Yu Y

    2016-01-01

    Full Text Available Yang Yu,1 Hui Guan,1 Yuanli Dong,1 Ligang Xing,2 Xiaolin Li2 1School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan, 2Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, Shandong Province, People’s Republic of China Objective: To summarize the research progress about the dosimetry and biological predictors of radiation-induced esophagitis.Methods: We performed a systematic literature review addressing radiation esophagitis in the treatment of lung cancer published between January 2009 and May 2015 in the PubMed full-text database index systems.Results: Twenty-eight eligible documents were included in the final analysis. Many clinical factors were related to the risk of radiation esophagitis, such as elder patients, concurrent chemoradiotherapy, and the intense radiotherapy regimen (hyperfractionated radiotherapy or stereotactic body radiotherapy. The parameters including Dmax, Dmean, V20, V30, V50, and V55 may be valuable in predicting the occurrence of radiation esophagitis in patients receiving concurrent chemoradiotherapy. Genetic variants in inflammation-related genes are also associated with radiation-induced toxicity.Conclusion: Dosimetry and biological factors of radiation-induced esophagitis provide clinical information to decrease its occurrence and grade during radiotherapy. More prospective studies are warranted to confirm their prediction efficacy. Keywords: lung cancer, esophagitis, radiation injuries, predictors

  15. [Pathophysiology of reflux esophagitis in the elderly patients].

    Science.gov (United States)

    Nakamura, Toshiya; Uetake, Tomoyoshi; Fujino, Masayuki A

    2002-08-01

    Recent reports indicate an increased prevalence of reflux esophagitis(RE) in Japan. There are many factors causing RE, and many kinds of changes associating aging are important in the causes of RE in the elderly patients. Characteristic features of the causes of RE in elderly patients are summarized here. Within the elderly patients, there are cases with persistent gastric acid secretion. Aging affections lead to esophageal motor dysfunctions and to failure of LES function(presbyesophagus). The elderly are complicated by orthopedic degenerative diseases with posture change due to osteoporosis; some pharmaceutical agents such as Ca-channel blockers or NSAIDs. Hiatal hernia is also an aggravating factor. In the future, elderly people with persistent gastric acid secretion will be increased based on declining prevalence of Helicobacter pylori. Therefore further increase in the prevalence and development of RE is foreseen in our country. Pathophysiology of RE in the elderly patients is expected to show various changes in the future.

  16. Per-oral Endoscopic Myotomy (POEM) After the Learning Curve: Durable Long-term Results With a Low Complication Rate.

    Science.gov (United States)

    Hungness, Eric S; Sternbach, Joel M; Teitelbaum, Ezra N; Kahrilas, Peter J; Pandolfino, John E; Soper, Nathaniel J

    2016-09-01

    We aimed to report long-term outcomes for patients undergoing per-oral endoscopic myotomy (POEM) after our initial 15-case learning curve. POEM has become an established, natural-orifice surgical approach for treating esophageal motility disorders. To date, published outcomes and comparative-effectiveness studies have included patients from the early POEM experience. Consecutive patients undergoing POEM after our initial 15 cases, with a minimum of 1-year postoperative follow-up, were included. Treatment success was defined as an Eckardt score ≤3 without reintervention. Gastroesophageal reflux was defined by abnormal pH-testing or reflux esophagitis >Los Angeles grade A. Between January 2012 and March 2015, 115 patients underwent POEM at a single, high-volume center. Operative time was 101 ± 29 minutes, with 95% (109/115) of patients discharged on postoperative day 1. Clavien-Dindo grade III complications occurred in 2.7%, one of which required diagnostic laparoscopy to rule out Veress needle injury to the gall bladder. The rate of grade I complications was 15.2%. At an average of 2.4 years post-POEM (range 12-52 months), the overall success rate was 92%. Objective evidence of reflux was present in 40% for all patients and 33% for patients with a body mass index POEM performed by experienced surgeons provided durable symptomatic relief in 94% of patients with nonspastic achalasia and 90% of patients with type 3 achalasia/spastic esophageal motility disorders, with a low rate of complications. The rate of gastroesophageal reflux was comparable with prior studies of both POEM and laparoscopic Heller myotomy.

  17. with esophageal squamous cell cancer

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    Tao Li

    2017-02-01

    Full Text Available Purpose: The aim of this study was to retrospectively observe and analyze the long-term treatment outcomes of 191 elderly patients with esophageal squamous cell cancer (ESCC who were treated with californium-252 (252Cf neutron brachytherapy (NBT in combination with external beam radiotherapy (EBRT. Material and methods : From January 2002 to November 2012, 191 patients with ESCC underwent NBT in combination with EBRT. The total radiation dose to the reference point via NBT was 8-25 Gy-eq in two to five fractions with one fraction per week. The total dose via EBRT was 50-60 Gy, which was delivered over a period of 5 to 6 weeks with normal fractionation. Results : The median survival time for the 191 patients was 23.6 months, and the 5-year rates for overall survival (OS and local-regional control (LRC were 28.7% and 54.2%, respectively. The patients’ age was a factor that was significantly associated with OS (p = 0.010, according to univariate analysis. The 5-year OS (LRC was 37.3% (58.6% for patients aged 70-74 years and 14.5% (47.9% for patients aged > 74 years (p = 0.010 and p = 0.038. In multivariate analysis, age and clinical N stage were associated with OS and LRC (p = 0.011 [0.041] and p = 0.005 [0.005]. From the time of treatment completion to the development of local-regional recurrence or death, 5 (2.6% patients experienced fistula and 15 (7.9% experienced massive bleeding. The incidence of severe late complications was related to older age (p = 0.027, higher NBT dose/fraction (20-25 Gy/5 fractions, and higher total dose (> 66 Gy. Conclusions : The clinical data indicated that NBT in combination with EBRT produced favorable local control and long-term survival rates for elderly patients with ESCC, and that the side effects were tolerable. Patient’s age, clinical stage N status, and radiation dose could be used to select the appropriate treatment for elderly patients.

  18. Application of colon interposition among the esophageal cancer patients with partial gastrectomy.

    Science.gov (United States)

    Chen, Qiuqiang; Mao, Weimin; Yu, Huanming; Liang, Yixian; Wang, Jiane; Chen, Guoping

    2016-12-01

    Esophageal reconstruction with colon interposition is an alternative solution for the esophageal cancer patients who have partial gastrectomy. The aim of this study was to investigate the therapeutic effects of colon interposition among the esophageal carcinoma patients with partial gastrectomy. Under institutional review board approval, 32 esophageal carcinoma patients with a history of partial gastrectomy were included in this study. All the patients had been diagnosed and confirmed squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma by histopathological examination. Surgical approaches, complications and therapeutic results were analyzed in the current study. Thirty-two esophageal carcinoma patients (29 men, 3 women, median age 63.2 years) were included in this study. Isoperistaltic colon interposition was carried out on 14 patients; their 1-year and 2-year survival rate was 92.9% and 78.6%, respectively. Antiperistaltic colon interposition was carried out on 18 patients; their 1-year and 2-year survival rate was 88.9% and 77.8%, respectively. In which, cervical anastomotic leakage was observed on six patients. Colon interposition is an ideal surgical approach for the esophageal carcinoma patients who had partial gastrectomy. Isoperistaltic colon interposition is preferred, but antiperistaltic colon interposition has the advantage that a longer colon can be used.

  19. Esophageal Stricture Secondary to Candidiasis in a Child with Glycogen Storage Disease 1b.

    Science.gov (United States)

    Lee, Kyung Jae; Choi, Shin Jie; Kim, Woo Sun; Park, Sung-Sup; Moon, Jin Soo; Ko, Jae Sung

    2016-03-01

    Esophageal candidiasis is commonly seen in immunocompromised patients; however, candida esophagitis induced stricture is a very rare complication. We report the first case of esophageal stricture secondary to candidiasis in a glycogen storage disease (GSD) 1b child. The patient was diagnosed with GSD type 1b by liver biopsy. No mutation was found in the G6PC gene, but SLC37A4 gene sequencing revealed a compound heterozygous mutation (p.R28H and p.W107X, which was a novel mutation). The patient's absolute neutrophil count was continuously under 1,000/µL when he was over 6 years of age. He was admitted frequently for recurrent fever and infection, and frequently received intravenous antibiotics, antifungal agents. He complained of persistent dysphagia beginning at age 7 years. Esophageal stricture and multiple whitish patches were observed by endoscopy and endoscopic biopsy revealed numerous fungal hyphae consistent with candida esophagitis. He received esophageal balloon dilatation four times, and his symptoms improved.

  20. Radiobiological evaluation of simultaneously dose-escalated versus non-escalated intensity-modulated radiation therapy for patients with upper thoracic esophageal cancer

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    Huang BT

    2017-04-01

    Full Text Available Bao-Tian Huang,1,* Li-Li Wu,1,* Long-Jia Guo,1,* Liang-Yu Xu,1,* Rui-Hong Huang,1 Pei-Xian Lin,2 Jian-Zhou Chen,1,3 De-Rui Li,1 Chuang-Zhen Chen1 1Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, 2Department of Nosocomial Infection Management, The Second Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China; 3CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom *These authors contributed equally to this work Objective: To compare the radiobiological response between simultaneously dose-escalated and non-escalated intensity-modulated radiation therapy (DE-IMRT and NE-IMRT for patients with upper thoracic esophageal cancer (UTEC using radiobiological evaluation. Methods: Computed tomography simulation data sets for 25 patients pathologically diagnosed with primary UTEC were used in this study. DE-IMRT plan with an escalated dose of 64.8 Gy/28 fractions to the gross tumor volume (GTV and involved lymph nodes from 25 patients pathologically diagnosed with primary UTEC, was compared to an NE-IMRT plan of 50.4 Gy/28 fractions. Dose-volume metrics, tumor control probability (TCP, and normal tissue complication probability for the lung and spinal cord were compared. In addition, the risk of acute esophageal toxicity (AET and late esophageal toxicity (LET were also analyzed. Results: Compared with NE-IMRT plan, we found the DE-IMRT plan resulted in a 14.6 Gy dose escalation to the GTV. The tumor control was predicted to increase by 31.8%, 39.1%, and 40.9% for three independent TCP models. The predicted incidence of radiation pneumonitis was similar (3.9% versus 3.6%, and the estimated risk of radiation-induced spinal cord injury was extremely low (<0.13% in both groups. Regarding the esophageal toxicities, the estimated grade ≥2 and grade ≥3 AET predicted by the Kwint model were increased by 2.5% and 3.8%. Grade ≥2

  1. Coccidioides immitis Cervical Lymphadenitis Complicated by Esophageal Fistula

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    Michael Loudin

    2016-01-01

    Full Text Available Coccidioidomycosis (valley fever is caused by the dimorphic fungi Coccidioides immitis or Coccidioides posadasii. Most infections are asymptomatic or result in self-limited pneumonia; extrapulmonary dissemination via either hematogenous or lymphatic spread is rare. Here, we present a case of cervical C. immitis lymphadenitis that resulted in fistula formation to the esophagus via mediastinal extension. This case highlights a very unusual extrapulmonary manifestation of coccidioidomycosis, the difficulty in diagnosing coccidioidal infection when it is not suspected, and the importance of obtaining a thorough exposure history to assist with diagnosis.

  2. Coccidioides immitis Cervical Lymphadenitis Complicated by Esophageal Fistula.

    Science.gov (United States)

    Loudin, Michael; Clayburgh, Daniel R; Hakki, Morgan

    2016-01-01

    Coccidioidomycosis (valley fever) is caused by the dimorphic fungi Coccidioides immitis or Coccidioides posadasii. Most infections are asymptomatic or result in self-limited pneumonia; extrapulmonary dissemination via either hematogenous or lymphatic spread is rare. Here, we present a case of cervical C. immitis lymphadenitis that resulted in fistula formation to the esophagus via mediastinal extension. This case highlights a very unusual extrapulmonary manifestation of coccidioidomycosis, the difficulty in diagnosing coccidioidal infection when it is not suspected, and the importance of obtaining a thorough exposure history to assist with diagnosis.

  3. Esophageal pH monitoring

    Science.gov (United States)

    ... Esophageal pH monitoring References Katzka DA, Falk G. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap ... Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. ...

  4. [Esophageal histoplasmosis. A case report].

    Science.gov (United States)

    Henry, M A; Mendes, E F; Saad, L H; Rodrigues, P A; Gonçalves, I

    1996-01-01

    The authors report a case of a patient with complaint of progressive disphagia. Stenoses of lower third of esophagus was revealed by radiological and endoscopic examinations. Fungi were showed in biopsy of lesion, with demonstration of Histoplasm capsulate by tissue culture. Endoscopic dilatation was performed because especific medical treatment failed but esophageal rupture was observed. Partial esophagectomy was performed with symptoms remission.

  5. Esophageal Carcinoma Following Bariatric Procedures

    Science.gov (United States)

    Leeman, Matthew F.; Richardson, J. David

    2004-01-01

    Background: The long-term success of bariatric operations for weight reduction has been well documented, but their potential effects on the risk of esophageal cancer have not been evaluated. Methods: We performed operations on 3 patients for esophageal cancer following bariatric operations: 2 had Roux-en-Y gastric bypass, and 1 underwent vertical banded gastroplasty. All of these patients had adenocarcinoma at the gastroesophageal junction; 1 involved the entire intrathoracic esophagus. Results: The intervals between the weight-loss operations and cancer diagnoses were 21, 16, and 14 years. All 3 patients had symptoms of reflux for many years before dysphagia developed and cancer was diagnosed. We performed a limited esophagogastrectomy, a classic IvorLewis procedure, and a total esophagectomy with jejunal free-tissue transfer from stomach to cervical esophagus. Two patients had positive lymph nodes. One patient is alive at 6 years; 2 died at 13 and 15 months after undergoing operation for recurrent cancer. Conclusion: The effect of bariatric operations on gastroesophageal reflux is not known, although gastric bypass has been advocated as the “ultimate antireflux procedure.” The presence of esophageal cancer in these 3 patients years after the weight loss operation is worrisome. We believe that patients who develop new symptoms should have endoscopic evaluation and that epidemiologic studies on the incidence of esophageal cancer occurring years after bariatric operation should be performed. PMID:15554284

  6. THE REAL PREVALENCE OF EROSIVE ESOPHAGITIS AND BARRETT'S ESOPHAGUS IN SYSTEMIC SCLERODERMA: DATA FROM 12-MONTHS PROSPECTIVE STUDY

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    Andrey Evgenievich Karateev

    2012-01-01

    Full Text Available Complicated forms of reflux-esophagitis, i.e., erosive esophagitis and Barrett's esophagus (BE — are common types of visceral pathology in systemic scleroderma (SSD, which require adequate therapy and follow up. Although real prevalence of esophageal involvement in SSD in Russian patients remains uncertain. Objective — to identify prevalence of erosive esophagitis and BE, and to quantify gastro-intestinal (GI symptoms in patients with SSD. Material and methods. During 1 year (December 2009 — January 2011 all consecutive SSD patients, hospitalized to FSBI «SRIR» RAMS, after signing informed consent, were subjected to esophagogastroduodenoscopy with biopsy of esophageal mucosa in upper 1/3. Totally 123 patients were examined (96,8% females, 3,2% males, aged 50,5±13,1 years. Esophageal mucous was evaluated for presence of pathologic changes and BE (intestinal metaplasia in biopsy samples was a BE diagnostic criterion. SODA questionnaire was used to quantify GIT symptoms Results. Erosive esophagitis was detected in 30 (24,3% patients, BE — in 11 (8,9%. In 80% of patients marked changes in esophageal mucosa were associated with typical symptoms (heartburn, regurgitaion, dysphagia, while in some cases (in 3 patients erosive esophagitis and BE were asymptomatic. Quantitative evaluation of symptoms with SODA questionnaire demonstrated clear correlation between subjective assessment and severity of esophageal pathologic changes. In patients with erosive gastritis and BE the SODA «pain» and «non-pain» parameters scores were significantly higher and satisfaction in dyspepsia management was lower (p<0,05, then in individuals without erosions and mucosal inflammation. Here was no clear correlation between esophageal pathology and SSD type (limited, diffuse, age, duration of the disease, presence of pulmonary interstitial lesion and Sjogren's syndrome. Patients with erosive esophagitis were significantly more often (36,6% using proton pomp

  7. Dumping syndrome after esophageal, gastric or bariatric surgery : pathophysiology, diagnosis, and management

    NARCIS (Netherlands)

    van Beek, A. P.; Emous, M.; Laville, Maurice; Tack, Johannes

    Background: Dumping syndrome, a common complication of esophageal, gastric or bariatric surgery, includes early and late dumping symptoms. Early dumping occurs within 1 h after eating, when rapid emptying of food into the small intestine triggers rapid fluid shifts into the intestinal lumen and

  8. Efficacy of Intensity Modulated Radiation Therapy After Surgery in Early Stage of Esophageal Carcinoma;

    Science.gov (United States)

    2017-10-20

    Esophageal Neoplasm; Esophageal Cancer TNM Staging Primary Tumor (T) T2; Esophageal Cancer TNM Staging Primary Tumor (T) T3; Esophageal Cancer TNM Staging Regional Lymph Nodes (N) N0; Esophageal Cancer TNM Staging Distal Metastasis (M) M0

  9. Rigid Esophagoscopy for Head and Neck Cancer Staging and the Incidence of Synchronous Esophageal Malignant Neoplasms.

    Science.gov (United States)

    McGarey, Patrick O; O'Rourke, Ashli K; Owen, Scott R; Shonka, David C; Reibel, James F; Levine, Paul A; Jameson, Mark J

    2016-01-01

    Rigid esophagoscopy (RE) was once an essential part of the evaluation of patients with head and neck squamous cell carcinoma (HNSCC) due to the high likelihood of identifying a synchronous malignant neoplasm in the esophagus. Given recent advances in imaging and endoscopic techniques and changes in the incidence of esophageal cancer, the current role for RE in HNSCC staging is unclear. To analyze the current role of RE in evaluating patients with HNSCC, and to determine the incidence of synchronous esophageal malignant neoplasms in patients with HNSCC. In this retrospective study performed at an academic tertiary care center, 582 patients were studied who had undergone RE for HNSCC staging from July 1, 2004, through October 31, 2012. To assess the incidence of synchronous esophageal malignant neoplasms, a literature review was performed, and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data set was queried. The primary outcome measure was the incidence of synchronous esophageal malignant neoplasms, as measured by retrospective review at our institution, SEER data set analysis, and literature review. Secondary outcome measures were RE complications and nonmalignant findings during RE. A total of 601 staging REs were performed in 582 patients. The mean age was 60.2 years and 454 (78.0%) were men. There were 9 complications (1.5%), including 1 esophageal perforation (0.2%). Rigid esophagoscopy was aborted in 50 cases. Of the 551 completed REs, no abnormal findings were noted in 523 patients (94.9%), and nonmalignant pathologic findings were identified in 28 patients (5.1%). No synchronous primary esophageal carcinomas were detected. The incidence of synchronous esophageal malignant neoplasms found on screening endoscopy based on literature review and on SEER data set analysis was very low and has decreased from 1980 to 2010 in North America. The incidence reported in South America and Asia was relatively high. Rigid esophagoscopy

  10. Video-thoracoscopic enucleation of esophageal leiomyoma

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    Luh Shi-Ping

    2012-03-01

    Full Text Available Abstract Background Leiomyoma is the most common benign tumor of the esophagus. Surgical enucleation is indicated in case of symptoms or an unclear diagnosis, and open thoracotomy has long been the standard approach for this procedure. However, enucleation through video assisted thoracoscopic surgery (VATS has been developed as a preferred approach for most lesions in recent years. Method Herein we report our twelve patients (seven men and five women, with median age of 42 years from 2001 to 2009, who underwent enucleation through VATS for esophageal leiomyomas, with a size from 1 to 8 cm in diameter (median: 5, and at different locations, from the thoracic outlet to near the diaphragmatic level of the thoracic esophagus. Intraoperative fiberoptic esophagoscopy was performed in two patients for localization by illumination. A right-sided approach was performed in eight cases (upper two thirds of esophagus and the left-sided in another four cases (lower third of esophagus. Result The median operative time was 95 minutes (70 to 230 minutes. Four of them required small utility incisions (4-6 cm for better exploration and manipulation. There were no major complications, such as death or empyema due to leaks from mucosal tears, and the presenting symptoms were improved during the follow-up period, from 12 to 98 months. Conclusion VATS can be considered as an initial approach for most patients with esophageal leiomyomas, even large in size, irregular in shape, or at unfavorable location. It is a safe, minimally invasive, and effective treatment. However, conversion to open thoracotomy should be required for the sake of clinical or technical concern.

  11. [Laparoscopic treatment of para-esophageal hernias].

    Science.gov (United States)

    Collet, D; Wagner, T; Sa Cunha, A; Rault, A; Masson, B

    2006-10-01

    This retrospective study aims at analyzing the functional results obtained in patients operated by laparoscopy for a para-esophageal hernia. From 1994 to 2004, 38 patients underwent a laparoscopic procedure for a symptomatic para-esophageal hiatal hernia of at least 3/4 of the proximal stomach: 27 females and 11 males, mean age 65 years (extreme: 22-84). There was no case on emergency, 4 patients had have at least one episode of intrathoracic volvulus. The operation consisted in gastric reduction into the abdominal cavity, excision of the sac, suture of the crura reinforced with a mesh in 6 patients and the construction of a gastric wrap. A postoperative barium swallow was performed on POD 3 in order to confirm the anatomical result. Mean operating time was 157 minutes (75-480), no case was converted into laparotomy. Four postoperative complications were observed (morbidity 10.8%): one gastric perforation diagnosed on POD 1, 2 severe dysphagias linked to the wrap, and one atelectasia. There was no death in this series. Functional results were evaluated by the mean of a questionnaire in 33 patients who had a follow up more than 6 months. Thirty-three questionnaires have been sent, 3 patients were lost and one was dead. Among the 29 patients analyzed, 14 were very satisfied, 11 were satisfied and 3 were deceived by the operation. Best results are obtained in patients with GERD, dysphagia or postprandial cardiothoracic symptoms. These results compared to the published data allow us to discuss about indications of surgery, the necessity to removal the hernia sac, and the advantages to reinforce the crura by the mean of a non absorbable mesh.

  12. Toll-like receptors in esophageal cancer

    Directory of Open Access Journals (Sweden)

    Joonas H Kauppila

    2014-05-01

    Full Text Available Esophageal squamous cell carcinoma and esophageal adenocarcinoma are cancers of high mortality. Esophageal adenocarcinoma develops through Barrett’s esophagus and columnar dysplasia, preceded by gastroesophageal reflux disease. The risk of esophageal squamous cell carcinoma is increased by smoking and alcohol consumption. New treatment options for esophageal cancer are desperately needed. Toll-like receptors (TLRs play a central role in mammalian immunity and cancer. TLRs are activated by microbial components, such as lipopolysaccharide, flagellin, DNA and RNA, as well as endogenous ligands, including heat-shock proteins and endogenous DNA.This review summarizes the studies on Toll-like receptors in esophageal squamous cell carcinoma and esophageal adenocarcinoma. It has been shown that TLRs 1-10 are expressed in the normal esophagus. In esophageal squamous cell carcinoma, TLRs 3, -4, -7, and 9 have been studied, showing associations to aggressive disease properties. In Barrett’s esophagus and esophageal adenocarcinoma, only TLRs 4, -5 and -9 have been studied. In the review, we discuss the implications of TLRs in esophageal cancer.

  13. Animal Model of Acid-Reflux Esophagitis: Pathogenic Roles of Acid/Pepsin, Prostaglandins, and Amino Acids

    Directory of Open Access Journals (Sweden)

    Koji Takeuchi

    2014-01-01

    Full Text Available Esophagitis was induced in rats within 3 h by ligating both the pylorus and transitional region between the forestomach and glandular portion under ether anesthesia. This esophageal injury was prevented by the administration of acid suppressants and antipepsin drug and aggravated by exogenous pepsin. Damage was also aggravated by pretreatment with indomethacin and the selective COX-1 but not COX-2 inhibitor, whereas PGE2 showed a biphasic effect depending on the dose; a protection at low doses, and an aggravation at high doses, with both being mediated by EP1 receptors. Various amino acids also affected this esophagitis in different ways; L-alanine and L-glutamine had a deleterious effect, while L-arginine and glycine were highly protective, both due to yet unidentified mechanisms. It is assumed that acid/pepsin plays a major pathogenic role in this model of esophagitis; PGs derived from COX-1 are involved in mucosal defense of the esophagus; and some amino acids are protective against esophagitis. These findings also suggest a novel therapeutic approach in the treatment of esophagitis, in addition to acid suppressant therapy. The model introduced may be useful to test the protective effects of drugs on esophagitis and investigate the mucosal defense mechanism in the esophagus.

  14. Animal Model of Acid-Reflux Esophagitis: Pathogenic Roles of Acid/Pepsin, Prostaglandins, and Amino Acids

    Science.gov (United States)

    2014-01-01

    Esophagitis was induced in rats within 3 h by ligating both the pylorus and transitional region between the forestomach and glandular portion under ether anesthesia. This esophageal injury was prevented by the administration of acid suppressants and antipepsin drug and aggravated by exogenous pepsin. Damage was also aggravated by pretreatment with indomethacin and the selective COX-1 but not COX-2 inhibitor, whereas PGE2 showed a biphasic effect depending on the dose; a protection at low doses, and an aggravation at high doses, with both being mediated by EP1 receptors. Various amino acids also affected this esophagitis in different ways; L-alanine and L-glutamine had a deleterious effect, while L-arginine and glycine were highly protective, both due to yet unidentified mechanisms. It is assumed that acid/pepsin plays a major pathogenic role in this model of esophagitis; PGs derived from COX-1 are involved in mucosal defense of the esophagus; and some amino acids are protective against esophagitis. These findings also suggest a novel therapeutic approach in the treatment of esophagitis, in addition to acid suppressant therapy. The model introduced may be useful to test the protective effects of drugs on esophagitis and investigate the mucosal defense mechanism in the esophagus. PMID:24672789

  15. Hemostasis by esophageal stent placement for management of esophageal tumor bleeding:a case report.

    Science.gov (United States)

    Isono, Yoshiaki; Saito, Tomonori; Tochio, Tomomasa; Kumazawa, Hiroaki; Tanaka, Hiroki; Matsusaki, Shimpei; Sase, Tomohiro; Okano, Hiroshi; Baba, Youichirou; Mukai, Katsumi

    2016-01-01

    A 67-year-old male was diagnosed with advanced esophageal cancer. A computed tomography scan showed multiple intra-abdominal lymphadenopathies. Because the tumor was thought to be unresectable, we initiated chemotherapy. Twelve months later, the patient was admitted to our hospital because of hematemesis. Gastroduodenoscopy revealed oozing bleeding from the esophageal tumor. Hemostasis was not achieved with conservative treatment, and frequent blood transfusions were required. Endoscopic hemostasis was difficult to achieve because of the malignant esophageal stenosis. To treat the malignant esophageal stricture and esophageal tumor bleeding, we attempted to insert an esophageal covered self-expandable metallic stent. After the procedure, hemostasis was achieved by mechanical tamponade. Here we report a rare case of esophageal tumor bleeding that was managed with mechanical tamponade using an esophageal covered self-expandable metallic stent.

  16. Internal Drainage of an Esophageal Perforation in a Patient with a High Surgical Risk

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    Hongsun Kim

    2017-10-01

    Full Text Available A 71-year-old man presented with a productive cough and fever, and he was diagnosed as having an esophageal perforation and a mediastinal abscess. He had a history of traumatic hemothorax and pleural drainage for empyema in the right chest and was considered unable to tolerate thoracic surgery because of sepsis and progressive aspiration pneumonia. In order to aggressively drain the mediastinal contamination, we performed internal drainage by placing a Levin tube into the mediastinum through the perforation site. This procedure, in conjunction with controlling sepsis and providing sufficient postpyloric nutrition, allowed the esophageal injury to completely heal.

  17. Extended complications of urethroplasty

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    Hosam S. Al-Qudah

    2005-08-01

    Full Text Available INTRODUCTION: An extensive study of complications following urethroplasty has never been published. We present 60 urethroplasty patients who were specifically questioned to determine every possible early and late complication. MATERIALS AND METHODS: Retrospective chart review of urethroplasty patients between August 2000 and March 2004. An "open format" questioning style allowed maximal patient reporting of all complications, no matter how minor. RESULTS: 60 patients underwent 62 urethroplasties (24 anterior anastomotic, 19 buccal mucosal and 10 fasciocutaneous, 9 posterior anastomotic with mean follow-up of 29 months. Early complications occurred in 40%, but only 3% were major (rectal injury and urosepsis. Early minor complications included scrotal swelling, scrotal ecchymosis and urinary urgency. Late complications occurred in 48%, but only 18% were significant (erectile dysfunction, chordee and fistula. Late minor complications included a feeling of wound tightness, scrotal numbness and urine spraying. Fasciocutaneous urethroplasty caused the most significant complications, and buccal mucus urethroplasty the least, while also resulting in the lowest recurrence rate (0%. CONCLUSIONS: Serious complications after urethroplasty (3% early and 18% late appear similar to those reported elsewhere, but minor bothersome complications appear to occur in much higher numbers than previously published (39% early and 40% late. While all the early complications were resolved and most (97% were minor, less than half of the late complications were resolved, although most (82% were minor. These complication rates should be considered when counseling urethroplasty patients, and generally tend to support the use of buccal mucosal onlay urethroplasty as it had the lowest rate of serious side effects.

  18. The Changing Face of Esophageal Cancer

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    Rachel E. Melhado

    2010-06-01

    Full Text Available The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction.

  19. The Changing Face of Esophageal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Melhado, Rachel E., E-mail: raye732001@yahoo.co.uk; Alderson, Derek; Tucker, Olga [Academic Department of Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham (United Kingdom)

    2010-06-28

    The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction.

  20. Radiation-induced esophagitis in lung cancer

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    Baker S

    2016-10-01

    Full Text Available Sarah Baker, Alysa Fairchild Department of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada Abstract: Radiation-induced esophagitis is the most common local acute toxicity of radiotherapy (RT delivered for the curative or palliative intent treatment of lung cancer. Although concurrent chemotherapy and higher RT dose are associated with increased esophagitis risk, advancements in RT techniques as well as adherence to esophageal dosimetric constraints may reduce the incidence and severity. Mild acute esophagitis symptoms are generally self-limited, and supportive management options include analgesics, acid suppression, diet modification, treatment for candidiasis, and maintenance of adequate nutrition. Esophageal stricture is the most common late sequela from esophageal irradiation and can be addressed with endoscopic dilatation. Approaches to prevent or mitigate these toxicities are also discussed. Keywords: non–small cell lung cancer, acute, late, toxicity, stricture

  1. Complications of mechanical ventilation

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    Drašković Biljana

    2011-01-01

    Full Text Available Mechanical ventilation of the lungs, as an important therapeutic measure, cannot be avoided in critically ill patients. However, when machines take over some of vital functions there is always a risk of complications and accidents. Complications associated with mechanical ventilation can be divided into: 1 airway-associated complications; 2 complications in the response of patients to mechanical ventilation; and 3 complications related to the patient’s response to the device for mechanical ventilation. Complications of artificial airway may be related to intubation and extubation or the endotracheal tube. Complications of mechanical ventilation, which arise because of the patient’s response to mechanical ventilation, may primarily cause significant side effects to the lungs. During the last two decades it was concluded that mechanical ventilation can worsen or cause acute lung injury. Mechanical ventilation may increase the alveolar/capillary permeability by overdistension of the lungs (volutrauma, it can exacerbate lung damage due to the recruitment/derecruitment of collapsed alveoli (atelectrauma and may cause subtle damages due to the activation of inflammatory processes (biotrauma. Complications caused by mechanical ventilation, beside those involving the lungs, can also have significant effects on other organs and organic systems, and can be a significant factor contributing to the increase of morbidity and mortality in critically ill of mechanically ventilated patients. Complications are fortunately rare and do not occur in every patient, but due to their seriousness and severity they require extensive knowledge, experience and responsibility by health-care workers.

  2. Elimination diets in the management of eosinophilic esophagitis

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    Wechsler JB

    2014-05-01

    Full Text Available Joshua B Wechsler, Sally Schwartz, Katie Amsden, Amir F Kagalwalla Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA Abstract: Eosinophilic esophagitis, an increasingly recognized chronic inflammatory disorder isolated to the esophagus, is triggered by an abnormal allergic response to dietary antigens. Current treatment includes swallowed topical steroids and dietary modification, which aim to resolve symptoms and prevent long-term complications such as formation of strictures. The dietary approach has become more widely accepted because long-term steroid therapy is associated with potential risks. Dietary treatment includes elemental and elimination diets. An exclusive elemental diet, which requires replacement of all intact protein with amino acid-based formula, offers the best response of all available therapies, with remission in up to 96% of subjects proving it to be superior to all other available therapies including topical steroids. However, compliance with this approach is challenging because of poor taste and monotony. The high cost of formula and the associated psychosocial problems are additional drawbacks of this approach. Empiric and allergy test-directed elimination diets have gained popularity given that elimination of a limited number of foods is much easier and as such is more readily acceptable. There is a growing body of literature supporting this type of therapy in both children and adults. This paper reviews the evidence for all types of dietary therapy in eosinophilic esophagitis. Keywords: eosinophilic esophagitis, dietary therapy, empiric elimination, elemental, allergy test-directed

  3. Endoscopic and Radiologic Findings in Eosinophilic Esophagitis.

    Science.gov (United States)

    Alexander, Jeffrey A

    2018-01-01

    Eosinophilic esophagitis (EoE) was first described by Landis in 1978. The disease is characterized by esophageal symptoms, primarily dysphagia in adult patients, and esophageal eosinophilic infiltration. The disease is associated with characteristic endoscopic findings, including edema, rings, furrows, exudates, and strictures. The typical radiographic findings of this disorder are rings, strictures, and small-caliber esophagus. The endoscopic and radiographic findings of EoE are the topic of this review. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Fatal esophageal perforation caused by invasive candidiasis.

    Science.gov (United States)

    Gock, Michael; Schäfer, Markus; Perren, Aurel; Demartines, Nicolas; Clavien, Pierre-Alain

    2005-09-01

    Instrumental lesions, spontaneous rupture, and trauma cause most esophageal perforations. Transmural fungal infection is extremely rare, although Candida may be detected in as many as 25% of normal esophagus. In this report we present a case of fatal esophageal perforation due to transmural Candida infection in a 76-year-old woman. The patient died from septic shock and multiorgan failure, despite esophageal resection and systemic antifungal therapy. Pathogenetic aspects and treatment strategies are discussed.

  5. [Esophageal diseases: GERD, Barrett, achalasia and eosinophilic esophagitis].

    Science.gov (United States)

    Calvet, Xavier; Villoria, Albert

    2014-09-01

    At Digestive Disease Week (DDW) 2014, developments in esophageal disease were presented. Highlights include: the usefulness of impedancemetry to diagnose reflux disease, or the effectiveness of PPIs for treating non-cardiac chest pain. Concerning Barrett's esophagus, its prevalence is identical in patients with and without reflux symptoms, Barrett segments less than 1cm probably do not require follow-up, and in older patients with long-segment Barrett, initial endoscopies overlooked up to 2% of significant lesions. Regarding achalasia, surgical myotomy is no more effective than endoscopic dilation and may even be less effective than peroral endoscopic myotomy (POEM). In terms of eosinophilic esophagitis, it is important to systematically take biopsies in patients with dysphagia so that cases of eosinophilic esophagitis are not overlooked. In addition, for this condition, routine endoscopic dilations not only do not seem useful in improving the course of the disease, but could also worsen the response to medical treatment. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  6. Acute Necrotizing Esophagitis Followed by Duodenal Necrosis

    Science.gov (United States)

    del Hierro, Piedad Magdalena

    2011-01-01

    Acute Necrotizing Esophagitis is an uncommon pathology, characterized by endoscopic finding of diffuse black coloration in esophageal mucosa and histological presence of necrosis in patients with upper gastrointestinal bleeding. The first case of acute necrotizing esophagitis followed by duodenal necrosis, in 81 years old woman with a positive history of Type 2 Diabetes Mellitus, Hypertension, and usual intake of Nonsteroidal Anti-inflammatory drugs, is reported. Although its etiology remains unknown, the duodenal necrosis suggests that ischemia could be the main cause given that the branches off the celiac axis provide common blood supply to the distal esophageal and duodenal tissue. The massive gastroesophagic reflux and NSAID intake could be involved. PMID:27957030

  7. Dialysis complications in acute kidney injury patients treated with prolonged intermittent renal replacement therapy sessions lasting 10 versus 6 hours: results of a randomized clinical trial.

    Science.gov (United States)

    Albino, Bianca Ballarin; Balbi, André Luis; Abrão, Juliana Maria Gera; Ponce, Daniela

    2015-05-01

    Prolonged intermittent renal replacement therapy (PIRRT) has emerged as an alternative to continuous renal replacement therapy in the management of acute kidney injury (AKI) patients. This trial aimed to compare the dialysis complications occurring during different durations of PIRRT sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline doses ranging from 0.3 to 0.7 µg/kg/min. Patients were divided into two groups randomly: in G1, 6-h sessions were performed, and in G2, 10-h sessions were performed. Seventy-five patients were treated with 195 PIRRT sessions for 18 consecutive months. The prevalence of hypotension, filter clotting, hypokalemia, and hypophosphatemia was 82.6, 25.3, 20, and 10.6%, respectively. G1 was composed of 38 patients treated with 100 sessions, whereas G2 consisted of 37 patients treated with 95 sessions. G1 and G2 were similar in male predominance (65.7 vs. 75.6%, P = 0.34), age (63.6 ± 14 vs. 59.9 ± 15.5 years, P = 0.28) and Sequential Organ Failure Assessment score (SOFA; 13.1 ± 2.4 vs. 14.2 ± 3.0, P = 0.2). There was no significant difference between the two groups in hypotension (81.5 vs. 83.7%, P = 0.8), filter clotting (23.6 vs. 27%, P = 0.73), hypokalemia (13.1 vs. 8.1%, P = 0.71), and hypophosphatemia (18.4 vs. 21.6%, P = 0.72). However, the group treated with sessions of 10 h were refractory to clinical measures for hypotension, and dialysis sessions were interrupted more often (9.5 vs. 30.1%, P = 0.03). Metabolic control and fluid balance were similar between G1 and G2 (blood urea nitrogen [BUN]: 81 ± 30 vs. 73 ± 33 mg/dL, P = 1.0; delivered Kt/V: 1.09 ± 0.24 vs. 1.26 ± 0.26, P = 0.09; actual ultrafiltration: 1731 ± 818 vs. 2332 ± 947 mL, P = 0.13) and fluid balance (-731 ± 125 vs. -652 ± 141

  8. Pregnancy Complications

    Science.gov (United States)

    ... To receive Pregnancy email updates Enter email Submit Pregnancy complications Complications of pregnancy are health problems that ... pregnancy. Expand all | Collapse all Health problems before pregnancy Before pregnancy, make sure to talk to your ...

  9. Are minimum volume standards appropriate for lung and esophageal surgery?

    Science.gov (United States)

    Harrison, Sebron; Tangel, Virginia; Wu, Xian; Christos, Paul; Gaber-Baylis, Licia; Turnbull, Zachary; Port, Jeff; Altorki, Nasser; Stiles, Brendon

    2017-12-06

    Several medical systems have adopted minimum volume standards for surgical procedures, including lung and esophageal resection. We sought to determine whether these proposed hospital cutoffs are associated with differences in outcomes. Analyzing the State Inpatient Databases and Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, we evaluated all patients (aged ≥ 18 years) who underwent lobectomy/pneumonectomy or esophagectomy for cancer in California, Florida, and New York (2009-2011). Hospitals were defined as low volume for each procedure per proposed minimum volume standards by year: lung resections and volume hospitals. Propensity matching (of demographic characteristics, income, payer, and comorbidities) was performed to balance the cohorts for analysis. During the time period, 20,138 patients underwent lobectomy/pneumonectomy of which 12,432 operations (61.7%) were performed at low-volume hospitals (n = 456) and 7706 operations were performed at high-volume hospitals (n = 48). Of 1324 patients undergoing esophagectomy, 1087 operations (82.1%) were performed at low-volume hospitals (n = 184), whereas only 237 operations were at high-volume hospitals (n = 6). After propensity matching (lung 1:1 and esophagus 2:1), no major differences were apparent for in-hospital mortality nor major complications for either lung or esophageal resection. Length of stay was longer in low-volume hospitals after lung resection (median 6 vs 5 days; P volume requirements for surgical procedures, the majority of patients undergo lung and esophageal resection at hospitals below the proposed cutoffs. The proposed standards for lung and esophageal resection are not associated with a difference in outcomes in this large administrative database. Efforts should be made to determine more meaningful minimum volume requirements and to determine whether such standards are appropriate. Copyright © 2017 The American Association for Thoracic

  10. Post-corrosive injuries of upper gastrointestinal tract.

    Science.gov (United States)

    Chibishev, A; Simonovska, N; Shikole, A

    2010-01-01

    Acute poisonings with corrosive substances may cause serious chemical injuries to upper gastrointestinal tract, the most common location being the esophagus and the stomach. If the patient survives the acute phase of the poisoning, regenerative response may result in esophageal and/or gastric stenosis and increased risk for esophageal cancer. Acute corrosive intoxications pose a major problem in clinical toxicology since the most commonly affected population are the young with psychic disorders, suicidal intent and alcohol addiction. In establishing the diagnosis of acute corrosive poisonings, the severity of the post-corrosive endoscopic changes of the esophagus, stomach and duodenum is of major importance. According to Holinder and Fridman classification, post-corrosive endoscopic changes are classified in three degrees: First degree--superficial damage associated with hyperthermia, epithelial desquamation and mucous edema. Second degree--transmucous damage affecting all of the mucosal layers, followed by exudation, erosions and ulcerations. Third degree--transmural damage associated with ulcer's penetration in the deep layers of the tissue and neighboring organs. Severity of the lesions depends on the nature, quantity and concentration of the corrosive substance, the duration of exposure and current state of the exposed organs. Most often caustic injuries occur to the esophagus and stomach since the corrosive substance remains there for a longer period of time. Treatment of the acute corrosive intoxications include: neutralization of corrosive agents, antibiotics, corticosteroids, anti-secretory therapy, nutritional support, collagen synthesis inhibitors, esophageal dilation and stent placement, and surgery. The most common complications that may appear are: perforation, gastrointestinal bleeding, sepsis, esophageal strictures and stenosis, stenosis of gastric antrum and pylorus, cancer of the esophagus and the stomach. Today, owing to the substantially enhanced

  11. Eosinophilic esophagitis: indications for treatment.

    Science.gov (United States)

    Straumann, Alex

    2014-01-01

    At present, it is still debated whether the focus of treatment in eosinophilic esophagitis (EoE) should be directed toward a symptomatic or histological response, or even toward a combination of both. This question cannot be answered as long as we have no solid data evaluating the long-term consequences of untreated symptoms and untreated inflammation. Nevertheless, today there are at least three established reasons to treat patients with clinically and histologically active EoE. First, dysphagia has a substantial negative impact on the patient's daily life. Despite the fact that patients often cope with this symptom and accept even marked restrictions in their nutritional habits, they usually experience a marked enhancement in quality of life under treatment. Second, untreated EoE harbors the risk of long-lasting food impactions. There is evidence that this unpleasant, unforeseeable and even risky incident can be prevented by efficient treatment of the eosinophilic inflammation. Third, it has been demonstrated in several clinical studies as well as in animal models that unbridled eosinophilic inflammation leads to a so-called remodeling of the esophagus with wall thickening, stiffness of the organ and stricture. Prevention of esophageal damage caused by tissue remodeling is therefore another reason to strongly advocate a consequential treatment. Finally, there is increasing evidence that untreated EoE might be a risk factor for acute infection of the esophagus with herpes simplex virus (HSV), leading to a severe ulcerative and extremely painful esophagitis. Prevention of HSV esophagitis might therefore be a fourth indication for treating EoE. 2014 S. Karger AG, Basel.

  12. Acute Esophageal Necrosis: An Update

    Science.gov (United States)

    Inayat, Faisal; Hurairah, Abu; Virk, Hafeez Ul Hassan

    2016-01-01

    Acute esophageal necrosis (AEN) or “black esophagus” is a rare clinical entity with an unclear etiology. It is diagnosed at upper gastrointestinal endoscopy with the presence of strikingly black necrotic esophagus. The treatment is primarily medical, but the prognosis is generally poor due to advanced age and comorbid illnesses in patients who develop AEN. Herein, we discussed the implications of poor glycemic control in regards with AEN and undertook a literature review of this rare diagnosis. PMID:27583242

  13. Spontaneous esophageal-pleural fistula

    Directory of Open Access Journals (Sweden)

    Sameer Vyas

    2011-01-01

    Full Text Available Spontaneous esophageal-pleural fistula (EPF is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed.

  14. Vitiligo associated with esophageal adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Ali Asilian

    2013-01-01

    Full Text Available Vitiligo is a disease that results in depigmented areas in the skin. It may develop at any age but the average age at onset is 20 years. Association of vitiligo and melanoma has been commonly reported, but malignancies other than melanoma have been rarely associated with vitiligo. We report a 73-year-old patient with new onset vitiligo who developed esophageal adenocarcinoma in the following years.

  15. [Complications in brachial plexus surgery].

    Science.gov (United States)

    Martínez, Fernando; Pinazzo, Samantha; Moragues, Rodrigo; Suarez, Elizabeth

    2015-01-01

    Although traumatic brachial plexus injuries are relatively rare in trauma patients, their effects on the functionality of the upper limb can be very disabling. The authors' objective was to assess the complications in a series of patients operated for brachial plexus injuries. This was a retrospective evaluation of patients operated on by the authors between August 2009 and March 2013. We performed 36 surgeries on 33 patients. The incidence of complications was 27.7%. Of these, only 1 (2.7%) was considered serious and associated with the procedure (iatrogenic injury of brachial artery). There was another serious complication (hypoxia in patients with airway injury) but it was not directly related to the surgical procedure. All other complications were considered minor (wound dehiscence, hematoma, infection). There was no mortality in our series. The complications in our series are similar to those reported in the literature. Serious complications (vascular, neural) are rare and represent less than 5% in all the different series. Given the rate of surgical complications and the poor functional perspective for a brachial plexus injury without surgery, we believe that surgery should be the treatment of choice. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  16. Global trends in esophageal cancer.

    Science.gov (United States)

    Malhotra, Gautam K; Yanala, Ujwal; Ravipati, Advaitaa; Follet, Matthew; Vijayakumar, M; Are, Chandrakanth

    2017-04-01

    Esophageal Cancer (EC) is a lethal malignancy with poor prognosis and significant variations in the incidence, mortality, and histopathology based on geographic regions. The aim of this study was to quantitatively analyze these variations to identify patterns and areas for further research. We utilized the GLOBOCAN 2012, and Cancer Incidence in five Continents, Volume X (CI5X) database to analyze variations in EC incidence and mortality. We found the EC incidence and mortality is geographically varied with a particularly high burden in East Asia and Eastern/Southern Africa where esophageal squamous cell carcinoma (SCC) predominates over adenocarcinoma (AC). Interestingly, there is a dichotomy between the high incidence of esophageal SCC in East Africa and low incidence in West Africa. The global incidence and mortality from EC is expected to rise in the coming decades. Asia, and China in particular, will continue to be the areas most burdened by EC, while Africa is expected to surpass the incidence and mortality rates of Europe. The global burden of EC is expected to rise in the coming years. Understanding the geographic, environmental, and genetic contributors to the development of EC will be essential in combating its prevalence. © 2017 Wiley Periodicals, Inc.

  17. Novel methylene blue staining technique for localizing small esophageal leiomyomas during thoracoscopic enucleation.

    Science.gov (United States)

    Zhang, Z; Ai, B; Liao, Y; Liu, L; Liu, M

    2016-11-01

    The treatment of choice for leiomyoma, the most common benign esophageal tumor, is thoracoscopic enucleation. One of the most difficult aspects of thoracoscopic enucleation is the precise localization of small tumors (≤1.5 cm) and tumors without external protrusion. No simple, feasible solutions to this problem are available. We developed a novel methylene blue staining technique to localize small esophageal leiomyomas and evaluated the feasibility of our technique. Between January 2013 and July 2014, eight patients with small esophageal leiomyomas (≤1.5 cm) underwent thoracoscopic enucleation in Tongji Hospital. Preoperative endoscopic ultrasonography was performed in all patients. The leiomyomas were located in the middle (n = 5) and lower (n = 3) thirds of the esophagus. We preoperatively injected 0.5-1.0 mL methylene blue in the submucosa adjacent to the tumors under standard gastroscope guidance. The entire staining process took about 10 minutes. Staining was successful in all patients. The unstained tumor was exposed after the blue-stained mediastinal pleura, and overlying muscle were incised longitudinally. All procedures were successfully completed without conversion to open surgery. No abnormalities were detected in the esophageal mucosa. The median operating time was 60 minutes (range, 40-90 minutes). Postoperative histopathology confirmed leiomyoma in all patients. The median postoperative hospital stay was 6 days (range, 5-7 days). No major complications, such as esophageal leakage or esophageal diverticulum, occurred. Endoscopic methylene blue staining is safe and feasible for localizing small esophageal leiomyomas during thoracoscopic enucleation. This method will enable precise and easy enucleation. © 2015 International Society for Diseases of the Esophagus.

  18. Successful treatment of cervical esophageal leakage by endoscopic-vacuum assisted closure therapy.

    Science.gov (United States)

    Lenzen, Henrike; Negm, Ahmed A; Erichsen, Thomas J; Manns, Michael P; Wedemeyer, Jochen; Lankisch, Tim O

    2013-07-16

    To evaluate the efficacy and safety of endoscopic-vacuum assisted closure (E-VAC) therapy in the treatment of cervical esophageal leakage. Between May and November 2012, three male patients who developed post-operative cervical esophageal leakage were treated with E-VAC therapy. One patient had undergone surgical excision of a pharyngo-cervical liposarcoma with partial esophageal resection, and the other two patients had received surgical treatment for symptomatic Zenker's diverticulum. Following endoscopic verification of the leakage, a trimmed polyurethane sponge was fixed to the distal end of a nasogastric silicone tube and endoscopically positioned into the wound cavity, and with decreasing cavity size the sponge was positioned intraluminally to cover the leak. Continuous suction was applied, and the vacuum drainage system was changed twice a week. The initial E-VAC placement was technically successful for all three patients, and complete closure of the esophageal leak was achieved without any procedure-related complications. In all three patients, the insufficiencies were located either above or slightly below the upper esophageal sphincter. The median duration of the E-VAC drainage was 29 d (range: 19-49 d), with a median of seven sponge exchanges (range: 5-12 sponge exchanges). In addition, the E-VAC therapy reduced inflammatory markers to within normal range for all three patients. Two of the patients were immediately fitted with a percutaneous enteral gastric feeding tube with jejunal extension, and the third patient received parenteral feeding. All three patients showed normal swallow function and no evidence of stricture after completion of the E-VAC therapy. E-VAC therapy for cervical esophageal leakage was well tolerated by patients. This safe and effective procedure may significantly reduce morbidity and mortality following cervical esophageal leakage.

  19. A Case of Ruptured Aneurysm of the Proper Esophageal Artery with Symptomatic Mediastinal Hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Jiajia; Sato, Yusuke, E-mail: yusuke@doc.med.akita-u.ac.jp [Akita University Graduate School of Medicine, Department of Thoracic Surgery (Japan); Takahashi, Satoshi [Akita University Graduate School of Medicine, Department of Radiology (Japan); Motoyama, Satoru; Yoshino, Kei; Sasaki, Tomohiko; Imai, Kazuhiro; Saito, Hajime; Minamiya, Yoshihiro [Akita University Graduate School of Medicine, Department of Thoracic Surgery (Japan)

    2016-08-15

    Mediastinal aneurysms are rare but potentially life-threatening. Among these, bronchial artery aneurysms are most frequently reported, whereas up to now aneurysms of the proper esophageal artery had never been reported. A 69-year-old woman was referred to our hospital for treatment of a massive mediastinal hematoma. Enhanced computed tomography and selective proper esophageal arteriography revealed a 5-mm aneurysm in the proper esophageal artery that arises from the thoracic aorta at the Th8 level and has an anastomotic branch with the bronchial artery peripherally. Transcatheter arterial embolization was successfully performed using a mixture of N-butyl cyanoacrylate and lipiodol (1:3 ratio, 0.3 ml). Post-embolization angiography showed no filling into the aneurysm. The patient recovered with no complications and was discharged on the 25th post-procedure day.

  20. A late diagnosed case of Spontaneous esophageal perforation in an elderly patient

    Science.gov (United States)

    Wei, Lu; Wang, Fei; Chen, Shuyan

    2015-01-01

    Spontaneous esophageal perforation, also known as Boerhaave’s syndrome, is a rare but potentially life-threatening condition, especially in elderly patients with more complications, speedy development and higher mortality. Successful handling of the disease depends on a timely diagnosis and the appropriate choice of treatment. Unfortunately, late diagnosis is common because of the non-specific clinical presentation. We here present a 72-year-old patient of spontaneous esophageal perforation who complained of chest pain, but sharply deteriorated with septic shock. With a vomiting history and gastrointestinal-genic bacterium identified in the chest fluid, the patient was highly suspected for esophageal perforation, though the oral methylene blue test was negative for three times. The diagnosis was finally established by esophagoscopy on the 10th day. The perforation was successfully healed by active conservative management and the patient was discharged home on the 43rd day eating normal diet. PMID:26379988

  1. Long-lived keratin 15+ esophageal progenitor cells contribute to homeostasis and regeneration.

    Science.gov (United States)

    Giroux, Véronique; Lento, Ashley A; Islam, Mirazul; Pitarresi, Jason R; Kharbanda, Akriti; Hamilton, Kathryn E; Whelan, Kelly A; Long, Apple; Rhoades, Ben; Tang, Qiaosi; Nakagawa, Hiroshi; Lengner, Christopher J; Bass, Adam J; Wileyto, E Paul; Klein-Szanto, Andres J; Wang, Timothy C; Rustgi, Anil K

    2017-06-01

    The esophageal lumen is lined by a stratified squamous epithelium comprised of proliferative basal cells that differentiate while migrating toward the luminal surface and eventually desquamate. Rapid epithelial renewal occurs, but the specific cell of origin that supports this high proliferative demand remains unknown. Herein, we have described a long-lived progenitor cell population in the mouse esophageal epithelium that is characterized by expression of keratin 15 (Krt15). Genetic in vivo lineage tracing revealed that the Krt15 promoter marks a long-lived basal cell population able to self-renew, proliferate, and generate differentiated cells, consistent with a progenitor/stem cell population. Transcriptional profiling demonstrated that Krt15+ basal cells are molecularly distinct from Krt15- basal cells. Depletion of Krt15-derived cells resulted in decreased proliferation, thereby leading to atrophy of the esophageal epithelium. Further, Krt15+ cells were radioresistant and contributed to esophageal epithelial regeneration following radiation-induced injury. These results establish the presence of a long-lived and indispensable Krt15+ progenitor cell population that provides additional perspective on esophageal epithelial biology and the widely prevalent diseases that afflict this epithelium.

  2. Novel device to sample the esophageal microbiome--the esophageal string test.

    Directory of Open Access Journals (Sweden)

    Sophie A Fillon

    Full Text Available A growing number of studies implicate the microbiome in the pathogenesis of intestinal inflammation. Previous work has shown that adults with esophagitis related to gastroesophageal reflux disease have altered esophageal microbiota compared to those who do not have esophagitis. In these studies, sampling of the esophageal microbiome was accomplished by isolating DNA from esophageal biopsies obtained at the time of upper endoscopy. The aim of the current study was to identify the esophageal microbiome in pediatric individuals with normal esophageal mucosa using a minimally invasive, capsule-based string technology, the Enterotest™. We used the proximal segment of the Enterotest string to sample the esophagus, and term this the "Esophageal String Test" (EST. We hypothesized that the less invasive EST would capture mucosal adherent bacteria present in the esophagus in a similar fashion as mucosal biopsy. EST samples and mucosal biopsies were collected from children with no esophageal inflammation (n = 15 and their microbiome composition determined by 16S rRNA gene sequencing. Microbiota from esophageal biopsies and ESTs produced nearly identical profiles of bacterial genera and were different from the bacterial contents of samples collected from the nasal and oral cavity. We conclude that the minimally invasive EST can serve as a useful device for study of the esophageal microbiome.

  3. Palliative enteral feeding for patients with malignant esophageal obstruction: a retrospective study.

    Science.gov (United States)

    Yang, C W; Lin, H H; Hsieh, T Y; Chang, W K

    2015-11-05

    Malignant esophageal obstruction leads to dysphagia, deterioration in quality of life, and malnutrition. Traditional bedside nasogastric (NG) tube placement is very difficult under these circumstances. However, endoscopically assisted NG tube placement under fluoroscopic guidance could be an alternative option for establishing palliative enteral nutrition. This study aimed to compare the clinical outcomes of enteral tube feeding and esophageal stenting for patients with malignant esophageal obstruction and a short life expectancy. Thirty-one patients were divided into 3 groups according to their treatment modality: NG tube (n = 12), esophageal stent group (n = 10), and supportive care with nil per os (NPO) (n = 9). Enteral nutrition, clinical outcomes, length of hospital stay, and median survival were evaluated. There were no significant baseline differences among the groups, except in age. The tube and stent groups had significantly higher enteral calorie intake (p = 0.01), higher serum albumin (p Palliative enteral feeding by NG tube is safe, inexpensive, and has a low complication rate. Endoscopically assisted NG tube placement under fluoroscopic guidance could be a feasible palliative option for malignant esophageal obstruction for patients who have a short life expectancy.

  4. Endoscopic therapy for esophageal perforation or anastomotic leak with a self-expandable metallic stent.

    Science.gov (United States)

    Leers, Jessica M; Vivaldi, Carlo; Schäfer, Hartmut; Bludau, Marc; Brabender, Jan; Lurje, Georg; Herbold, Till; Hölscher, Arnulf H; Metzger, Ralf

    2009-10-01

    Leaks of the esophagus are associated with a high mortality rate and need to be treated as soon as possible. Therapeutic options are surgical repair or resection or conservative management with cessation of oral intake and antibiotic therapy. We evaluated an alternative approach that uses self-expandable metallic stents (SEMS). Between 2002 and 2007, 31 consecutive patients with iatrogenic esophageal perforation (n = 9), intrathoracic anastomotic leak after esophagectomy (n = 16), spontaneous tumor perforation (n = 5), and esophageal ischemia (n = 1) were treated at our institution. All were treated with endoscopic placement of a covered SEMS. Stent removal was performed 4 to 6 weeks after implantation. To exclude continuous esophageal leak after SEMS placement, radiologic examination was performed after stent implantation and removal. SEMS placement was successful in all patients and a postinterventional esophagogram demonstrated full coverage of the leak in 29 patients (92%). In two patients, complete sealing could not be achieved and they were referred to surgical repair. Stent migration was seen in only one patient (3%). After removal, a second stent with larger diameter was placed and no further complication occurred. Two patients died: one due to myocardial infarction and one due to progressive ischemia of the esophagus and small bowl as a consequence of vascular occlusion. Stent removal was performed within 6 weeks, and all patients had radiologic and endoscopic evidence of esophageal healing. Implantation of covered SEMS in patients with esophageal leak or perforation is a safe and feasible alternative to operative treatment and can lower the interventional morbidity rate.

  5. Prevalence of esophageal candidiasis among patients treated with inhaled fluticasone propionate.

    Science.gov (United States)

    Kanda, Naoki; Yasuba, Hirotaka; Takahashi, Teruko; Mizuhara, Yuka; Yamazaki, Syuji; Imada, Yuko; Izumi, Yoshio; Kobayashi, Yoshiki; Yamashita, Kenzo; Kita, Hideo; Tamada, Takashi; Chiba, Tsutomu

    2003-10-01

    Development of oropharyngeal candidiasis is a frequently reported adverse effect of inhaled corticosteroid use, but the prevalence of esophageal candidiasis is unknown. The aim of this study was to estimate the prevalence of esophageal candidiasis among patients treated with an inhaled corticosteroid, fluticasone propionate. Upper GI endoscopy was performed on 49 patients treated with inhaled fluticasone propionate to examine the prevalence of esophageal candidiasis. Of the patients, 36 had bronchial asthma and 13 had chronic obstructive pulmonary disease. To compare the prevalence with control patients, upper GI endoscopy was performed on 700 consecutive patients without malignancy or immunosuppression. The prevalence of esophageal candidiasis was 37% among patients treated with inhaled fluticasone propionate, whereas only 0.3% of the control patients had the infection. The prevalence was especially high among patients with diabetes mellitus or those who were treated with a high dose of inhaled fluticasone propionate. Moreover, a reduction in the daily dose of inhaled fluticasone propionate eliminated the infection in four of five patients. Esophageal candidiasis is a common complication of inhaled corticosteroid use.

  6. Outcome of esophageal cancer in the elderly - systematic review of the literature.

    Science.gov (United States)

    Skorus, Urszula A; Kenig, Jakub

    2017-12-01

    As the population ages, the number of elderly patients with esophageal cancer increases. Esophageal cancer has a poor prognosis and is associated with decreased life quality. To review the literature about the outcome of esophageal cancer in patients over 65. Articles published between January 2006 and November 2016 in the PubMed/Medline and ResearchGate databases were reviewed. Nineteen retrospective studies were included. Six thousand seven hundred and twenty-nine patients over 65 were analyzed. Thirty-day mortality ranges from 3.2% to 8.1%. Overall 5-year survival rates range from 0% to 49.2%, and the median survival rate ranges from 9.6 to 108.2 months. The incidence of complications in the surgery group ranges from 27% to 69%. Chemoradiotherapy grade ≥ 3 toxicity was observed in 22-36% of patients. Chronological age seems to have little influence on outcome of esophageal cancer. Open esophagectomy seems to be the mainstay of treatment for patients with esophageal cancer, regardless of age. There is still high mortality and morbidity involved in this procedure. To reduce them, some less invasive methods are being trialed.

  7. [Tension pneumothorax during peroral endoscopic myotomy for treatment of esophageal achalasia under general anesthesia].

    Science.gov (United States)

    Li, Tsung-Shih; Lee, Tsung-Yang; Liao, Kate Hsiurong

    More and more endoscopically gastrointestinal procedures require anesthesiologists to perform general anesthesia, such as "peroral endoscopic myotomy". Peroral endoscopic myotomy is a novel invasive treatment for the primary motility disorder of esophagus, called esophageal achalasia. Despite of its minimally invasive feature, there are still complications during the procedure which develop to critical conditions and threat patients' lives. Herein we describe a case about tension pneumothorax subsequent to esophageal rupture during peroral endoscopic myotomy. The emergent management of the complication is stated in detail. The pivotal points of general anesthesia for patients undergoing peroral endoscopic myotomy are emphasized and discussed. Also, intraoperative and post-operative complications mentioned by literature are integrated. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  8. Sclerotherapy of esophageal varices by consecutive injection of anhydrous ethanol: 1% polydocanol and thrombin.

    Science.gov (United States)

    Kumagai, Y; Makuuchi, H; Yamazaki, E

    1987-01-01

    In 1978, the first Japanese report of sclerotherapy with the flexible esophagoscope was published. At the Second Meeting of the Japanese Society of Sclerotherapy for Esophageal Varices (August 1986), reports were given on over 4000 cases treated by over 70 groups of endoscopists using various methods and sclerosants. These cases included 15 (about 0.4%) in which esophageal perforation occurred, and other complications, some fatal, were also reported. The main problem is to reduce the frequency of these serious complications. Over 400 cases have been treated by the authors in the past 3 years with a method involving consecutive injections of anhydrous ethanol when it is certain that the needle is in the varices. If there is any possibility of the needle being dislocated, 3-5 ml 1% polydocanol is administered instead. Weekly injections should be repeated until all varices have been sclerosized. No major complications have been observed, and the results are satisfactory [7].

  9. Esophageal cancer awareness in Bomet district, Kenya

    African Journals Online (AJOL)

    EB

    Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital ... Objective: To determine baseline level of knowledge of esophageal cancer in ... studies of esophageal cancer in Africa have come ..... educating people of the community. A mobile endoscopy unit may ideally complement the current.

  10. Candidial esophagitis - A marker for HIV infection

    Directory of Open Access Journals (Sweden)

    B Kumar

    1990-01-01

    Full Text Available A case of AIDS manifested as candidial esophagitis. In addition , he had genital herpes, frequent diarrhoea, loss of weight and generalized lymphadenopathy. The diagnosis was confirmed by endoscopy. The patient died in 3 months due to unremitting diarrhoea. This importance of candidial esophagitis in a person at risk for developing AIDS is highlighted.

  11. Management of complicated wounds.

    Science.gov (United States)

    Hendrix, Sam M; Baxter, Gary M

    2005-04-01

    Most injuries, including those with significant tissue loss, can be successfully managed with proper therapy. With delayed healing, potential causes for the delay, such as sequestra, foreign bodies, and excessive motion,should be determined and treated to permit complete wound resolution. Horses have the innate ability to heal rapidly; however, minor injuries can quickly turn into complicated wounds, given the severity of the inciting trauma and the less than ideal environment in which the horses are housed. Wound management must focus on a combination of timely surgical and medical intervention to ensure the best potential outcome.

  12. Early-onset Infectious Complications among Penetrating and Severe Closed Traumatic Brain Injury in Active Duty Deployed during OIF and OEF, 2008-2013

    Science.gov (United States)

    2015-02-01

    Clinical Practice Guidelines (CPG) developed first in 2008 and updated in 2011 to provide recommendations for injury-specific antimicrobial prophylaxis...brain injury: a post-hoc analysis of the SOAP study. Intensive Care Med. 2008;34:720-727. 11. Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term...Lloyd BA, Weintrob AC, Hinkle MK, et al. Adherence to published antimicrobial prophylaxis guidelines for wounded service members in the ongoing

  13. Association of a globus sensation with esophageal diseases.

    Science.gov (United States)

    Nagano, Hiromi; Yoshifuku, Kousuke; Kurono, Yuichi

    2010-04-01

    The aim of the study was to clarify the relationship between a globus sensation and esophageal diseases using upper gastrointestinal endoscopy. The study population consisted of 52 consecutive patients (33 men, 19 women, age 46-94 years old) with a globus sensation without laryngeal and hypopharyngeal findings who were referred to the Department of Otolaryngology at Ooshima Prefecture Hospital. The subjects were examined by upper gastrointestinal endoscopy. Nineteen patients (36.5%) had esophageal disorder, including 10 cases of reflux esophagitis, 5 of esophageal candidiasis, 3 of esophageal cancer. and 1 of herpes and reflux esophagitis. Neither age nor duration of symptoms differed significantly between patients without an esophageal disorder and those with reflux esophagitis or esophageal candidiasis. The results suggest that examination for esophageal diseases is important in patients with a globus sensation without laryngeal and hypopharyngeal findings. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

  14. Medical complications associated with earthquakes.

    Science.gov (United States)

    Bartels, Susan A; VanRooyen, Michael J

    2012-02-25

    Major earthquakes are some of the most devastating natural disasters. The epidemiology of earthquake-related injuries and mortality is unique for these disasters. Because earthquakes frequently affect populous urban areas with poor structural standards, they often result in high death rates and mass casualties with many traumatic injuries. These injuries are highly mechanical and often multisystem, requiring intensive curative medical and surgical care at a time when the local and regional medical response capacities have been at least partly disrupted. Many patients surviving blunt and penetrating trauma and crush injuries have subsequent complications that lead to additional morbidity and mortality. Here, we review and summarise earthquake-induced injuries and medical complications affecting major organ systems. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. The management of eosinophilic esophagitis.

    Science.gov (United States)

    Greenhawt, Matthew; Aceves, Seema S; Spergel, Jonathan M; Rothenberg, Marc E

    2013-01-01

    Eosinophilic esophagitis (EoE) is a clinicopathologic, chronic esophageal inflammatory disease resistant to acid suppressive therapy and is associated with variable symptoms indicative of upper gastrointestinal dysfunction. Per current guidelines established by The International Group of Eosinophil Researchers (TIGERS), the diagnosis is made in symptomatic patients after a biopsy that confirms a peak eosinophil level of ≥15 eosinophils/high-powered field (HPF). The esophagus is distinguished by pronounced tissue eosinophilia in which dietary antigens are key inciting factors for disease pathogenesis; EoE being reversed by elimination of triggering food allergens suggests that the disease is mediated in part by allergic sensitization to foods. Moreover, experimental EoE in mice can be induced not only via food exposure but also via aeroallergen exposure. Consistent with an allergic etiology rather than an acid-induced esophagitis, swallowed glucocorticoids are effective for the treatment of EoE. Evaluation by an allergist is a recommended part of the diagnostic workup, especially for management of allergic comorbidities. Clinical practice for the evaluation of patients with EoE mainly relies on prick skin tests due to the ease and validation of these tests in the context of immediate hypersensitivity. However, both atopy patch testing and serum IgE testing have been used in EoE. Herein, we reviewed the basic clinical features of EoE with a focus on the approach to diagnosing causative food allergens and to dietary therapy. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  16. Improvement of endocytoscopic findings after per oral endoscopic myotomy (POEM) in esophageal achalasia; does POEM reduce the risk of developing esophageal carcinoma? Per oral endoscopic myotomy, endocytoscopy and carcinogenesis.

    Science.gov (United States)

    Minami, Hitomi; Yamaguchi, Naoyuki; Matsushima, Kayoko; Akazawa, Yuko; Ohnita, Ken; Takeshima, Fuminao; Nakayama, Toshiyuki; Hayashi, Tomayoshi; Inoue, Haruhiro; Nakao, Kazuhiko; Isomoto, Hajime

    2013-01-30

    Per oral endoscopic myotomy (POEM) has been reported to be a new therapeutic option for esophageal achalasia. The possibility that POEM could reduce the risk of developing esophageal squamous cell carcinoma was evaluated. This was a single-centre, retrospective study. Fifteen consecutive patients with esophageal achalasia who underwent POEM in our institution between August 2010 and January 2012 were enrolled. Ultra-high magnification with endocytoscopy was performed, and both histopathological and immunohistochemical evaluations for Ki-67 and p53 were assessed before and 3 months after POEM. POEM was successfully performed and effectively released the dysphagia symptom in all patients without severe complications. Subjective symptoms (mean Ekcardt score, before 7.4 vs. after 0.5, pPOEM. The average numbers of esophageal epithelial nuclei before and after POEM on endocytoscopic images were 128.0 and 78.0, respectively (pPOEM, and the mean p53-positive ratio was 2.35 (median 2.61, 0.32-4.23) before and 0.97 (median 1.49, 0.32-1.56; pPOEM. A significant positive correlation was seen between the number of nuclei and the Ki-67-positive ratio (pPOEM appears to be an effective and less invasive treatment of choice against achalasia and may reduce the risk of esophageal carcinogenesis. Endocytoscopy can be useful for the assessment of esophageal cellular proliferation.

  17. Complications of laparoscopy.

    Science.gov (United States)

    Hulka, J F

    1980-09-01

    This monograph documents in detail the complications of laparoscopy that have been reported in the literature with the intent of forming a background for recommendations as to prevention. It reviews the history of US surveys of physicians regarding laparoscopic complications and results of survey reports. Discussion of the prevention of complications covers: physician training, patient selection (absolute contraindications, the high risk patient, informing the patient, and suitability for local anesthesia), equipment (electrocautery, selection of laparoscope size, uterine manipulator, and maintenance of instruments), the operating room team, anesthesia, abdominal entry, trocar entry, the hazards of diagnostic procedures, minimizing complications of laparoscopic sterilization (electrocoagulation, exicsion of tubal segment, spring clip, pain during and after surgery, and selection of sterilization method), and infections. The final focus of the monograph is on the management of major complications (bowel burns -- unipolar; bowel burns -- bipolar; other injuries to the bowel; large vessel injuries; and other bleeding) and late complications (reversibility of sterilization, subsequent pregnancies -- intrauterine and ectopic, and "post-tubal syndrome"). The survey performed in the US in 1979 by the American Association of Gynecologic Laparoscopists (AAGL) reported that the unipolar technique, which had been the only technique in the early 1970s, was used by only 30% of the membership. The vast majority of the membership had converted to bipolar coagulation (43%), with a smaller number having switched to the ring (24%) and the spring clip (3%). For the 1st time, a meaningful number of both intratuerine and ectopic pregnancies was reported for all methods, allowing a relatively valid comparison of the risk of ectopic pregnancies as a function of different sterilization techniques. It appeared that the more destructive techniques (coagulation, unipolar or bipolar including

  18. Gastrointestinal complications in renal transplantation

    Directory of Open Access Journals (Sweden)

    Kamal Jeet Singh

    2004-01-01

    Full Text Available Objective: Gastrointestinal complications are responsible for substantial morbidity and mortality among renal allograft recipients. We retrospectively analyzed incidence of these complications and their impact on the patient outcome. Materials & Methods: Between 1998 to Aug 2002, 558 live related renal transplants were performed at our center. The immunosuppression used consisted mainly of cyclosporine, azathioprine and prednisolone, though varied in some patients. These patients were followed for any occurrence of significant gastrointestinal problems. Results: Out of the of 538 renal transplant recipients studied, gastro esophageal ulcerations were seen in 3% patients. Acute pancreatitis was observed in twelve (2.2% patients and four patients had acute intestinal obstruction secondary to fecal impaction. Infectious complications included acute diarrheas in 18% of patients. Three patients developed abdominal tuberculosis. Acute rejection episodes were encountered in 26% of the patients. During these episodes, 58% of patients experienced prolonged ileus. Most of these complications (66% occurred within first one-year post transplant. Three patients presenting with acute intestinal obstruction required laparotomy (two- bands, one-intussusception. There were four mortalities -two patients had severe pancreatitis, one patient had massive upper GI bleed and one succumbed due to perforation peritonitis. Conclusions: Gastrointestinal complications account for significant morbidity and mortality in renal transplant recipients. Paralytic ileus secondary to acute vascular rejection is quite common and resolves spontaneously with recovery of renal function.

  19. Local complications

    NARCIS (Netherlands)

    van den Akker, H.P.; Baart, J.A.; Baart, J.A.; Brand, H.S.

    2017-01-01

    Local anaesthesia is frequently used in dentistry and seldom leads to serious local complications. Nevertheless, it is of great importance to be aware of the causes of each local complication and – if necessary – implement correct treatment. The patient must be informed extensively and, if

  20. Operative outcome of colon interposition in the treatment of esophageal cancer: a 20-year experience.

    Science.gov (United States)

    Klink, Christian Daniel; Binnebösel, Marcel; Schneider, Mark; Ophoff, Kerstin; Schumpelick, Volker; Jansen, Mark

    2010-04-01

    In patients with esophageal cancer and a history of gastric surgery, colonic interposition is the treatment of choice. Our aim was to review our experience with this technique and to identify possible predictors of the clinical outcome. Between 1986 and 2006, 43 patients underwent esophageal reconstruction accomplished by colon interposition in our surgical department. Data from these patients were collected consecutively and reviewed retrospectively. Colon interposition was performed isoperistaltically in 15 patients and was performed in 28 patients anisoperistaltically. In 18 patients, the right colon was used for interposition, whereas in 25 patients, the left colon was used. The mean survival time was 23+/-29 months. Artificial ventilation more than 24h, tumor differentiation grade III, the presence of major complications, and the presence of multivisceral resection had a significant negative influence on the operative outcome of colon interposition for esophageal replacement. Colon interposition for esophageal replacement provides a satisfactory operative outcome with high complication rates. Therefore, it should be reserved as a treatment of second choice for cases in which the stomach is not available. Crown Copyright 2010. Published by Mosby, Inc. All rights reserved.

  1. [Biweekly paclitaxel and platinum chemotherapy followed by surgery for esophageal squamous cell carcinoma].

    Science.gov (United States)

    Zhang, L Z; Li, W W; Cui, C X; Zhang, H T; Song, Y; Mao, Y S; Huang, J

    2017-03-23

    Objective: To evaluate the feasibility and efficacy of biweekly paclitaxel and platinum chemotherapy followed by surgery for esophageal squamous cell carcinoma. Methods: We retrospectively analyzed the clinicopathological data of 20 patients with esophageal squamous cell carcinoma treated in our hospital between January 2012 and March 2016. All patients received biweekly paclitaxel and platinum chemotherapy followed by surgery. Results: 20 cases received preoperative chemotherapy for 3-8 cycles with an average of 4 cycles. The main chemotherapy-related adverse events were bone marrow suppression (18/20, 90.0%), followed by vomiting and nausea (10/20, 50.0%). Five patients (25.0%) had grade 4 neutropenia and all toxicities were torlerable and manageable. After chemotherapy, all patients received surgery. The histological responses in the primary tumors were grade 1 in 13 (65.0%) patients, grade 2 in 7 (35.0%) patients, and grade 3 in 0 (0%) patient. None had disease progression. Downstaging of T-stage was observed in 5 cases (25.0%) after chemotherapy. Among them, 4 cases were with moderate histologicl responses and one case with mild histological response. The incidence of postoperative complications was 25.0%(5/20), and the complications were improved following symptomatic treatments. There was no treatment-related death. Conclusions: Biweekly paclitaxel and platinum chemotherapy followed by surgery for esophageal squamous cell carcinoma is safe and effective. Further randomized clinical trial should be conducted to assess the value of this therapeutic regimen in the preoperative chemotherapy for esophageal cancer.

  2. Failure-to-rescue in patients undergoing surgery for esophageal or gastric cancer.

    Science.gov (United States)

    Busweiler, L A; Henneman, D; Dikken, J L; Fiocco, M; van Berge Henegouwen, M I; Wijnhoven, B P; van Hillegersberg, R; Rosman, C; Wouters, M W; van Sandick, J W

    2017-10-01

    Complex surgical procedures such as esophagectomy and gastrectomy for cancer are associated with substantial morbidity and mortality. The purpose of this study was to evaluate trends in postoperative morbidity, mortality, and associated failure-to-rescue (FTR), in patients who underwent a potentially curative resection for esophageal or gastric cancer in the Netherlands, and to investigate differences between the two groups. All patients with esophageal or gastric cancer who underwent a potentially curative resection, registered in the Dutch Upper GI Cancer Audit (DUCA) between 2011 and 2014, were included. Primary outcomes were (major) postoperative complications, postoperative mortality and FTR. To investigate groups' effect on the outcomes of interest a mixed model was used. Overall, 2644 patients with esophageal cancer and 1584 patients with gastric cancer were included in this study. In patients with gastric cancer, postoperative mortality (7.7% in 2011 vs. 3.8% in 2014) and FTR (38% in 2011 and 19% in 2014) decreased significantly over the years. The adjusted risk of developing a major postoperative complication was lower (OR 0.54; 95% CI 0.42-0.70), but the risk of FTR was higher (OR 1.85; 95% CI 1.05-3.27) in patients with gastric cancer compared to patients with esophageal cancer. Once a postoperative complication occurred, patients with gastric cancer were more likely to die compared to patients with esophageal cancer. Underlying mechanisms like patient selection, and differences in structure and organization of care should be investigated. Next to morbidity and mortality, failure-to-rescue should be considered as an important outcome measure after esophagogastric cancer resections. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  3. Association of esophageal candidiasis and squamous cell carcinoma.

    Science.gov (United States)

    Delsing, C E; Bleeker-Rovers, C P; van de Veerdonk, F L; Tol, J; van der Meer, J W M; Kullberg, B J; Netea, M G

    2012-01-01

    Chronic esophageal candidiasis is an infection that is mostly seen in immunocompromised conditions, among which is chronic mucocutaneous candidiasis (CMC). Recently an association between CMC and esophageal carcinoma has been reported. Here we present two patients with chronic esophageal candidiasis who developed esophageal squamous cell carcinoma and we discuss the etiologic role of Candida-induced nitrosamine production, the loss of STAT1 function and impaired tumor surveillance and T-lymphocyte function in the development of esophageal carcinoma.

  4. [Current Status and Effectiveness of Perioperative Oral Health Care Management for Lung Cancer and Esophageal Cancer Patients].

    Science.gov (United States)

    Nishino, Takeshi; Takizawa, Hiromitsu; Yoshida, Takahiro; Inui, Tomohiro; Takasugi, Haruka; Matsumoto, Daisuke; Kawakita, Naoya; Inoue, Seiya; Sakiyama, Shoji; Tangoku, Akira; Azuma, Masayuki; Yamamura, Yoshiko

    2016-01-01

    The effectiveness of perioperative oral health care management to decrease the risk of postoperative pneumonia have been reported lately. Since 2014, we introduced perioperative oral health care management for lung cancer and esophageal cancer patients. We report current status and effectiveness of perioperative oral health care management for lung cancer and esophageal cancer patients. Every 100 cases of lung cancer and esophageal cancer patients treated by surgery were classified 2 group with or without perioperative oral health care management and compared about postoperative complications retrospectively. In the lung cancer patients, the group with oral health care management could prevent postoperative pneumonia significantly and had shorter length of hospital stay than the group without oral health care management. In the esophageal cancer patients, there was little occurrence of postoperative pneumonia without significant difference between both group with or without oral health care management. A large number of esophageal cancer patients received neo-adjuvant chemotherapy and some patients developed oral mucositis and received oral care treatment before surgery. Treatment for oral mucositis probably improved oral environment and affected prevention of postoperative pneumonia. Perioperative oral health care management can prevent postoperative pneumonia of lung cancer and esophageal cancer patients by improvement of oral hygiene.

  5. A Sequence Variant in the Phospholipase C Epsilon C2 Domain Is Associated With Esophageal Carcinoma and Esophagitis

    OpenAIRE

    Wang, Li-Dong; Bi, Xiuli; Song, Xin; Pohl, Nicole M.; Cheng, Yulan; Zhou, Yixing; Shears, Stephen; Ansong, Emmanuel; XING, MENGTAO; Wang, Shaomeng; Xu, Xiao-Chun; Huang, Peng; Xu, Liyan; Wang, Liang; Fan,Zongmin

    2013-01-01

    A single-nucleotide polymorphism (rs2274223: A5780G:His1927Arg) in the phospholipase C epsilon gene (PLCε) was recently identified as a susceptibility locus for esophageal cancer in Chinese subjects. To determine the underlying mechanisms of PLCε and this SNP in esophageal carcinogenesis, we analyzed PLCε genotypes, expression, and their correlation in esophageal cancer cell lines, non-transformed esophageal cells, 58 esophageal squamous cell carcinomas and 10,614 non-cancer subjects from Chi...

  6. Esophageal variceal ligation for hemostasis of acute variceal bleeding: efficacy and safety.

    Science.gov (United States)

    Lahbabi, Mounia; Elyousfi, Mounia; Aqodad, Nouredine; Elabkari, Mohammed; Mellouki, Ihssane; Ibrahimi, Sidi Adil; Benajah, Dafr Allah

    2013-01-01

    Endoscopic variceal ligation is widely accepted as the optimum endoscopic treatment for esophageal variceal hemorrhage. In Morocco, there are no data regarding the efficacy of this technique. Our aim was to evaluate the effectiveness and safety of endoscopic variceal ligation in the management of oesophageal variceal bleeding in cirrhosis in a located population in Morocco. Via a retrospective study over 118 months (December 2001- October 2011), cirrhotic patients with endoscopically proven esophageal variceal hemorrhage were treated by endoscopic variceal ligation. We studied the rate of haemostasis, rebleeding, complications and mortality. 360 cirrhotic patients were included and 378 haemostatic variceal ligations were performed. Primary haemostasis was obtained in 96.5 % (N=365) of cases. Thirty three patients (8.7%) bled during follow-up. The rate of minor complications was 15.3 % (N=58). Retrosternal pain, fever, dysphagia and Overtube's migration developed in 8.4 % (N=32); 2.6 % (N=10); 3,7 % (N=14) and 0.5 % (N=2) of the patients respectively. Severity of these complications was mild and transient. The rate of oesophageal ulcers was 5 % (N=19), while the mortality rate by haemorrhage was 5 % (N=18). Our data showed that band ligation is an effective and safe treatment modality of esophageal variceal bleeding with low rates of rebleeding and complications.

  7. "Incidence And Epidemiology Of Esophagitis In Children Admitted To Endoscopy Unit Medical Center Of Children In Tehran "

    Directory of Open Access Journals (Sweden)

    Rafeey M

    2004-06-01

    Full Text Available Background: There has been a little attention to pediatrics esophagus problems until recent years. The term esoghagitis can be used to described chemical, infectious, inflammatory, ischemic, immunologic and degenerative abnormalities. Prevalence of reflux esophagitis varies between 2 to 5 percent of general population but little data about its incidence in pediatric age groups. The aim of this study was to evaluate the epidemiology and prevalence of esophagitis and study of symptom, diagnostic measures, therapeutic intervention and prevention of its complication. Materials and Methods: In this prospective and cross sectional study 500 patient under16 years with upper digestive complaints or alteration of their state of health under went upper endoscopy, with special attention paid to esophagus. Results: Among 500 children (205 male, 207 female, pathology reported esophagi is in 325 cases. Majority of the patient were 8 to12 years. Most common complaints was abdominal pain (45/7% and the second complaints was vomiting (13%, but most common complaints in severe esophagitis was melena (66% and hematemes(18/8%. Most of patient (63% had a mild grade of esophagitis. When difference between endoscopy and pathology compared: Mild esophagitis in endoscopy (67% ,but in pathology was (63%, moderate esophagitis (14/7% in endoscopy was (17% in pathology and severe form 2/8% in endoscopy but (4/9%in pathology. Conclusion: According to results of our study in children age group with chronic abdominal pain ,vomiting ,excessive regurgitation, failure to thrive, we noticed that esophagitis is common etiologic factor. Histological esophagitis frequently occur in the absence of gross endoscopic findings and we need biopsy and histological examination to confirm diagnosis.

  8. The potential of photodynamic therapy to treat esophageal candidiasis coexisting with esophageal cancer.

    Science.gov (United States)

    Qiu, Haixia; Mao, Yongping; Gu, Ying; Zhu, Jianguo; Wang, Ying; Zeng, Jing; Huang, Naiyan; Liu, Qingsen; Yang, Yunsheng

    2014-01-05

    Photodynamic therapy (PDT) has been used in recent years to deal with fungal infections because of the prevalence of fungi resistance to drugs. However, PDT for gastrointestinal fungal infection has not been reported. This study was conducted to assess the potential of PDT to deal with esophageal candidiasis. Two male patients with histological evidence of esophageal candidiasis coexisting with esophageal cancer were included in this retrospective study. Both patients were treated with PDT. This treatment was repeated at least 1month after the initial PDT if the patient still had residual cancer or esophageal candidiasis. Short-term efficacy was evaluated on the basis of endoscopy and histology findings. Further follow-up data were obtained from endoscopy results or telephone conversation. The esophageal candidiasis located 21-24cm and 25-28cm from the incisors of case 1 reached complete remission after one and two PDT sessions, respectively. The esophageal cancer coexisting with esophageal candidiasis located 21-24cm from the incisors reached complete remission after two PDT sessions. No recurrence was found at a 14-month follow-up. The esophageal cancer located 30-35cm from the incisors reached partial response after three PDT sessions. Both of the esophageal candidiasis and the coexisting esophageal cancer at 23-26cm from the incisors of case 2 reached complete remission and the esophageal cancer at 34-37cm from the incisors reached complete remission after one PDT session. No recurrence was found at a 24-month follow-up. There were no serious adverse events found in either of the two cases. Results of this preliminary study indicate that PDT may be a potential method to deal with esophageal candidiasis. Copyright © 2013 Elsevier B.V. All rights reserved.

  9. Fabrication of a Delaying Biodegradable Magnesium Alloy-Based Esophageal Stent via Coating Elastic Polymer

    Directory of Open Access Journals (Sweden)

    Tianwen Yuan

    2016-05-01

    Full Text Available Esophageal stent implantation can relieve esophageal stenosis and obstructions in benign esophageal strictures, and magnesium alloy stents are a good candidate because of biodegradation and biological safety. However, biodegradable esophageal stents show a poor corrosion resistance and a quick loss of mechanical support in vivo. In this study, we chose the elastic and biodegradable mixed polymer of Poly(ε-caprolactone (PCL and poly(trimethylene carbonate (PTMC as the coated membrane on magnesium alloy stents for fabricating a fully biodegradable esophageal stent, which showed an ability to delay the degradation time and maintain mechanical performance in the long term. After 48 repeated compressions, the mechanical testing demonstrated that the PCL-PTMC-coated magnesium stents possess good flexibility and elasticity, and could provide enough support against lesion compression when used in vivo. According to the in vitro degradation evaluation, the PCL-PTMC membrane coated on magnesium was a good material combination for biodegradable stents. During the in vivo evaluation, the proliferation of the smooth muscle cells showed no signs of cell toxicity. Histological examination revealed the inflammation scores at four weeks in the magnesium-(PCL-PTMC stent group were similar to those in the control group (p > 0.05. The α-smooth muscle actin layer in the media was thinner in the magnesium-(PCL-PTMC stent group than in the control group (p < 0.05. Both the epithelial and smooth muscle cell layers were significantly thinner in the magnesium-(PCL-PTMC stent group than in the control group. The stent insertion was feasible and provided reliable support for at least four weeks, without causing severe injury or collagen deposition. Thus, this stent provides a new stent for the treatment of benign esophageal stricture and a novel research path in the development of temporary stents in other cases of benign stricture.

  10. Fast-tracked Rehabilitation and Return to Sport of an Elite Rugby Player with a Complicated Posterolateral Corner Injury and Associated Peroneal Paralysis

    NARCIS (Netherlands)

    Paget, L. D. A.; Kuijer, P. P. F. M.; Maas, M.; Kerkhoffs, G. M. M. J.

    2017-01-01

    Acute posterolateral corner injuries of the knee with associated hamstring avulsions and peroneal paralysis are rare in rugby. Regain of motor function following a complete paralysis is documented to be 38%. To our knowledge, only one case describes return to preinjury level of competitive sport

  11. Nasoenteric tube complications.

    Science.gov (United States)

    Prabhakaran, S; Doraiswamy, V A; Nagaraja, V; Cipolla, J; Ofurum, U; Evans, D C; Lindsey, D E; Seamon, M J; Kavuturu, S; Gerlach, A T; Jaik, N P; Eiferman, D S; Papadimos, T J; Adolph, M D; Cook, C H; Stawicki, S P A

    2012-01-01

    The use of nasoenteric tubes (NETs) is ubiquitous, and clinicians often take their placement, function, and maintenance for granted. NETs are used for gastrointestinal decompression, enteral feeding, medication administration, naso-biliary drainage, and specialized indications such as upper gastrointestinal bleeding. Morbidity associated with NETs is common, but frequently subtle, mandating high index of suspicion, clinical vigilance, and patient safety protocols. Common complications include sinusitis, sore throat and epistaxis. More serious complications include luminal perforation, pulmonary injury, aspiration, and intracranial placement. Frequent monitoring and continual re-review of the indications for continued use of any NET is prudent, including consideration of changing goals of care. This manuscript reviews NET-related complications and associated topics.

  12. MAST CELLS DISTINGUISH EOSINOPHILIC ESOPHAGITIS IN PEDIATRIC PATIENTS

    Directory of Open Access Journals (Sweden)

    Elizete Aparecida LOMAZI

    2017-05-01

    Full Text Available ABSTRACT BACKGROUND: Mast cells exert a substantial role in gastrointestinal allergic diseases. Therefore, it is reasonable to presume that mast cell may aid diagnosis in eosinophilic gastroenteropathy. OBJECTIVE: To evaluate whether mast cell count in the esophageal epithelium can discriminate eosinophilic esophagitis, proton-pump inhibitor (PPI-responsive eosinophilic esophagitis and gastroesophageal reflux esophagitis. METHODS: Retrospectively we reviewed the files of 53 consecutive patients (age: 7.8 years; range: 8-14 years with definitive diagnose established during clinical follow up in a universitary outpatient clinic as follow: eosinophilic esophagitis (N=23, PPI-responsive eosinophilic esophagitis (N=15 and gastroesophageal reflux esophagitis (N=15. Eosinophil count in the esophageal epithelium in slides stained with H-E was reviewed and immunohistochemistry for mast cell tryptase was performed. RESULTS: Count of eosinophils/high-power field (HPF higher than 15 were found in 14 out of 15 reflux esophagitis patients. The mean count of eosinophils/HPF was similar in eosinophilic esophagitis patients and in those with PPI-responsive eosinophilic esophagitis (42 and 39 eosinophils/HPF, respectively, P=0.47. Values of mast cell tryptase (+ were higher in eosinophilic esophagitis [median: 25 mast cells/HPF; range (17-43 ] and in PPI-responsive eosinophilic esophagitis patients [25 (16-32 ], compared to reflux esophagitis [4 (2-14 ], P<0.001. There was no difference between the mean count of mast cells/HPF in the esophageal epithelium of eosinophilic esophagitis patients and PPI-responsive eosinophilic esophagitis patients, respectively, 26 and 24 mast cells/HPF, P=0.391. CONCLUSION: Tryptase staining of mast cells differentiates eosinophilic esophagitis from reflux esophagitis.

  13. Axial force measurement for esophageal function testing

    DEFF Research Database (Denmark)

    Gravesen, Flemming Holbæk; Funch-Jensen, Peter; Gregersen, Hans

    2009-01-01

    The esophagus serves to transport food and fluid from the pharynx to the stomach. Manometry has been the "golden standard" for the diagnosis of esophageal motility diseases for many decades. Hence, esophageal function is normally evaluated by means of manometry even though it reflects the squeeze...... force (force in radial direction) whereas the bolus moves along the length of esophagus in a distal direction. Force measurements in the longitudinal (axial) direction provide a more direct measure of esophageal transport function. The technique used to record axial force has developed from external...

  14. Esophageal Metastasis From Occult Lung Cancer

    Directory of Open Access Journals (Sweden)

    Po-Kuei Hsu

    2010-06-01

    Full Text Available A 66-year-old man with dysphagia was found to have a poorly differentiated esophageal carcinoma by incision biopsy. Following esophagectomy, reconstruction with a gastric tube was performed. Pathological examination and immunohisto-chemistry showed infiltration of adenocarcinoma cells with positive thyroid transcription factor 1-staining in the submucosal layer, which indicated metastatic esophageal carcinoma. Although no pulmonary lesion could be visualized by imaging or bronchoscopy, pulmonary origin was highly suspected as a result of positive thyroid transcription factor 1-staining. To the best of our knowledge, this is the first reported case of metastatic esophageal carcinoma from occult lung cancer (AJCC TNM stage TX.

  15. Diphtheria Complications

    Science.gov (United States)

    ... Search Form Controls Cancel Submit Search The CDC Diphtheria Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . Diphtheria Home About Diphtheria Causes and Transmission Symptoms Complications ...

  16. Complicated Pancreatitis

    NARCIS (Netherlands)

    Bakker, O.J.

    2015-01-01

    Research questions addressed in this thesis: What is the accuracy of serum blood urea nitrogen as early predictor of complicated pancreatitis? ; What is difference in clinical outcome between patients with pancreatic parenchymal necrosis and patients with extrapancreatic necrosis without necrosis

  17. Complicated rhinosinusitis

    OpenAIRE

    Hansen, F.S.

    2016-01-01

    Complicated rhinosinusitis: a title chosen for its multi-interpretable nature. In the Oxford dictionary ‘complicated’ is defined as ‘consisting of many interconnecting parts or elements’ and ‘involving many different and confusing aspects’ as well as ‘involving complications’ in medicine. It is the last definition that is applicable to chapter 2 which focuses on the medical complications of acute rhinosinusitis. Chapter 2.1 describes the incidence and management of orbital and intracranial co...

  18. Intramural Hematoma of the Esophagus Complicating Severe Preeclampsia

    Directory of Open Access Journals (Sweden)

    Simone Garzon

    2017-01-01

    Full Text Available Intramural hematoma of the esophagus is a rare injury causing esophageal mucosal dissection. Forceful vomiting and coagulopathy are common underlying causes in the elderly population taking antiplatelets or anticoagulation agents. Acute retrosternal pain followed by hematemesis and dysphagia differentiates the hematoma from other cardiac or thoracic emergencies, including acute myocardial infarction or aortic dissection. Direct inspection by endoscopy is useful, but chest computed tomography best assesses the degree of obliteration of the lumen and excludes other differential diagnoses. Intramural hematoma of the esophagus is generally benign and most patients recover fully with conservative treatment. Bleeding can be managed medically unless in hemodynamically unstable patients, for whom surgical or angiographic treatment may be attempted; only rarely esophageal obstruction requires endoscopic decompression. We report an unusual case of esophageal hematoma, presenting in a young preeclamptic woman after surgical delivery of a preterm twin pregnancy, with a favorable outcome following medical management.

  19. Effect of Low-Dose Aspirin on Chronic Acid Reflux Esophagitis in Rats.

    Science.gov (United States)

    Masuda, Takahiro; Yano, Fumiaki; Omura, Nobuo; Tsuboi, Kazuto; Hoshino, Masato; Yamamoto, Se Ryung; Akimoto, Shunsuke; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

    2018-01-01

    Clinical role of low-dose aspirin (LDA) in pathogenesis of gastroesophageal reflux disease is by far controversial. This can be attributed to the paucity of basic research detailing the mechanism of LDA-induced esophageal mucosal injury (EI) on underlying chronic acid reflux esophagitis (RE). The aim of this study was to clarify the effect of LDA on chronic RE in rats. Esophagitis was induced in 8-week-old male Wistar rats by ligating the border between forestomach and glandular portion with a 2-0 silk tie and covering the duodenum with a small piece of 18-Fr Nélaton catheter. Seventy-eight chronic RE rat models were divided into five treatment groups, consisting of orally administered vehicle (controls), and aspirin doses of 2, 5, 50 or 100 mg/kg once daily for 28 days. EI was assessed by gross area of macroscopic mucosal injury, severity grade of esophagitis and microscopic depth of infiltration by inflammatory cells. Area of esophagitis in animals with aspirin dose of 100 mg/kg/day showed a 36.5% increase compared with controls, although it failed to achieve statistical significance (p = 0.812). Additionally, the rate of severe EI was increased in animals with aspirin dose of 100 mg/kg/day as compared with controls (p < 0.05). The grade of severity correlated with the depth of inflammation (r s = 0.492, p < 0.001). Maximal dose aspirin (100 mg/kg/day) contributed in exacerbating preexisting EI. LDA (2 and 5 mg/kg/day), on the other hand, did not affect chronic RE in this model. LDA seems to be safe for use in patients with chronic RE.

  20. Study on establishment of esophageal carcinoma animal models

    Directory of Open Access Journals (Sweden)

    ZHAO Qiang

    2013-08-01

    Full Text Available Esophageal cancer is one of the common human gastrointestinal malignancies.In recent years,the global incidence of esophageal cancer and its mortality rise.China is the high incidence area of esophageal cancer with the highest morbidity and mortality in the world.However,the exact pathogeny of esophageal cancer has not been fully clarified yet.Thus,it is of significant importance to establish ideal and stable esophageal carcinoma animal models with similar biological characteristics to clinical tumors,which will provide a reliable research basis for the occurrence,development,metastasis and drug responses of esophageal carcinoma,and is also helpful for anti-esophageal cancer drug screening and the development of rational dinical therapeutic treatment.This article provides an overview of the development of esophageal carcinoma animal models in recent years,the classification of esophageal carcinoma animal models,modeling methods and the progress of model evaluation.

  1. Balloon Dilatation of Esophageal Strictures in Children With Bullous Epidermolysis: Description of Case Series

    Directory of Open Access Journals (Sweden)

    A. V. Tupylenko

    2017-01-01

    Full Text Available Esophageal strictures are the most common complications of bullous epidermolysis in children. Strictures cause the development of dysphagia that prevents oral alimentation and receipt of an adequate amount of nutrients that is accompanied by a violation of nutritional status, weight loss, and delayed physical development of a child. Disturbed swallowing can also cause aspiration syndrome, pneumonia, and airway obstruction. To eliminate dysphagia and reduce the risk of complications, it is necessary to restore esophageal patency. The article describes the results of X-ray with assisted balloon dilatation in 19 children with bullous epidermolysis and dysphagia. It is shown that this method of esophagus recanalization allows to effectively and safely restore oral alimentation of children already in the first day after intervention with a gradual expansion of the diet.

  2. Proteomic profiling of fetal esophageal epithelium, esophageal cancer, and tumor-adjacent esophageal epithelium and immunohistochemical characterization of a representative differential protein, PRX6

    Science.gov (United States)

    Guo, Jun-Hui; Xing, Guo-Lan; Fang, Xin-Hui; Wu, Hui-Fang; Zhang, Bo; Yu, Jin-Zhong; Fan, Zong-Min; Wang, Li-Dong

    2017-01-01

    AIM To understand the molecular mechanism of esophageal cancer development and provide molecular markers for screening high-risk populations and early diagnosis. METHODS Two-dimensional electrophoresis combined with mass spectrometry were adopted to screen differentially expressed proteins in nine cases of fetal esophageal epithelium, eight cases of esophageal cancer, and eight cases of tumor-adjacent normal esophageal epithelium collected from fetuses of different gestational age, or esophageal cancer patients from a high-risk area of esophageal cancer in China. Immunohistochemistry (avidin-biotin-horseradish peroxidase complex method) was used to detect the expression of peroxiredoxin (PRX)6 in 91 cases of esophageal cancer, tumor-adjacent normal esophageal tissue, basal cell hyperplasia, dysplasia, and carcinoma in situ, as well as 65 cases of esophageal epithelium from fetuses at a gestational age of 3-9 mo. RESULTS After peptide mass fingerprint analysis and search of protein databases, 21 differential proteins were identified; some of which represent a protein isoform. Varying degrees of expression of PRX6 protein, which was localized mainly in the cytoplasm, were detected in adult and fetal normal esophageal tissues, precancerous lesions, and esophageal cancer. With the progression of esophageal lesions, PRX6 protein expression showed a declining trend (P < 0.05). In fetal epithelium from fetuses at gestational age 3-6 mo, PRX6 protein expression showed a declining trend with age (P < 0.05). PRX6 protein expression was significantly higher in well-differentiated esophageal cancer tissues than in poorly differentiated esophageal cancer tissues (P < 0.05). CONCLUSION Development and progression of esophageal cancer result from interactions of genetic changes (accumulation or superposition). PRX6 protein is associated with fetal esophageal development and cancer differentiation. PMID:28293090

  3. Comparison of Efficacy of Self-Expandable Metallic Stent Placement in the Unresectable Esophageal Cancer Patients.

    Science.gov (United States)

    Uesato, Masaya; Akutsu, Yasunori; Murakami, Kentarou; Muto, Yorihiko; Kagaya, Akiko; Nakano, Akira; Aikawa, Mizuho; Tamachi, Tomohide; Arasawa, Takahiro; Amagai, Hiroyuki; Muto, Yasuhide; Matsubara, Hisahiro

    2017-01-01

    This is a retrospective study to evaluate the prevention of complications of metallic stent placement in patients with unresectable advanced esophageal cancer. A total of 87 patients were treated with 4 types of metal stents in the esophagus over a period of 18 years. Stent placement was technically successful. The most common prior treatment was chemoradiotherapy. There were no significant differences in the rate of patients with no complications among the prior treatments. Approximately, 30% of patients had the most common chest pain in complications. Stent placement within one month after the completion of chemoradiotherapy should be avoided for the prevention of the chest pain. There was no significant difference in the rate of patients with no complications by lesion location. The rate of no complications was higher for the Niti-S stent than the Gianturco Z-stent or Ultraflex stent. Of note, no complications were noted for the Niti-S ultrathin stent at all. Among cases of stent-related death, the most common type of complication was respiratory disorder caused by the stent that seems to be thick and hard. Therefore, the stent with thin and flexible characteristics like the Niti-S ultrathin stent will solve the various problems of esophageal stent placement.

  4. Prevalence of reflux esophagitis among patients undergoing ...

    African Journals Online (AJOL)

    Ahmed Gado

    2013-10-25

    steroidal anti- inflammatory drugs and 8 (2%) were consuming alcohol. The duration of RS ranged from one. Abbreviations: GERD, gastro-esophageal reflux disease; NSAIDs, non-steroidal anti-inflammatory drugs; RS, reflux ...

  5. Herpetic esophagitis: An uncommon cause of dysphagia

    National Research Council Canada - National Science Library

    Rinkesh K Bansal; Piyush Ranjan

    2014-01-01

    Herpes simplex esophagitis usually occurs in immune-compromised patients. We report a case of 44 year-old lady without any immune deficient state, who presented with dysphagia and retrosternal pain...

  6. Esophageal transit scintigraphy in systemic sclerosis.

    Science.gov (United States)

    Chojnowski, Marek; Kobylecka, Małgorzata; Olesińska, Marzena

    2016-01-01

    Systemic sclerosis is a rare connective tissue disease, distinctive features of which are fibrosis and microangiopathy. The esophagus is one of the most commonly involved internal organs. Most patients experience dysphagia, difficulties in swallowing and gastro-esophageal reflux. However, in up to one third of cases, the initial onset of esophageal disease may be clinically silent. There are several diagnostic modalities available for assessing both morphological and functional abnormalities of the esophagus. If structural abnormalities are suspected, endoscopy is the method of choice. Functional evaluation is best achieved with manometry. Both endoscopy and manometry are invasive techniques, with low patient acceptance. Barium-contrast study is well tolerated, but qualitative assessment of functional abnormalities is imprecise. Esophageal scintigraphy is an easy, non-invasive, sensitive and specific diagnostic modality. It can detect esophageal dysfunction even in asymptomatic patients. In patients already diagnosed with systemic sclerosis, scintigraphy is useful in evaluating severity and progression of the disease.

  7. Regenerative Medicine Strategies for Esophageal Repair

    Science.gov (United States)

    Londono, Ricardo

    2015-01-01

    Pathologies that involve the structure and/or function of the esophagus can be life-threatening. The esophagus is a complex organ comprising nonredundant tissue that does not have the ability to regenerate. Currently available interventions for esophageal pathology have limited success and are typically associated with significant morbidity. Hence, there is currently an unmet clinical need for effective methods of esophageal repair. The present article presents a review of esophageal disease along with the anatomic and functional consequences of each pathologic process, the shortcomings associated with currently available therapies, and the latest advancements in the field of regenerative medicine with respect to strategies for esophageal repair from benchtop to bedside. PMID:25813694

  8. Eosinophilic Esophagitis (EE) or (EoE)

    Science.gov (United States)

    ... Primary Immunodeficiency Disease Related Conditions Drug Guide Conditions Dictionary Just for Kids Library School Tools Videos Virtual ... reintroduction of foods to your diet. Eosinophilic Esophagitis: Environmental Allergies Environmental allergies to substances such as dust ...

  9. False aneurysm of the interosseous artery and anterior interosseous syndrome - an unusual complication of penetrating injury of the forearm: a case report

    Directory of Open Access Journals (Sweden)

    Garavaglia Guido

    2009-12-01

    Full Text Available Abstract Background Palsies involving the anterior interosseous nerve (AIN comprise less than 1% of all upper extremity nerve palsies. Objectives This case highlights the potential vascular and neurological hazards of minimal penetrating injury of the proximal forearm and emphasizes the phenomenon of delayed presentation of vascular injuries following seemingly obscure penetrating wounds. Case Report We report a case of a 22-year-old male admitted for a minimal penetrating trauma of the proximal forearm that, some days later, developed an anterior interosseous syndrome. A Duplex study performed immediately after the trauma was normal. Further radiologic investigations i.e. a computer-tomographic-angiography (CTA revealed a false aneurysm of the proximal portion of the interosseous artery (IA. Endovascular management was proposed but a spontaneous rupture dictated surgical revision with simple excision. Complete neurological recovery was documented at 4 months postoperatively. Conclusions/Summary After every penetrating injury of the proximal forearm we propose routinely a detailed neurological and vascular status and a CTA if Duplex evaluation is negative.

  10. [Esophageal perforation: analysis of seven cases treated by early surgical treatment with good functional results].

    Science.gov (United States)

    Sanna, Stefano; Taurchini, Marco; Mengozzi, Marta; Monteverde, Marco; Argnani, Desiderio; Dell'Amore, Davide

    2006-01-01

    Esophageal perforation has been considered a catastrophic and often life-threatening event, with very high mortality rates. Most of the cases are due to a complication in endoscopic manouvers and the best treatment, conservative rather than aggressive, remains a controversial topic. In 1995-2005 period we observed 7 cases of esophageal perforation, 5 women and 2 men mean age 73.2 y (range 60-87). Three cases are due to foreign body ingestion, 2 cases to endoscopic manoeuvres, 2 cases were spontaneous. In 3 cases the lesion was in the cervical tract of the esophagus, in the thoracic tract the others. All the patients were admitted very early to our Unit and presented disphagia, vomiting and dyspnoea, 2 out of them also a pleural effusion. In iatrogenic perforation we performed a cervicotomy and a drainage of mediastinic abscess, while in spontaneous lesions mono (one case) or bipolar esophageal exclusion (one case) with primary suture, jujunostomy and drainage of pleural effusion were the treatment. In foreign body perforation we performed thoracotomic and cervicotomic esophagotomy, extraction of the foreign body, direct suture with pleural or muscle protection. We didn't observe any intra or post-operative mortality. About the complications, we observed a bilateral pleural empyema, a chylous fistula, a digestive bleeding due to gastric ulcer, a laparotomic infection, a parossistic FA and a persistent esophageal fistula. Mean hospital stay was 24.3 days (range 10-43). All the patients were discharged to the hospital in good conditions. In conclusion in most of the cases of esophageal perforation the surgical treatment is the treatment of choice for its lower morbidity and mortality and good functional results.

  11. Ablative Therapy for Esophageal Dysplasia and Early Malignancy: Focus on RFA

    Science.gov (United States)

    Tuttle, Rebecca; Nurkin, Steven J.; Hochwald, Steven N.

    2014-01-01

    Ablative therapies have been utilized with increasing frequency for the treatment of Barrett's esophagus with and without dysplasia. Multiple modalities are available for topical ablation of the esophagus, but radiofrequency ablation (RFA) remains the most commonly used. There have been significant advances in technique since the introduction of RFA. The aim of this paper is to review the indications, techniques, outcomes, and most common complications following esophageal ablation with RFA. PMID:25140320

  12. Ablative Therapy for Esophageal Dysplasia and Early Malignancy: Focus on RFA

    Directory of Open Access Journals (Sweden)

    Rebecca Tuttle

    2014-01-01

    Full Text Available Ablative therapies have been utilized with increasing frequency for the treatment of Barrett’s esophagus with and without dysplasia. Multiple modalities are available for topical ablation of the esophagus, but radiofrequency ablation (RFA remains the most commonly used. There have been significant advances in technique since the introduction of RFA. The aim of this paper is to review the indications, techniques, outcomes, and most common complications following esophageal ablation with RFA.

  13. Herpetic esophagitis: An uncommon cause of dysphagia

    Directory of Open Access Journals (Sweden)

    Rinkesh K Bansal

    2014-01-01

    Full Text Available Herpes simplex esophagitis usually occurs in immune-compromised patients. We report a case of 44 year-old lady without any immune deficient state, who presented with dysphagia and retrosternal pain. Upper GI endoscopy revealed multiple punched out ulcers in esophagus. Biopsy from these ulcers revealed intranuclear eosinophilic inclusion bodies and multinucleated epithelial giant cells suggestive of herpetic esophagitis. Serum HSV-1 IgM antibodies was positive. Dysphagia improved on treatment with acyclovir.

  14. Esophageal Metastasis From Occult Lung Cancer

    OpenAIRE

    Hsu, Po-Kuei; Shai, Sen-Ei; Wang, John; Hsu, Chung-Ping

    2010-01-01

    A 66-year-old man with dysphagia was found to have a poorly differentiated esophageal carcinoma by incision biopsy. Following esophagectomy, reconstruction with a gastric tube was performed. Pathological examination and immunohisto-chemistry showed infiltration of adenocarcinoma cells with positive thyroid transcription factor 1-staining in the submucosal layer, which indicated metastatic esophageal carcinoma. Although no pulmonary lesion could be visualized by imaging or bronchoscopy, pulmon...

  15. CT findings of esophageal schwannoma: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Man Ho; Ryu, Dae Shick; Eom, Dae Woon; Shin, Dong Rock; Choi, Soo Jung; Ahn, Jae Hong; Park, Man Soo; Yoo, Dong Kon [Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung (Korea, Republic of)

    2015-03-15

    Esophageal schwannomas are a relative rare benign neoplasm that usually occurs in the upper esophagus, in the middle aged women. We report a case of a 67-year-old man with a lower esophageal schwannoma. This lesion was composed of homogenous density, iso-attenuating with the chest wall muscle on pre- and post-contrast chest computed tomography (CT). The CT findings of the esophageal schwannoma are similar to those of esophageal leiomyoma. Hense, esophageal schwannoma may be a differential diagnosis with esophageal leiomyoma.

  16. Diagnosis and management of esophageal achalasia.

    Science.gov (United States)

    Stavropoulos, Stavros N; Friedel, David; Modayil, Rani; Parkman, Henry P

    2016-09-13

    Achalasia is a rare esophageal motility disorder that is usually idiopathic in origin. It is characterized by dysphagia, and patients often have chest pain, regurgitation, weight loss, and an abnormal barium radiograph showing esophageal dilation with narrowing at the gastroesophageal junction. Abnormal or absent esophageal peristalsis and impaired relaxation of the lower esophageal sphincter (LES) are typically seen on esophageal manometry. The advent of high resolution manometry (HRM) has allowed more precise diagnosis of achalasia, subtype designation, and differentiation from other esophageal motor disorders with an initial seminal publication in 2008 followed by further refinements of what has been termed the Chicago classification. Potential treatments include drugs, endoscopic botulinum toxin injection, balloon dilation, traditional surgery (usually laparoscopic Heller myotomy; LHM), and a novel, less invasive, natural orifice transluminal endoscopic surgery (NOTES) approach to Heller myotomy termed peroral endoscopic myotomy (POEM). The first human POEM was performed in 2008, with the first publication appearing in 2010 and evidence now rapidly accumulating showing POEM to be comparable to traditional surgery in terms of clinical success and radiologic and manometric post-therapy outcomes. This review discusses the diagnosis and management of achalasia with particular emphasis on the recent developments of HRM and POEM, which arguably represent the most important advances in the field since the advent of laparoscopic Heller myotomy in the 1990s. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Managing eosinophilic esophagitis: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Shah NA

    2016-09-01

    Full Text Available Nisha A Shah, Dustin M Albert, Noah M Hall, Fouad J Moawad Department of Medicine, Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA Abstract: Eosinophilic esophagitis (EoE is a chronic and progressive immune-mediated condition defined by symptoms of esophageal dysfunction and dense eosinophilic infiltration of the esophageal mucosa. Therapies consist of anti-eosinophilic medications and specialized diets aimed to decrease the progression of EoE and alleviate its symptoms, namely, dysphagia and food impaction. Assessing response to therapy remains challenging, as treatment end points are not well defined and currently consist of clinical, histologic, and endoscopic features. Newer validated measures may help standardize treatment end points. Emerging data support the use of maintenance therapy, which may reduce disease progression. Optimal dosages, delivery techniques, and duration of treatment need to be determined. When features of fibrostenosis develop, esophageal dilation is a safe and effective adjunctive strategy for improving symptoms. In EoE cases refractory to conventional treatments, newer therapies targeting inflammatory mediators and cytokines are on the horizon. Keywords: eosinophilic esophagitis, esophagitis, eosinophilia, dysphagia, allergy, corticosteroids, dietary treatment, dilation 

  18. Esophageal Intramural Pseudodiverticulosis: A Rare Endoscopic Finding

    Directory of Open Access Journals (Sweden)

    Luciana Lopes de Oliveira

    2013-01-01

    Full Text Available A 76-year-old woman, presenting with a 4-year history of progressive dysphagia, was submitted to endoscopic examination. The upper endoscopy revealed a proximal esophageal stricture and inflammatory mucosa associated with multiples small orifices in the esophageal wall, some of them fulfilled with white spots suggestive of fungal infection. This was a typical endoscopic finding of esophageal intramural pseudodiverticulosis, a benign and rare condition, related to chronic esophagitis and others comorbid states, such as gastroesophageal reflux disease or infectious esophagitis, diabetes mellitus, alcohol consumption, and achalasia. Dysphagia is the predominant symptom and can be accompanied by esophageal stricture in 80% to 90% of patients. The pathogenesis is unknown, and as the pseudodiverticulosis is an intramural finding, endoscopy biopsies are inconclusive. The main histological finding is dilation of the submucosal glands excretory ducts, probably obstructed by inflammatory cells. The treatment consists in management of the underlying diseases and symptoms relief. In this particular case, the patient was submitted to antifungal drugs followed by endoscopic dilation with thermoplastic bougies, with satisfactory improvement of dysphagia.

  19. Do large hiatal hernias affect esophageal peristalsis?

    Science.gov (United States)

    Roman, Sabine; Kahrilas, Peter J; Kia, Leila; Luger, Daniel; Soper, Nathaniel; Pandolfino, John E

    2013-01-01

    Background & Aim Large hiatal hernias can be associated with a shortened or tortuous esophagus. We hypothesized that these anatomic changes may alter esophageal pressure topography (EPT) measurements made during high-resolution manometry (HRM). Our aim was to compare EPT measures of esophageal motility in patients with large hiatal hernias to those of patients without hernia. Methods Among 2000 consecutive clinical EPT, we identified 90 patients with large (>5 cm) hiatal hernias on endoscopy and at least 7 evaluable swallows on EPT. Within the same database a control group without hernia was selected. EPT was analyzed for lower esophageal sphincter (LES) pressure, Distal Contractile Integral (DCI), contraction amplitude, Contractile Front Velocity (CFV) and Distal Latency time (DL). Esophageal length was measured on EPT from the distal border of upper esophageal sphincter to the proximal border of the LES. EPT diagnosis was based on the Chicago Classification. Results The manometry catheter was coiled in the hernia and did not traverse the crural diaphragm in 44 patients (49%) with large hernia. Patients with large hernias had lower average LES pressures, lower DCI, slower CFV and shorter DL than patients without hernia. They also exhibited a shorter mean esophageal length. However, the distribution of peristaltic abnormalities was not different in patients with and without large hernia. Conclusions Patients with large hernias had an alteration of EPT measurements as a consequence of the associated shortened esophagus. However, the distribution of peristaltic disorders was unaffected by the presence of hernia. PMID:22508779

  20. Systematic review: Eosinophilic esophagitis in Asian countries.

    Science.gov (United States)

    Kinoshita, Yoshikazu; Ishimura, Norihisa; Oshima, Naoki; Ishihara, Shunji

    2015-07-21

    To investigate the prevalence and the clinical characteristics of Asian patients with eosinophilic esophagitis. We conducted a systematic search of the PubMed and Web of Science databases for original studies, case series, and individual case reports of eosinophilic esophagitis in Asian countries published from January 1980 to January 2015. We found 66 and 80 articles in the PubMed and Web of Science databases, respectively; 24 duplicate articles were removed. After excluding animal studies, articles not written in English, and meeting abstracts, 25 articles containing 217 patients were selected for analysis. Sample size-weighted mean values were determined for all pooled prevalence data and clinical characteristics. The mean age of the adult patients with eosinophilic esophagitis was approximately 50 years, and 73% of these patients were male. They frequently presented with allergic diseases including bronchial asthma, allergic rhinitis, food allergy, and atopic dermatitis. Bronchial asthma was the most frequent comorbid allergic disease, occurring in 24% of patients with eosinophilic esophagitis. Dysphagia was the primary symptom reported; 44% of the patients complained of dysphagia. Although laboratory blood tests are not adequately sensitive for an accurate diagnosis of eosinophilic esophagitis, endoscopic examinations revealed abnormal findings typical of this disease, including longitudinal furrows and concentric rings, in 82% of the cases. One-third of the cases responded to proton pump inhibitor administration. The characteristics of eosinophilic esophagitis in Asian patients were similar to those reported in Western patients, indicating that this disease displays a similar pathogenesis between Western and Asian patients.

  1. Prognosis Prediction for Postoperative Esophageal Cancer Patients Using Onodera's Prognostic Nutritional Index.

    Science.gov (United States)

    Matsumoto, Hideo; Okamoto, Yuko; Kawai, Akimasa; Ueno, Daisuke; Kubota, Hisako; Murakami, Haruaki; Higashida, Masaharu; Hirai, Toshihiro

    2017-01-01

    Preoperative nutritional status may impact surgical outcome and prognosis. We evaluated the predictive value of Onodera's prognostic nutritional index (O's-PNI) of surgical outcome following esophagectomy in esophageal cancer patients. In total, 144 patients undergoing esophagectomy for esophageal cancer from April 2010 to May 2015 were evaluated, retrospectively. Eighty-four patients were enrolled in this study. O's-PNIs were calculated before surgery, discharge, and 1, 2, and 6 mo after discharge. The relationship between O's-PNI and occurrence of complications as classified by the Clavien-Dindo (C-D) classification, length of hospital stay, and survival time was investigated. The mean O's-PNI for patients with complications of more than Grade 2 by the C-D classification was 37.4, which was significantly lower than that for Grades 0 or 1 (40.5, P = 0.0094). A negative correlation was obtained between O's-PNI and hospital stay length (P = 0.0006), whereas a positive correlation was obtained for O's-PNI at 6 mo postsurgery and overall survival (P = 0.0171, P = 0.0201). O's-PNI may represent a useful indicator of the occurrence of complications and length of hospital stay, and may influence overall survival at 6 mo postsurgery. Nutritional management during the perioperative period could therefore contribute to satisfactory outcomes following esophagectomy in esophageal cancer patients.

  2. [Conservative management of esophageal perforation after pneumatic dilatation for achalasia].

    Science.gov (United States)

    Scatton, Olivier; Gaudric, Marianne; Massault, Pierre-Philippe; Chaussade, Stanislas; Houssin, Didier; Dousset, Bertrand

    2002-10-01

    To assess the results and indications of conservative management of esophageal perforation following pneumatic dilatation for achalasia. Thirteen esophageal perforations complicating 524 dilatations in 412 patients (3%) were diagnosed by esophagogram. Medical treatment consisted of nasogastric succion, antibiotics and pleural drainage, if necessary. Conservative surgical treatment included left thoracophrenotomy, perforation closure, controlateral myotomy and anterior fundoplication. Surgical decision was based upon clinical and radiological parameters. Functional outcome was assessed by the means of the Eckardt's grading score. Six patients were successfully managed by medical treatment. Seven patients underwent conservative surgery, three of whom after failure of medical treatment. The presence of a pneumomediastinum at initial presentation led to immediate (n=2) or delayed (n=2) surgery in all instances. No patients died. In the surgical group, morbidity consisted of one wound infection, one pleural effusion and one venous thrombosis. One severe chest infection occurred in the medical group. Oral feeding was reintroduced after a median of 10 and 11 days in the surgical and medical groups, respectively. Functional results were satisfactory and similar in both groups. Conservative medical or surgical management of oesophageal perforation following pneumatic dilatation is safe, if the diagnosis is done early. Pneumomediastinum at initial presentation seems to predict failure of conservative medical treatment.

  3. Colon interposition for esophageal replacement: isoperistaltic or antiperistaltic? Experimental results.

    Science.gov (United States)

    Dreuw, B; Fass, J; Titkova, S; Anurov, M; Polivoda, M; Ottinger, A P; Schumpelick, V

    2001-01-01

    Isoperistaltic colon is preferred to antiperistaltic colon for esophageal replacement, but experimental data do not exist to support this practice. In 7 dogs a 20 cm long colon loop was interposed between the skin and the small bowel, isoperistaltically in 3 dogs and antiperistaltically in 4 dogs. Three months later five strain-gauges were implanted and evacuation was investigated by motility testing, barium studies, and scintigraphy. Motility recording showed normal colon motility in the excluded loops. Quiescent states (duration 40.2 +/- 13.6 minutes) were followed by contractile states (duration 7.5 +/- 2.4 minutes, frequency 3.3 +/- 0.6 per minute). The main peristaltic direction of isoperistaltic loops was isoperistaltic, and the main peristaltic direction of antiperistaltic loops was antiperistaltic. Evacuation took place exclusively during the contractile status. Half time emptying was more rapid in isoperistaltic loops (35 +/- 11 vs 69 +/- 16 minutes). The content of antiperistaltic loops was held back by antiperistaltic activity. Application of oatmeal porridge into the loops shortened the quiescent status from 40.2 to 13.2 +/- 4.8 minutes. The colon graft for esophageal replacement is an active system. Food is stored during the quiescent states and evacuated during the contractile states. The original peristaltic direction is preserved so that retroperistalsis in antiperistaltic loops may lead to patient discomfort and pulmonary complications.

  4. Esophagitis

    Science.gov (United States)

    ... stomach anatomy Esophagus References Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap ... Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. ...

  5. Subtle lower esophageal sphincter relaxation abnormalities in patients with unexplained esophageal dysphagia

    NARCIS (Netherlands)

    Herregods, T. V. K.; van Hoeij, F. B.; Bredenoord, A. J.; Smout, A. J. P. M.

    2018-01-01

    Esophageal dysphagia is a relatively common symptom. We aimed to evaluate whether subtle, presently not acknowledged forms of dysfunction of the lower esophageal sphincter (LES) could explain dysphagia in a subset of patients with normal findings at high-resolution manometry (HRM) according to the

  6. Impact of thoracic surgery on esophageal motor function-Evaluation by high resolution manometry.

    Science.gov (United States)

    Wäsche, Anja; Kandulski, Arne; Malfertheiner, Peter; Riedel, Sandra; Zardo, Patrick; Hachenberg, Thomas; Schreiber, Jens

    2017-06-01

    Alteration of esophageal function is a potential risk factor for postoperative complications in thoracic surgery. This prospective study investigates esophageal motility and function during and after thoracic procedures via high resolution manometry (HRM) and impedance technology with spatiotemporal representation of pressure data. Twelve consecutive patients eligible for elective thoracic surgery underwent preoperative and postoperative (48 hours and 7 days) esophageal HRM. Swallowing acts were carried out with 5 mL of water, 10 mL of water and 1 cm 3 bread in physiological posture to evaluate distal contraction integral (DCI). Length and location of contractile integrity breaks were measured by investigators blinded to the form of surgical intervention. The impact of surgical procedures on esophageal motility was quantified according to current Chicago Classification (CC) criteria. Pre-, intra- and postoperative 24-hour multi-channel impedance pH-metry (MII-pH) was performed to further analyze gastroesophageal reflux patterns. All patients were investigated 48 hours prior to and 7 days after thoracic procedures, with a total of n=675 swallowing acts being included in our study. Increased motility patterns of the tubular esophagus occurred temporally 48 hours postoperatively. DCI 48 hours after surgery increased significantly (5 mL, P=0.049; solid, P=0.014) and returned to baseline values after seven days (5 mL, P=0.039; solid, P=0.039). Break length was significantly reduced 48 hours postoperatively, especially in the proximal esophageal segment (transition zone). Follow-up measurements after another week were comparable to preoperative baseline findings. The perioperative MII-pH measurement showed numerous artifacts caused by intubation and ventilation during surgery also with increasing short and frequent acidic reflux episodes. Thoracic procedures cause a transient modulation of esophageal peristalsis with postoperative increased contractility of the tubular

  7. Impact of thoracic surgery on esophageal motor function—Evaluation by high resolution manometry

    Science.gov (United States)

    Kandulski, Arne; Malfertheiner, Peter; Riedel, Sandra; Zardo, Patrick; Hachenberg, Thomas; Schreiber, Jens

    2017-01-01

    Background Alteration of esophageal function is a potential risk factor for postoperative complications in thoracic surgery. This prospective study investigates esophageal motility and function during and after thoracic procedures via high resolution manometry (HRM) and impedance technology with spatiotemporal representation of pressure data. Methods Twelve consecutive patients eligible for elective thoracic surgery underwent preoperative and postoperative (48 hours and 7 days) esophageal HRM. Swallowing acts were carried out with 5 mL of water, 10 mL of water and 1 cm3 bread in physiological posture to evaluate distal contraction integral (DCI). Length and location of contractile integrity breaks were measured by investigators blinded to the form of surgical intervention. The impact of surgical procedures on esophageal motility was quantified according to current Chicago Classification (CC) criteria. Pre-, intra- and postoperative 24-hour multi-channel impedance pH–metry (MII-pH) was performed to further analyze gastroesophageal reflux patterns. Results All patients were investigated 48 hours prior to and 7 days after thoracic procedures, with a total of n=675 swallowing acts being included in our study. Increased motility patterns of the tubular esophagus occurred temporally 48 hours postoperatively. DCI 48 hours after surgery increased significantly (5 mL, P=0.049; solid, P=0.014) and returned to baseline values after seven days (5 mL, P=0.039; solid, P=0.039). Break length was significantly reduced 48 hours postoperatively, especially in the proximal esophageal segment (transition zone). Follow-up measurements after another week were comparable to preoperative baseline findings. The perioperative MII-pH measurement showed numerous artifacts caused by intubation and ventilation during surgery also with increasing short and frequent acidic reflux episodes. Conclusions Thoracic procedures cause a transient modulation of esophageal peristalsis with postoperative

  8. [A case of the esophageal candidiasis supposedly caused by rhinenchysis steroid chronic administration before sleep].

    Science.gov (United States)

    Shuto, Hiroshi; Noguchi, Hisashi; Nishikata, Hikaru; Takizawa, Kenji; Shuto, Chizuru; Nagata, Makoto; Terashi, Yoshinori; Yamaguchi, Michiya; Takizawa, Takao; Watanabe, Kensuke; Tosaka, Kaoru; Okano, Masahiko; Koizumi, Akira

    2007-07-01

    In general, steroid is mainly used as anti-inflammatory action in case of allergic diseases. As one of the side effects of inhalation steroid, a report is given below regarding buccal capsule/esophageal candidiasis. The patient came to the hospital with the chief complaint regarding passage dysphagia in the time of deglutition; pharyngitis and esophageal candidiasis were found by endoscopy of upper gastrointestinal tract.The interview after the endoscopy revealed that the patient, a 69-year-old female was diagnosed as chronic perennial allergic rhinitis a few years ago, and had been inhaling rhinenchysis Beclometasone dipropionate (BDP) before sleep every day for the past two years because using this collunarium seemed to mitigate the nasal obstruction and mucus during sleep. The patient did not report this fact before the endocsopy because she did not associate it with her subjective symptom. In this case, it was assumed that nebulized rhinenchysis BDP was accidentally swallowed to the pharynx and esophagus during sleep. As a treatment, rhinenchysis BDP was canceled and instead Azunol mouth washing (gargling/nasal douche) was used. No antifungal agent was used. In two weeks, the patient reported some improvement, and this was confirmed by reexamination of the upper gastrointestinal tract using endoscope in one month and a half. Pharyngitis was improved, and in the digital endoscopic assessment of esophageal candidiasis complicating inhaled steroid therapy the esophageal candidiasis became Grade I (mild grade). As for the later progress, the patient did not report any subjective symptoms such as nasal obstruction and dysphagia. In addition, the inflammation caused by candidiasis and found in the early examination was improved. The patient in this case was under treatment for thrombosis in the vein of lower extremity, but no complications such as diabetes mellitus or immune deficiency syndrome were observed. Esophageal candidiasis by chronic administration of

  9. Complications and patient-injury after ankle fracture surgery. -A closed claim analysis with data from the Patient Compensation Association in Denmark

    DEFF Research Database (Denmark)

    Bjørslev, Naja; Ebskov, Lars Bo; Mersø, Camilla

    2018-01-01

    BACKGROUND: The Patient Compensation Association (PCA) receives claims for financial compensation from patients who believe they have sustained damage from their treatment in the Danish health care system. In this study, we have analysed closed claims in which patients suffered injuries due....... This study indicates that extra attention should be paid to the most technically demanding fractures as the pronation-external-rotation-, diabetic- and fragility fractures. Surgeons should follow the recommendations for ORIF. Emphasis should also focus on adequate postoperative plans. This study finds a high...

  10. OPTIONS FOR USE OF APPROPRIATE ANTICOAGULANT THERAPY IN PATIENTS WITH THERMAL INJURY WITH A HIGH RISK OF THROMBOEMBOLIC COMPLICATIONS DEVELOPMENT ASSOCIATED WITH RECURRENT INTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    V. S. Borisov

    2015-01-01

    Full Text Available ABSTRACT. Patients with major thermal injury require anticoagulant therapy during almost the whole period of the burn disease, forcing the physician to balance constantly between the risk of possible bleeding associated with surgical treatment and the risk of thrombosis development in patients demonstrating a number of factors predisposing to the development of VTС. We report a clinical case of appropriate anticoagulant therapy using the new oral anticoagulants in a patient with a high risk of VTС development and recurrent bleeding from the tumor of the ascending colon. 

  11. A Prospective Study of Proton Beam Reirradiation for Esophageal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Fernandes, Annemarie, E-mail: Annemarie.fernandes@gmail.com [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Berman, Abigail T. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Mick, Rosemarie [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Both, Stefan; Lelionis, Kristi; Lukens, John N.; Ben-Josef, Edgar; Metz, James M.; Plastaras, John P. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)

    2016-05-01

    Purpose: Reirradiation to the esophagus carries a significant risk of complications. Proton therapy may offer an advantage in the reirradiation setting due to the lack of exit dose and potential sparing of previously radiated normal tissues. Methods and Materials: Between June 2010 and February 2014, 14 patients with a history of thoracic radiation and newly diagnosed or locally recurrent esophageal cancer began proton beam reirradiation on a prospective trial. Primary endpoints were feasibility and acute toxicity. Toxicity was graded according Common Toxicity Criteria version 4.0. Results: The median follow-up was 10 months (2-25 months) from the start of reirradiation. Eleven patients received concurrent chemotherapy. The median interval between radiation courses was 32 months (10-307 months). The median reirradiation prescription dose was 54.0 Gy (relative biological effectiveness [RBE]) (50.4-61.2 Gy[RBE]), and the median cumulative prescription dose was 109.8 Gy (76-129.4 Gy). Of the 10 patients who presented with symptomatic disease, 4 patients had complete resolution of symptoms, and 4 had diminished or stable symptoms. Two patients had progressive symptoms. The median time to symptom recurrence was 10 months. Maximum acute nonhematologic toxicity attributable to radiation was grade 2 (64%, N=9), 3 (29%, N=4), 4 (0%), and 5 (7%, N=1). The acute grade 5 toxicity was an esophagopleural fistula more likely related to tumor progression than radiation. Grade 3 nonhematologic acute toxicities included dysphagia, dehydration, and pneumonia. There was 1 late grade 5 esophageal ulcer more likely related to tumor progression than radiation. There were 4 late grade 3 toxicities: heart failure, esophageal stenosis requiring dilation, esophageal ulceration from tumor, and percutaneous endoscopic gastrostomy tube dependence. The median time to local failure was 10 months, and the median overall survival was 14 months. Conclusions: Our data demonstrate that

  12. Complicated Grief

    Science.gov (United States)

    ... that may increase the risk of developing complicated grief include: An unexpected or violent death, such as death from a car accident, or the murder or suicide of a loved one Death of a child Close or dependent relationship to the deceased person Social isolation or loss ...

  13. Complicated rhinosinusitis

    NARCIS (Netherlands)

    Hansen, F.S.

    2016-01-01

    Complicated rhinosinusitis: a title chosen for its multi-interpretable nature. In the Oxford dictionary ‘complicated’ is defined as ‘consisting of many interconnecting parts or elements’ and ‘involving many different and confusing aspects’ as well as ‘involving complications’ in medicine. It is the

  14. Surgical outcome of colon interposition by the posterior mediastinal route for thoracic esophageal cancer.

    Science.gov (United States)

    Motoyama, Satoru; Kitamura, Michihiko; Saito, Reijiro; Maruyama, Kiyotomi; Sato, Yusuke; Hayashi, Kaori; Saito, Hajime; Minamiya, Yoshihiro; Ogawa, Jun-ichi

    2007-04-01

    For thoracic esophageal cancer patients with a history of gastrectomy, esophageal reconstruction using segments of colon was often accomplished using the anterior mediastinal route to avoid fatal complications related to colon necrosis. Our aim was to review our experience with reconstruction by the posterior mediastinal route and assess the surgical outcomes. Between 1989 and August 2006, 34 esophageal cancer patients at Akita University Hospital underwent esophageal reconstruction accomplished by colon interposition by the posterior mediastinal route. Data from these patients were reviewed. Colon conduits consisted of left colon segments in 4 patients and right colon segments in 30. The grafts were supplied with blood by the left colonic artery in 13 patients, the middle colonic artery in 20, and the right colonic artery in 1. The esophagocolic (pharyngocolic) anastomosis was located in the neck in 33 patients (97%) and in the thorax in 1. No patient died during the initial hospital stay. There were no instances of colon necrosis. An anastomotic fistula occurred in 3 patients (9%). Proximal anastomotic strictures occurred in 2 patients (6%). No late graft redundancies resulting in significant dysphagia occurred. Reductions in body weight did not differ from those seen when the gastric tube was used for reconstruction, and alimentary function was good after surgery. The 1-, 2-, 3-, and 5-year survival rates were 66%, 52%, 48%, and 48%, respectively. Colon interposition by the posterior mediastinal route provides a good outcome and is considered the route of first choice.

  15. Hemothorax following Uncomplicated Endoscopic Variceal Sclerotherapy and Ligation for Esophageal Varices

    Directory of Open Access Journals (Sweden)

    Tomoko Ochiai

    2017-09-01

    Full Text Available Endoscopic variceal sclerotherapy and ligation are standard treatment modalities used for the management of esophageal varices. Reportedly, sclerotherapy and ligation are associated with complications such as hematuria, pulmonary thrombus formation, pleural effusion, renal dysfunction, and esophageal stenosis. However, hemothorax following sclerotherapy and ligation has not yet been reported. We treated a patient who presented with liver cirrhosis and polycythemia vera and later developed hemothorax following the above-mentioned procedures. An 86-year-old man diagnosed with liver cirrhosis due to chronic hepatitis type B and alcohol abuse underwent variceal sclerotherapy using ethanolamine oleate to treat his esophageal varices. Oozing from the esophageal varices continued even after the sclerotherapy procedure; therefore, we performed endoscopic variceal ligation. The patient developed left-sided hemothorax within 24 h after treatment of his varices, and an emergency thoracotomy was performed. A pulmonary ligament of the left lung was bulging and ripping because of mediastinal hematoma, and oozing was noted. Cessation of bleeding was noted after the laceration of the left pulmonary ligament had been sutured. Ours is the first case of hemothorax reported in a patient following an uncomplicated procedure of sclerotherapy and ligation.

  16. Activity of mitogen-activated protein kinases in the esophageal epithelium of patients with Barrett's esophagus.

    Science.gov (United States)

    Chwiesko, A; Baniukiewicz, A; Semeniuk, J; Kaczmarski, M; Wasielica-Berger, J; Milewski, R; Dabrowski, A

    2015-01-01

    Barrett's esophagus (BE), a complication of gastroesophageal reflux disease, is associated with an increased risk of esophageal cancer. Mitogen-activated protein kinases may play an important role in the pathogenesis of this process. We aimed to evaluate mitogen-activated protein kinases activity in esophageal mucosa of patients with BE and find possible relationship between reflux type and BE. Twenty-four patients (mean age: 59 years) with gastroesophageal reflux disease symptoms and endoscopically suspected esophageal metaplasia (ESEM) were prospectively enrolled for testing by a multichannel intraluminal impedance monitoring along with a Bilitec 2000. Endoscopic biopsies were taken from methylene blue-positive pit patterns (sites suggesting specialized intestinal metaplasia [SIM]), from 2 cm above the Z-line and from cardial parts of the stomach. The biopsies were analyzed for extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), p38 activity by Western blot. Seventeen ESEMs had histologically proven metaplasia: eight patients had SIM and nine had gastric-type epithelia (GE). Biliary reflux was more evident in SIM (P = 0.019) but not in GE (P = 0.019); non-biliary reflux was typical for GE (P = 0.005) but not for SIM (P = 0.04). Strong activations of ERK and p38 were found predominantly in SIM, but not in normal esophageal mucosa (NE) (P = 0.01 and P Diseases of the Esophagus.

  17. Regression of esophageal varices and splenomegaly in two patients with hepatitis-C-related liver cirrhosis after interferon and ribavirin combination therapy

    Directory of Open Access Journals (Sweden)

    Soon Jae Lee

    2016-09-01

    Full Text Available Some recent studies have found regression of liver cirrhosis after antiviral therapy in patients with hepatitis C virus (HCV-related liver cirrhosis, but there have been no reports of complete regression of esophageal varices after interferon/peg-interferon and ribavirin combination therapy. We describe two cases of complete regression of esophageal varices and splenomegaly after interferon-alpha and ribavirin combination therapy in patients with HCV-related liver cirrhosis. Esophageal varices and splenomegaly regressed after 3 and 8 years of sustained virologic responses in cases 1 and 2, respectively. To our knowledge, this is the first study demonstrating that complications of liver cirrhosis, such as esophageal varices and splenomegaly, can regress after antiviral therapy in patients with HCV-related liver cirrhosis.

  18. Anterior cervical spine surgery-associated complications in a retrospective case-control study.

    Science.gov (United States)

    Tasiou, Anastasia; Giannis, Theofanis; Brotis, Alexandros G; Siasios, Ioannis; Georgiadis, Iordanis; Gatos, Haralampos; Tsianaka, Eleni; Vagkopoulos, Konstantinos; Paterakis, Konstantinos; Fountas, Kostas N

    2017-09-01

    Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration. The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded. The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF). Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

  19. Esophageal wall dose-surface maps do not improve the predictive performance of a multivariable NTCP model for acute esophageal toxicity in advanced stage NSCLC patients treated with intensity-modulated (chemo-)radiotherapy

    Science.gov (United States)

    Dankers, Frank; Wijsman, Robin; Troost, Esther G. C.; Monshouwer, René; Bussink, Johan; Hoffmann, Aswin L.

    2017-05-01

    In our previous work, a multivariable normal-tissue complication probability (NTCP) model for acute esophageal toxicity (AET) Grade  ⩾2 after highly conformal (chemo-)radiotherapy for non-small cell lung cancer (NSCLC) was developed using multivariable logistic regression analysis incorporating clinical parameters and mean esophageal dose (MED). Since the esophagus is a tubular organ, spatial information of the esophageal wall dose distribution may be important in predicting AET. We investigated whether the incorporation of esophageal wall dose-surface data with spatial information improves the predictive power of our established NTCP model. For 149 NSCLC patients treated with highly conformal radiation therapy esophageal wall dose-surface histograms (DSHs) and polar dose-surface maps (DSMs) were generated. DSMs were used to generate new DSHs and dose-length-histograms that incorporate spatial information of the dose-surface distribution. From these histograms dose parameters were derived and univariate logistic regression analysis showed that they correlated significantly with AET. Following our previous work, new multivariable NTCP models were developed using the most significant dose histogram parameters based on univariate analysis (19 in total). However, the 19 new models incorporating esophageal wall dose-surface data with spatial information did not show improved predictive performance (area under the curve, AUC range 0.79-0.84) over the established multivariable NTCP model based on conventional dose-volume data (AUC  =  0.84). For prediction of AET, based on the proposed multivariable statistical approach, spatial information of the esophageal wall dose distribution is of no added value and it is sufficient to only consider MED as a predictive dosimetric parameter.

  20. Refractory esophageal strictures: what to do when dilation fails

    NARCIS (Netherlands)

    Boeckel, P.G. van; Siersema, P.D.

    2015-01-01

    OPINION STATEMENT: Benign esophageal strictures arise from a diversity of causes, for example esophagogastric reflux, esophageal resection, radiation therapy, ablative therapy, or the ingestion of a corrosive substance. Most strictures can be treated successfully with endoscopic dilation using

  1. Prevalence and risk factors of erosive esophagitis in Taiwan

    Directory of Open Access Journals (Sweden)

    Jian-Lin Ou

    2012-02-01

    Conclusion: The current prevalence of erosive esophagitis in Taiwan is 17.3%. Male sex, smoking, obesity, and hiatus hernia are four independent risk factors for the development of erosive esophagitis in the Taiwanese population.

  2. Nutrition in peri-operative esophageal cancer management

    NARCIS (Netherlands)

    Steenhagen, E.; Vulpen, J.K. van; Hillegersberg, R. van; May, A.M.; Siersema, P.D.

    2017-01-01

    INTRODUCTION: Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review

  3. Hot and cold mate drinking and esophageal cancer in Paraguay

    National Research Council Canada - National Science Library

    P A Rolón; X Castellsagué; M Benz; N Muñoz

    1995-01-01

    A hospital-based case-control study, including 131 cases of esophageal cancer and 381 controls, was carried out in Paraguay to investigate the role of hot and cold mate drinking in esophageal cancer risk...

  4. Novel mechanisms and signaling pathways of esophageal ulcer healing: the role of prostaglandin EP2 receptors, cAMP, and pCREB.

    Science.gov (United States)

    Ahluwalia, Amrita; Baatar, Dolgor; Jones, Michael K; Tarnawski, Andrzej S

    2014-09-15

    Clinical studies indicate that prostaglandins of E class (PGEs) may promote healing of tissue injury e.g., gastroduodenal and dermal ulcers. However, the precise roles of PGEs, their E-prostanoid (EP) receptors, signaling pathways including cAMP and cAMP response element-binding protein (CREB), and their relation to VEGF and angiogenesis in the tissue injury healing process remain unknown, forming the rationale for this study. Using an esophageal ulcer model in rats, we demonstrated that esophageal mucosa expresses predominantly EP2 receptors and that esophageal ulceration triggers an increase in expression of the EP2 receptor, activation of CREB (the downstream target of the cAMP signaling), and enhanced VEGF gene expression. Treatment of rats with misoprostol, a PGE1 analog capable of activating EP receptors, enhanced phosphorylation of CREB, stimulated VEGF expression and angiogenesis, and accelerated esophageal ulcer healing. In cultured human esophageal epithelial (HET-1A) cells, misoprostol increased intracellular cAMP levels (by 163-fold), induced phosphorylation of CREB, and stimulated VEGF expression. A cAMP analog (Sp-cAMP) mimicked, whereas an inhibitor of cAMP-dependent protein kinase A (Rp-cAMP) blocked, these effects of misoprostol. These results indicate that the EP2/cAMP/protein kinase A pathway mediates the stimulatory effect of PGEs on angiogenesis essential for tissue injury healing via the induction of CREB activity and VEGF expression.

  5. Endoscopic assessment of reflux esophagitis concurrent with hiatal hernia in male Japanese patients with obstructive sleep apnea.

    Science.gov (United States)

    Zenda, Takahiro; Hamazaki, Kei; Oka, Rie; Hagishita, Tomomi; Miyamoto, Susumu; Shimizu, Junzo; Inadera, Hidekuni

    2014-09-01

    The pathogenetic relationship underlying the high prevalence of gastroesophageal reflux disease (GERD) in patients with obstructive sleep apnea (OSA) remains unclear. In addition, GERD has not been adequately assessed by endoscopy in patients with OSA. The purpose of this study was to use endoscopy to investigate potential interactions among reflux esophagitis, hiatal hernia (HH) and OSA. A total of 243 consecutive male Japanese participants who underwent both overnight ambulatory polygraphic monitoring and esophagogastroduodenoscopy were retrospectively evaluated in a cross-sectional study. The prevalence and severity of HH and reflux esophagitis were assessed according to the Los Angeles classification and the Makuuchi classification, respectively. Associations among reflux esophagitis, HH and OSA were examined by univariate and multivariate analyses. OSA was diagnosed in 98 individuals (40.3%). Endoscopy-confirmed esophagitis (p = 0.027) and HH (p < 0.001) were significantly more prevalent among patients with OSA. Multivariate regression model analysis adjusted for age, body mass index, visceral obesity represented by waist circumference, presence of OSA, concurrence of OSA and HH, smoking, and alcohol consumption yielded OSA as the only variable significantly associated with HH (odds ratio [OR], 2.60; 95% confidence interval [CI], 1.35-4.99; p = 0.004), while concurrence of OSA and HH was related to reflux esophagitis (OR, 3.59; CI, 1.87-6.92; p < 0.001). OSA was associated with HH and concurrent OSA and HH with reflux esophagitis in male Japanese patients with OSA. Our results support the hypothesis that complicating HH may link reflux esophagitis to OSA.

  6. The prognostic influence of body mass index, resting energy expenditure and fasting blood glucose on postoperative patients with esophageal cancer.

    Science.gov (United States)

    Wu, Ning; Zhu, Yongjun; Kadel, Dhruba; Pang, Liewen; Chen, Gang; Chen, Zhiming

    2016-12-21

    Body mass index (BMI), resting energy expenditure (REE) and fasting blood glucose (FBG) are major preoperative assessments of patients' nutrition and metabolic state. The relations and effects of these indices on esophageal cancer patients' postoperative short-term and long-term outcomes remain controversial and unclear. We aimed to study the impact of BMI, REE and FBG in esophageal cancer patients undergoing esophagectomy. Three hundred and six esophageal cancer patients who underwent esophagectomy were observed retrospectively. Clinical characteristics, postoperative complications and survival analysis were compared among different BMI, REE and FBG groups. There were significant linear relationships between REE, BMI and FBG indices, patients with low BMI tended to have low REE (p cancer undergoing esophagectomy and preoperative evaluation of these indices help to determine the prognosis in these patients.

  7. Association of esophageal candidiasis and squamous cell carcinoma

    OpenAIRE

    Delsing, C.E.; Bleeker-Rovers, C.P.; Veerdonk, F.L. van de; Tol, J.; van der Meer, J.W.M.; Kullberg, B. J.; Netea, M. G.

    2012-01-01

    Chronic esophageal candidiasis is an infection that is mostly seen in immunocompromised conditions, among which is chronic mucocutaneous candidiasis (CMC). Recently an association between CMC and esophageal carcinoma has been reported. Here we present two patients with chronic esophageal candidiasis who developed esophageal squamous cell carcinoma and we discuss the etiologic role of Candida-induced nitrosamine production, the loss of STAT1 function and impaired tumor surveillance and T-lymph...

  8. An updated review on gastro-esophageal reflux in pediatrics.

    Science.gov (United States)

    Vandenplas, Yvan; Hauser, Bruno

    2015-01-01

    Comprehensive guidelines for the diagnosis and management of gastro-esophageal reflux (GER) and GER disease (GERD) were developed by the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition. GERD is reflux associated with troublesome symptoms or complications. The recognition of GER and GERD is relevant to implement best management practices. A conservative management is indicated in infants with uncomplicated physiologic reflux. Children with GERD may benefit from further evaluation and treatment. Since the publications of the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition guidelines in 2009, no important novelties in drug treatment have been reported. Innovations are mainly restricted to the management of regurgitation in infants. During the last 5 years, pros and cons of multichannel intraluminal impedance have been highlighted. However, overall 'not much has changed' in the diagnosis and management of GER and GERD in infants and children.

  9. Effect of H. pylori density by histopathology on its complications and eradication therapy.

    Science.gov (United States)

    Shah, Dharmesh K; Jain, Samit S; Mohite, Ashok; Amarapurkar, Anjali D; Contractor, Q Q; Rathi, Pravin M

    2015-01-01

    Helicobacter pylori (H. pylori) infection causes chronic gastritis and is a major risk factor for duodenal and gastric ulceration, gastric adenocarcinoma, and primary gastric lymphoma. Increased gastric bacterial density may lead to increased levels of inflammation and epithelial injury. 1) To study the effect of H. pylori density by histological changes in stomach. 2) To study the effect of H. pylori density on the efficacy of standard triple drug eradication treatment. 3) To study the effect of H. pylori density on the complication related to H. pylori. All the patients visiting gastroenterology OPD with the symptoms of dyspepsia not responding to proton pump inhibitor or having alarm symptoms were subjected to upper GI endoscopy and biopsy. If H. pylori was present they were included in the study. The patients were given standard 14 day triple antibiotic combination for H. pylori eradication. H. pylori eradication was confirmed by urea breath test after six weeks of completion of treatment. Out of 250 patients screened, 120 patients enrolled in the study. On clinical history 41.5% patients had symptoms of heart burn where as 63.3% patients had dyspeptic symptoms. Success rate of anti H. pylori triple drug therapy was 80%. Rate of eradication was significantly lower among the patients with higher H. pylori density (p H. pylori density (p H. pylori density by histopathology correlates with the complication related to H. pylori i.e. duodenal ulcer, reflux esophagitis and antral erosions. It also correlates with the success of the standard triple drug eradication treatment.

  10. Peroral endoscopic esophageal myotomy: defining the learning curve.

    Science.gov (United States)

    Kurian, Ashwin A; Dunst, Christy M; Sharata, Ahmed; Bhayani, Neil H; Reavis, Kevin M; Swanström, Lee L

    2013-05-01

    Peroral endoscopic myotomy (POEM) is an endoscopic alternative to laparoscopic esophageal myotomy. It requires a demanding skill set that involves both advanced endoscopic skills and knowledge of surgical anatomy and complication management. Determine the learning curve for POEM. Prospective cohort study. Tertiary-care teaching hospital. The study involved the first 40 consecutive patients undergoing the POEM procedure under a prospective institutional review board protocol (research.gov #NCT01399476, 1056). Peroral endoscopic myotomy for esophageal motility disorders. Length of procedure (LOP) and technical errors (inadvertent mucosotomy). A total of 40 patients underwent POEM. The mean LOP was 126 ± 41 minutes. The mean myotomy length was 9 cm (range, 6-20 cm). The LOP per centimeter myotomy and variability decreased as our experience progressed. The means (± standard deviation) of the LOP per centimeter myotomy were as follows: first cohort, 16 ± 4 minutes; second, 17 ± 5 minutes; third, 13 ± 3 minutes; fourth, 15 ± 2 minutes; and fifth, 13 ± 4 minutes. The incidence of inadvertent mucosotomy also decreased with increasing experience, to 8, 6, 4, 0, and 1, respectively. These minor complications were repaired intraoperatively with clips. There were 7 patients with capnoperitonium and another with bilateral capnothoraces that were associated with hemodynamic instability but resolved by Veress needle decompression. Two patients required endoscopy in the early postoperative period: self-limited hematemesis in one and radiologic evidence of leakage at the mucosotomy site in another. Nonrandomized study. Mastery of operative technique in POEM is evidenced by a decrease in LOP, variability of minutes per centimeter of myotomy, and incidence of inadvertent mucosotomies and plateaus in about 20 cases for experienced endoscopists. The learning curve can be shortened with very close supervision and/or proctoring. Copyright © 2013 American Society for

  11. Conservative long-term treatment of children with eosinophilic esophagitis.

    Science.gov (United States)

    Levine, Jeremiah; Lai, Joanne; Edelman, Morris; Schuval, Susan J

    2012-05-01

    Current treatments of eosinophilic esophagitis (EoE), including restrictive diets or glucocorticoids, provide only transient improvement. Proton pump inhibitor (PPI) use in EoE does not lead to histologic improvement; however, the long-term use of PPI on symptoms and prevention of complications has not been evaluated. To evaluate the use of PPI as maintenance therapy in children with EoE. Eosinophilic esophagitis was diagnosed based on initial endoscopic biopsies and persistent eosinophilic inflammation despite PPI therapy. Inclusion criteria included diagnosis of EoE and PPI use as primary maintenance treatment. Patients were excluded if they were treated with dietary or glucocorticoid therapy. Histologic evidence of inflammation as well as degree of subepithelial fibrosis at presentation was compared with most recent biopsies while receiving PPI therapy. Thirty-eight patients (30 males and 8 females; average age 6.7 ± 5.4 years) fulfilled inclusion criteria. Duration of follow-up was 3.0 ± 2.4 years. At presentation, vomiting was significantly more frequent in the younger patients, whereas dysphagia occurred more frequently in the older patients. At follow-up, 26 patients were asymptomatic, and the remaining 12 patients' symptoms were significantly improved. No complications of stricture or food impaction were seen. Significant eosinophilic inflammation persisted in 28 patients. No difference in degree of subepithelial fibrosis at diagnosis compared with most recent biopsies. The z-scores of the treated EoE patients significantly improved. Patients with EoE treated with PPIs show an improvement in symptoms and z-scores despite persistent eosinophilic inflammation. PPI treatment may be useful maintenance therapy in children with EoE. Copyright © 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  12. Management of complications of Dupuytren contracture.

    Science.gov (United States)

    Cheung, Kevin; Walley, Kempland C; Rozental, Tamara D

    2015-05-01

    This evidence-based article discusses the current management options of Dupuytren disease and strategies to avoid and manage any potential complications. Treatment options include fasciectomy, needle fasciotomy/aponeurotomy, and collagenase injection. Complications include digital nerve and artery injury, flexor tendon injury, skin fissures and wound healing complications, hematoma, infection, flare reaction/complex regional pain syndrome, and recurrence. Complication rates, prevention, and management differ with each treatment modality. A detailed understanding of each of these options allows hand surgeons to select the most appropriate treatment for each patient. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Dilated intercellular spaces in eosinophilic esophagitis.

    Science.gov (United States)

    Ravelli, Alberto; Villanacci, Vincenzo; Cadei, Moris; Fuoti, Maurizio; Gennati, Giada; Salemme, Marianna

    2014-11-01

    Dilated intercellular spaces (DIS) in the esophageal epithelium can be induced by acid and reduced by proton pump inhibitors (PPI), and are thus considered a marker of gastroesophageal reflux disease (GERD). Over the years, however, DIS have also been reported in esophagitis unrelated to GERD. Because DIS have never been formally measured in eosinophilic esophagitis (EoE), we aimed at detecting and measuring DIS in EoE before and after nutritional or pharmacological therapy. In 22 children with EoE, DIS were measured by morphometry and transmission electron microscopy (TEM), before and after treatment with topical steroids (n = 16) and/or exclusion diet (n = 13). A total of 30 children undergoing upper gastrointestinal endoscopy with biopsy for nonesophageal disorders acted as controls. In controls, the mean (± standard deviation [SD]) number of esophageal eosinophils was 0.91 (± 0.47) and the mean DIS values were 0.62 (± 0.08) μm at morphometry and 0.33 (± 0.24) μm at TEM. In patients with EoE, the mean (± SD) number of esophageal eosinophils decreased from 31.8 (± 6.96) to 6.64 (± 5.01) (P treatment. DIS are a prominent morphological feature of EoE, in which they can be significantly reduced by an appropriate non-PPI therapy.

  14. Esophageal candidiasis in an immunocompetent girl.

    Science.gov (United States)

    Hasosah, Mohammed Yahya; Showail, Mahmmod; Al-Sahafi, Ashraf; Satti, Mohammed; Jacobson, Kevan

    2009-05-01

    Infections of the esophagus are rare and most commonly seen in children with immune suppression resulting from malignancy, chronic metabolic or infectious disease, or immunosuppressive drug therapy. An 18-month-old girl on inhaled corticosteroid for bronchial asthma presented with coffee-ground emesis and melena. Upper endoscopy revealed yellow-white plaques scattered over the mucosa of the distal esophagus. Biopsy results showed chronic esophagitis with features of reflux disease. Gram staining of esophageal brushing showed pseudohyphae, and the culture was positive for candida species. The patient was treated with omeprazole 2 mg/kg per day and fluconazole 6 mg/kg per day for three weeks. Immunological workup was normal and she was negative for human immunodeficiency virus. Post treatment endoscopy showed normal appearance of esophageal mucosa and normal histology. At 12 months after treatment, the child remained asymptomatic and continued to thrive. We believe that this child developed esophageal candidiasis secondary to long-term use of inhaled corticosteroid associated with immune suppression on a background of reflux esophagitis. Anti-acid and antifungal therapies are effective in the treatment.

  15. Oral complications of cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dreizen, S.; Daly, T.E.; Drane, J.B.; Brown, L.R.

    1977-02-01

    Injury to surrounding tissues during radiotherapy for oral cancer can have devastating physical and psychologic consequences for the patient. Oral complications include xerostomia, dental decay, mucositis, taste loss, osteoradionecrosis, infection, and trismus. In many instances, these problems can be eradicated or controlled with appropriate treatment.

  16. Use of glucagon in relieving esophageal food bolus impaction in the era of eosinophilic esophageal infiltration.

    Science.gov (United States)

    Thimmapuram, Jayaram; Oosterveen, Scott; Grim, Rodney

    2013-06-01

    Esophageal food bolus impaction may require an urgent endoscopy. Glucagon is often administered to promote spontaneous passage of the food bolus. Eosinophilic esophagitis is increasingly recognized as a cause of dysphagia, and food impaction is often the presenting symptom. Our study was aimed at determining the effectiveness of glucagon in relieving esophageal foreign body obstruction in general and in the setting of esophageal eosinophilic infiltration (EEI). A retrospective chart review was performed using the ICD codes and the emergency department database of adult patients presenting with symptoms of esophageal food bolus impaction from July 2004 to October 2010. Response to glucagon was defined as symptomatic relief of obstruction prior to endoscopic intervention. A total of 213 episodes of esophageal food bolus obstruction in 192 patients were identified during the study period. Glucagon was given in 125 cases of which 41 had a response (32.8 %). A total of 170 episodes had an Esophagogastroduodenoscopy performed either during the impaction event or at a later date. Of the 60 patients' biopsies, 45 had received glucagon (17 with EEI, 28 without EEI). None of the 17 episodes with EEI as compared to 8 of the 28 without EEI responded to glucagon (0 % vs. 28.5 %, p = 0.017). Glucagon is effective in about one third of patients with esophageal food bolus impaction, which is consistent with historical data. Patients with EEI appear less likely to respond to glucagon.

  17. Complications of the Latarjet procedure.

    Science.gov (United States)

    Gupta, Ashish; Delaney, Ruth; Petkin, Kalojan; Lafosse, Laurent

    2015-03-01

    The Latarjet procedure is an operation performed either arthroscopically or open for recurrent anterior shoulder instability, in the setting of glenoid bone loss; with good to excellent functional results. Despite excellent clinical results, the complication rates are reported between 15 and 30 %. Intraoperative complications such as graft malpositioning, neurovascular injury, and graft fracture can all be mitigated with meticulous surgical technique and understanding of the local anatomy. Nonunion and screw breakage are intermediate-term complications that occur in less than 5 % of patients. The long-term complications such as graft osteolysis are still an unsolved problem, and future research is required to understand the etiology and best treatment option. Recurrent instability after the Latarjet procedure can be managed with iliac crest bone graft reconstruction of the anterior glenoid. Shoulder arthritis is another complication reported after the Latarjet procedure, which poses additional challenges to both the surgeon and patient.

  18. Neurological Complications of Bariatric Surgery.

    Science.gov (United States)

    Goodman, Jerry Clay

    2015-12-01

    Obesity has attained pandemic proportions, and bariatric surgery is increasingly being employed resulting in turn to more neurological complications which must be recognized and managed. Neurological complications may result from mechanical or inflammatory mechanisms but primarily result from micro-nutritional deficiencies. Vitamin B12, thiamine, and copper constitute the most frequent deficiencies. Neurological complications may occur at reasonably predictable times after bariatric surgery and are associated with the type of surgery used. During the early post-operative period, compressive or stretch peripheral nerve injury, rhabdomyolysis, Wernicke's encephalopathy, and inflammatory polyradiculoneuropathy may occur. Late complications ensue after months to years and include combined system degeneration (vitamin B12 deficiency) and hypocupric myelopathy. Bariatric surgery patients require careful nutritional follow-up with routine monitoring of micronutrients at 6 weeks and 3, 6, and 12 months post-operatively and then annually after surgery and multivitamin supplementation for life. Sustained vigilance for common and rare neurological complications is essential.

  19. Urodynamic results, clinical efficacy, and complication rates of sacral intradural deafferentation and sacral anterior root stimulation in patients with neurogenic lower urinary tract dysfunction resulting from complete spinal cord injury.

    Science.gov (United States)

    Krasmik, D; Krebs, Jörg; van Ophoven, Arndt; Pannek, Jürgen

    2014-11-01

    To investigate the outcome and complications of sacral deafferentation (SDAF) and sacral anterior root stimulation (SARS) in patients with neurogenic lower urinary tract dysfunction (NLUTD) resulting from complete spinal cord injury (SCI). Retrospective chart analysis of 137 patients who underwent SDAF/SARS at a single institution. Patients were categorized as being at risk of renal damage when the maximum detrusor pressure was >40 cmH2 O or detrusor compliance was <20 ml/cmH2 O. After a mean follow-up time of 14.8 ± 5.3 years, SDAF/SARS treatment significantly (P < 0.001) reduced the number of patients suffering from elevated detrusor pressure from 65 to 2, and from low detrusor compliance from 62 to 13, respectively. Mean bladder capacity significantly (P < 0.001) improved from 272.4 ± 143.0 to 475.0 ± 82.7 ml. The mean number of symptomatic UTI also decreased significantly (P < 0.001) from 6.2 ± 4.5 to 2.5 ± 2.6 per year. The number of patients suffering from incontinence had significantly (P < 0.001) decreased from 70 to 44. At the last follow-up visit, 107 (78.1%) patients were still using the stimulator. A total of 84 complications requiring surgical revision were observed. Defects of the stimulator cables or the receiver plate were the most common events (n = 38). The retrospective design pertains to the limitations of the study. Sacral deafferentation and SARS are an effective treatment option for refractory NLUTD in patients with complete SCI, despite a substantial long-term complication rate. © 2014 Wiley Periodicals, Inc.

  20. A comparative analysis by SAGE of gene expression profiles of esophageal adenocarcinoma and esophageal squamous cell carcinoma

    NARCIS (Netherlands)

    van Baal, Jantine W. P. M.; Milana, Francesco; Rygiel, Agnieszka M.; Sondermeijer, Carine M. T.; Spek, C. Arnold; Bergman, Jacques J. G. H. M.; Peppelenbosch, Maikel P.; Krishnadath, Kausilia K.

    2008-01-01

    Esophageal adenocarcinoma (EA) and esophageal squamous cell carcinoma (ESCC) are the two main types of esophageal cancer. Despite extensive research the exact molecular basis of these cancers is unclear. Therefore we evaluated the transcriptome of EA in comparison to non-dysplastic Barrett's

  1. [Study on thoracoabdominal incision for thoracic esophageal carcinoma by rotation position].

    Science.gov (United States)

    Chai, Li-xun; Feng, Yun; Bai, Xiao-ming

    2011-07-19

    To explore the clinical feasibility of thoracoabdominal incision for thoracic esophageal carcinoma by rotation position. From January 2004 to December 2007, 126 patients with thoracic esophageal carcinoma performed operation by rotation position. There were 75 males and 51 females aged 46 to 78 years. Tumor was located mid-esophagus in 74 patients, whereas sub-esophagus was present in 52 patients. All patients underwent esophagectomy by rotation position (thoracoabdominal incision). Thoracic and abdominal cavity were exposed well. All operations were completed successful. Anastomotic stoma was located right thorax. The mean number of tow-field lymph node dissection was 25.6. There was no mortality. Postoperative complication include pulmonary complication, incision infection, recurrent laryngeal nerve damage, arrhythmia. The operation time was significantly shortened by rotation position. The number of lymph node dissection was significantly increased. The results of this study demonstrated that thoracoabdominal incision for thoracic esophageal carcinoma by rotation position exposes the operation fields clearly and make radical lymphadenectomy thoroughly. Disease-free survival is significantly improved.

  2. Esophageal Carcinoma Histology Affects Perioperative Morbidity Following Open Esophagogastrectomy

    Directory of Open Access Journals (Sweden)

    Charles E. Woodall

    2008-01-01

    Full Text Available Background. Esophagectomy for esophageal cancer is being practiced routinely with favorable results at many centers. We sought to determine if tumor histology is a powerful surrogate marker for perioperative morbidity. Methods. Seventy three consecutive patients managed operatively were reviewed from our prospectively maintained database. Results. Adenocarcinoma (AC was present in 52 (71% and squamous cell (SCC in 21 (29%. The use of neoadjuvant therapy was similar for the AC (34.62% and SCC (42.86% groups. The SCC group had a higher incidence of prior pulmonary disease than the AC group (23.8% versus 5.8%, resp.; =.03. SCC patients were more likely to have a prolonged ICU stay than AC patients (=.004 despite similar complication rates, EBL, and prognostic nutritional index. The SCC group did, however, experience higher grades of complications (=.0053. Conclusions. Presence of SCC was the single best predictor of prolonged ICU stay and more severe complications as defined by this study. Only a past history of pulmonary disease was different between the two histologic subgroups.

  3. Herpetic esophagitis: a diagnosis to remember

    Directory of Open Access Journals (Sweden)

    Marina Pinheiro

    2016-02-01

    Full Text Available Introduction: Herpetic esophagitis is a well-recognized infection in immunocompromised hosts, having been rarely described in immunocompetent individuals. Case report: The authors describe a case of a 16-year-old female adolescent admitted to the emergency room with a threeday history of fever, odynophagia, dysphagia for liquid and solid food and retrosternal pain. The upper endoscopy revealed linear and round erosions in the distal esophagus and the histologic findings were compatible with herpetic esophagitis. Discussion/conclusion: Herpetic esophagitis is an underdiagnosed condition in immunocompetent children and adolescents, but it should not be overlooked. An esophagoscopy is required to make a definitive diagnosis. It is usually a selflimited infection and the mainstay of treatment is supportive care. The use of acyclovir is still controversial but its early initiation may shorten the clinical course of the disease.

  4. Herpetic Esophagitis in Immunocompetent Medical Student

    Directory of Open Access Journals (Sweden)

    Andréia Vidica Marinho

    2014-01-01

    Full Text Available Esophagitis caused by herpes simplex virus (HSV is often documented during periods of immunosuppression in patients infected with human immunodeficiency virus (HIV; it is rare in immunocompetent diagnosed patients. Case reports of herpetic esophagitis in students of health sciences are extremely rare. The disease presents with a clinical picture characterized by acute odynophagia and retrosternal pain without obvious causes and ulcers, evidenced endoscopically in the middistal esophagus. Diagnosis depends on endoscopy, biopsies for pathology studies, and immunohistochemistry techniques. The disease course is often benign; however, treatment with acyclovir speeds the disappearance of symptoms and limits the severity of infection. In this report, we present a case of herpetic esophagitis in an immunocompetent medical student, with reference to its clinical features, diagnosis, and treatment. The disease may have manifested as a result of emotional stress experienced by the patient.

  5. Management guidelines of eosinophilic esophagitis in childhood

    DEFF Research Database (Denmark)

    Papadopoulou, A; Koletzko, S; Heuschkel, R

    2014-01-01

    at providing practical guidelines for the management of children and adolescents with EoE. METHODS: Relevant literature from searches of PubMed, CINAHL, and recent guidelines was reviewed. In the absence of an evidence base, recommendations reflect the expert opinion of the authors. Final consensus...... for severe symptoms requiring rapid relief or where other treatments have failed. Esophageal dilatation is an option in children with EoE who have esophageal stenosis unresponsive to drug therapy. Maintenance treatment may be required in case of frequent relapse, although an optimal regimen still needs...

  6. [Diagnosis and treatment of cervicothoracic injuries].

    Science.gov (United States)

    Tatarinova, E V; Pogodina, A N; Abakumov, M M

    2014-01-01

    It analyzed the diagnosis and treatment results of 123 patients with cervicothoracic injuries for 21 years. The frequency of cervicothoracic injuries among all patients with cervical injuries was 5.7%. Preoperative and postoperative diagnosis included radial and endoscopic methods. The complications rate was 43.6%. The most severe complications were observed in patients with delayed diagnosis of trachea and esophagus injuries.

  7. Two cases of cisplatin-induced permanent renal failure following neoadjuvant chemotherapy for esophageal cancer.

    Science.gov (United States)

    Sasaki, Tomohiko; Motoyama, Satoru; Komatsuda, Atsushi; Shibata, Hiroyuki; Sato, Yusuke; Yoshino, Kei; Wakita, Akiyuki; Saito, Hajime; Anbai, Akira; Jin, Mario; Minamiya, Yoshihiro

    2016-01-01

    We experienced two esophageal cancer patients who developed severe acute renal failure after neoadjuvant chemotherapy with cisplatin and 5-fluorourasil. After administration of cisplatin, their serum creatinine increased gradually until they required hemodialysis and their renal failure was permanent. In both cases, renal biopsy examination indicated partial recovery of the proximal tubule, but renal function did not recover. After these events, one patient underwent definitive radiotherapy and the other underwent esophagectomy for their esophageal cancers, while continuing dialysis. Both patients are alive without cancer recurrence. In these two cases of cisplatin-induced renal failure, renal biopsy examination showed only slight disorder of proximal tubules and tendency to recover. Although cisplatin-related nephrotoxicity is a well-recognized complication, there have been few reports of renal failure requiring hemodialysis in cancer patients. In this report, we present their clinical courses and the pathological findings of cisplatin-related renal failure. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Esophageal Granular Cell Tumor and Eosinophilic Esophagitis: Two Interesting Entities Identified in the Same Patient

    Directory of Open Access Journals (Sweden)

    Alfredo J. Lucendo

    2008-02-01

    Full Text Available We illustrate the case of a 41-year-old male with allergic manifestations since childhood. He sought medical attention for intermittent, progressive dysphagia from which he had been suffering for a number of years, having felt the sensation of a retrosternal lump and a self-limited obstruction to the passage of food. Endoscopy detected a submucosal tumor in the upper third of the esophagus, which was typified, via biopsy, as a granular cell tumor with benign characteristics and probably responsible for the symptoms. Two years later, the patient sought medical attention once again as these symptoms had not abated, hence digestive endoscopy was repeated. This revealed stenosis of the junction between the middle and lower thirds of the organ which had not been detected previously but was passable under gentle pressure. Eosinophilic esophagitis was detected after biopsies were taken. Esophageal manometry identified a motor disorder affecting the esophageal body. Following three months of treatment using fluticasone propionate applied topically, the symptoms went into remission, esophageal stenosis disappeared and the esophageal biopsies returned to normal. This is the first documented case of the link between granular cell tumors and Eosinophilic esophagitis, two different disorders which could cause dysphagia in young patients.

  9. Trauma: Spinal Cord Injury.

    Science.gov (United States)

    Eckert, Matthew J; Martin, Matthew J

    2017-10-01

    Injuries to the spinal column and spinal cord frequently occur after high-energy mechanisms of injury, or with lower-energy mechanisms, in select patient populations like the elderly. A focused yet complete neurologic examination during the initial evaluation will guide subsequent diagnostic procedures and early supportive measures to help prevent further injury. For patients with injury to bone and/or ligaments, the initial focus should be spinal immobilization and prevention of inducing injury to the spinal cord. Spinal cord injury is associated with numerous life-threatening complications during the acute and long-term phases of care that all acute care surgeons must recognize. Published by Elsevier Inc.

  10. Partial gastric pull-up in the treatment of patients with long-gap esophageal atresia.

    Science.gov (United States)

    Reismann, Marc; Granholm, Tina; Ehrén, Henrik

    2015-08-01

    This study was to analyze outcomes of long-gap esophageal atresia (LGEA) treated with partial gastric pull-up (PGP) into the thorax. The medical records of all children who had undergone PGP for LGEA from 1999 to 2012 were reviewed. Preoperative data, initial postoperative course, complications, time to full oral nutrition, follow-up diagnostics and nutritional status were assessed. Nine children who had undergone PGP were followed up for a mean period of 6.2 ± 3.1 years. Their median gestational age was 37 ± 2 weeks, and mean birth weight 2462 ± 658 g. Eight children were primarily treated with a gastrostomy, their mean age at PGP was 11.4 ± 10.9 weeks and mean weight was 4484 ± 1966 g. Their mean operation time was 199 ± 51 minutes. Leakage was an early postoperative complication in three children, one of whom had a consecutive stricture resection. Late complications were stenosis (n=7) and gastro-esophageal reflux (n=5). The general status of the children was judged as "good" or "very good" on the last presentation. The median percentile of the body-mass-index was 25. Gastroscopy at 3.7 ± 3.2 years after the operation revealed a grade I esophagitis in two children. There was no death in this group of children. Because of its high complication rate, partial gastric pull-up cannot be recommended as an alternative for the treatment of LGEA at present. A final judgment could be made on the basis of a comparative study.

  11. Modified Spitz procedure using a Collis gastroplasty for the repair of long-gap esophageal atresia.

    Science.gov (United States)

    Schneider, A; Ferreira, C G; Kauffmann, I; Lacreuse, I; Becmeur, F

    2011-05-01

    We report here on our experience with a modified Spitz procedure using a Collis gastroplasty for the repair of long-gap esophageal atresia (EA). The authors reviewed 5 cases of children with long-gap (5-6 vertebral bodies) EA. The repair was carried out after 3 months of permanent monitoring, enteral nutrition through a gastrostomy tube and permanent aspiration of the proximal esophagus. The Collis gastroplasty was performed to create a gastric tube along the gastric lesser curvature using an Endo-GIA linear stapler. The gastric tube can be easily mobilized into the thorax after ligation of the left gastric vessels and anastomosed to the proximal esophageal segment. There were no intraoperative complications. The median postoperative hospital stay was 39 days (range: 30-60) with a median follow-up of 20 months (range: 16-29). During the early follow-up period, a digestive occlusion occurred in one patient, and several months later, she suffered from hiatal herniation. Other postoperative complications included anastomotic stricture (n = 2) treated by dilatations, gastroesophageal reflux (GER) (n = 3), and weight delay (n = 3) requiring additional enteral nutrition in 2 cases. No mortality was seen in our series. We propose a modified Spitz procedure using a Collis gastroplasty in the primary repair of long-gap EA as an alternative option to esophageal replacement or elongation techniques. The complications noted in our series are common complications of EA surgical repair, such as GER, anastomotic stricture and ponderal stagnation. © Georg Thieme Verlag KG Stuttgart · New York.

  12. HAND-SEWN VERSUS STAPLER ESOPHAGOGASTRIC ANASTOMOSIS AFTER ESOPHAGEAL RESSECTION: SISTEMATIC REVIEW AND META-ANALYSIS

    Science.gov (United States)

    CASTRO, Paula Marcela Vilela; RIBEIRO, Felipe Piccarone Gonçalves; ROCHA, Amanda de Freitas; MAZZURANA, Mônica; ALVAREZ, Guines Antunes

    2014-01-01

    Introduction Postoperative anastomotic leak and stricture are dramatic events that cause increased morbidity and mortality, for this reason it's important to evaluate which is the best way to perform the anastomosis. Aim To compare the techniques of manual (hand-sewn) and mechanic (stapler) esophagogastric anastomosis after resection of malignant neoplasm of esophagus, as the occurrence of anastomotic leak, anastomotic stricture, blood loss, cardiac and pulmonary complications, mortality and surgical time. Methods A systematic review of randomized clinical trials, which included studies from four databases (Medline, Embase, Cochrane and Lilacs) using the combination of descriptors (anastomosis, surgical) and (esophagectomy) was performed. Results Thirteen randomized trials were included, totaling 1778 patients, 889 in the hand-sewn group and 889 in the stapler group. The stapler reduced bleeding (p <0.03) and operating time (p<0.00001) when compared to hand-sewn after esophageal resection. However, stapler increased the risk of anastomotic stricture (NNH=33), pulmonary complications (NNH=12) and mortality (NNH=33). There was no significant difference in relation to anastomotic leak (p=0.76) and cardiac complications (p=0.96). Conclusion After resection of esophageal cancer, the use of stapler shown to reduce blood loss and surgical time, but increased the incidence of anastomotic stricture, pulmonary complications and mortality. PMID:25184776

  13. Vascular complications in orthopedic surgery.

    Science.gov (United States)

    Chervu, A; Quinones-Baldrich, W J

    1988-10-01

    Vascular complications may be seen secondary to trauma or in the perioperative period following elective surgery. Prompt recognition and correction of these problems are of utmost importance to assure functional viability of the affected extremity. Evaluation may be complicated by the presence of preexisting atherosclerotic occlusive disease in the elderly patient. Relevant points in the history and physical examination include mechanism of injury, preexisting disease, evaluation of motor and sensory function, and presence and character of pulses. Noninvasive vascular studies should be obtained in all patients. Absolute indications for angiography include absent pulses, signs and symptoms of ischemia, a bruit, and a posterior knee dislocation; decreased pulses, a significant hematoma, and proximity of the fracture fragment are relative indications. Controversial issues in the management of combined orthopedic and vascular injuries include the use of internal versus external fixation, the use of prosthetic versus autogenous material, and the need for venous reconstruction. Popliteal artery trauma is still associated with a high limb loss rate, and careful evaluation of knee injuries is necessary. Vascular compromise may also complicate joint replacement surgery. These complications are preventable, and management is greatly simplified by a detailed preoperative evaluation.

  14. [Corrosive esophagitis in children (author's transl)].

    Science.gov (United States)

    Arcand, P; Guerguerian, A J

    1982-01-01

    The treatment of corrosive esophagitis in children remains a controversial subject. A review of the literature and the various forms of treatment is presented with a retrospective study done a the Ste-Justine Hospital in Montreal. We studied the charts (327) of patients hospitalized for ingestion of corrosive substances for the period extending between 1970 to 1976 inclusively. The mean age of the patients involved was 2 years 4 months with a slight male predominance (60%). Javel water, sodium hydroxide, Chlorine, ammoniac and different acids were, in this order, the agents most frequently encountered. Esophageal burns proven by endoscopy was noted in 81 cases. Even in the absence of oropharyngeal burns, esophageal involvement was still present in 46% of cases. The low incidence of stenosis (9%) tends to confirm the beneficial role of steroids in the treatment of corrosive esophagitis. This is particularly true for 1st and 2nd degree burns whereas their administration in severe 3rd degree burn remains controversial.

  15. Epidemiology and histopathological features of esophageal cancer ...

    African Journals Online (AJOL)

    ... frequent site of origin of these tumors. Squamus cell carcinoma was commonest histologic type of tumor. In 15.2% of cases tumor was metastasis to other organs. In 46.6% were in advanced stage at diagnosis. Discussion: Based on result of present study, esophageal cancer in our country more presented in Squamus cell ...

  16. Esophageal Sphincter Device for Gastroesophageal Reflux Disease

    NARCIS (Netherlands)

    Ganz, Robert A.; Peters, Jeffrey H.; Horgan, Santiago; Bemelman, Willem A.; Dunst, Christy M.; Edmundowicz, Steven A.; Lipham, John C.; Luketich, James D.; Melvin, W. Scott; Oelschlager, Brant K.; Schlack-Haerer, Steven C.; Smith, C. Daniel; Smith, Christopher C.; Dunn, Dan; Taiganides, Paul A.

    2013-01-01

    BACKGROUND Patients with gastroesophageal reflux disease who have a partial response to proton-pump inhibitors often seek alternative therapy. We evaluated the safety and effectiveness of a new magnetic device to augment the lower esophageal sphincter. METHODS We prospectively assessed 100 patients

  17. Esophageal achalasia in adolescence - two case reports

    Directory of Open Access Journals (Sweden)

    Inês Vaz Silva

    2016-02-01

    Full Text Available Introduction: Achalasia is a rare disorder, particularly in pediatrics, characterized by esophageal aperistalsis and inadequate relaxation of the lower esophageal sphincter. Its etiology remains unclear. Cases: We describe two adolescents with dysphagia for solids and liquids, vomiting, weight loss and nocturnal cough for a few months. Initially it was considered to be an eating disorder, and the diagnosis of achalasia was reached later by esophageal manometry in one case and by intraoperative biopsy in another. The patients were submitted to Heller myotomy with an antireflux procedure, laparoscopically in one case, and by laparotomy in another, both with a favorable outcome. Discussion/Conclusions: We emphasize the rarity and diagnostic challenge of these cases. The nonspecific symptoms often lead to the diagnosis of an eating disorder, delaying the correct treatment. If symptoms persist achalasia must be considered and the esophageal manometry is the diagnostic test of choice. The gold standard in treatment is surgical, and we highlight the effectiveness of the techniques applied.

  18. Candida Esophagitis in an Immunocompetent Pregnant Woman

    Directory of Open Access Journals (Sweden)

    Jeffrey S. Greenspoon

    1993-01-01

    Full Text Available Background: Nausea and vomiting are common during the first half of pregnancy and usually require only supportive measures. When symptoms are progressive and weight loss occurs, treatable causes should be sought by means of upper gastrointestinal endoscopy. We report a case of an immunocompetent gravida with invasive Candida albicans esophagitis.

  19. Herpes Simplex Esophagitis in Immunocompetent Hosts

    Directory of Open Access Journals (Sweden)

    Daniel Eymard

    1997-01-01

    Full Text Available Over four months, three cases of biopsy-proven herpes simplex esophagitis were seen at Centre hospitalier Pierre-Boucher, Longueuil, in young adult males with no evidence of immunosuppression and negative serological testing for antibody against the human immunodeficiency virus. Clinical presentation consisted of odynophagia, fever and retrosternal chest pain. All patients rapidly improved with acyclovir therapy.

  20. Prevalence of reflux esophagitis among patients undergoing ...

    African Journals Online (AJOL)

    Background: Gastro-esophageal reflux disease (GERD) is one of the most prevalent diseases seen in western countries. The prevalence of GERD is lower in the Asian population and the spectrum of the disease is mild. Data from Africa and the Middle East are sparse. Aim: The aim of the study was to determine the ...

  1. [Eosinophilic esophagitis: increasing incidence in paediatric population].

    Science.gov (United States)

    Braga-Tavares, Hugo; Teles, Andreia; Nogueira, Rosete; Cardoso Rodrigues, Fernando; Costa, Cristina

    2009-01-01

    Eosinophilic Esophagitis has been increasingly diagnosed and results from a chronic esophagic inflammation with eosinophilic infiltrate. Evaluation of the diagnosed paediatric cases in our centre between 2004 and 2008 and revision of current literature on this subject. Four caucasian boys, aged eight to fifteen years old, were diagnosed with Eosinophilic Esophagitis. They presented with disphagia and food impaction and endoscopic findings included multiple concentric rings (pseudo-trachea pattern) and friable mucosa. All of them had mucosal eosinophil counts higher than 20 eosinophils/high-powered field and were given corticosteroids, either topic or systemic (one case) with therapeutic success. The diagnosis of Eosinophilic Esophagitis must be considered in presence of disphagia, food impaction or gastroesophageal reflux symptoms refractory to treatment. Endoscopic evaluation may be normal and the diagnosis is based on histological findings, making biopsy mandatory whenever clinically suspected. The increasing incidence of the last years associated with the high recurrence rate will lead to future prevalence increased both in child and adulthood.

  2. Stent placement for esophageal strictures : an update

    NARCIS (Netherlands)

    Hirdes, Meike Madeleine Catharine; Vleggaar, Frank Paul; Siersema, Peter Derk

    2011-01-01

    The use of stents for esophageal strictures has evolved rapidly over the past 10 years, from rigid plastic tubes to flexible self-expanding metal (SEMS), plastic (SEPS) and biodegradable stents. For the palliative treatment of malignant dysphagia both SEMS and SEPS effectively provide a rapid relief

  3. Autoreactive T Cells and Chronic Fungal Infection Drive Esophageal Carcinogenesis.

    Science.gov (United States)

    Zhu, Feng; Willette-Brown, Jami; Song, Na-Young; Lomada, Dakshayani; Song, Yongmei; Xue, Liyan; Gray, Zane; Zhao, Zitong; Davis, Sean R; Sun, Zhonghe; Zhang, Peilin; Wu, Xiaolin; Zhan, Qimin; Richie, Ellen R; Hu, Yinling

    2017-04-12

    Humans with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), a T cell-driven autoimmune disease caused by impaired central tolerance, are susceptible to chronic fungal infection and esophageal squamous cell carcinoma (ESCC). However, the relationship between autoreactive T cells and chronic fungal infection in ESCC development remains unclear. We find that kinase-dead Ikkα knockin mice develop APECED-like phenotypes, including impaired central tolerance, autoreactive T cells, chronic fungal infection, and ESCCs expressing specific human ESCC markers. Using this model, we investigated the link between ESCC and fungal infection. Autoreactive CD4 T cells permit fungal infection and incite tissue injury and inflammation. Antifungal treatment or autoreactive CD4 T cell depletion rescues, whereas oral fungal administration promotes, ESCC development. Inhibition of inflammation or epidermal growth factor receptor (EGFR) activity decreases fungal burden. Fungal infection is highly associated with ESCCs in non-autoimmune human patients. Therefore, autoreactive T cells and chronic fungal infection, fostered by inflammation and epithelial injury, promote ESCC development. Published by Elsevier Inc.

  4. Effect of omentum graft on esophageal anastomosis in dogs

    Directory of Open Access Journals (Sweden)

    A. K. Mahdi

    2011-01-01

    Full Text Available The aim of this study was to evaluate the complications and final function outcome of wrapping nonvascularized omentum graft around the suture line of esophageal anastomosis. Twelve adult local breed dogs were used in this study. The animals were divided into two equal groups (control and treated, all animal induced into general anesthesia by injection of atropen sulphate in a dose 0.04 mg/kg B.W, intramuscularly then after 15 minute given mixture of ketamine hydrochloride and xylazine hydrochloride in doses 15 mg/kg and 5 mg/kg B.W intramuscularly respectively. An oblique resection of about 1cm of the esophageal length and anastomosis by double layer of simple interrupted pattern by 2.0 cat gut suture (control group, same procedure was done in treated group except the wrapping the anastomosis site with patch of omentum tissue after lapratomy operation in the left flank region procedure. The clinical signs of treated animal revealed signs of dysphagia and regurgitation in treated group while this signs disappear in the control group. Radiological and histopathological examination of the anastomosis site performed at 15 and 30 days post operation. Radiological study recorded high degree of stenosis in the anastomosis site in treated group at 15 and 30 days post operation in compared with animals in control group that record mean degree of stenosis in treated group at 15 day (57.61±0.2 and at 30 day (55.78±0.2 while it recorded in control group at 15 day (39.34±1.04 and at 30 day (36.0.6 ±0.9, histopathological results recorded enhanced healing of anastomosis site in treated animals more than control animals. In conclusion we found that non vascularized omental graft prevent leak when used around the anastomosis line in esophageal and enhanced healing of anastomosis line but it increase the stenosis, fibrosis and adhesion of anastomosis site with surrounding muscle and this interferes with the swallowing as well as dysphagia and regurgitation

  5. [Value of endoscopy application in the management of complications after radical gastrectomy for gastric cancer].

    Science.gov (United States)

    Zhang, Yiqun; Zhou, Pinghong

    2017-02-25

    Endoscopy plays an important role in the diagnosis and treatment of postoperative complications of gastric cancer. Endoscopic intervention can avoid the second operation and has attracted wide attention. Early gastric anastomotic bleeding after gastrectomy is the most common. With the development of technology, emergency endoscopy and endoscopic hemostasis provide a new treatment approach. According to the specific circumstances, endoscopists can choose metal clamp to stop bleeding, electrocoagulation hemostasis, local injection of epinephrine or sclerotherapy agents, and spraying specific hemostatic agents. Anastomotic fistula is a serious postoperative complication. In addition to endoscopically placing the small intestine nutrition tube for early enteral nutrition support treatment, endoscopic treatment, including stent, metal clip, OTSC, and Over-stitch suture system, can be chosen to close fistula. For anastomotic obstruction or stricture, endoscopic balloon or probe expansion and stent placement can be chosen. For esophageal anastomotic intractable obstruction after gastroesophageal surgery, radial incision of obstruction by the hook knife or IT knife, a new method named ERI, is a good choice. Bile leakage caused by bile duct injury can be treated by placing the stent or nasal bile duct. In addition, endoscopic methods are widely used as follows: abdominal abscess can be treated by the direct intervention under endoscopy; adhesive ileus can be treated by placing the catheter under the guidance of endoscopy to attract pressure; alkaline reflux gastritis can be rapidly diagnosed by endoscopy; gastric outlet obstruction mainly caused by cancer recurrence can be relieved by metal stent placement and the combination of endoscopy and X-ray can increase success rate; pyloric dysfunction and spasm caused by the vagus nerve injury during proximal gastrectomy can be treated by endoscopic pyloromyotomy, a new method named G-POEM, and the short-term outcomes are

  6. Button battery injuries in the pediatric aerodigestive tract.

    Science.gov (United States)

    Ettyreddy, Abhinav R; Georg, Matthew W; Chi, David H; Gaines, Barbara A; Simons, Jeffrey P

    2015-12-01

    Children with a button battery impaction present with nonspecific symptoms that may account for a delay in medical care. We conducted a retrospective study of the clinical presentation, management, and complications associated with button battery ingestion in the pediatric aerodigestive tract and to evaluate the associated long-term morbidity. We reviewed the medical records of 23 patients who were treated for button battery impaction at our tertiary care children's hospital from Jan. 1, 2000, through July 31, 2013. This population was made up of 14 boys and 9 girls, aged 7 days to 12 years (mean: 4 yr). Patients were divided into three groups based on the site of impaction; there were 9 impactions in the esophagus and 7 each in the nasal cavity and stomach. We compiled information on the type and size of each battery, the duration of the impaction, presenting symptoms, treatment, and outcomes. The mean duration of battery impaction was 40.6, 30.7, and 21.0 hours in the esophagus, nasal cavity, and stomach, respectively. We were able to identify the specific type of battery in 13 cases; 11 of these cases (85%) involved a 3-V 20-mm lithium ion battery, including all cases of esophageal impaction in which the type of battery was identified. The most common presenting signs and symptoms were vomiting (n = 7 [30%]), difficulty feeding (n = 5 [22%]), cough (n = 5), and bloody nasal discharge (n = 5); none of the presenting signs and symptoms predicted the severity of the injury or the outcome. The median length of hospital stay was far greater in the esophageal group (12 days) than in the nasal and stomach groups (1 day each; p = 0.006). Battery impaction in the esophagus for more than 15 hours was associated with a significantly longer postoperative hospital stay than impaction for less than 15 hours (p = 0.04). Esophageal complications included strictures (n = 5), perforation (n = 3), and tracheoesophageal fistula formation (n = 2). Clinicians should consider battery

  7. Delayed diagnosis of esophageal foreign body: A case report.

    Science.gov (United States)

    Yahyaoui, Salem; Jahaouat, Imen; Brini, Ines; Sammoud, Azza

    2017-01-01

    Foreign body (FB) ingestion, a common and serious problem in children, can present with a wide variety of symptoms. This paper describes and discusses the case of an esophageal foreign body (EFB), in which the patient presented with primarily respiratory clinical signs causing delayed diagnosis. A six month old boy presented with three months history of harsh cough, stridor and pulmonary congestion. He was repeatedly treated with steroids and antibiotics. His symptoms worsened progressively. On examination, he was tachypneic with suprasternal recession, scattered crepitations, diffuse wheeze and a continuous stridor. Chest X-ray was normal. The flexible bronchoscopy showed a posterior external compression on the middle wall of the trachea. The CT scan was normal. The contrast X-ray study of the esophagus revealed an endoluminal filling defect. The esophagoscopy revealed narrowing at 12cm of dental arch, and a bourgeoning yellow mass easily bleeding on contact. Esophageal biopsies were obtained, and histology was inconclusive. A surgical exploration was planned, but the infant forced out a pistachio shell after a chest physiotherapy session. Ingestion of FB by small children is a common problem. The majority of EFBs pass harmlessly through the gastrointestinal tract; however, some EFBs can cause significant morbidities. The diagnosis may be delayed leading to several complications especially if the ingestion of the FB is unwitnessed and when the clinician does not think of FB ingestion as part of the differential diagnosis of chronic respiratory signs. This case highlights, the importance of recognizing, the rare and often forgotten respiratory symptoms of EFB body to avoid diagnostic delay especially in unwitnessed FB ingestion. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  8. Eosinophilic Esophagitis: Clinical Features, Endoscopic Findings and Response to Treatment

    Directory of Open Access Journals (Sweden)

    Robert Enns

    2010-01-01

    Full Text Available Eosinophilic esophagitis (EE is a motility disorder of the esophagus that typically presents with dysphagia. The objective of the present study was to explore patient characteristics, clinical and endoscopic features, and response to treatment of patients with EE. Patients were selected retrospectively based on a review of biopsy results from previous endoscopies performed between 2004 and 2008. A total of 54 patients (41 men and 13 women with biopsy-proven EE were included in the study. Further information regarding the patients’ clinical and endoscopic features, and response to treatment were obtained through chart reviews and patient telephone interviews. The mean age of the patients at symptom onset was 30 years. All patients complained of dysphagia, 81% had a history of bolus obstruction, 43% had a history of asthma and 70% had a history of environmental allergies. Thirty-three per cent had a family history of asthma, while 52% had a family history of food or seasonal allergies. The most common endoscopic findings were rings and/or corrugations, which were found in 63% of patients. Swallowed fluticasone therapy resulted in symptom resolution in 74% of patients; however, 79% of these patients relapsed after discontinuing fluticasone therapy and required repeat treatments. Esophageal dilation was complication free and resulted in improvement in 80% of patients. However, 83% of those reporting improvement relapsed within one year. The clinical and endoscopic findings were similar to those found in the literature, with most patients requiring ongoing, repeated therapies. Further studies are needed to assess the safety and efficacy of treatment modalities ideally suited to patients with EE.

  9. Patch esophagoplasty: esophageal reconstruction using biologic scaffolds.

    Science.gov (United States)

    Nieponice, Alejandro; Ciotola, Franco F; Nachman, Fabio; Jobe, Blair A; Hoppo, Toshitaka; Londono, Ricardo; Badylak, Stephen; Badaloni, Adolfo E

    2014-01-01

    Standard techniques for surgical reconstruction of the esophagus remain suboptimal. Primary closure of diseased or injured esophagus has been associated with high morbidity, primarily due to leak and stricture, and synthetic materials are contraindicated due to the high risk of erosion and infection. Degradable bioscaffolds composed of extracellular matrix (ECM) have recently shown promising results in both pre-clinical and clinical settings to prevent stricture after extended endoscopic mucosal resection. We propose a novel surgical technique that utilizes an ECM scaffold as a reconstructive patch to augment the esophageal diameter during primary repair. Four patients requiring esophageal reconstruction underwent a patch esophagoplasty using an ECM scaffold composed of porcine urinary bladder ECM. The full thickness wall of the esophagus was replaced with an ECM patch that was sutured to the edges of the remaining esophagus, similar to the patch angioplasty performed in vascular procedures. All patients had a favorable clinical outcome with immediate recovery from the procedure and reinstated oral intake after 7 days. One patient had a micro leak at day 5 that closed spontaneously 2 days after drainage. Follow-up studies including barium swallow and esophagogastroduodenoscopy (EGD) showed adequate esophageal emptying through the surgical segment in all patients. The EGD showed complete mucosal remodeling at 2 months, with approximately 20% area contraction at the patch level. The area of the defect was indistinguishable from surrounding healthy tissue. Biopsy of the patch area showed normal squamous epithelium. One of the patients had a separate intrathoracic stricture that required further surgery. Clinical outcomes were otherwise favorable in all cases. An alternative for the treatment of esophageal stenosis is presented which uses a biological scaffold and an innovative surgical procedure. Additional work, including prospective studies and long-term follow

  10. Effect of age on proximal esophageal response to swallowing

    Directory of Open Access Journals (Sweden)

    Roberto Oliveira Dantas

    2010-12-01

    Full Text Available CONTEXT: It has been demonstrated that the ageing process affects esophageal motility. OBJECTIVES: To evaluate the effect of the age on the proximal esophageal response to wet swallows. METHOD: We measured the proximal esophageal response to swallows of a 5 mL bolus of water in 69 healthy volunteers, 20 of them aged 18-30 years (group I, 27 aged 31-50 years (group II, and 22 aged 51-74 years (group III. We used the manometric method with continuous perfusion. The proximal esophageal contractions were recorded 5 cm from a pharyngeal recording site located 1 cm above the upper esophageal sphincter. The time between the onset of the pharyngeal and of the proximal esophageal recording (pharyngeal-esophageal time and the amplitude, duration and area under the curve of the proximal esophageal contraction were measured. RESULTS: The pharyngeal-esophageal time was shorter in group I subjects than in group II and III subjects (P<0.05. The duration of proximal esophageal contractions was longer in group I than in groups II and III (P<0.001. There was no differences between groups in the amplitude or area under the curve of contractions. There were no differences between groups II and III for any of the measurements. CONCLUSION: We conclude that the age may affects the response of the proximal esophagus to wet swallows.

  11. Reflux esophagitis and its relationship to hiatal hernia.

    Science.gov (United States)

    Yeom, J. S.; Park, H. J.; Cho, J. S.; Lee, S. I.; Park, I. S.

    1999-01-01

    We performed this study to evaluate the prevalence of reflux esophagitis and/or hiatal hernia in patients referred to a medical center and to examine the relationship between endoscopic reflux esophagitis and hiatal hernia. The study was carried out in 1,010 patients referred to Yong Dong Severance Hospital for upper gastrointestinal endoscopy because of symptoms related to the gastrointestinal tract from September 1994 to March 1996. The presence of hiatal hernia was defined as a circular extension of the gastric mucosa of 2 cm or more above the diaphragmatic hiatus. Reflux esophagitis was found in 5.3% of patients, hiatal hernia in 4.1%, duodenal ulcer in 7.2% and gastric ulcer in 8.2%. The prevalence rates of reflux esophagitis and hiatal hernia in males were significantly higher than those in females. Thirty-two percent of patients with reflux esophagitis had hiatal hernia. In patients without reflux esophagitis, hiatal hernia was found in only 2.5% (phiatal hernia and the degree of esophagitis on endoscopy. Duodenal ulcer was the second most common endoscopic abnormality found in patients with reflux esophagitis. The prevalence rate of reflux esophagitis and/or hiatal hernia at a medical center is relatively low compared to peptic ulcer disease and other reports from the Western countries. Our study confirms the close association between reflux esophagitis and hiatal hernia. PMID:10402166

  12. Ophthalmic complications associated with orthognathic surgery.

    Science.gov (United States)

    Lanigan, D T; Romanchuk, K; Olson, C K

    1993-05-01

    Ophthalmic complications are rare following maxillary osteotomies. Potential complications include a decrease in visual acuity, extraocular muscle dysfunction, neuroparalytic keratitis, and nasolacrimal problems involving both an increase or a decrease in tearing. Ophthalmic injuries appear to be primarily mediated through indirect injuries to neurovascular structures occurring from traction, compression, or contrecoup injuries from forces transmitted during the pterygomaxillary dysjunction using an osteotome or from fractures extending to the base of the skull or orbit associated with the pterygomaxillary dysjunction or the maxillary downfracture. A review of the literature of previous ophthalmic complications as well as eight new cases are reported. The possible etiologic basis for these injuries is discussed in detail as well as treatment possibilities when appropriate.

  13. Screening pre-bariatric surgery patients for esophageal disease with esophageal capsule endoscopy

    Science.gov (United States)

    Shah, Ashish; Boettcher, Erica; Fahmy, Marianne; Savides, Thomas; Horgan, Santiago; Jacobsen, Garth R; Sandler, Bryan J; Sedrak, Michael; Kalmaz, Denise

    2013-01-01

    AIM: To determine if esophageal capsule endoscopy (ECE) is an adequate diagnostic alternative to esophagogastroduodenoscopy (EGD) in pre-bariatric surgery patients. METHODS: We conducted a prospective pilot study to assess the diagnostic accuracy of ECE (PillCam ESO2, Given Imaging) vs conventional EGD in pre-bariatric surgery patients. Patients who were scheduled for bariatric surgery and referred for pre-operative EGD were prospectively enrolled. All patients underwent ECE followed by standard EGD. Two experienced gastroenterologists blinded to the patient’s history and the findings of the EGD reviewed the ECE and documented their findings. The gold standard was the findings on EGD. RESULTS: Ten patients with an average body mass index of 50 kg/m2 were enrolled and completed the study. ECE identified 11 of 14 (79%) positive esophageal/gastroesophageal junction (GEJ) findings and 14 of 17 (82%) combined esophageal and gastric findings identified on EGD. Fisher’s exact test was used to compare the findings and no significant difference was found between ECE and EGD (P = 0.64 for esophageal/GEJ and P = 0.66 for combined esophageal and gastric findings respectively). Of the positive esophageal/GEJ findings, ECE failed to identify the following: hiatal hernia in two patients, mild esophagitis in two patients, and mild Schatzki ring in two patients. ECE was able to identify the entire esophagus in 100%, gastric cardia in 0%, gastric body in 100%, gastric antrum in 70%, pylorus in 60%, and duodenum in 0%. CONCLUSION: There were no significant differences in the likelihood of identifying a positive finding using ECE compared with EGD in preoperative evaluation of bariatric patients. PMID:24115815

  14. Indications, new surgical technique and results of colon interposition or bypass in esophageal surgery.

    Science.gov (United States)

    Cseke, L; Horváth, O P

    1997-01-01

    Over a 5-year period, 29 patients with esophageal disease underwent colon interposition or bypass. The indication was cure of cancer in 11 patients, who underwent earlier a gastric resection. Other indications was benign stricture in 7 patients, bypass for unrespectable cancer in 6, having a caustic injury in 3 and after an esophageal perforation in 2. In 14 patients the left colon, in 15 the right colon was used. The colon was transected without dividing the mesentery other than just along its mesenteric border. This preserves additional blood supply from the marginal artery, also improves the function of the graft in transporting food. Anastomosis leakage occurred in 4 cases (13.7%). Graft necrosis occurred in 2 of 29 patients, one of whom alter underwent a successful second reconstruction. The 30 day operative mortality rate was 13.7%. A colon interposition provides good quality of deglution, and is the organ of choice for patients who require an esophageal substitute and are potential candidates for long survival, or when the stomach is unsuited for replacement or bypass.

  15. Coagulation complications following trauma.

    Science.gov (United States)

    Martini, Wenjun Z

    2016-01-01

    Traumatic injury is one of the leading causes of death, with uncontrolled hemorrhage from coagulation dysfunction as one of the main potentially preventable causes of the mortality. Hypothermia, acidosis, and resuscitative hemodilution have been considered as the significant contributors to coagulation manifestations following trauma, known as the lethal triad. Over the past decade, clinical observations showed that coagulopathy may be present as early as hospital admission in some severely injured trauma patients. The hemostatic dysfunction is associated with higher blood transfusion requirements, longer hospital stay, and higher mortality. The recognition of this early coagulopathy has initiated tremendous interest and effort in the trauma community to expand our understanding of the underlying pathophysiology and improve clinical treatments. This review discusses the current knowledge of coagulation complications following trauma.

  16. Esophageal Toxicity From High-Dose, Single-Fraction Paraspinal Stereotactic Radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Cox, Brett W., E-mail: coxb@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Jackson, Andrew; Hunt, Margie [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Bilsky, Mark [Department of Surgery (Neurosurgical Division), Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Yamada, Yoshiya [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2012-08-01

    Purpose: To report the esophageal toxicity from single-fraction paraspinal stereotactic radiosurgery (SRS) and identify dosimetric and clinical risk factors for toxicity. Methods and Materials: A total of 204 spinal metastases abutting the esophagus (182 patients) were treated with high-dose single-fraction SRS during 2003-2010. Toxicity was scored using the National Cancer Institute Common Toxicity Criteria for Adverse Events, version 4.0. Dose-volume histograms were combined to generate a comprehensive atlas of complication incidence that identifies risk factors for toxicity. Correlation of dose-volume factors with esophageal toxicity was assessed using Fisher's exact test and logistic regression. Clinical factors were correlated with toxicity. Results: The median dose to the planning tre