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At least 1,243 records · Page 69Linked to original sources
PubMed1986

Inadvertent gastric balloon inflation within the chest in the management of esophageal varices.

Balloon tamponade of esophageal variceal hemorrhage is palliative therapy which is associated with a certain incidence of morbidity, perhaps mortality. Three cases of intrathoracic inflation of the gastric balloon of such tubes are described. The precise mechanism of thoracic placement remains uncertain. Fluoroscopy or chest x-ray should be used to confirm appropriate tube tip placement.

Esophageal Perforation↗
PubMed1980

Thoracic esophageal and tracheal injury following blunt trauma.

A 20-year-old man injured in a motor vehicular accident sustained a nonpenetrating double blowout injury of the upper thoracic esophagus. A simultaneous membraneous rupture of the trachea occurred. Treatment was by operative primary closure. A collective review of blunt upper thoracic esophageal perforations reveals a nearly uniform occurrence of associated tracheal injury.

Accidents, Traffic↗
PubMed1990

Pancreaticopleural fistula. Report of 7 patients and review of the literature.

Pancreaticopleural fistula is an uncommon clinical condition. Its presentation is often confusing because of the paucity of clues suggestive of pancreatic disease and the preponderance of pulmonary symptoms and signs. Most patients are alcoholics but only one-half will have a clinical history of previous pancreatitis. Pleural effusions are large, recurrent, and highly exudative in nature. Many patients go through extensive pulmonary evaluation before the pancreas is identified as the site of primary pathology. An elevated serum amylase may be the first clue to the diagnosis. However, the key to the diagnosis is a dramatically elevated pleural fluid amylase. Effusions in association with acute pancreatitis, esophageal perforation, and thoracic malignancy are important to consider in the differential diagnosis of an elevated pleural fluid amylase but are usually easy to exclude. Computed tomography is excellent in defining pancreatic abnormalities and should be the first abdominal imaging study in suspected cases. Endoscopic retrograde cholangiopancreatography (ERCP) is used as a diagnostic tool only in confusing cases. Although no systematic study evaluates medical versus surgical therapy, we recommend an initial 2 to 4-week trial of medical therapy, including allowance of no oral intake, total parenteral nutrition, chest tube thoracostomy, and possibly a regimen of somatostatin or its analogs. The major complication in these patients is superinfection, which results in significant morbidity and mortality. Failure of medical therapy should be considered failure of pleural effusion(s) to clear, recurrence after reinstatement of oral intake, or superinfection. For those patients who fail to benefit from medical therapy, surgery is indicated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1977

Cervical spondylotic dysphagia.

Reported is a patient who had severe dysphagia caused by cervical osteophytes. Both of the cervical vertebral spurs were excised, and anterior interbody stabilization was unnecessary. In the diagnosis of such patients, esophagoscopy is recommended, but it must be done with extreme care because of the increased risk of esophageal perforation. Treatment may consist of reassurance and a trial of anti-inflammatory agents if the symptoms are minimal, but definitive treatment, usually associated with complete recovery, is surgical excision.

Aged↗
PubMed1997

Esophageal 'stars': a sinister foreign body ingestion.

This paper describes an "epidemic" of foreign body ingestion in six consecutive prisoners from the same jail. The resulting esophageal perforations won all patients "temporary vacations" from prison. The nature of the ingested foreign body (hypodermic needles fashioned into a "star") guaranteed perforation of the esophagus. All six patients had emergency esophagotomy for foreign body removal. In the only case of significant morbidity, suture line disruption with mediastinitis and empyema led to esophagectomy, cervical esophagostomy, and tube gastrostomy. This patient survived and subsequently had uncomplicated esophagocoloplasty. Foreign objects of this type have not been described in the literature. Because of their specific design, they necessitate immediate and aggressive surgical management.

Adult↗
PubMed2001

Abdominal compartment syndrome in children.

OBJECTIVE: To investigate the frequency, predisposing factors, clinical presentation, and outcome of abdominal compartment syndrome (ACS) in critically ill pediatric patients. DESIGN: A prospective study over a 5-yr period. SETTING: Pediatric intensive care unit of a tertiary care, university hospital. PATIENTS: All patients admitted to the pediatric intensive care unit were screened for the presence of ACS and were treated with a uniform protocol. ACS was defined as abdominal distention with intra-abdominal pressure (IAP) > 15 mm Hg, accompanied by at least two of the following: oliguria or anuria; respiratory decompensation; hypotension or shock; metabolic acidosis. MEASUREMENTS AND MAIN RESULTS: Of 1762 patients admitted over 5 yrs, ten patients (0.6%) had a total of 15 episodes of ACS. Of 406 trauma cases, three had ACS (0.7%). Three of the ten patients had primary abdominal conditions (mesenteric vein thrombosis, intussusception, enterocolitis), three had abdominal surgery (trauma, Kasai operation, esophageal perforation and peritonitis), three had primary central nervous system involvement, and one had meningococcemia. At laparotomy, bowel ischemia or necrosis was found in four episodes of ACS (27%). Mean IAP at diagnosis of ACS was 23.9 +/- 3.8 (range 17-31) mm Hg. Physiologic parameters were compared during 4 hrs before the development of ACS, during ACS, and after abdominal decompression. Mean arterial pressure, Pao(2), Pao(2)/Fio(2) ratio, and urinary output decreased significantly, whereas Paco(2), peak inspiratory pressures, positive end-expiratory pressures, and base deficit increased significantly after the development of ACS. After decompressive laparotomy, the condition of the patients improved promptly and these variables returned to pre-ACS values. Overall mortality rate in this group was 60%. CONCLUSIONS: Although relatively infrequent compared with adults, ACS occurs in critically ill children. Timely decompression of the abdomen results in uniform improvement, but overall mortality is still high. In contrast with adults, children with ACS have diverse primary diagnoses, with a significant number of primary extra-abdominal-mainly central nervous system-conditions. Ischemia and reperfusion injury appear to be the major mechanisms for development of ACS in children. Clinical presentation is similar to adults, but children may develop ACS at a lower IAP (as low as 16 mm Hg).

Journal Article↗
PubMed2004

Clinical experience of patients undergoing photodynamic therapy for Barrett's dysplasia or cancer.

INTRODUCTION: Barrett's oesophagus is the most important risk factor in the increase in incidence of oesophageal adenocarcinoma. Photodynamic therapy using porfimer sodium is the only approved endoscopic treatment for use in patients with Barrett's high-grade dysplasia. AIM: To determine clinical characteristics, endoscopic findings and treatment complications in Barrett's high-grade dysplasia patients undergoing photodynamic therapy. METHODS: We reviewed our experience using porfimer sodium photodynamic therapy to treat patients with Barrett's oesophagus and high-grade dysplasia or mucosal carcinoma. Data collected included patients characteristics, presentation symptoms, endoscopic findings, subsequent use of surveillance endoscopy and outcome after photodynamic therapy. RESULTS: Since 1997, 102 patients with Barrett's high-grade dysplasia (69 patients) or mucosal adenocarcinoma (33 patients) have been treated with photodynamic therapy using porfimer sodium as an alternative to oesophagectomy (median series follow-up time = 1.6 years). Almost half (46%) of patients had high-grade dysplasia or carcinoma detected on their first endoscopy and the remainder (54%) were found during surveillance of known Barrett's oesophagus. Symptoms typically associated with oesophageal disease were only found in 29 of 47 (62%) patients in whom dysplasia/carcinoma was detected on the initial endoscopy - chest pain in 13 patients, dysphagia in nine patients and chronic gastro-oesophageal disease in seven patients. Comparison of endoscopic characteristics found the median Barrett's glandular segment length was significantly shorter in adenocarcinoma patients (median 3 cm; range: 1-12) vs. Barrett's high-grade dysplasia patients (median 5 cm; range: 1-16, P < 0.001). Overall treatment results found complete ablation of glandular epithelium with one course of photodynamic therapy in most patients (56%). Stricture requiring dilation occurred in 20 patients (20%) was the most common serious adverse event. Photodynamic therapy failed to ablate dysplasia or carcinoma in four patients and subsequent oesophagectomy was curative in three of these patients. CONCLUSIONS: Approximately 40% of newly diagnosed patients with Barrett's associated dysplasia or carcinoma had no oesophageal symptoms and had carcinoma associated with short segment (3 cm or less). Photodynamic therapy is a highly effective, safe and minimally invasive first-line treatment for patients with Barrett's dysplasia and mucosal adenocarcinoma.

Adenocarcinoma↗
PubMed2005

Malpositioning of fine bore feeding tube: a serious complication.

Feeding tubes are used frequently in the intensive care unit to provide enteral nutrition. For critically ill patients, enteral nutrition is preferable to parenteral in terms of cost, complication and gut mucosal maintenance. Fine bore feeding tubes are always preferred because their soft, flexible construction and narrow diameter enables these tubes to be well tolerated by patients and they rarely contribute to sinus infections or obstruction of breathing. On the other hand it is not uncommon that these tubes are misplaced in the tracheobronchial tree or the pleural cavity, especially in high-risk patients, i.e. sedated patients, patients with weak cough reflex, endotracheally intubated patients and agitated patients. Malpositioning in the peritoneal cavity or the mediastinum through gastric or esophageal perforation is also possible; even intravascular and intracranial misplacement have been reported. The incidence of misplacement of a feeding tube is difficult to estimate because few studies have been performed. The largest study of 1100 such tubes revealed an overall malposition rate of 1.3%, but it should be mentioned that this study included only radiographically detected misplacements. Other researchers estimate the occurrence of accidental misplacement and migration out of position as high as 13% to 20% in high-risk patients.

Aged↗
PubMed2005

[Fungi in the mediastinum: rare, but relevant].

Fungal infections of the mediastinum are rare. There are five forms to be differentiated: (i) hematogenous fungal infection of the mediastinum after fungemia; (ii) postoperative fungal infection after cardiosurgical sternotomy; (iii) as special form of a descending necrotizing fasciitis; (iv) infection of the mediastinum per continuitatem; (v) fungal infection of the posterior mediastinum after esophageal perforation. In the surgical department, University of Schleswig-Holstein, Campus Lübeck, five patients with a fungal mediastinitis were treated during a period of 10 years. Three patients suffered from a descending mediastinitis, one patient from a fungal infection after pseudarthrosis of the sternum (postoperatively after cardiosurgery). The section results of one other patient with pulmonary aspergillosis showed a complete invasion of the mediastinum by Aspergillus fumigatus.

Fungi↗
PubMedDate not supplied

Sinography in the investigation of draining tracts in small animals: retrospective review of 25 cases.

The signalment, history, clinical signs, radiographic findings, and surgical findings of 25 consecutive animals that had sinography were reviewed to assess the contribution made by sinography to diagnosing and surgically managing draining tracts in small animals. There were 23 dogs and 2 cats; a variety of breeds and both sexes were represented (18 males, 7 females). Before referral the mean duration of clinical signs was 9.8 months (range, 0.5 to 33 months) and a mean of 2.0 surgical procedures (range, 1 to 5) had been performed. Sinuses occurred in a variety of locations, most commonly the neck (10), head (6), and paws (5). The most common cause was foreign body (15). Survey radiographs showed abnormalities in 21 of 26 (78%) instances, including soft-tissue swelling (11), chronic-appearing periosteal reaction on adjacent bones (5), possible foreign body (4), and gas in soft tissues (2). Sinography (or fistulography) enabled definite diagnosis of the cause of the sinus (or fistula) in 15 of 26 (58%) instances and demonstrated 13 of 15 foreign bodies (sensitivity 87%; specificity 100%). Tracts caused by an esophageal perforation and otitis media were also correctly shown by fistulography. In 11 animals, sinography indicated that the position or extent of the lesion was different to that expected on the basis of clinical signs and survey radiographs.

Animals↗
PubMed2000

Spontaneous candida mediastinitis diagnosed by endoscopic ultrasound-guided, fine-needle aspiration.

Candida mediastinitis is a rare clinical entity associated with high mortality and morbidity. It is emerging as an important clinical entity, probably due to increased recognition of candida as a significant pathogen in mediastinitis. Candida mediastinitis is usually associated with cardiothoracic surgery, esophageal perforation, and head and neck infections. Optimal therapy for candida mediastinitis remains undefined. Aggressive, combined surgical debridement and antifungal therapy appears to be the most effective of available therapies. We report a case of spontaneous candida mediastinitis diagnosed by endoscopic ultrasound-guided, fine-needle aspiration and successfully treated with oral antifungal therapy alone.

Biopsy, Needle↗
PubMed2006

Thermal ablation of Barrett's esophagus: a heated debate.

A study reported in this issue of the American Journal of Gastroenterology has explored the efficacy of high-power argon plasma coagulation (APC) for the eradication of nonneoplastic Barrett's epithelium. Complete eradication was achieved in 77% of 48 patients, with a 10% rate of major complications including hemorrhage, esophageal stricture, and esophageal perforation. Although these observations indicate that high-power APC can eradicate Barrett's epithelium in some patients, it is not clear that this expensive and hazardous therapy conveys any clinical benefit. Even if one makes the substantial leap of faith that APC can decrease the risk of cancer in Barrett's esophagus, that risk is so small for patients without dysplasia that the number needed to treat is unacceptably large. Available data do not support the routine application of endoscopic ablative therapy for patients who have Barrett's esophagus without dysplasia.

Argon↗
PubMed1982

Six years' experience of oesophageal transection for oesophageal varices, using a circular stapling gun.

Eighty patients with bleeding oesophageal varices, who were considered to be unfit for shunt surgery, were treated by oesophageal transection and subdiaphragmatic devascularisation. The overall hospital mortality was 14% and, after an average follow-up of nearly three years, 69% are still alive. Late recurrent bleeding occurred in 14 patients but varices were shown to be responsible in only four. Postoperative portal systemic encephalopathy has not been a problem.

Adolescent↗
PubMed1984

Unusual histological appearances of barium sulphate--a case report with scanning electron microscopy and energy dispersive x ray analysis.

Multiple birefringent rhomboidal crystals seen on histological examination of a resected oesophagus were subsequently found to contain elemental barium and sulphur on energy dispersive x ray ( EDX ) analysis. Scanning electron microscopy and EDX analysis of readily available commercial barium sulphate suspensions suggested that the two forms of barium sulphate previously described in tissue sections may be a result of the method of preparation of the commercial suspension used. With increased use of barium sulphate prepared by crushing the natural compound, birefringent rhomboidal crystals should be found with increasing frequency in endoscopic biopsy samples and resected specimens.

Barium Sulfate↗