Successful Management of Sengstaken– Blakemore Tube–Induced Esophageal Perforation Using Metallic Covered Stent for a Patient with a History of Variceal Bleeding

Abstract Background Lymphocytic esophagitis is a new and rare clinicopathological entity. It is a histological pattern characterized by lymphocytic infiltrate without granulocytes. Its etiology and clinical significance remains unclear. The clinical manifestations are typically mild, with reflux and dysphagia the most commonly reported symptoms. Aims We describe a case report of spontaneous esophageal perforation associated with lymphocytic esophagitis. Methods Case report Results A previously well 31-year-old male presented to the emergency department with acute food impaction. His antecedent symptoms were acute chest discomfort and continuous odynophagia following his most recent meal, with persistent globus sensation. The patient had no reported history of allergies, atopy, rhinitis, or asthma. A previous history of non-progressive dysphagia was noted after resuscitation. Emergent endoscopy revealed no food bolus, but a deep 6 cm mucosal tear in the upper-mid esophagus extending 24 to 30 cm from the incisors. Chest computed tomography observed small volume pneumoperitoneum consistent with esophageal perforation. The patient’s recovery was uneventful; he was managed conservatively with broad-spectrum antibiotics, proton pump inhibitor therapy, and a soft-textured diet. Endoscopy was repeated 48 hours later and revealed considerable healing with only a residual 3-4cm linear laceration. Histology of biopsies taken from the mid and distal esophagus demonstrated marked infiltration of intraepithelial lymphocytes. There were no eosinophils or neutrophils identified, consistent with a diagnosis of lymphocytic esophagitis. Autoimmune indices including anti-nuclear antibodies and immunoglobulins were normal, ruling out a contributory autoimmune or connective tissue process. The patient was maintained on a proton pump inhibitor (pantoprazole 40 mg once daily) following discharge. Nearly six months following his presentation, the patient had a recurrence of symptoms prompting representation to the emergency department. He described acute onset chest discomfort while eating turkey. Computed tomography of the chest redemonstrated circumferential intramural gas in the distal esophagus and proximal stomach. Conclusions Esophageal perforation is a potentially life-threatening manifestation of what had been considered and described as a relatively benign condition. From isolated dysphagia to transmural perforation, this case significantly expands our current understanding of the clinical spectrum of lymphocytic esophagitis. Funding Agencies None

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3-Methylcyclohex-2-en-1-one and the Douglas-fir beetle (Coleoptera: Curculionidae): history of successful bark beetle pheromone treatments

The Canadian Entomologist ◽

10.4039/tce.2020.62 ◽

2020 ◽

Vol 153 (1) ◽

pp. 62-78

Author(s):

Darrell W. Ross

Keyword(s):

Bark Beetle ◽

Douglas Fir ◽

Future Research ◽

Beetle Species ◽

Successful Management ◽

Dendroctonus Pseudotsugae ◽

Successful Development ◽

History Of ◽

Antiaggregation Pheromone

AbstractThis paper reviews the literature on the identification of 3-methylcyclohex-2-en-1-one (MCH) as the antiaggregation pheromone of the Douglas-fir beetle (Dendroctonus pseudotsugae Hopkins) (Coleoptera: Curculionidae) and the development of successful management applications using the pheromone. Previously unpublished data from two studies on novel uses of MCH are included. The successful development of antiaggregation pheromone-based treatments for the Douglas-fir beetle is discussed in relation to efforts to develop similar treatments for other bark beetle species, and opportunities for future research on MCH and the Douglas-fir beetle are suggested.

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Did Statins Really Improve Survival in Cirrhotic Patients With a History of Variceal Bleeding?

Gastroenterology ◽

10.1053/j.gastro.2016.06.056 ◽

2016 ◽

Vol 151 (5) ◽

pp. 1037

Author(s):

Gin-Ho Lo

Keyword(s):

Variceal Bleeding ◽

History Of ◽

Cirrhotic Patients

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Abstract 1122‐000097: Recurrent Carotid Cavernous Fistula Requiring Complex Repair of Ruptured Cavernous Carotid Aneurysm: A Case Report

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000097 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Rami Z. Morsi ◽

Faten El Ammar ◽

Sonam Thind ◽

Scott J. Mendelson ◽

Cedric McKoy ◽

...

Keyword(s):

Visual Acuity ◽

Case Report ◽

Large Scale ◽

Mechanical Valve ◽

Covered Stent ◽

Stent Grafts ◽

Cerebral Angiogram ◽

Safety And Efficacy ◽

Third Nerve Palsy ◽

History Of

Introduction : There are no studies investigating the safety and efficacy of covered stent grafts, particularly the newly developed stents such as the PK Papyrus stent, for endovascular treatment of direct carotid cavernous fistulas (CCFs). Methods : We present a case of a 75‐year‐old female who presented to the hospital with a three‐week history of worsening left eye vision, chemosis, proptosis, and partial third nerve palsy. Patient was found to have left direct Type A CCF secondary to ruptured cavernous segment carotid aneurysm. Results : The CCF was treated with coil embolization and pipeline Shield stent embolization devices with immediate stagnation and improvement of symptoms. Patient had history of an aortic mechanical valve and thus was started on warfarin and ASA. After achieving INR level of 2.5‐3.5, patient started to have recurrent swelling of the left eye associated and decreased visual acuity. Repeated diagnostic cerebral angiogram revealed residual CCF. Onyx liquid embolization and a Surpass Evolve Flow Diverter were attempted to slow the fistulization with no success. Multiple attempts for direct percutaneous superior ophthalmic vein cannulation were also unsuccessful. At this point, two coronary graft‐covered PK Papyrus stents were implanted across the fistula pouch, which resulted in immediate resolution of the CCF with evidence of persistent normal flow within left ophthalmic artery. Patient’s visual acuity and left eye movement improved. Conclusions : This case report highlights the effectiveness and safety of covered stent grafts, particularly more flexible stents such as the PK Papyrus stent, in navigating the carotid vasculature and closing direct CCFs and may be used as a first‐line technique. More large‐scale studies are warranted to investigate the safety and efficacy of using such stent grafts to treat direct CCFs in the setting of antithrombotic agents and anticoagulation.

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CLINICAL CASE OF SUCCESSFUL MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION DURING PREGNANCY

Wiadomości Lekarskie ◽

10.36740/wlek201902130 ◽

2019 ◽

Vol 72 (2) ◽

pp. 298-301

Author(s):

Oleh A. Loskutov ◽

Andrii O. Zhezher ◽

Yevhen M. Sulimenko

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Clinical Case ◽

Bare Metal Stent ◽

Key Factors ◽

Successful Management ◽

Diagnostic Measures ◽

Specialized Center ◽

Stent System ◽

History Of

Introduction: There have recently been increasingly frequent reports of myocardial infarction (MI) in pregnancy and in the postpartum period. Pertinent and timely treatment affect maternal and fetal morbidity and mortality. Clinical case: We are reporting about a 42 years old woman at the 19th week of gestation, with complains of chest pain with irradiation into the left arm, and shortness of breath. It was known from the history of present illness, that at the time of the event ventricular fibrillation was recorded and resuscitation measures with cardioversion were performed. Subsequently, after an additional examination in the hospital, a diagnosis of MI has been determined. Coronary angiography with cardiac ventriculography (CVG) has been performed and stenosis of left anterior descending coronary artery (LAD) and right coronary artery (RCA) detected. A revascularization with the insertion of the bare-metal stent system has performed and double antiplatelet therapy prescribed. At 37 weeks of gestation, the patient gave birth to a healthy child by caesarean section. Conclusions: This clinical case illustrates the importance of minimizing the time to hospitalization of a pregnant woman with a MI to a specialized center for timely and complete diagnostic measures, which, in turn, allow to properly choose the tactics of patient management. Timely revascularization and properly selected anticoagulation are the key factors of the successful management in this category of patients.

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Subacute Thyroiditis from COVID-19 Infection: A Case Report and Review of Literature

European Thyroid Journal ◽

10.1159/000511872 ◽

2020 ◽

pp. 1-5

Author(s):

Akshay Khatri ◽

Esti Charlap ◽

Angela Kim

Keyword(s):

Clinical Features ◽

Clinical Laboratory ◽

Early Recognition ◽

Subacute Thyroiditis ◽

The Novel ◽

Review Of Literature ◽

Successful Management ◽

Case Presentation ◽

Radiologic Findings ◽

History Of

Introduction: The novel severe-acute-respiratory-syndrome-coronavirus-2 (SARS-CoV-2) virus has led to the ongoing Coronavirus disease 2019 (COVID-19) disease pandemic. There are increasing reports of extrapulmonary clinical features of COVID-19, either as initial presentations or sequelae of disease. We report a patient diagnosed with subacute thyroiditis precipitated by COVID-19 infection, as well as review the literature of similar cases. Case Presentation: A 41-year-old female with no significant personal or family history of endocrinologic disorders presented with clinical features of thyroiditis that began after COVID-19 infection. Clinical, laboratory, and radiologic findings were indicative of subacute thyroiditis. Workup for potential triggers other than SARS-CoV-2 was negative. Discussion/Conclusion: We compared the clinical and diagnostic findings of our patient with other well-documented cases of subacute thyroiditis presumed to be triggered by SARS-CoV-2 viral infection. We also reviewed the literature related to the potential mechanisms leading to thyroiditis. Clinicians must be aware of the possibility of thyroid dysfunction after COVID-19 infection. Early recognition and timely anti-inflammatory therapy help in successful management.

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Combined Petrosal Approach for Resection of a Large Trigeminal Schwannoma With Meckel's Cave Involvement—Part I: Anatomic Rationale and Analysis: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa363 ◽

2020 ◽

Author(s):

Ali Tayebi Meybodi ◽

James K Liu

Keyword(s):

Cerebellopontine Angle ◽

Skin Incision ◽

Petrous Apex ◽

Successful Management ◽

Meckel’S Cave ◽

Trigeminal Schwannoma ◽

Skull Base Approach ◽

Meckel's Cave ◽

History Of ◽

Anterior Petrosectomy

Abstract Resection of large trigeminal schwannomas involving both posterior and middle cranial fossae is challenging. The depth of the surgical target in the superomedial corner of the cerebellopontine angle and the petrous apex makes for a difficult lesion to favorably access, expose, and safely resect. Judicious planning of a skull base approach is therefore the most crucial step in successful management of these formidable tumors. When properly chosen, planned, and executed, the combined petrosal approach sets the stage for an optimal exposure of such tumors that involve both posterior and middle cranial fossae. The present video is the first of a 2-part video presentation that explains the anatomic rationale of selecting a combined petrosal approach (anterior petrosectomy and retrolabyrinthine petrosectomy) for the resection of a large trigeminal schwannoma involving the posterior and middle cranial fossae with an extension into Meckel's cave in a 54-yr-old female presenting with 5-yr history of increasing headaches, left-sided face numbness, and disequilibrium. The benefits, risks, and alternatives of the surgical procedure were discussed in detail with the patient and she consented to proceed with surgery. Part I also discusses the important nuances of positioning the patient, as well as planning and execution of the skin incision, including pericranial flap harvesting. Of note, the patient consented to the publication of images obtained from her.

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