1/7. Oral contraceptive-induced esophageal ulcer. Two cases and literature review.Two patients with esophageal ulcers following ingestion of oral contraceptives are presented. Without discontinuing the drug, but providing that the pills were correctly ingested, the ulcers completely healed. This new adverse side effect of oral contraceptive emphasizes once more what appears to be a never-ending problem due to the lack of awareness of the prescribing physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. "Occult" Boerhaave's syndrome.Spontaneous rupture of the esophagus (Boerhaave's syndrome) usually presents in a dramatic fashion. Classically, following repeated episodes of vomiting, patients present with chest pain, dyspnea, cyanosis, shock, and cardiovascular collapse. We present a case of occult Boerhaave's syndrome diagnosed by an upper gastrointestinal series in a 33-year-old man who arrived at the emergency department with a chief complaint of hematemesis. This case report reviews the usual presenting signs and symptoms of Boerhaave's syndrome and concludes with a caution to physicians not to ignore the possibility of this disease entity in relatively stable patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Gastrointestinal manifestations of epidermolysis bullosa in children.The medical and surgical management of the chronic and recurrent esophageal and anal lesions of recessive dystrophic epidermolysis bullosa pose challenging problems for the physician. Various therapeutic approaches are discussed, and the case histories of four problem patients are reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Boerhaave's syndrome: an elusive diagnosis.Boerhaave's syndrome represents a diagnostic dilemma for the emergency physician. The prognosis of this truly life-threatening emergency is darkened by any significant diagnostic delay. Unfortunately, classic or expected symptoms and signs are frequently absent at presentation, a circumstance that leads to frequent misdiagnosis. Two cases of Boerhaave's syndrome with "atypical" clinical presentations are reviewed and discussed. It is clear that Boerhaave's syndrome should always be suspected in the evaluation of any sudden chest, abdominal, or back pain associated with emesis. However, emphasis should be placed on the fact that this entity may occur without emesis. The chest radiograph is the most helpful diagnostic aid. Undoubtedly, maintenance of a high degree of suspicion by the emergency physician for Boerhaave's syndrome will lead consistently to earlier diagnosis, and subsequent aggressive intervention should result in considerable reduction in rates of both morbidity and mortality.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/7. Complications of the Angelchik antireflux prosthesis.Various complications have been reported recently for the Angelchik antireflux prosthesis, a silicone-gel prosthesis used in the treatment of gastroesophageal reflux and associated hiatal hernia. We have studied the cases of 11 patients with complications of this prosthesis and have reviewed the literature for others. Complications included 8 erosions of the device into the gastrointestinal tract, 1 migration, 1 improper placement, and 1 case believed to be surgical trauma. These complications represent those typical to reflux surgery and some unique to the Angelchik prosthesis (migration and erosion). The exact frequency is unknown, with the manufacturer estimating migration at 0.81% and erosion at 0.15%. Available data indicate that complications may occur up to several years after implantation, and physicians may not recognize the problems with the prosthesis if they are unaware of the complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Quadruple cancer in a columnar-lined (Barrett) esophagus.In a 28-year-old man with a long history of esophageal reflux, two polypoid lesions in a columnar-lined (Barrett) esophagus proved to be adenopapillary cancer. Despite extensive preoperative endoscopic evaluation, no other malignant foci were found until after complete postoperative dissection of the esophageal specimen, when two more small flat lesions were diagnosed as adenocarcinoma. Dysplastic changes of specialized columnar epithelium and junctional epithelium were mild, except around the tumors. In the preoperative assessment of patients with a columnar-lined esophagus, physicians should be aware of the possibility of multifocal development of tumors either exophytic or superficial spreading, and multiple biopsies should be taken from normal-looking areas.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Atraumatic panmural rupture of the esophagus: Boerhaave syndrome.Three cases of spontaneous rupture of the distal esophagus are presented. All three patients presented in acute distress, exhibiting epigastric pain and signs of cardiovascular collapse. They all underwent surgery for repair of the lesion. One died postoperatively, and the other two patients recovered after a complicated postoperative period. Because Boerhaave syndrome has a high mortality rate and its diagnosis can be elusive, a high index of suspicion should be maintained by the attending physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |