Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

76 year-old man was transferred to emergency room because of severe epigastralgia and dyspnea. He was well until 5 hours before admission, when he suddenly felt severe epigastralgia followed by vomiting. He was found to be in warm shock state. Chest X-ray film showed dilation of mediastinum, pneumo mediastinum, left pleural effusion and subcutaneous emphysema, which were consistent with esophageal perforation. Esophageal contrast study was diagnostic. Emergency operation was performed in which rupture of the lowest esophagus causing remarkable mediastinitis and pleuritis was observed. Esophageal tear was primarily closed and chest drains were placed. Despite severe post-operative complications, he was discharged with recovery 5 months later.
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PMID:[A case of idiopathic esophageal perforation (Boerhaave's syndrome)]. 213 Jul 99

An alcoholic man with known reflux esophagitis and Barrett's esophagus developed fever, epigastric pain, subcutaneous crepitus, and leukocytosis from an esophageal perforation at a Barrett's ulcer. Possible risk factors for perforation in this patient included alcoholism, severe gastroesophageal reflux, corticosteroid therapy, noncompliance with antacid and H2 blocker therapy, and the presence of acid-secreting parietal cells in the Barrett's epithelium. Five cases of this complication have previously been reported in a review of the literature, which included 536 cases of Barrett's esophagus or esophageal perforation. This entity may present with a clinical triad of a patient (a) in acute distress with fever and epigastric or noncardiac chest pain and without signs of peritonitis, (b) with symptoms of or known gastroesophageal reflux, and (c) with chest examination revealing subcutaneous crepitus, or chest roentgenogram revealing subcutaneous emphysema, pneumomediastinum, or hydropneumothorax.
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PMID:Esophageal perforation at a Barrett's ulcer. 258 67

Oesophageal barotraumatism is a rare lesion and only 19 cases have been reported in the literature. Four new cases are described, the mechanism involved being either a jet of gas into the oesophagus or an explosion close to the face producing rupture of the oesophagus by increased endoluminal pressure. Four characteristic clinical signs are noted: wounds or burns to the face or mouth, chest or epigastric pain, subcutaneous emphysema and respiratory distress. A pneumomediastinum or pleural effusion is a constant finding, and a perforation is identified regularly by an oesophageal water soluble opacification. Of the 19 cases reported in the literature, 4 were detected at autopsy, one patient died after surgery and 14 recovered after operation. The mediastinal infection was either subacute requiring external thoracic drainage after oesophageal exclusion, or acute, necessitating emergency direct oesophageal repair. Only one of the 4 patients reported in this paper survived the accident.
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PMID:[Barotraumatic rupture of the esophagus. 4 cases. Review of the literature]. 372 84

Spontaneous intramural rupture or intramural haematoma of the oesophagus is a rare cause of acute pain in the chest and upper abdomen. Much less ominous than spontaneous complete rupture from which it must be distinguished, it seldom if ever necessitates operation. Five new cases are described and reviewed together with 15 collected from published reports. The dominant symptom of every case was severe and constant retrosternal or epigastric pain; concomitant dysphagia was mentioned in 11 cases. In seven the pain was preceded by or coincided with vomiting. The condition was related to other stresses in three and appeared to be truly spontaneous in 10. In approximately one-third of cases it started suddenly but more often it began as discomfort worsening rapidly. Fourteen patients vomited blood after experiencing pain but only four were given transfusions. In contradistinction to complete rupture, none had surgical emphysema and plain chest radiographs were unremarkable. All had abnormal gastrografin or barium swallows. Intramural haematomas with or without mucosal tears were seen in the 11 cases in which oesophagoscopy was performed. Fifteen patients made rapid and complete recoveries on conservative management. Of the four who did not respond satisfactorily, one had the oesophagus repaired, two had drainage of the mediastinum after failure to find the false lumen at thoracotomy, and one had only an abdominal exploration. The only death in the whole series occurred after a disastrous emergency exploration and subsequent total oesophagectomy.
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PMID:Spontaneous intramural rupture and intramural haematoma of the oesophagus. 697 33

Pneumoperitoneum is most commonly caused by the perforation of a hollow viscus, in which case an emergency laparotomy is indicated. We report herein the case of a patient who presented with the signs and symptoms of peritonitis, but who was found to have idiopathic pneumoperitoneum which was successfully managed by conservative treatment. A 70-year-old man presented with epigastric pain, nausea, and a severely distended and tympanitic abdomen. Abdominal examination revealed diffuse tenderness with guarding, but no rebound tenderness. He was febrile with leukocytosis and high C-reactive protein. Chest X-ray and abdominal computed tomography demonstrated a massive pneumoperitoneum without pneumothorax, pneumomediastinum, pneumoretroperitoneum, or subcutaneous emphysema, and subsequent examinations failed to demonstrate perforation of a hollow viscus. Thus, a diagnosis of idiopathic pneumoperitoneum was made, and the patient was managed conservatively, which resulted in a successful outcome. This experience and a review of the literature suggest that idiopathic pneumoperitoneum is amenable to conservative management, even when the signs and symptoms of peritonitis are present.
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PMID:Conservative management of idiopathic pneumoperitoneum masquerading as peritonitis: report of a case. 764 Apr 58

The authors describe a 50-year-old man who was hospitalized on account of one-week increasing epigastric pain with marked regression several hours after admission. The revealed small subcutaneous emphysema near the umbilicus directed the diagnostic procedure and led to detection of a covered perforation of a peptic prepyloric ulcer.
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PMID:[A rare symptom of peptic ulcer perforation: subcutaneous emphysema]. 818 75

Mediastinitis caused by infection with Clostridium perfringens and spontaneous rupture of the esophagus are both life threatening conditions. The combination of these two entities led to septic multiorgan failure in a 38-year-old woman. The patient was treated successfully by esophagectomy and postoperative lavage through a partially open abdomen. The lack of information regarding emesis, the leading symptom of Boerhaave's syndrome, caused delayed diagnosis: the triad of emesis, severe epigastric pain and emphysema of the skin was not established until 30 h after the onset of symptoms.
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PMID:[Gas gangrene mediastinitis after Boerhaave syndrome]. 941 Jun 84

A case of peliosis hepatis in a 64-year-old woman treated with azathioprine because of a lung transplantation is described. The patient was admitted owing to epigastric pain and jaundice. Sixteen months before admission the patient had had a lung transplantation because of pulmonary emphysema. A liver biopsy showed multiple, dilated, blood-filled liver sinusoids consistent with peliosis hepatis. Besides azathioprine, the patient was treated with cyclosporine and prednisolone, but none of these drugs are known to be responsible for the development of peliosis hepatis. This rare condition, which causes liver affection in patients treated with azathioprine, should be kept in mind.
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PMID:[Peliosis hepatis as the cause of liver affection in a patient treated with immunosuppressive agents]. 1208 71

This is a case report of oesophageal perforation as the complication of a commonly encountered benign disease -- gastroenteritis. A 68-year-old man first presented to the Emergency Department complaining of watery diarrhoea. He was treated and discharged. He re-attended 5 h later complaining of epigastric pain radiating to his back, vomiting bloodstained fluid and persistent watery diarrhoea. Again, he was treated and discharged. He re-attended 3 days later complaining of anorexia, cough, dyspnoea and right-sided chest pain radiating to his back, and subjective weight loss in the previous few days. Chest X-ray revealed right pleural effusion, pneumomediastinum and subcutaneous emphysema in the supraclavicular fossae. Computed chest tomogram and water-soluble contrast swallow confirmed 'spontaneous' oesophageal perforation. Although rare, this entity must be considered in any acutely ill patient complaining of respiratory and gastrointestinal symptoms, especially after recent vomiting.
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PMID:Spontaneous oesophageal perforation as a complication of vomiting in gastroenteritis -- case report. 1524 14

Spontaneous rupture of the oesophagus (Boerhaave's syndrome) is a rare life-threatening disease requiring urgent surgical management. Symptoms can masquerade many other clinical disorders like acute myocardial infarction, dissecting aneurysm or upper gastro-intestinal tract diseases. Without prompt diagnosis and treatment, Boerhaave's syndrome has a very high mortality rate. We report a case of perforation of the distal oesophagus. A 40-year-old male patient presented at the emergency department with a classic history of acute epigastric pain and dyspnoea after an episode of vomiting. On clinical examination we found a firm, tender abdomen and cervical subcutaneous emphysema. Boerhaave's syndrome was suspected on a clinical basis and was confirmed by thoraco-abdominal CT scan, showing an apparent pneumomediastinum and fluid at both lung bases. The patient underwent surgical repair of the distal oesophageal tear by laparoscopy. A mediastinal drain was left behind and a feeding gastrostomy was established. After initial improvement, the patient developed fever and dyspnoea. A thoracic CT scan revealed left-sided empyema. A thoracoscopic drainage of pus was performed and antibacterial and antifungal treatment was adapted. The patient recovered well and was discharged from the hospital 34 days after admission.
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PMID:Laparoscopic treatment of Boerhaave's syndrome: a case report and review of the literature. 1796 33


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