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J Clin Neurophysiol 2021 Mar 30. Epub 2021 Mar 30.

Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; and Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.

Summary: The autonomic nervous system is a complex neural network that controls several organ systems. Its assessment includes a detailed history of autonomic functions, clinical examination, and autonomic tests. Most widely used is a battery of tests that assess cardiovascular reflex autonomic and sudomotor tests, which include deep breathing (assesses parasympathetic function), Valsalva maneuver, tilt test (both assess parasympathetic and adrenergic functions), and sudomotor testing for the evaluation of postganglionic sudomotor fibers. Read More

Pan Afr Med J 2021 21;38:74. Epub 2021 Jan 21.

Cardiocare Specialty Hospital, Limi Hospital, Abuja, Nigeria.

Boerhaave's syndrome is an uncommon syndrome characterized by spontaneous rupture of the oesophagus with a high mortality rate. While excessive alcohol intake and binge-eating are the classic precipitants of this syndrome, medication-induced vomiting causing Booerhave's is quite uncommon. Traditionally managed operatively, conservative management is being increasingly reported in selected cases. Read More

Endocrine 2021 Jun 9;72(3):923-927. Epub 2021 Jan 9.

Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Purpose: Lingual thyroid glands are rare embryologic variants of undescended tissue centered in the base of the tongue. Despite notable size, many lingual thyroids can be asymptomatic, though intervention is warranted for progressive or emergent symptoms. We report a rare manifestation of a hemorrhagic lingual thyroid addressed with both interventional radiology and robotic techniques. Read More

Rev Esp Enferm Dig 2021 Jan 4. Epub 2021 Jan 4.

Department of Gastroenterology, The First Affiliated Hospital of Wannan Medical Co, China.

A 63-year-old male took magnesium sulfate for bowel cleansing; subsequently, he developed severe nausea and vomiting, and then suffered from acute epigastric pain and compression pain in the right chest, with dyspnea, chest tightness and palpitation. Physical examination revealed subcutaneous emphysema in the neck, with crepitus, and diminished breathing sounds on the right side of the chest. A thoracic computed tomography (CT) scan showed mediastinal emphysema, right-sided pleural effusion and pneumothorax (Figure 1A). Read More

Am J Case Rep 2020 Oct 22;21:e925046. Epub 2020 Oct 22.

Diagnostic Radiology, University of Puerto Rico, San Juan, Puerto Rico.

BACKGROUND Cerebral air embolism is a rare iatrogenic complication of endoscopic procedures that can result in irreversible neurological damage. The symptoms of cerebral air embolism are nonspecific and may be attributed to sedation-related complications and central nervous system insults. Having awareness of this rare iatrogenic event and deciding on immediate imaging when it is suspected are essential for prompt diagnosis and treatment. Read More

Medicine (Baltimore) 2020 May;99(22):e20474

Pediatric Unit, Maternal and Child Department, Azienda USL of Reggio Emilia, Sant'Anna Hospital, Castelnovo ne' Monti, Italy.

Rationale: Triple-A syndrome, or Allgrove syndrome (AS), is a rare autosomal recessive disorder characterized by the alacrimia, achalasia, and adrenal insufficiency triad. Alacrimia usually starts at early infancy, while achalasia and adrenal insufficiency appear later during childhood or adulthood. Some patients may also present with the so-called Double-A syndrome (i. Read More

Am Heart J 2020 03 9;221:19-28. Epub 2019 Dec 9.

Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada. Electronic address:

Background: Although there have been several reports documenting complications related with transesophageal echocardiography (TEE) manipulation following cardiac surgery, there is a paucity of data regarding the safety of TEE used to guide catheter-based interventions. The aim of this study was to determine the prevalence, types and risk factors of complications associated with procedures requiring active TEE guidance.

Methods: This study included 1249 consecutive patients undergoing either transcatheter aortic valve implantation (TAVI), Mitraclip, left atrial appendage occlusion (LAAO) or paravalvular leak closure (PVLC). Read More

World J Gastroenterol 2019 Sep;25(34):5174-5184

Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.

Background: Adverse events during endoscopic submucosal dissection (ESD) of superficial esophageal neoplasms, such as perforation and bleeding, have been well-documented. However, the Mallory-Weiss Tear (MWT) during esophageal ESD remains under investigation.

Aim: To investigate the incidence and risk factors of the MWT during esophageal ESD. Read More

JAAPA 2019 Aug;32(8):1-3

Ryan Olivero practices general and thoracic surgery at St. John Providence Hospital in Novi, Mich. The author has disclosed no potential conflicts of interest, financial or otherwise.

Spontaneous esophageal perforation, also called Boerhaave syndrome, is a relatively rare condition that can result in significant morbidity or mortality. The tear commonly involves all three layers of the esophagus. It results from increased intraluminal pressure, most commonly from violent retching and vomiting. Read More

Gastrointest Endosc 2019 06 26;89(6):1251-1252. Epub 2019 Feb 26.

Division of Gastroenterology and Hepatology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.

Emerg Radiol 2019 Aug 21;26(4):373-379. Epub 2019 Feb 21.

McGovern Medical School, Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX, 77030, USA.

Purpose: To evaluate chest injury patterns in pediatric patients involved in all-terrain vehicle (ATV) accidents.

Methods: Retrospective review of patients 0-18 years old admitted to a level I trauma institute following an ATV-related incident from 2004 to 2013 was performed. Chest injury type, accident mechanism, driver/passenger status, and demographic and clinical data were compared between patients with and without chest injury. Read More

Medicine (Baltimore) 2018 Nov;97(48):e13422

Department of Gastroenterology, The Fifth Affiliated Hospital of Wenzhou Medical University.

Rationale: Most of esophageal rupture is a very serious life-threatening benign gastrointestinal tract disease with high mortality. However, there are a few cases of spontaneous esophageal rupture during gastroscopy.

Patient Concerns: A 57-year-old man who underwent a routine diagnostic gastroscopy due to food obstruction was reported. Read More

Gastrointest Endosc Clin N Am 2018 Jan;28(1):97-110

Division of Digestive Diseases & Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Boulevard, MDC 72, Tampa, FL 33612, USA. Electronic address:

In eosinophilic esophagitis, the main cause of solid-food dysphagia is tissue remodeling resulting in strictures and narrowed esophagus. Endoscopy and biopsies help to identify the degree of inflammation but often miss the fibrosis. Although initially considered dangerous, esophageal dilation has evolved into an extremely effective and safe treatment in fibrostenotic disease. Read More

J Biomed Res 2017 Jan;31(2):82-94

Department of Medicine, Division of Cardiology, College of Human Medicine, Michigan State University, East Lansing, MI, USA.

Cholesterol crystal embolic (CCE) syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulation that embolize into various tissue organs. Plaque rupture seems to be triggered by an expanding necrotic core during cholesterol crystallization forming sharp tipped crystals that perforate and tear the fibrous cap. Read More

Rev Esp Enferm Dig 2017 Jul;109(7):537

Radiología, Agencia Sanitaria Alto Guadalquivir. J Andalucía.

We present a case of a young 16 year old patient that had an esophageal perforation in the context of eosinophilic esophagitis. The esophagus showed vertical lacerations and mucosal thickness on endoscopy, thus a biopsy was performed in the proximal section which resulted in profuse bleeding due to a deep mucosal tear. A subsequent computed tomography scan revealed a perforation. Read More

Endoscopy 2017 Sep 31;49(9):848-854. Epub 2017 May 31.

Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia.

Chemoradiotherapy for head and neck cancer (HNC) with/without laryngectomy commonly causes dysphagia. Pharyngoesophageal junction (PEJ) stricturing is an important contributor. We aimed to validate a functional lumen imaging probe (the EndoFLIP system) as a tool for quantitating pretreatment PEJ distensibility and treatment-related changes in HNC survivors with dysphagia and to evaluate the diagnostic accuracy of EndoFLIP-derived distensibility in detecting PEJ strictures. Read More

Gastrointest Endosc 2017 10 28;86(4):733-734. Epub 2017 Apr 28.

Department of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

J Neurosurg Spine 2017 May 3;26(5):560-566. Epub 2017 Feb 3.

Institute of Clinical Orthopedic and Neurosciences, Desert Regional Medical Center, Palm Springs, California.

Anterior cervical discectomy and fusion (ACDF) is a very common surgery performed globally. Although a few cases of expectorating screws or extrusion of screws into the gastrointestinal tract through esophageal perforations have previously been reported, there has not been a case reporting pharyngeal perforation and entire cervical construct extrusion in the literature to date. In this report the authors present the first case involving the extrusion of an entire cervical construct via a tear in the posterior pharyngeal wall. Read More

Rev Esp Enferm Dig 2017 Jan;109(1):65-66

Aparato Digestivo, CHUS.

A 47-year-old man was attended at the emergency room for severe chest pain after eating sausage with subsequent vomiting and mild upper gastrointestinal bleeding. In the chest radiography we could not see abnormalities. He referred previous episodes of choking without consulting. Read More

Comp Med 2016 ;66(5):399-404

Department of Veterinary Medicine and Surgery, Division of Basic Science Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

A 5.5-mo-old castrated, male Red Duroc pig presented acutely with depression and abdominal pain 9 d after an altercation with another pig. A CT examination indicated right pneumothorax and herniation of the stomach into the thoracic cavity. Read More

Ann Thorac Surg 2016 Nov 15;102(5):1536-1542. Epub 2016 Jun 15.

Department of Radiology, Mie University Hospital, Mie, Japan.

Background: Type A aortic dissection (TAAD) is a rare complication associated with thoracic endovascular aortic repair (TEVAR). Although TAAD can result in catastrophic outcomes, the pathology of the condition has not been thoroughly clarified yet.

Methods: We retrospectively reviewed details from the medical records of 546 patients with diseases of the thoracic aorta (thoracic aortic aneurysm, n = 362; aortic dissection, n = 178; and fistula between the descending thoracic aorta and esophagus, n = 6) who underwent TEVAR in five hospitals from May 1997 through February 2015 to identify patients in whom TAAD developed during or after TEVAR. Read More

Neuro Endocrinol Lett 2016 Jul;37(3):184-188

Centogene AG, Rostock, Germany.

We report a young woman with the clinical picture of Allgrove syndrome in whom neurological symptoms are prominent. It usually presents in the first decade of life with a deficiency of tears, recurrent vomiting and dysphagia due to achalasia, severe hypoglycemic seizures and shock due to adrenal insufficiency. Neurological symptoms such as hyperreflexia, dysarthria, hypernasal speech, ataxia, sensory impairment, muscle weakness, and mental retardation are extremely slow to develop and manifest at a later age. Read More

Rev Esp Enferm Dig 2016 Mar;108(3):156-7

Radiología, Hospital de Bellvitge, España.

A 35-year-old man, with a history of rhinitis, eczema and a dubious achalasia was admitted due to chest pain and sialorrhea. Upper endoscopy showed a little hole and a narrowing of the distal esophagus. A CT-scan with oral contrast exposed a discontinuity of the lumen of the middle third of the esophagus and a dissection of submucosal space 16 cm long. Read More

Pediatr Gastroenterol Hepatol Nutr 2015 Dec 23;18(4):224-9. Epub 2015 Dec 23.

Department of Pediatrics, NSCB Medical College, Jabalpur, India.

Cyclic vomiting syndrome (CVS) is a functional disorder characterized by stereotypical episodes of intense vomiting separated by weeks to months. Although it can occur at any age, the most common age at presentation is 3-7 years. There is no gender predominance. Read More

J Clin Gastroenterol 2015 Nov-Dec;49(10):848-52

*Division of Gastroenterology and Hepatology, Drexel University College of Medicine, Philadelphia, PA †Department of Internal Medicine, University of Maryland, College Park, MD.

Goal: To determine if esophagogastroduodenoscopy (EGD) before transesophageal echocardiography (TEE) will change patient management.

Background: Before TEE gastroenterologists are often consulted to evaluate patients with a history of dysphagia, known gastrointestinal (GI) disease, or GI bleed. There are no known published data on the clinical utility of EGD before TEE. Read More

Endoscopy 2014 14;46 Suppl 1 UCTN:E471. Epub 2014 Oct 14.

Department of Radiology, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey.

Eur J Cardiothorac Surg 2013 Apr 7;43(4):e105. Epub 2013 Jan 7.

Department of Surgery, Division of Thoracic Surgery, School of Medicine, Changhua Christian Hospital, National Yang-Ming University, Taipei, Taiwan.

Radiol Case Rep 2013 7;8(2):433. Epub 2015 Dec 7.

Boerhaave syndrome, or spontaneous rupture of the esophagus, is a complication of violent vomiting. Although the syndrome is rare, awareness of it is important because delayed or missed diagnosis can be fatal. Radiographic imaging, particularly computed tomography, is the mainstay of diagnosis, and endoscopy generally does not play a role. Read More

J Emerg Med 2012 Sep 12;43(3):423-7. Epub 2011 Jun 12.

Department of Emergency Medicine, Chang Gung Memorial Hospital at Kaohsiung, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Background: Foreign body (FB) ingestion is a common problem presenting to the emergency department (ED). The standard treatment, removal by endoscopy, is well established. However, some patients may refuse this invasive procedure due to their fear of an uncomfortable or painful experience. Read More

Spine (Phila Pa 1976) 2011 May;36(12):E798-802

Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.

Study Design: We present a unique case of a 54-year-old woman who developed a prevertebral abscess 2 years after anterior cervical fusion in the absence of previously reported risk factors for late infection. The literature relevant to this topic is reviewed.

Objective: To report a rare complication of a commonly performed surgery. Read More