Upper-esophageal perforation with a flexible endoscope secondary to cervical osteophytes

A case report of esophageal perforation by fiberoptic endoscopy in a patient with severe cervical spine disease has been described. A literature review reveals a paucity of data regarding cervical osteoarthropathy and endoscopy. A discussion of the implications of cervical spine disease with precautionary suggestions has been made.     

Macular hole secondary to retrobulbar needle perforation

An unusual case of cerebral toxoplasmosis leading to a fatal vehicular crash is presented. Massive intracerebral hemorrhage, a rare complication of cerebral toxoplasmosis in persons with acquired immunodeficiency syndrome (AIDS), caused sudden onset of increased intracranial pressure that led to loss of control of the vehicle and an ensuing fatal traffic crash.     

Small bowel perforation secondary to metastatic lung carcinoma

Since 1961, there have been a total of seven patients with small bowel perforation caused by metastatic lung carcinoma reported in the literature. Perforation of the small bowel to metastatic lung carcinoma must be considered when evaluating older patients who have histories of heavy cigarette smoking and signs and symptoms suggestive of pulmonary neoplasia. Primary resection and end-to-end anastomosis of the perforated bowel is the treatment of choice. No patient with small bowel perforation secondary to lung carcinoma has survived more than four months.     

Nonoperative management of esophageal perforation secondary to balloon dilatation

Esophageal perforation is usually considered a surgical emergency. However, esophageal perforation after therapeutic endoscopic manipulation is a different entity. This type of perforation occurs in a controlled environment and the perforation is usually detected early. Three documented cases of perforation during endoscopic balloon dilatation are described. They were successfully treated nonoperatively.     

Delayed presentation of esophageal perforation as a result of overtube placement

The first use of an overtube to assist endoscopy was described more than 20 years ago. Since then a number of uses of overtubes have been described, but relatively few complications have been reported. We report a case of esophageal perforation caused by overtube insertion during endoscopic band ligation of varices. This case is unique in that the patient presented 13 days after the original procedure, and it is the first reported case of esophageal injury involving the modified Bard overtube. The existing literature involving overtube injury is also reviewed.     

Liver abscess secondary to intrahepatic perforation of the gallbladder, presenting as a liver mass

We present an unusual case of a large pyogenic liver abscess containing multiple stones caused by perforation of a necrotic gallbladder and spread of the infection into the liver. It manifested by weakness, weight loss, and a palpable liver mass, pointing toward a neoplastic process. Workup for metastatic disease was negative, and tumor markers also were negative. Ultrasound and computerized tomography were inconclusive, and the diagnosis was established by laparoscopy. Open drainage and cholecystectomy were performed, with good outcome. In the literature, there have been very few reports of intrahepatic perforation of the gallbladder resulting in formation of hepatic abscess. The presentation, diagnosis, and management of liver abscesses, as well as the complications of acute cholecystitis, are discussed.     

Transesophageal echocardiography diagnosis of perforation of the mitral valve secondary to infective endocarditis

We report on a patient with infective endocarditis and severe mitral regurgitation secondary to perforation in the base of the posterior mitral leaflet. Transthoracic echocardiography was inconclusive. Only transesophageal echocardiography could confirm the presence of vegetations, their characteristics and the existence of valvular perforation. We also review the literature on the contribution of transesophageal echocardiography to the diagnosis of infective endocarditis and its complications.     

Septic knee arthritis secondary to a functional brace after ACL reconstruction

Falls are associated with a wide range of acute medical illness across all ages. They have prognostic implications, and screening for falls on admission can help identify those patients who are likely to have an adverse hospital outcome and may benefit from more intense levels of care.     

Penumopericardium due to transdiaphragmatic perforation of a gastric ulcer

A 65-year-old man presented with cardiogenic shock and massive pneumopericardium. A gastropericardial fistula due to transdiaphragmatic penetration of a large fundal ulcer was documented radiographically and confirmed at autopsy. Previously recorded cases of penumopericardium complicating gastric ulcers or other diseases of the digestive tract are briefly reviewed.     

Acquired hemophilia secondary to factor VIII inhibitors after pregnancy

According to current concepts, the excitatory amino acid glutamate is involved in the pathogenesis of Parkinson's disease (PD). Overactivity of glutamatergic projection neurons and beneficial effect of antiglutamatergic substances in animal experiments suggest that excess supply of glutamate might contribute to the pathophysiology of PD. Reduced activity of the glutamate metabolizing enzyme glutamine synthetase (GS) leads to decreased uptake of glutamate and thus abundant glutamate. Here we report that PD patients and age-matched controls are comparable with respect to GS activity in peripheral blood mononuclear cells (PBMC). These results imply no systemic dysregulation of the enzyme GS in patients with PD.     

A normal initial colonoscopy after age 50 does not predict a polyp-free status for life

OBJECTIVES: The prevalence of colon polyps increases with age in the general population. It is unknown whether a lack of adenomatous polyps determined at one time point after the age of 50 is predictive of a subsequent low risk of polyp development. METHODS: Twenty-nine patients between ages 50 and 70 who had no prior history of polyps and had a normal colonoscopy at least 5 yr previously were recruited for follow-up colonoscopy to evaluate the incidence of neoplastic disease in this presumably low-risk group. RESULTS: The incidence of adenomatous polyps after a mean of 5.74 yr was 41.4% (95% confidence interval: 23.5-61.1%). A total of 20 adenomatous polyps were found in 12 patients. Seven polyps were 5 mm or more in size. CONCLUSIONS: We conclude that in patients with no history of colonic neoplasia who are 50 yr old, or older, the finding of a normal colonoscopy does not predict diminished risk of neoplasia.