Background Spontaneous esophageal rupture, or Boerhaave syndrome, is a fatal disorder caused by an elevated esophageal pressure derived from forceful vomiting, and subsequent presentation of chest pain, dyspnea, and shock. Case presentation: We present two cases of Boerhaave syndrome that were both triggered by excessive alcohol consumption and quickly detected in the emergency room. The first patient complained of severe chest pain, nausea, and vomited on his arrival: he was diagnosed with Boerhaave syndrome complicated with mediastinitis from the computed tomography (CT) and esophagogram findings. An emergency operation was successfully performed, where a 3-cm tear was found on the left-posterior wall of the distal esophagus. The patient subsequently suffered from anastomotic leakage but was discharged 41 days later. The second patient reported severe chest pain, nausea, vomiting, and hematemesis on his arrival: he was suspected of having Boerhaave syndrome without mediastinitis based on the CT findings. The symptoms gradually disappeared after a conservative treatment. Upper gastrointestinal endoscopy performed on the 9th day revealed a scar on the left wall of the distal esophagus. The patient was discharged 11 days later. In addition to the varying severity between the cases, the second patient was also differently diagnosed with Mallory-Weiss syndrome. Conclusion Emergency clinicians must accurately distinguish Boerhaave syndrome from Mallory-Weiss syndrome as they both have similar history and symptoms. CT can be a valuable and useful modality to detect any severity of Boerhaave syndrome.
Objectives: Since esophageal carcinoma progresses asymptomatically, for many patients the disease is already advanced at the time of diagnosis. The main methods that are currently used to diagnose esophageal carcinoma are upper gastrointestinal radiographic contrast examinations and upper gastrointestinal endoscopy, but early discovery of this disease remains difficult.There is a need to develop a diagnostic method using biomarkers that is non-invasive while both highly sensitive and specific. Materials and Methods:Exhaled breath was collected from 17 patients with esophageal squamous cell carcinoma (ESCC), as well as 9 control subjects without history of any cancer. For each fasting subject, 1L of exhaled breath was collected in a gas sampling bag. Volatile organic compounds (VOCs) were then extracted from each sample using Solid phase micro-extraction (SPME) fibers and analyzed by gas chromatography-mass spectrometry (GC-MS). Results: Levels of acetonitrile, acetic acid, acetone, and 2-butanone in exhaled breath were significantly higher in the patient group than in the control group (p = 0.0037, 0.0024, 0.0024 and 0.0037, respectively). ROC curves were drawn for these 4 VOCs, and the results for the area-under-the-curve (AUC) indicated that ESCC patients can be identified with a high probability of 0.93. Conclusion:We found distinctive VOCs in exhaled breath of ESCC patients. These VOCs have a potential as new clinical biomarkers for ESCC. The measurement of VOCs in exhaled breath may be a useful, non-invasive method for diagnosis of ESCC.
Background: Spontaneous esophageal rupture, or Boerhaave syndrome, is a fatal disorder caused by an elevated esophageal pressure owing to forceful vomiting. Patients with Boerhaave syndrome often present with chest pain, dyspnea, and shock. We report on two patients of Boerhaave syndrome with different severities that was triggered by excessive alcohol consumption and was diagnosed immediately in the emergency room.Case presentation: The patient in case 1 complained of severe chest pain and nausea and vomited on arrival at the hospital. He was subsequently diagnosed with Boerhaave syndrome coupled with mediastinitis using computed tomography (CT) and esophagogram. An emergency operation was successfully performed, in which a 3-cm tear was found on the left-posterior wall of the distal esophagus. The patient subsequently had anastomotic leakage but was discharged 41 days later. The patient in case 2 complained of severe chest pain, nausea, vomiting, and hematemesis on arrival. He was suggested of having Boerhaave syndrome without mediastinitis on CT. The symptoms gradually disappeared after conservative treatment. Upper gastrointestinal endoscopy performed on the ninth day revealed a scar on the left wall of the distal esophagus. The patient was discharged 11 days later. In addition to the varying severity between the cases, the patient in case 2 was initially considered to have Mallory–Weiss syndrome.Conclusion: Owing to similar histories and symptoms, Boerhaave syndrome and Mallory–Weiss syndrome must be accurately distinguished by emergency clinicians. CT can be a useful modality to detect any severity of Boerhaave syndrome and also offers the possibility to distinguish Boerhaave syndrome from Mallory–Weiss syndrome.
Objectives The goal of the study was to examine the relationships among micrometastasis, pathological degree of differentiation and survival in patients with esophageal squamous cell carcinoma (SCC). Design A single-center retrospective study of patients diagnosed with thoracic esophageal SCC. Methods Immunostaining using CK13 was carried out for all lymph nodes resected by radical esophagectomy with three-field lymphadenectomy. The relationships among micrometastasis to lymph nodes, degree of differentiation and survival were investigated. Results The 25 patients included 14 (56.0%) well-differentiated and 11 (44.0%) moderately differentiated cases. In multivariate analysis, well-differentiated cases were not related to micrometastasis (odds ratio (OR): 1.5, confidence interval (CI): 0.2-12, p=0.7). In multivariate analysis of survival, cases in pStage III or higher were likely to have shorter survival (hazard ratio (HR): 2.8, CI: 0.7-12, p=0.16), and those with micrometastasis also tended to have shorter survival (HR: 2.7, CI: 0.8-9, p=0.11)); however, well-differentiated cases were not significantly related to survival (HR: 1.5, CI: 0.4-5.5, p=0.5). Conclusion Micrometastasis to lymph nodes may be a prognostic factor even in advanced esophageal cancer. The degree of differentiation was not related to micrometastasis or survival.
Some patients complain of serious postoperative digestive symptoms after esophagectomy. However, it has not been clear what clinical factors are related to these symptoms. In this study, we investigate the relationships between postoperative digestive symptoms (body weight loss, subjective oral intake, and reflux) and clinical factors. Of 155 patients who underwent esophagectomy at our department from April 2019 to July 2021, 75 patients were eligible because they could be followed up at our outpatient clinic without relapse. Postoperative symptoms including body weight loss, oral intake ≥70%, and reflux were asked. Regarding clinical factors, age, sex, route of reconstruction, the width and the location of the gastric tube in CT images, and the location of pylorus ring in CT images were investigated retrospectively. The median body weight loss was 10.5%. Oral intake ≥70% was found in 37/61. 24/50 patients complained of reflux. The mean body weight loss was 6.2% in the intrathoracic anastomosis, 10.5% in the posterior mediastinal route, and 12.6% in the retrosternal route (p=0.04). Oral intake ≥70% was found in 20/29 of the wide gastric tube group and 16/31 of the narrow gastric tube group (p=0.197). The group with oral intake ≥70% was likely to be younger (p<0.01), and male is likely to have oral intake ≥70% (p=0.193). Regarding reflux, there were no difference in clinical factors. Although this is a retrospective study and biases in each group are found, body weight loss is less found in the intrathorax anastomosis and in the duodenostomy group via a retrosternal route. Oral intake is likely to be more in younger patients, in male, and in patients with wider gastric tube. On the other hand, no clinical factors were found related to reflux.
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