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Circumferential mucosal dissection and esophageal perforation in a patient with eosinophilic esophagitis

World Journal of Gastroenterology 2008年第5期14卷 803-804页

作者： gennaro liguori Maurizio Cortale Fabrizio Cimino Michele Sozzi Department of General and Thoracic Surgery Cattinara Hospital Trieste 34149 Italy Service of Gastroenterology Cattinara Hospital Trieste 34149 Italy

A young man with a previous history of episodes of mild solid food dysphagia was admitted with a total dysphagia. The esophagogastroduodenoscopy (EGDS) showed an extensive disruption of mucosal layer with a cul-de-sac in the lower part of the esophagus. Soon after the procedure, the patient suffered from an acute chest pain and subsequent CT scan demonstrated an intramural circumferential dissection of thoracic esophagus, and a mediastinal emphysema. An emergency right thoracotomy was performed, followed by a total esophagectomy with esophagogastroplasty and jejunostomy. The histopathology confirmed that mucosal and submucosal layers were circumferentially detached from muscular wall and showed an eosinophilic infiltration of the whole organ with necrosis and erosions of mucosal, submucosal and muscular layers. The diagnosis was esophageal perforation in eosinophilic esophagitis.

关键词： Thoracic surgery emergency Esophagea perforation Eosinophilic esophagitis Esophagea mucosal dissection Esophagus surgery

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Depression and chronic heart failure in the elderly： an intriguing relationship

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Journal of Geriatric Cardiology 2018年第6期15卷 451-459页

作者： Ilaria liguori gennaro Russo Francesco Curcio Giuseppe Sasso David Della-Morte Gaetano Gargiulo Flora Pirozzi Francesco Cacciatore Domenico Bonaduce Pasquale Abete Gianluca Testa Department of Translational Medical Sciences University of Naples 'Federico Ⅱ' Naples Italy Department of Systems Medicine University of Rome Tor Vergata Rome ltaly IRCCS San Raffaele Pisana Rome Italy Division of Internal Medicine A OU San Giovanni di Dio e Ruggi di Aragona Salerno Italy Azienda Ospedaliera dei Colli Monaldi Hospital Heart Transplantation Unit Naples Italy Department of Medicine and Health Sciences University of Molise Campobasso Italy

Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including： psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.

关键词： Chronic heart failure Depression The elderly

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