Successful Surgical Treatment of a Spontaneous Rupture of the Esophagus Diagnosed Two Days after Onset

Esophageal perforation is a relatively uncommon disease with a high rate of mortality and morbidity. Delay in the diagnosis and treatment occurs in more than 50% of cases, leading to a mortality rate of 40–60%. Primary repair is generally considered the gold standard for patients who present within the first 24 h following perforation of the esophagus. In this paper, we present a case of successful surgical treatment of spontaneous rupture of the esophagus that was diagnosed 2 days after onset. The patient was a 42-year-old man admitted to internal medicine with a diagnosis of pleuritis and complaining of chest and back pain. The next day, computed tomography revealed left-sided pleural effusion and mediastinal emphysema. An esophagogram revealed extravasation of the contrast medium from the lower left esophagus to the mediastinal cavity. These results confirmed a rupture of the esophagus, and an emergency left thoracotomy was performed. The perforation was repaired with a single-layered closure and was covered with elevated great omentum obtained by laparotomy. The patient was discharged 23 days after the first surgery. In conclusion, primary repair surgery must be selected as the best treatment beyond 24 h if the patient's general state was stable and there was no evidence of clinical sepsis

Social-Ecological Determinants of Elite Student Athletes’ Dual Career Development in Hong Kong and Taiwan

[[abstract]]Previous research has encouraged a cultural specific framework to be developed through research in Asian countries, such as China, to help internationalize the findings and help athletes to adapt them to their society and culture. Based on a socioecological framework, this study investigated how social-ecological determinants affect elite student athletes’ (ESA) experience of the socialization process of dual career development in Hong Kong and Taiwan. We interviewed eight ESAs who trained at the national level, studying simultaneously at universities in Hong Kong and Taiwan. Grounded theory techniques and procedures were used to analyze the data. Results revealed that ESAs are affected by interrelated determinants at different levels: individual (career aims, identities, roles, characters, self-efficacy, and motivation), micro-level (coaches, teammates, parents, siblings, physical education [PE] teachers, other teachers, alumni, seniors, and classmates), meso-level (interrelations between individual and micro-level), exo-level (government, financial, policy, academic, medical, and parent–teacher association), macro-level (attitudes, norms, values, beliefs, resources, and culture), and chrono-level (transition).[[notice]]補正完