Submucosal hematoma: a new distinctive sign during emergency upper digestive endoscopy for ammonia ingestion

Abstract Background Submucosal hematoma has never been associated with caustic injuries. Long-term follow-up of patients who ingested ammonia is not well known and ammonia ingestion is rare. Methods In a Single-center observational study, prospective data were collected from 2009 to 2013, in patients over the age of 14 years old referred for ammonia ingestion. The emergency and follow-up endoscopic data and the outcome were reported. Results Ammonia ingestion occurred in 43 patients. Submucosal hematoma of the gastric wall was a distinctive endoscopic sign observed in 15 (34.8%) cases. Oropharyngeal lesions were present in 30 (69.8%) patients, which was associated with ingestion with suicidal intent in 18 cases. Mild and severe endoscopic lesions (grade IIB to IIIB) were found in 16 (37.2%) cases with 10 (23.3%) cases presenting submucosal hematoma at initial endoscopy. A complete spontaneous gastric healing was frequently observed in 36 (83.7%) cases. In 11 cases with submucosal hematoma, a favourable outcome was observed with a medical treatment, however 6 of these patients had severe endoscopic lesions initially. Conclusions Submucosal hematoma of the gastric wall is an endoscopic sign occurring frequently in ammonia ingestion. Submucosal hematoma should be distinguished from necrosis in order to avoid false misclassification in favour of more severe lesions, which would lead to an abusive surgery

The Characteristics of Diverticular Disease in Caribbean Population: A Control Group Study

Background. Diverticulosis is not well characterized in the Caribbeans. Our aim was to compare the anatomical presentation of colonic diverticulosis in African Caribbeans (group AC) versus Europeans (group E) and severity. Methods. We conducted a prospective controlled study involving 274 patients admitted for lower gastrointestinal haemorrhage (LGIH) in France (center 1: Guadeloupe; center 2: La Roche-sur-Yon); 179 cases with diverticular haemorrhage, including 129 in group AC and 40 in group E. Exploration of the colon included a detailed assessment of diverticula using a dedicated endoscopic grid. Results. AC and E had similar characteristics in terms of age, gender, previous history of LGIH, body mass index, dietary habits, and medications, but AC had significantly poorer hemodynamic parameters at admission and required more blood transfusions (66.7% vs. 42.5%; p=0.01) during hospitalization. Out of the 169 patients included in the study, a complete exploration of the colon was achieved in 81% (N = 137) (AC, n = 106; E, n = 31), and revealed right-side diverticulosis in AC (in 90.6%, included into a pancolonic form in 73.6% vs. 35.5%; p=0.0002) and left-side diverticulosis in E (in 96.8%, isolated form in 58.1% vs. 9.4%, p=0.0002). These data were confirmed by a sensitivity analysis using an endoscopic grid in 92 patients, achieving a higher frequency and larger size of diverticula in AC. Conclusion. Our study has shown that diverticulosis was pancolonic in AC and more frequently associated with more severe haemorrhage than the left-sided diverticulosis of Europeans. This anatomical presentation may be driven by the genetic background more than the environment and diet

The Characteristics of Diverticular Disease in Caribbean Population: A Control Group Study

International audienceBACKGROUND: Diverticulosis is not well characterized in the Caribbeans. Our aim was to compare the anatomical presentation of colonic diverticulosis in African Caribbeans (group AC) versus Europeans (group E) and severity. METHODS: We conducted a prospective controlled study involving 274 patients admitted for lower gastrointestinal haemorrhage (LGIH) in France (center 1: Guadeloupe; center 2: La Roche-sur-Yon); 179 cases with diverticular haemorrhage, including 129 in group AC and 40 in group E. Exploration of the colon included a detailed assessment of diverticula using a dedicated endoscopic grid. RESULTS: AC and E had similar characteristics in terms of age, gender, previous history of LGIH, body mass index, dietary habits, and medications, but AC had significantly poorer hemodynamic parameters at admission and required more blood transfusions (66.7% vs. 42.5%; p=0.01) during hospitalization. Out of the 169 patients included in the study, a complete exploration of the colon was achieved in 81% (N = 137) (AC, n = 106; E, n = 31), and revealed right-side diverticulosis in AC (in 90.6%, included into a pancolonic form in 73.6% vs. 35.5%; p=0.0002) and left-side diverticulosis in E (in 96.8%, isolated form in 58.1% vs. 9.4%, p=0.0002). These data were confirmed by a sensitivity analysis using an endoscopic grid in 92 patients, achieving a higher frequency and larger size of diverticula in AC. CONCLUSION: Our study has shown that diverticulosis was pancolonic in AC and more frequently associated with more severe haemorrhage than the left-sided diverticulosis of Europeans. This anatomical presentation may be driven by the genetic background more than the environment and diet

Additional file 1: of Submucosal hematoma: a new distinctive sign during emergency upper digestive endoscopy for ammonia ingestion

All data generated or analyzed during this study are included in the supplementary information files. The collected data were: epidemiological data (age, gender), type of caustic agent (ammonia, volume of the ingested agent, mode of ammonia ingestion), clinical evaluation upon admission (clinical signs of severity, associated oropharyngeal lesions), endoscopic esophago-gastric lesions at first endoscopy (endoscopic lesions according to Zargar classification, presence of submucosal hematoma and its localization), endoscopic follow-up (date, duration and result), therapeutic management (medical, surgical, endoscopic dilation, results of computed tomography). (XLS 70 kb

L'âge d'or de l'Opéra-Comique / Verdi, Mozart, Gounod... [et al.], comp.

Titre uniforme : [Falstaff]. Extrait en françaisTitre uniforme : [Mignon]. ExtraitTitre uniforme : [Il barbiere di Siviglia]. Extrait en françaisTitre uniforme : [Don Giovanni. KV 527]. ExtraitTitre uniforme : [La Basoche]. ExtraitTitre uniforme : [Werther]. ExtraitTitre uniforme : [Richard cœur de lion]. ExtraitTitre uniforme : [Mireille. CG 8]. ExtraitTitre uniforme : [La dame blanche]. ExtraitTitre uniforme : [Les pêcheurs de perles. GB 4]. ExtraitTitre uniforme : [Carmen. GB 9]. ExtraitTitre uniforme : [La traviata]. Extrait en russeTitre uniforme : [La Basoche]. ExtraitTitre uniforme : [Werther]. ExtraitTitre uniforme : [Sapho]. ExtraitTitre uniforme : [Manon]. Extr.Titre uniforme : [Cavalleria rusticana]. ExtraitTitre uniforme : [La vida breve]. Extr. adapt.Titre uniforme : [La dame blanche]. ExtraitTitre uniforme : [Carmen. GB 9]. ExtraitTitre uniforme : [Il dottor Antonio]. ExtraitTitre uniforme : [Le châlet]. Extr.Titre uniforme : [Samson et Dalila. R 288]. ExtraitTitre uniforme : [Tosca]. Extrait en françaisTitre uniforme : [Tosca]. ExtraitTitre uniforme : [Madama Butterfly]. ExtraitTitre uniforme : [Fortunio]. Extr.Titre uniforme : [Manon]. Extr.Titre uniforme : [Fedora]. ExtraitTitre uniforme : [Don Pasquale]. ExtraitTitre uniforme : [Lakmé]. ExtraitTitre uniforme : [Louise]. ExtraitCollection : Bel cantoComprend : Falstaff. Quand j'étais page / Verdi, comp. ; Victor Maurel, BAR - Don Giovanni. Sérénade / Mozart, comp. ; Victor Maurel, BAR - Mireille. Valse / Gounod, comp. ; Lise Landouzy, S - La dame blanche. Ah ! quel plaisir d'être soldat / Boieldieu, comp. ; Edmond Clément, T - Les mousquetaires de la Reine. Air de Roland, Pas de beauté pareille / Halévy, comp. ; Hippolyte Belhomme, B - Werther. Air des larmes / Massenet, comp. ; Geneviève Vix, S - Mignon. Elle ne croyait pas / Thomas, comp. ; Léon David, T - Faust. Air des bijouxGounod, comp. ; Georgette Bréjan-Silver, S - Le barbier de Séville. Place au factotum de la ville / Rossini, comp. ; Valentin Soulacroix, BAR - Carmen. Air des cartesBizet, comp. ; Clotilde Bressler-Gianoli, MS - Le cor / Flégier, comp. ; Félix Vieuille, B - Les pêcheurs de perles. O Dieu Brahma / Bizet, comp. ; Jeanne Merey, S - La basoche. Quand tu connaîtras Colette / Messager, comp. ; Fernand Francell, T - Le soir / Charles Gounod, comp. ; Louis Azéma, B - Richard-Coeur-de-Lion. Si l'univers entier m'oublie / Grétry, comp. ; César Vezzani, T - Philémon et Baucis. Air de Jupiter, Que les songes heureux / Gounod, comp. ; Paul Payan, B - Mignon. Ah ! que ton âme enfin... / A. Thomas, comp. ; René Lapelletrie, T - La dame blanche. Viens, gentille dame / Boïeldieu, comp. ; David Devriès, T - La traviata. Grand air : en russe / Verdi, comp. ; Maria Kousnezoff, S - La basoche. Elle m'aime / Messager, comp. ; Etienne Billot, BAR - Le bon roi Dagobert. 2ème acte, air du roiMarcel-Samuel Rousseau, comp. ; Charles Friant, T - Manon. "Adieu, notre petite table / Massenet, comp. ; Emma Luart, S - Résurrection. Katiouchka, ce jour exquis / Franco Alfano, comp. ; René Maison, T - Werther. J'aurais sur ma poitrine / Massenet, comp. ; Gaston Micheletti, T - Carmen. Près des remparts de Séville / Bizet, comp. ; Rose Pocidalo, MS - Le chalet. Vallons de l'Helvétie / Adolphe Adam, comp. ; Pierre Dupré, B - Suzanne. Comme un petit oiseau / Paladilhe, comp. ; Victor Pujol, T - Sapho. Air de Divonne, Petit, voici ta lampe / Jules Massenet, comp. ; Germaine Cernay, MS - Le chemineau. Ici, c'était ici.. / Xavier Leroux, comp. ; Julien afont, BAR - Cavalleria rusticana. O Lola, blanche fleur : Sicilienne / Mascagni, comp. ; Enrico Di Mazzei, T - Danse espagnole n° 5 / Manuel de Falla, comp. ; La Argentina, castagnettes - Jota / Manuel de Falla, comp. ; Ninon Vallin, S - La Tosca. Prière / Puccini, comp. ; Germaine Lubin, S - Manon. "Le rêve de Des Grieux / Massenet, comp. ; Miguel Villabella, T - Lakmé. "Pourquoi dans les grands bois / Léo Delibes, comp. ; Leïla Ben Sedira, S - Fortunio. Couplets du chandelier : duo / Messager, comp. ; Roger Bourdin, BAR ; Ninon Vallin, S - Lakmé. Dans la forêt, près de vous / Delibes, comp. ; Solange Delmas, S - La Tosca. Le ciel luisait d'étoiles / Puccini, comp. ; Paul-Henri Vergne, T - Samson et Dalila. Printemps qui commence... / Saint-Saëns, comp. ; Conchita Supervia, MS - Louise. Berceuse / Gustave Charpentier, comp. ; André Pernet, B - L'attaque du moulin. Les adieux à la forêt / Alfred Bruneau, comp. ; René Verdière, T - Madame Butterfly. Un bel di vedremo : en italien) / Puccini, comp. ; Rosetta Pampanini, S - Don Paquale. Air de Norinaen italien / G. Donizetti, comp. ; Rosina Storchio, S - Fedora. Air de Loris, Amor ti vieta : en italien / Giordano, comp. ; Amedeo Bassi, T - La Tosca. Duo du Ier actePuccini, comp. ; Jan Kiepura, T ; Lotte Lehmann, SBnF-Partenariats, Collection sonore - BelieveContient une table des matière