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Esophageal perforation is a fatal entity if not diagnosed in a timely fashion. Once diagnosed, it requires collaborative effort of team of doctors including radiologists, thoracic surgeons and general surgeons. We share hereby our experience with esophageal perforation and successful outcome.

A 37-year-old woman presented to us for the complaints of pain and swelling over her right side of the neck and high spiking fever for the last 3 days. Her previous medical history was significant for intravenous drug abuse and she reported injecting heroin and methamphetamine by mixing with tap

Venous thromboembolism (VTE) is a major public health concern since the incidence of VTE rises substantially with age. Furthermore, the diagnosis can be elusive since patients can present differently, causing delay in diagnosis and initiation of treatment and resulting in major morbidity and mortality. In addition to accuracy and precision in diagnosis, antithrombotic therapies are the cornerstones of VTE management. In traditional paradigm, vitamin K antagonists (warfarin), indirect factor Xa inhibitors, and heparin are the foundation in management of VTE. Warfarin has been the only available oral anticoagulant therapy for several decades. Although warfarin is effective in both treatment and prophylaxis against VTE, there are several limitations. Therefore, the novel anticoagulation therapies, including rivaroxaban, apixaban, and dabigatran etexilate, have apparent advantages over warfarin in terms of clinical efficacy and adverse effects. The objective of this review is to describe the background and clinical implications of these novel anticoagulants.

We constructed a decision model to simulate costs and benefits for persons in the context of hepatitis A prevention. Three strategies were compared: i) no intervention; ii) vaccination against hepatitis A without screening; iii) vaccination against hepatitis A for those susceptible after screening for anti-HAV. We divided the population into 3 age groups : 3-11 years, 12-18 years and 19-40 years. Data regarding the cost of treatment and vaccination were obtained from the King Chulalongkorn Memorial Hospital. Relevant probabilities were obtained from published literature and expert opinion. At the present incidence of hepatitis A infection, in all age groups examined, the net benefits of a universal no-intervention strategy were higher than those of either vaccination (intervention) strategy. The cost of vaccination without screening in the 3-11-year and 12-18-year groups would equal the benefit if the incidence rates amounted to approximately 138 and 212 infected individuals per 100,000, respectively, that of vaccination with screening at incidence rates of about 200 and 260 infected persons per 100,000, respectively. In the 19-40-year group, the cost incurred by vaccination either with or without screening would equal the benefit at an incidence rate above 450 infected individual per 100,000. For the benefits to outweigh the estimated vaccination costs at present the vaccine is still too expensive. The cost of vaccination without screening in the 3-11-year group would equal the benefit if the cost of vaccine was about 586 baht/2 doses (293 baht/dose), and about 500 baht/2 doses (250 baht/dose) in the 12-18-year group. Likewise, because of the cost of vaccine, it would not be cost-beneficial in the 19-40-year group both with and without screening, and neither would it be in the 3-11-year and 12-18-year groups including screening. According to current standards, under the conditions of the present study the benefit of hepatitis A vaccination administered to the general population between the age of 3 and 40 years in Thailand does not justify the expenses incurred. Major changes in hepatitis A incidence, anti-HAV seroprevalence, vaccine cost or the treatment outcome would be required to potentially render either intervention strategy cost beneficial.