Reviewer's report
Title:Cerebral Air Embolism as a Complication of Peptic Ulcer in the Gastric
Tube: Case report
Version: 1Date:2 October 2011
Reviewer: Keith L Obstein
Reviewer's report:
This manuscript represents a case report of a cerebral air embolism likely
secondary to an ulcer in the surgically created gastric tube 8 years after subtotal
esophagectomy for squamous cell carcinoma of the esophagus. Background
information was presented, followed by clinical details of the case (including
imaging studies and pathology).
Major Compulsory Revisions:
(1) There have been several reports in the medical literature of cerebral gas
embolism (in patients who have a gastric tube) after esophagetomy. While there
are no apparent reports of this complication being directly secondary to
spontaneous perforation of a gastric tube ulcer, I would recommend that the
reference list in this case report be updated and that more recent publications be
cited (i.e. ter Laan M, Totte E, van Hulst RA, et al. Cerebral gas embolism due to
upper gastrointestinal endoscopy. Eur J Gastroenterol Hepatol. 2009
Jul;21(7):833-5.)
(2) Conclusion, first sentence, "...postoperative endoscopic surveillance should
be conducted regularly." Regular postoperative endoscopic surveillance is
currently being actively debated. If this is not the current standard of care, I would
re-phrase the sentence to state "...postoperative endoscopic surveillance should
be considered based on the risk-benefit profile and clinical symptoms of each
individual patient."
Minor Essential Revisions:
(1) The figures in this .pdf created for the peer-review process are currently
labeled as Figure 1, Figure 2, Figure 3, and Figure 4. Figure 2 includes a "b" in
the lower left hand corner; Figure 3 includes an "a" in the lower left hand corner;
and Figure 4 includes a "b" in the lower left hand corner. While it is clear after
reading the Figure Legends section of the manuscript that Figure 1 is actually
both the current Figure 1 and Figure 2; and that Figure 2 is actually both the
current Figure 3 and Figure 4; this will need to be fixed as appropriate and
confirmed as correct in the edited article proof.
Discretionary Revisions:
(1) Case-presentation, 4th sentence. "Laboratory studies revealed elevated
C-reactive protein..." Would consider deleting "elevated C-reactive protein" and
instead include information on the white blood cell count (WBC) and Lactic Acid
(if performed).
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Cerebral Air Embolism as a Complication of Peptic Ulcer in the Gastric
Tube: Case report
Version: 1Date:2 October 2011
Reviewer: Keith L Obstein
Reviewer's report:
This manuscript represents a case report of a cerebral air embolism likely
secondary to an ulcer in the surgically created gastric tube 8 years after subtotal
esophagectomy for squamous cell carcinoma of the esophagus. Background
information was presented, followed by clinical details of the case (including
imaging studies and pathology).
Major Compulsory Revisions:
(1) There have been several reports in the medical literature of cerebral gas
embolism (in patients who have a gastric tube) after esophagetomy. While there
are no apparent reports of this complication being directly secondary to
spontaneous perforation of a gastric tube ulcer, I would recommend that the
reference list in this case report be updated and that more recent publications be
cited (i.e. ter Laan M, Totte E, van Hulst RA, et al. Cerebral gas embolism due to
upper gastrointestinal endoscopy. Eur J Gastroenterol Hepatol. 2009
Jul;21(7):833-5.)
(2) Conclusion, first sentence, "...postoperative endoscopic surveillance should
be conducted regularly." Regular postoperative endoscopic surveillance is
currently being actively debated. If this is not the current standard of care, I would
re-phrase the sentence to state "...postoperative endoscopic surveillance should
be considered based on the risk-benefit profile and clinical symptoms of each
individual patient."
Minor Essential Revisions:
(1) The figures in this .pdf created for the peer-review process are currently
labeled as Figure 1, Figure 2, Figure 3, and Figure 4. Figure 2 includes a "b" in
the lower left hand corner; Figure 3 includes an "a" in the lower left hand corner;
and Figure 4 includes a "b" in the lower left hand corner. While it is clear after
reading the Figure Legends section of the manuscript that Figure 1 is actually
both the current Figure 1 and Figure 2; and that Figure 2 is actually both the
current Figure 3 and Figure 4; this will need to be fixed as appropriate and
confirmed as correct in the edited article proof.
Discretionary Revisions:
(1) Case-presentation, 4th sentence. "Laboratory studies revealed elevated
C-reactive protein..." Would consider deleting "elevated C-reactive protein" and
instead include information on the white blood cell count (WBC) and Lactic Acid
(if performed).
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Cerebral Air Embolism as a Complication of Peptic Ulcer in the Gastric
Tube: Case report
Version: 1Date:2 October 2011
Reviewer: Keith L Obstein
Reviewer's report:
This manuscript represents a case report of a cerebral air embolism likely
secondary to an ulcer in the surgically created gastric tube 8 years after subtotal
esophagectomy for squamous cell carcinoma of the esophagus. Background
information was presented, followed by clinical details of the case (including
imaging studies and pathology).
Major Compulsory Revisions:
(1) There have been several reports in the medical literature of cerebral gas
embolism (in patients who have a gastric tube) after esophagetomy. While there
are no apparent reports of this complication being directly secondary to
spontaneous perforation of a gastric tube ulcer, I would recommend that the
reference list in this case report be updated and that more recent publications be
cited (i.e. ter Laan M, Totte E, van Hulst RA, et al. Cerebral gas embolism due to
upper gastrointestinal endoscopy. Eur J Gastroenterol Hepatol. 2009
Jul;21(7):833-5.)
(2) Conclusion, first sentence, "...postoperative endoscopic surveillance should
be conducted regularly." Regular postoperative endoscopic surveillance is
currently being actively debated. If this is not the current standard of care, I would
re-phrase the sentence to state "...postoperative endoscopic surveillance should
be considered based on the risk-benefit profile and clinical symptoms of each
individual patient."
Minor Essential Revisions:
(1) The figures in this .pdf created for the peer-review process are currently
labeled as Figure 1, Figure 2, Figure 3, and Figure 4. Figure 2 includes a "b" in
the lower left hand corner; Figure 3 includes an "a" in the lower left hand corner;
and Figure 4 includes a "b" in the lower left hand corner. While it is clear after
reading the Figure Legends section of the manuscript that Figure 1 is actually
both the current Figure 1 and Figure 2; and that Figure 2 is actually both the
current Figure 3 and Figure 4; this will need to be fixed as appropriate and
confirmed as correct in the edited article proof.
Discretionary Revisions:
(1) Case-presentation, 4th sentence. "Laboratory studies revealed elevated
C-reactive protein..." Would consider deleting "elevated C-reactive protein" and
instead include information on the white blood cell count (WBC) and Lactic Acid
(if performed).
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
assistant