Canyoning is a recreational activity that has increased in popularity in the last decade in Europe and North America, resulting in up to 40% of the total search and rescue costs in some geographic locations. The International Commission for Mountain Emergency Medicine convened an expert panel to develop recommendations for on-site management and transport of patients in canyoning incidents. The goal of the current review is to provide guidance to healthcare providers and canyoning rescue professionals about best practices for rescue and medical treatment through the evaluation of the existing best evidence, focusing on the unique combination of remoteness, water exposure, limited on-site patient management options, and technically challenging terrain. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.

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(1973). Thorax, 28,[641][642][643]. Granular cell myoblastoma of the oesophagus. During evaluation of symptoms of oesophageal reflux in a 40-year-old man, a filling defect of the distal oesophagus was seen on the oesophagogram, and this was noted to be a submucosal mass at oesophagoscopy. He also had an oesophageal hiatus hernia. The lesion proved to be a granular cell myoblastoma, a rarity in the oesophagus, only 11 previous cases having been reported. Symptomatology evaluation and management of granular cell myoblastoma of the oesophagus are discussed. As with other submucosal lesions of the oesophagus, preoperative biopsy through an intact mucosa is to be avoided because of danger to the patient from haemorrhage or perforation and subsequent inflammatory reaction making surgical resection and microscopic diagnosis difficult.Over 50% of reported cases of granular cell myoblastoma occur in the skin, muscle, and breast. Occurrence in the respiratory tract, genitourinary tract, retroperitoneum, and gastrointestinal tract is relatively rare (Stout and Lattes, 1967). Therefore, when we encountered a case of granular cell myoblastoma of the oesophagus, incidental to an evaluation for hiatal hernia, we were stimulated to review the pertinent medical literature and discovered 11 other cases (Abrikossoff, 1931;