Anaesthetic management of acquired non malignant tracheo-oesophageal fistula.

Acquired non malignant tracheo-oesophageal fistula is an uncommon complication of endotracheal intubation and tracheostomy. Patients are usually diagnosed while on mechanical ventilation. The rationale of management is to prevent pulmonary contamination, maintain nutrition and achieve spontaneous ventilation prior to surgical repair. Cautious management of the airway is required during tracheal reconstruction. We present a case of non malignant tracheo-oesophageal fistula in which repair was achieved by primary closure of the tracheal and oesophageal defects.

Survival in multiple myeloma in Kerala.

BACKGROUND. The reported incidence of multiple myeloma in India ranges from 0.5 to 1.2 per 100,000 but there have been few studies on the effect of treatment of this condition. We, therefore, analysed the clinical profile of patients in Kerala with myeloma, the treatment given and the factors affecting survival. METHODS. Case records of 142 patients with multiple myeloma treated at the Regional Cancer Centre, Trivandrum, between 1984 and 1989 were reviewed and abstracted. Chemotherapy (using melphalan and prednisolone) and radiotherapy were the treatment modalities. Survival analysis was done using the Kaplan-Meier estimates and multivariate analysis of factors affecting survival was performed using Cox's proportional hazards regression model. RESULTS. The mean age of the patients was 61 years and 90 were males. Bone pain and pallor were the most common presenting symptoms and the median survival was 30 months. A combination of melphalan and prednisolone was found to be well tolerated and achieved a survival rate of 62% at 5 years. Hemibody irradiation was beneficial in a small group of patients. On a multivariate analysis, Bence-Jones proteinuria, melphalan and prednisolone combination chemotherapy and response to treatment at 6 months were the most significant factors affecting survival. Socioeconomic status did not seem to influence survival. CONCLUSIONS. Melphalan and prednisolone chemotherapy achieves prolonged survival in myeloma. Radiotherapy can relieve symptoms and in a small group of patients hemibody irradiation can achieve prolonged remission. Further studies are required to identify the subgroups in which certain treatments are most effective in improving survival.