ABSTRACT
BACKGROUND: These days, lung volume reduction surgery (LVRS) is used as an alternative or a bridge operation to lung transplantation in treating patients with severe emphysema. The procedure can be used in patients with pulmonary nodules combined with severe emphysema. We report the results of 21 months follow up after lung volume reduction surgery in 7 cases including 2 cases of concurrent resection of pulmonary nodules. MATERIAL AND METHOD: Seven patients with emphysema, including 2 cases of preoperatively suspected lung cancer were operated with LVRS technique between July 1996 and June 1997. RESULT: Postoperative mortality was observed in a case of squamous cell carcinoma in LUL with brain metastasis, detected at postoperative 13months. Average of 21months(19-25months) follow up was done for other cases without specific events. CONCLUSION: LVRS is a useful operation in the treatment of patients with severe emphysema, but further evaluation should be done about the long term results and precise criteria for patient selection. Simultaneous LVRS and tumor resection could be done in patients with emphysema with marginal reserve in the hope of maximizing postoperative lung functions.
Subject(s)
Humans , Brain , Carcinoma, Squamous Cell , Emphysema , Follow-Up Studies , Hope , Lung Neoplasms , Lung Transplantation , Lung , Mortality , Neoplasm Metastasis , Patient Selection , PneumonectomyABSTRACT
It is now generalized to perform cardiac surgery in the patients with end-stage renal disease. The growing number of patients with chronic renal failure wake us up to the need to prepare for proper management. There are not only the prevalence of coronary artery disease, but also a great amount of valve dysfunction exist in this group. Peritoneal dialysis may be one of the obstacles for cardiopulmonary bypass but it is not a great hindrance in cardiac surgery with careful preparation and well organized perioperative care. The author has performed mitral valve replacement in a 33-year-old anuric female patient with chronic renal failure and severe mitral insufficiency. Preoperatively, the patient was kept in adequate fluid and electrolyte balance using peritoneal dialysis. Peritoneal dialysis continued and regulated according to the laboratory data in this patient during and after the surgery. She recovered well showing an uneventful course and was discharged on postoperative 1 th day.
Subject(s)
Adult , Female , Humans , Cardiopulmonary Bypass , Coronary Artery Disease , Dialysis , Kidney Failure, Chronic , Mitral Valve , Mitral Valve Insufficiency , Perioperative Care , Peritoneal Dialysis , Prevalence , Thoracic Surgery , Water-Electrolyte BalanceABSTRACT
MATERIAL AND METHOD: Esophageal reconstruction by the hypopharyngointestinal anastomosis was done in 7 patients of corrosive upper esophageal stricture at St. Mary's Hospital from August 1995 to January 1997. RESULT: There were one male and six female patients ranging from 20 to 63 years of age. The causative agents were acid in 6 patients and alkali in 1 patient. The esophageal reconstruction was made by hypopharyngcolojejunostomy in 4 patients and hypopharyngocologastrostomy in 3 patients. There were no operative mortalities. One patient developed anastomotic stenosis but others were free from dysphagia. All gained 4 kg to 13 kg of body weight during the follow-up period. CONCLUSION: In this experience right colon and terminal ileum including ileocecal valve was revealed as a good substitute for the esophagus and the esophageal reconstruction by hypopharyngocologastro (jejuno)stomy seems to be a satisfactory method with acceptable morbidity and mortality in corrosive upper esophageal stricture patient.
Subject(s)
Female , Humans , Male , Alkalies , Body Weight , Colon , Constriction, Pathologic , Deglutition Disorders , Esophageal Stenosis , Esophagus , Follow-Up Studies , Ileocecal Valve , Ileum , MortalityABSTRACT
It would be possible to manage the intestinal anastomotic failure with intraluminal stenting, but its reports are very rare. We experienced a effective and dramatic improvement of esophago-jejunal anastomotic leak in a esophageal and gastric double cancer patient with intraluminal stenting. The intraluminal stenting was tried at the 28th postoperative day and the anastomotic leak and inflammatory signs were disappeared about 3 weeks later. Postoperative 11th months now, the stent was moved about 1 cm downward but not changed further, and he enjoys regular diet without any problems. And we think the stenting would be helful with some limitations in the intestinal anastomotic leak patient.
Subject(s)
Humans , Anastomotic Leak , Diet , Esophageal Neoplasms , Fistula , StentsABSTRACT
Primary malignant melanoma of the esophagus (PMME) is an uncommon neoplasm. And the world literature reports only about 200 cases. A case of primary malignant melanoma of the esophagus is presented, and followed by review of the literature. In our patient, the walnut-sized melanoma was located at the midportion of esophagus and there were two small satellite lesions at the esophagogastric junction. The main mass was diagnosed as primary malignant melanoma histologically and immunohistologically. The tumor was curatively resected by the transthoracic subtotal esophagectomy and the 2 fields node dissection. Post-operative immunotherapy was performed but the tumor recurred 7 months later at the stomach.