Cardiac complications in the first week post transhiatal esophagectomy for esophageal cancer

To determine cardiac complications and associated risk factors in the first week post transhiatal esophagectomy for esophageal cancer patients without detectable cardiac diseases. This descriptive study was conducted during the period from January 2000 through October 2007. Sixty-eight patients were included in this study. Patients with pre existing cardiac diseases were excluded. All the patients underwent transhiatal esophagectomy for a malignant lesion. All the cardiac complications were documented and analysed in the first week post operatively. There were 50 males [73.5%] and 18 females [26.5%], age ranged from 35 to 83 years [mean 62.7 +/- 10.3]. Post operative cardiac complications occurred in 25 patients [36.8%] during the first post operative week. Atrial fibrillation was the most commonly reported cardiac complication which occurred in 14 patients [20.6%], followed by supra ventricular tachycardia in six patients [8.8%], two patients developed atrial flutter [2.9%], fatal myocardial infarction in two patients [2.9%] and nonfatal myocardial infarction in one [1.5%]. Male gender, older age, longer procedure and first 48 hours post transhiatal esophagectomy were risk factors. Cardiac complications, mainly arrhythmias, are common after transhiatal esophagectomy. Preoperative evaluation, intraoperative and postoperative cardiac monitoring are mandatory in all patients even in those who have no cardiac illnesses

Thoracostomy tube complications and pitfalls: An experience at a tertiary level military hospital

To describe possible complications of thoracostomy tube insertion and common pitfalls regarding the management of the underwater seal system. This descriptive study was conducted at King Hussein Medical Center of the Royal Medical Services between December 2006 and January 2008. Two hundred twenty four patients were included in this study with 339 tube insertions. Complications related to the thoracostomy tube insertion and mistakes practiced by the medical staff regarding the management of thoracostomy tube and its system were documented and analyzed. There were 131 males [58.5%] and 93 females [41.5%]. Age ranged from 15 to 86 years [mean 41 +/- 10.11]. One hundred seventy one thoracostomy tubes [50.4%] were inserted in the operating theater post thoracotomy or thoracoscopic surgery, 99 [29.2%] were inserted in the intensive care unit and surgical wards, while 69 [20.4%] were inserted in the emergency department. The most common complications related to chest tube insertion were lung injury followed by intercostal vessels injury. The commonest mistakes related to the care of thoracostomy tube and its system were tube clamping during the transport of the patients, and improper handling of the negative suction system connected to the chest bottle. All the complications related to chest tube insertion resulted from the trocar. Mistakes in dealing with the tube and its system were common. All physicians working in the surgical field, in particular general surgery residents and nurses should have special courses in chest tube management and care

Complications of video assisted thoracoscopic sympathectomy for primary hyperhidrosis

To document the possible complications of video-assisted thoracoscopic sympathectomy procedure and their frequency of occurrence. This retrospective study was conducted at King Hussein Medical Center, Amman, Jordan, between April 2001 and January 2006. Two hundred and seven patients underwent thoracoscopic sympathectomy for the treatment of facial, axillary, and/or palmar hyperhidrosis. Follow up was completed for one year. All possible early and late complications were documented and analyzed. Males constituted 59.4% of the studied patients. Mean age range was 25.2 +/- 4.6 13-34 years. One hundred and fifty-three patients 73.9% had palmar hyperhidrosis as the main indication for sympathectomy, 4 patients 1.9% had axillary hyperhidrosis, and facial sweating or blushing in 7 patients 3.4%. Palmar hyperhidrosis combined with axillary and/or facial sweating were found in 43 patients 20.8%. The most common recorded complication was compensatory hyperhidrosis, which occurred in 142 patients 68.6%. Compensatory sweating remains the most common, and most disabling complication of video-assisted thoracoscopic sympathectomy. Other alternative more selective methods, rather than cutting the main trunk should be studied thoroughly to assess their efficacy in reducing the complication of compensatory sweating