A Study on Anastomotic Complications after Esophagectomy for Cancer of the Esophagus: A Comparison of Neck and Chest Anastomosis / 대한흉부외과학회지

BACKGROUND: Leakage, stricture formation, and tumor recurrence at the anastomotic site are serious problems after esophagectomy for cancer of the esophagus or cardia. The prevalence of these postoperative complications may be affected by whether an anastomosis is made in the neck or in the chest, therefore a comparison was made between anastomoses made at these two sites. MATERIAL AND METHOD: Between 1987 and 1998, 36 patients with cancer of the esophagus underwent transthoracic esophagectomy with cervical(NA, n=20) or thoracic anastomosis(CA, n=16). The tumors were staged postoperatively(stage IIA, n=13; s tage IIB, n=7; stage III, n=16) and were located in the middle thoracic(n=22) or lower thoracic esophagus and cardia(n=14). RESULT: The overall operative mortality was 8.3%(5% for NA group, 12.5% for CA group). The anastomotic leak rate for the NA group was 15.0% and 12.5% for the CA group. The anastomotic leak rate differed according to the manual(27.3%) or stapled(8.0%) techniques(p < 0.05). The median proximal resection margins in the NA and CA groups were 9.6 cm and 5.8 cm, and the corresponding rates of anastomotic tumor recurrence were 5.3% and 28.6%(p < 0.05). The prevalence of benign stricture formation (defined as moderate/severe dysphagia) was higher in the NA group(36.8%) than in the CA group(21.4%). When an anastomosis was made by the stapled technique, smaller size of the staple increased the prevalence of stricture formation - 41.7% with 25-mm staple and 9.1% with 28-mm staple(p < 0.05). CONCLUSION: Wider resection margin could decrease the anastomotic tumor recurrence, and the stapled technique could decrease the anastomotic leak. The prevalence of benign stricture was higher in the cervical anastomosis but the anastomotic leak and smaller size(25-mm) of the staple should be considered as risk factors.

A Case of Primary Pulmonary Histiocytosis-X associated With Central diabetes insipidus / 결핵

Pulmonary histiocytosis X is a granulomatous disorder of the lung of unknown cause. Patients with this disease often complain of cough, dyspnea on exertion and , occaionally, chest pain from pneumothorax or bone involvement. However, DI is uncommon in these patients. We report a case of primary pulmonary histiocytosis X with central diabetes insipidus. A 23-year-old man presented with dyspnea suffered from dry cough, exertional dyspnea, polydipsia and polyuria for 4 months. He was a heavy smoker. He was found to have reticulonodular interstitial opacities on chest X-ray film. High-resolution computed tomography revealed thin-walled cysts of various sizes in both lungs. Open lung biopsy was done. On light microscopic examination revealed proliferation and infiltration of Langerhans cells. Immunohistochemically, Langerhans cells showed strong cytoplasmic staining with S-100 protein and electronmicroscopic examination showed Birbeck granules in Langerhans cells. Water deprivation test showed central-type diabetes insipidus and brain MRI showed no abnormal lesion on suprasellar region. Smoking cessation was recommended. He was treated with oral desmopressin.