Esophagectomy for Cancer of the Esophagus- GMC Jammu Experience

We retrospectively reviewed a data of 202 patients, who underwent esophagectomy for cancer of the esophagusover 12 years at GMC, Jammu. Out of 262 patients, 202 patients underwent esophagectomy, mean age was53 years, ranging between 31-75 years. 160 patients had squamous cell carcinoma and 31 patients hadadenocarcinoma. 148 patients underwent transhiatal esophagectomy (Orringer’s procedure), whereas 18patients underwent McKeown’s three incision procedure and 10 patients underwent transthoracic esophagectomy(Ivor lewis) procedure. It was observed that mid third tumors accounted for 40%, lower third tumorsaccounted for 55 % and GE junction tumors 5% of the cases. Squamous cell carcinoma was the mostcommon histology (79.5 %). The overall morbidity (significant complications leading to prolonged hospitalization)was 38 %. Perioperative mortality was 13(6.43%). We hereby conclude that esophagectomy is a majorsurgical operation and gives palliation of dysphagia to patient and our experience with it has been with acceptablemorbidity and with favorable short-term results.

Esophageal Diverticulum Secondary to Impacted Foreign Body.

We report a two year old child who developed a large esophageal diverticulum over a period of ten months following ingestion of a multispiked leaf of Quercus semicarpipholia.Though the endoscopic removal of foreign body was successful, it did not relieve the symptoms and patient required surgical resection of the diverticulum. Patient is asymptomatic after 4 months of follow up.

Kimura’s Disease.

A rare case of Kimura’s disease alongwith AV Malformation around left pinna in a 26 year old male is being described. AV Malformation had two feeders from superficial temporal artery and occipital artery. The lesion was excised along with ligation of feeders. Post operatively patient was put on systemic corticosteroid therapy with some benefits.

Pleurocutaneous flap: how useful it is in management of chronic empyema.

BACKGROUND: Definitive surgical treatment of chronic empyema is associated with considerable morbidity and mortality. Methods. Retrospective study of 50 patients with chronic empyema who underwent pleurocutaneous flap procedure during the period 1994 to 2003. RESULTS: Their age ranged from 14 to 70 years; there were 32 males. Thirty-seven (74%) patients were on intercostal tube drainage; nine (18%) presented with bronchopleural fistula; and four (8%) had past-pneumonectomy empyema. Following pleurocutaneous flap procedure, 28 (56%) responded with re-expansion of the lung; 15 (30%) had persistence of pus discharge and air-leak suggestive of bronchopleural fistula. Definitive surgery could be undertaken in nine of the 15 patients. CONCLUSIONS: Pleurocutaneous flap procedure renders the patient ambulatory, facilitates re-expansion of the lung and helps as a tide-over procedure before definitive surgery in patients with chronic empyema.

Pulmonary Resections - Jammu Experience

Ten year registry of patients who underwent pulmonary resections at CTVS section of Govt Medical College Jammu is being presented. The cohort consisted of 94 patients operated between1994-2004. Males outnumbered females in this series Most number (30/94) of patients presented in the 4th decade. Etiology wise, Infective lung diseases were the leading causes leading to pulmonary resections, this included bronchiectasts with 32/94, chronic empyema in6/94 and middle lobe syndrome in one patient. Lung tumors were the causative factors in 20 and post tuberculosis destroyed lung in 17 cases. Two patients presented with intralobar lung sequestrations and one each with pulmonary blastoma and teratoma. The spectrum of resections included right pneumonectomy in19/94 followed by right and left lower lobectomies in 18 each. Thirteen patients underwent left pneumonectomy, 7 bilobectomy and 4 lingulectomy respectively. The mortality in our series was 6/94,20 patients had wound infection, 9 had bronchopleural fistula and 3 postoperative space infections.3 patients were reexplored because of hemorrhage in immediate postoperative period. Diagnostic video assisted thoracoscopy has been started and was employed in 6 patients.

Malignant Melanoma of Gastroesophageal Junction

A rare case of malignant melanoma arising from the gastroesophageal junction is being reported. Since part of the tumor was adherent with hiatus, palliative procedure in form of Mousseau Barbin tube insertion was necessitated. Postoperatively patient was subjected to radiotherapy. Malignant melanoma of gastroesophageal junction is rare accounting for only 0.1% of the lesions of this region. Surgical treatment requires a far greater margin of excision than the usual squamous cell carcinoma. Intracavitary radiotherapy has been recommended.

Angiosarcoma of Manubrium Sterni

A rare case of angiosarcoma affecting the manubrium sterni is being reported.Angiosarcoma is a very rare tumour affecting the bones with incidence as less as O.13%and its incidence involving the manubrium sternii is extremely rare.