Management of esophagorespiratory fistula due to carcinoma esophagus with palliative intubation, gastric decompression and transgastric feeding jejunostomy.

BACKGROUND: Carcinoma esophagus with esophagorespiratory fistula has a poor prognosis. Water and food intake suffers and pulmonary contamination leads to lung infection. Treatment is essentially palliative. METHODS: Thirty-five patients with esophagorespiratory fistula secondary to esophageal carcinoma were treated with palliative esophageal intubation, gastrostomy and transgastric feeding jejunostomy. RESULTS: Esophageal prosthesis could be implanted in 34 patients. One patient died in the postoperative period. Twenty-nine patients were able to swallow saliva without leakage into the lungs. Only four patients were able to take full diet orally for any significant length of time. An 18-G needle inserted in the gastrostomy Malecot's catheter provided outlet for air in the stomach and prevented rise in intragastric pressure and gastroesophageal reflux. Transgastric feeding jejunostomy functioned satisfactory. Twenty patients were followed up; the average survival was 58 days (range 9-337 days). CONCLUSION: Esophageal intubation, gastrostomy and transgastric feeding jejunostomy provide satisfactory palliation for patients with esophagorespiratory fistula secondary to carcinoma esophagus.

Volvulus and gangrene in intra-abdominal colon after colonoplasty for esophageal stricture.

Ten years after colonoplasty using the left colon for impassable corrosive stricture of the esophagus, a 27-year-old woman developed volvulus and gangrene of the remaining intra-abdominal colon. It was resected and colostomy was done. In the second stage, after 3 months, the ascending colon and cecum were mobilized and anastomosed to the rectal stump. Eight years later, the patient is asymptomatic.

Primary intrapulmonary teratoma presenting as pyothorax.

A female patient presented with empyema thoracis and was planned for decortication. Peroperatively a cystic mass was found in the left lower lobe which was resected and diagnosed as a case of teratoma of lung on histopathological examination. This unusual case of primary intrapulmonary teratoma is being reported here.

Foley catheter self dilatation for strictures of the upper end of oesophagus.

Three patients having corrosive stricture of the upper end of oesophagus and two patients of impassable corrosive stricture of oesophagus who were subjected to coloplasty using descending colon and who developed stricture at the site of upper anastomosis were being treated by antegrade dilatations with oesophageal bougies under general anaesthesia. These patients were put on controlled, progressive, self, domiciliary, dilatation with foley catheter. Four patients became asymptomatic and did not require any other type of dilatation. One patient initially was not able to do the dilatations properly so she required re-training, after which she remained asymptomatic. Foley catheter dilatation of the strictures of the upper end of oesophagus was found to be simple, effective, easy to carry out, comfortable for the patient and economical.

Late bronchoplasty for missed traumatic rupture of bronchus.

Two patients of traumatic rupture of main bronchus are reported here. One patient presented 2 years after blunt chest trauma while the other patient presented 9 weeks after trauma. Lesion in both patients were missed in the immediate post-trauma period. In both patients pulmonary angiogram demonstrated normal vasculature in the atelectatic lung, while intraoperatively good compliance and elasticity were found. Bronchoplasty done in both patients had good postoperative results.

Bilateral morgagni hernia masquerading as mediastinal mass.

Bilateral Morgagni hernia is a rare entity. A patient of bilateral Morgagni hernia presenting as mediastinal mass is being reported. The hernial contents included transverse colon so the diagnosis could be confirmed preoperatively by barium enema. Surgery was curative.

A case of bilateral pulmonary hydatid cysts.

A case of bilateral hydatid lung disease is reported who presented with a history of short duration and large opacities in both lung fields. A trial of medical treatment with albendazole 400 mg BD for 6 weeks failed. The patient was managed by surgical intervention which also ultimately established the diagnosis of hydatid disease.

Evaluation of peritoneovenous shunt in refractory cirrhotic ascites in Indian patients.

Ten patients with tense and refractory cirrhotic ascites underwent a modified peritoneovenous shunt procedure. Nine patients responded with complete resolution of ascites, mean weight gain of 5 (range 0-8) Kg, and rise in serum albumin level of 0.6 g/dL. Six patients improved from Child's class B to A. The longest survival period was 2.3 years. The main constraint in a developing country is the high cost of the shunt.

Immunodiagnosis in clinical practice.

Although the definitive diagnosis of diseases caused by worms and protozoa depends upon the demonstration of adult parasite or its ovum in excreta, blood and tissue biopsies of the patient, immunological methods can be of help in the identification of associated immunological syndromes, pathogeneses of these infections in man and as a guide to therapy. However, the non-availability of pure antigens is a limiting factor in effective application of these tests. The present paper describes the immunological syndromes associated with these diseases as well as some of the in-use immunodiagnostic tests.

The role of nerves in the production of cardiac arrest during surgical anaesthesia.

The role of cardiac nerves in the production of cardiac arrest during surgical anaesthesia on coronary ligated hypoxic heart has been studied. When atropinished coronary ligated dogs were exposed to hypoxia the terminal event was a cardiac asystole in 88% of the dogs. In propranolol treated dogs, or in dogs where sympathetic ganglia upto T6 were bilaterally removed earlier, coronary ligation and hypoxia produced ventricular extrasystoles, ventricular tachycardia and repeated sinus arrest followed by ventricular fibrillation. The possibility of the origin of arrythmia from the damaged myocardium, and the presence of an intact vagus in the production of ventricular fibrillation has been discussed.