Surgical Outcomes for Native Valve Endocarditis

Background@#The aim of this study was to evaluate the short-term and long-term results of surgical treatment for native valve endocarditis (NVE) and to investigate the risk factors associated with mortality. @*Methods@#Data including patients’ characteristics, operative findings, postoperative results, and survival indices were retrospectively obtained from Hallym University Sacred Heart Hospital. @*Results@#A total of 29 patients underwent surgery for NVE (affecting the mitral valve in 20 patients and the aortic valve in 9) between 2003 and 2017. During the follow-up period (median, 46.9 months; interquartile range, 19.1–107.0 months), the 5-year survival rate was 77.2%. In logistic regression analysis, body mass index (p=0.031; odds ratio [OR], 0.574; 95% confidence interval [CI], 0.346–0.951), end-stage renal disease (ESRD) (p=0.026; OR, 24.0; 95% CI, 1.459–394.8), and urgent surgery (p=0.010; OR, 34.5; 95% CI, 2.353–505.7) were significantly associated with in-hospital mortality. Based on Cox proportional hazard regression analysis, the statistically significant predictors of long-term outcomes were hypertension, ESRD, and urgent surgery. @*Conclusion@#Surgical treatment for NVE is associated with considerable mortality. The in-hospital mortality and 5-year survival rates of this study were 13.8% and 77.2%, respectively. Underlying conditions, including hypertension and ESRD, and urgent surgery were independent risk factors for unfavorable outcomes.

Analysis of Risk Factors for Conversion from Off-Pump to On-Pump Coronary Artery Bypass Graft

BACKGROUND: Off-pump coronary artery bypass (OPCAB) is performed worldwide, but significant risks are associated with conversion to on-pump surgery. Therefore, we evaluated the composite outcomes between an OPCAB group and a conversion group. METHODS: From January 2008 to December 2012, 100 consecutive patients underwent OPCAB at Hallym University Sacred Heart Hospital, of whom 84 underwent OPCAB without adverse events (OPCAB group), and 16 were converted to on-pump surgery (conversion group). Early morbidity, early and long-term mortality, and major adverse cardiac and cerebrovascular events (MACCEs) were the primary and long-term composite endpoints. RESULTS: The mean follow-up period was 55±26 months, with 93% of the patients completing follow-up. The composite outcomes in the OPCAB and conversion groups were as follows: early morbidity, 2.3% versus 12.5%; early mortality, 4.7% versus 0%; long-term mortality, 14.3% versus 25.0%; and MACCEs, 14.3% versus 18.8%, respectively. No composite endpoints showed statistically significant differences. Preoperative acute myocardial infarction (AMI) was identified as an independent risk factor for conversion (p=0.025). CONCLUSION: The conversion group showed no statistically significant differences in early mortality and morbidity, MACCEs, or long-term mortality compared with the OPCAB group. The preoperative diagnosis of AMI was associated with an increased number of conversions to on-pump surgery.

Liquid Chromatography-Mass Spectrometry-Based In Vitro Metabolic Profiling Reveals Altered Enzyme Expressions in Eicosanoid Metabolism

BACKGROUND: Eicosanoids are metabolites of arachidonic acid that are rapidly biosynthesized and degraded during inflammation, and their metabolic changes reveal altered enzyme expression following drug treatment. We developed an eicosanoid profiling method and evaluated their changes on drug treatment. METHODS: Simultaneous quantitative profiling of 32 eicosanoids in liver S9 fractions obtained from rabbits with carrageenan-induced inflammation was performed and validated by liquid chromatography-mass spectrometry coupled to anion-exchange solid-phase purification. RESULTS: The limit of quantification for the devised method ranged from 0.5 to 20.0 ng/mg protein, and calibration linearity was achieved (R 2>0.99). The precision (% CV) and accuracy (% bias) ranged from 4.7 to 10.3% and 88.4 to 110.9%, respectively, and overall recoveries ranged from 58.0 to 105.3%. Our method was then applied and showed that epitestosterone treatment reduced the levels of all eicosanoids that were generated by cyclooxygenases and lipoxygenases. CONCLUSIONS: Quantitative eicosanoid profiling combined with in vitro metabolic assays may be useful for evaluating metabolic changes affected by drugs during eicosanoid metabolism.

Hemoglobin Level to Facilitate Off-Pump Coronary Artery Bypass without Transfusion

BACKGROUND: Conservation of blood during cardiac surgery is important because of the shortage of donor blood, risks associated with transfusion, and the costs of allogeneic blood products. This retrospective study explored the feasibility of off-pump coronary artery bypass (OPCAB) without transfusion. METHODS: One hundred and two consecutive patients underwent OPCAB from January 2007 to June 2012 at Hallym University Sacred Heart Hospital. Excluding 10 chronic renal failures patients, 102 patients were enrolled. Their characteristics, clinical data, and laboratory data were analyzed. We investigated the success rate of OPCAB without transfusion according to preoperative hemoglobin (Hb), and the cutoff point of the Hb level and the risk factors for transfusion. We implemented multidisciplinary blood-saving protocols. RESULTS: The overall operative mortality and the success rate of OPCAB without transfusion were 2.9% (3/102) and 73.5% (75/102). The success rates in patients with Hb70 years, diagnosis of acute myocardial infarction, preoperative Hb and creatinine levels, and operation time. The events precipitating the need for transfusion were low Hb level in 9 patients and hypotension or excessive bleeding in 18 patients. CONCLUSION: The preoperative Hb level of >11 facilitates OPCAB without transfusion. These results suggest that transfusion-free OPCAB can be performed by modifying the risk factors and correctable causes of transfusion and improving various blood salvage methods.

A Convenient and Less Invasive Technique of Labial Minor Salivary Gland Biopsy Using a Minimal Incision With a Needle Tip

OBJECTIVES: This study was to show the technique and to compare the usefulness and complications of biopsy using a minimal incision with a needle tip of the labial minor salivary glands with those of conventional incisional lip biopsy in the diagnosis of Sjogren's syndrome. METHODS: We retrospectively reviewed the medical records of the patients who had the labial minor salivary gland biopsy for the diagnosis of Sjogren's syndrome between January 2005 and December 2008. One hundred forty-three patients were enrolled in this study. The yields of diagnostic salivary tissues and complications of the biopsy using a minimal incision with a needle tip and the conventional incisional lip biopsy were compared. RESULTS: Out of 143 patients, 56 patients underwent the conventional incisional lip biopsy and 87 patients received the biopsy using a minimal incision with a needle tip. In the biopsy using a minimal incision with a needle tip group, adequate salivary gland tissues were obtained in 85 patients out of 87 patients (97.7%). In the conventional incisional lip biopsy group, adequate specimens were acquired in 44 patients out of 56 patients (78.6%). There was no complication after the biopsy using a minimal incision with a needle tip, whereas there was one patient complained transient numbness of the lip after the conventional incisional lip biopsy. CONCLUSION: The less invasive labial minor salivary gland biopsy using a minimal incision with a needle tip was easy to perform and safe and showed the better result than the conventional incisional lip biopsy in terms of the adequate specimen in the diagnosis of Sjogren's syndrome. So it might be a good alternative to the conventional incisional lip biopsy.

Right Coronary Artery Fistula and Occlusion Causing Myocardial Infarction after Blunt Chest Trauma

Myocardial infarction (MI) secondary to coronary artery fistula and the subsequent occlusion of the distal right coronary artery (RCA) after blunt chest trauma is a rare entity. Here, we describe a case of coronary artery fistula and occlusion with an inferior MI that occurred following blunt chest trauma. At the initial visit to the emergency room after a car accident, this patient had been undiagnosed with acute myocardial infarction, readmitted five months after ischemic insult, and revealed to have experienced MI due to RCA-right atrial fistula and occlusion of the distal RCA. He underwent coronary surgery and recovered without complications.

Clinical Efficacy of Modified Inferior Meatal Mega-Antrostomy (Modified IMMA) Technique for Recalcitrant Chronic Isolated Maxillary Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Despite aggressive medical therapy and previous endoscopic sinus surgery, there are a subset of patients suffering from recalcitrant, persistent chronic isolated maxillary sinusitis which results from impaired mucocilliary clearance caused by long-standing inflammation. The corresponding patients underwent our newly devised Modified Inferior Meatal Mega-Antrostomy (Modified IMMA). The objective of this study was to review the clinical efficacy and complication after Modified IMMA in patients who had suffered from intractable maxillary sinusitis after endoscopic sinus surgery. SUBJECTS AND METHOD: Fourteen patients suffering from recalcitrant chronic isolated maxillary sinusitis underwent Modified IMMA between May 2010 and April 2013. The mean follow-up period was an average of about 13 months and regular intervals of postoperative 3-, 6-, 9-, 12-months were set. A retrospective review was performed to analyze the preoperative & postoperative Visual Analogue Scale score (VAS score) and Lund-Kennedy endoscopy score at each interval. VAS scores and endoscopic findings were processed statistically at the time of third postoperative month. The exclusion criteria were an obstructed ostiums, osteitis, systemic disease such as Ig A/G immunodeficiency, primary ciliary dyskinesia. RESULTS: The postoperative VAS scores and Lund-Kennedy scores, when compared with those prior to Modified IMMA, decreased from 16.5 to 2.5 and 5.0 to 1.0, respectively. Also, there was no serious complication or recurrence associated with the procedures. CONCLUSION: Our newly devised Modified IMMA could be a much effective option for surgical treatments in patients with recalcitrant chronic isolated maxillary sinusitis.

Fixation of Olecranon Fractures Using Plating System

PURPOSE: To evaluate the clinical and radiological outcomes of plate fixation for olecranon fractures which was difficult to be fixed firmly with tension band wiring alone. MATERIALS AND METHODS: From 1995 through 2008, 20 patients who underwent plate fixation of an olecranon fracture were included in this retrospective study. According to the Mayo classification, there were 3 type IIA fracture, 7 type IIB, and 10 type IIIB fractures. Clinical evaluation was done based on radiographic union of olecranon and measurements of range of motion at last follow-up. Disability of the arm, shoulder and hand (DASH) score and Mayo Elbow Performance score was used for evaluation of functional recovery. RESULTS: Union was achieved in 18 (90%) at an average of 5.6 months. The mean arc of elbow motion was 123degrees and the mean rotation arc was 81degrees. According to the MEPS, sixteen of twenty patients had a good or excellent outcome. The mean DASH score was 16.3. Most common complication was hardware irritation in 3 patients. CONCLUSION: Plate fixation is an effective treatment option for severe olecranon fracture pattern like comminuted fractures, Monteggia equivalent with unstable elbows and nonunions.

Descending Thoracic Aorta to Bilateral Femoral Artery Bypass in a Hostile Abdomen

Descending thoracic aorta to femoral artery bypass has been used as a remedial operation after aortic or axillofemoral graft failure or graft infection and other intra-abdominal pathologies not amenable to standard aortofemoral revascularization. It can avoid abdomen approach and has been known as a durable procedure with excellent long-term patency. We reported descending thoracic aorta to femoral artery bypass grafting for primary revascularization in a 55-year-old male with hostile abdominal conditions.

Comparison of Pharmacological Treatments for Burning Mouth Syndrome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Burning mouth syndrome (BMS) refers to a collection of symptoms of patients who complain about burning sensation of their mouths without any specific causes. Although this is not a rare disease, the etiology and effective treatment are not well established. We tried to compare the efficacy and side effects of the agents that are reported to be relatively effective to BMS. SUBJECTS AND METHOD: Fifty-one patients who were diagnosed as BMS were chosen as candidates. Trazodone, Paroxetine, Clonazepam, and Gabapentin, which were known to be effective medicines for BMS in previous research were prescribed randomly. We prescribed medication for two weeks and evaluated patients for the effect and side effects at the end of the treatment. The medication was prescribed for 2 more weeks and the patients were evaluated again. RESULTS: Three of 11 (27.3%) patients were prescribed Trazodone, 8 of 12 (66.7%) Paroxetine, 8 of 14 (57.1%) Clonazepam and 12 of 14 (85.7%) Gabapentin. Q showed improvements after 4 weeks of medication. The differential effectiveness among the medications was not significant, except for the inferiority of Trazodone. Five of 11 (45.5%) patients who had been prescribed Trazodone, 2 of 12 (16.7%) who had been prescribed Paroxetine, 2 of 14 (14.3%) who had been prescribed Clonazepam, 2 of 14 (14.3%) who had been prescribed Gabapentin complained of side effects during 4 weeks of medication. CONCLUSION: We can expect high success rates of treatment for burning mouth syndrome with Paroxetine, Clonazepam and Gabapentin. A further study for long term outcomes and side effects in large groups is warranted.

A Case of Ameloblastoma in the Maxilla

Ameloblastoma is a benign tumor originating from residues of the dental lamina. Ameloblastoma constitute approximately 1% of all tumors of the jaw, and the occurrence in the mandible is four times higher than that in the maxilla, suggesting that maxillary ameloblastoma is a rare histopathological entity. Although these tumors grow slowly and demonstrate a histologically benign appearance, ameloblastomas are notorious for local invasiveness and a high incidence of local recurrence. We experienced a case of ameloblastoma arising from the left maxilla in a 70-year-old male who complained of left nasal obstruction. The ameloblastoma was completely removed via the endoscopic endonasal approach combined with the Caldwell-Luc approach. At a 29-month follow-up, there was no evidence of recurrence.

Outcome of Video-assisted Thoracoscopic Surgery for Spontaneous Secondary Pneumothorax

BACKGROUND: Conventional treatment (i.e. chest tube insertion and chemical pleurodesis) still remains standard for patients with secondary spontaneous pneumothorax because the risk of surgical bullectomy is deemed high in this subset. However, it has been suggested that surgical treatment using thoracoscopy may expedite postoperative recovery and, thus, may reduce hospital stay. MATERIALS AND METHODS: Retrospective review of 61 patients with secondary spontaneous pneumothorax, who underwent conventional treatment (n=39) or video-assisted thoracoscopic surgery (VATS) (n=22) between January 2007 and December 2009, was performed. Talc was used for chemical pleurodesis in both groups. RESULTS: Hospital stay of conventional treatment group and VATS group was 14.2+/-14.2 days (4~58 days) and 10.6+/-5.8 days (5~32 days), respectively, with statistically significant difference (p=0.033). Recurrence rate of conventional treatment group was also significantly higher (12/39, 30%) compared to VATS group (1/22, 4.5%) (p=0.016). CONCLUSION: In selected patients with secondary spontaneous pneumothorax with continuous air leak or inadequate lung expansion, thoracoscopic surgery with chemical pleurodesis using talc results in shorter hospital stay and lower recurrence rate compared to conventional approach.

Endovenous Laser Treatment (EVLT) with High Ligation of an Incompetent Small Saphenous Vein / 대한흉부외과학회지

BACKGROUND: Endovenous laser treatment (EVLT) has recently been introduced as a less invasive technique for treating an incompetent small saphenous vein and many good results have been reported. The purpose of this study is to assess the efficacy and safety of EVLT combined with high ligation in patients with an incompetent small saphenous vein. MATERIAL AND METHOD: The study included 60 patients (66 limbs) who were treated with EVLT combined with high ligation of an incompetent small saphenous vein between January 2006 and May 2009. The preoperative clinical findings, the postoperative results and the postoperative ultrasonography follow up results at 1 and 3 months were reviewed. RESULT: Postoperative complications were observed in 17 patients (15 limbs, 28.3%) and postoperative paresthesia occurred in 5 limbs (7.6%), but there was no deep vein thrombosis. Ultrasonography follow up at 3 month was performed in 93.9% of the limbs (62/66). The vein occlusion rate at 1 and 3 months were found to be 91.9% (57/62) and 90.3% (56/62), respectively. CONCLUSION: We performed EVLT combined with high ligation and ambulatory phlebectomy in patients with an incompetent small saphenous vein, and this all revealed relatively satisfactory results with a low complication rate, but it showed a relatively low cure rate even though we also performed EVLT combined with high ligation altogether. We need to determine whether EVLT combined with a high ligation procedure will improve the venous occlusion rate. We also need to investigate how we can minimize the occurrence of nerve injury.

Daily dose of dopaminergic medications in Parkinson disease: Clinical correlates and a posteriori equation

Objectives: To survey daily doses of dopaminergic medications and to draw a posteriori equation of the dose in relation to the various clinical variables in Korean patients with Parkinson disease. Methods: A multi-center cross-sectional survey was conducted over a defi ned period. Information on patient demographics and clinical features including age at Parkinson disease onset, disease duration, treatment duration and Hoehn and Yahr stage, and daily doses of anti-parkinsonian drugs was obtained from the patients’ medical records. Results: A total of 1,762 patients with Parkinson disease were recruited from 6 referral centers. The mean L-dopa equivalent daily dose (LEDD) in the whole population was 608.9 mg/day, which tended to increase linearly depending on the duration of disease and Hoehn and Yahr stage. LEDD was also signifi cantly affected by age and gender. We performed multiple linear regression analyses and devised a posteriori equation of LEDD with clinical variables. Conclusions: This survey provides systematic data for mean LEDD in Korean Parkinson disease patients. In spite of profound individual variations in LEDD, our linear regression model provides an insight about the relationship between daily doses of dopaminergic medications and various clinical features of Parkinson disease.

Left Transradial Coronary Angiography in a Patient With Dextrocardia

Although dextrocardia occurs rarely, the incidence of coronary artery disease is similar to the general population. Because of unfamiliarity with performing catheterization, transradial coronary angiography has seldom been performed in a patient with dextrocardia. We successfully performed left transradial coronary angiography in a patient with a right side heart using counter-directional torquing of the catheters and mirror-image angiographic angles.

A Relationship between the Obstructive Sleep Apnea Syndrome and the Erythrocyte Sedimentation Rate

OBJECTIVES: The erythrocyte sedimentation rate (ESR) is a marker for inflammation, and it has been identified as a risk factor for atherothrombotic cardiovascular disease. The aim of this study was to determine the relationship between the plasma ESR level and nocturnal oxygen desaturation or other polysomnographic variables and to examine the role of obesity in patients with obstructive sleep apnea syndrome (OSAS). METHODS: This retrospective study included 72 patients with a diagnosis of OSAS who underwent overnight polysomnography and routine blood tests between July and December of 2005. We compared the plasma ESR level with the sum of all the polysomnographic variables and divided the patient group into obese and non-obese patients. RESULTS: The mean ESR level was 8.45 mm/hr. There was a significant difference in the ESR level between genders (P or =25, N=43, P=0.012). In addition, the ESR levels had a positive correlation with age in the obese group (P=0.002). However, there was no significant correlation with the percentage of time spent at a SpO2 below 90% in the whole group of patients and in the non-obese group (BMI <25, N=29). The ESR level showed no correlation with the other polysomnographic variables. CONCLUSION: The duration of deoxygenation in obese patients with OSAS may be associated with the ESR level which is an independent predictor of cardiovascular disease.

Reconstruction of the Posterior Canal Wall with Mastoid Obliteration after Canal Wall Down Mastoidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been heated controversies over the choice of the canal wall down mastoidectomy (CWD) and canal wall up mastoidectomy (CWU), which are operational methods used to eliminate the lesion of cholesteatoma. Combining the advantages of both methods, we reconstructed the posterior canal wall with conchal cartilage plate and obliterated mastoid cavity with bone chips (group I), or hydroxyapatite mixed with bone chips (group II) since 2001. This study was designed to evaluate the surgical outcomes of posterior canal wall reconstruction with mastoid obliteration in the treatment of cholesteatoma. SUBJECTS AND METHOD: From January of 2001 to March of 2007, the posterior canal wall reconstruction with mastoid obliteration was conducted on 66 patients. There were 30 cases of cholesteatoma and 36 cases of old radical cavity. The postoperative observation period ranged from 5 to 74 months, with the average period of 34.7 months. We analyzed the postoperative complications, and hearing results of the 33 ossicular reconstruction cases. RESULTS: There was 1 case of residual cholesteatoma in the middle ear cavity, but no recurrent cholesteatoma. In most cases, reconstructed canal wall was maintained well, but partial canal wall resorption and postauricular dimpling occurred in 5 cases of group I. On the other hand, the epithelization of posterior canal wall was incomplete in 4 cases of group II. After surgery, no patients complained any cavity problems at all. CONCLUSION: The present study suggests that this procedure can prevent cavity problems and reduce the recurrence of cholesteatoma with destructed canal wall.

Cloning of a Family of Serine Protease Genes Expressed in German Cockroach(Blattella germanica) and Possibility as Allergens / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The serine protease allergens have been known as one of the most important inhalent allergens of insects as well as house dust mites. There is no known serine protease allergen of German cockroach, which is a well-known etiological agent of allergic diseases. We identified the serine protease genes of cockroach, Blattella germanica, and examined its possibility as an allergen. MATERIALS AND METHOD: We have isolated three partial genes, Bg3, Bg5 and Bg6, of serine protease from the Blattella germanica cDNA library using the degenerate oligonucleotide PCR primers specific for the conserved regions. RESULTS: The genes, Bg3, Bg5 and Bg6, were composed of 396 bp 131 amino acids, 513 bp 170 amino acids, and 410 bp 136 amino acids, respectively. Northern hybridization analysis indicated that the size of Bg5 and Bg6 transcripts was approximately 0.7 kb. The gene, Bg5, was also identified as a multiple gene by the Southern blot analysis. The gene, Bg3, showed significant homology to trypsin-like serine protease of various insects. The deduced amino acids sequence of the gene Bg5 was matched to the mite group III allergen as well as various species of insect serine protease sequences. The gene Bg6 also showed high homology to the amino acids sequences of insect serine proteases and mite group III allergens. Three Blattella germanica serine protease gene fragments revealed close genetic relationships with Dermatophagoides farinae group III allergen in the phylogenetic analysis. CONCLUSION: The high homology and close phylogenetic relationship raise the possibility of three serine protease genes as being an allergen of German cockroach.

Comparison of the Efficacy of Systemic and Intratympanic Steroid Treatment on Sudden Sensorineural Hearing Loss with Diabetes / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: High dose systemic steroid therapy is currently the mainstay of the treatment for sudden sensorineural hearing loss (SSNHL). However, it makes a glycemic control worse in patients with diabetes. Intratympanic steroid injection (ITSI) can result in reduced systemic steroid toxicity and higher perilymph steroid level selectively. The purpose of this study is to compare the efficacy of ITSI (IT group) with that of systemic steroid (IV group) on SSNHL with diabetes. SUBJECTS AND METHOD: Thirty eight SSNHL patients who were diagnosed with diabetes were divided into the IV group (19 patients) and the IT group (19 patients). In the IV group, prednisolone was administrated intravenously for 7 days followed by tapered doses orally for 7 days. In the IT group, dexamethasone was administrated 4 times within a 2 week-period. Hearing outcome was assessed before and after treatment. RESULTS: In the IV group, 10 patients (58.8%) showed an improvement in the pure tone audiogram (PTA), with a mean improvement of 17.6 dB (p=0.023). In the IT group, 16 patients (84.2%) showed improvement in the PTA, with the mean improvement of 25.1 dB (p=0.000). But there was no significant difference in hearing gain and the recovery rate between the two groups. And it is more difficult to control blood sugar in the IV group rather than in the IT group. CONCLUSION: ITSI treatment is as effective as the systemic steroid treatment for SSNHL patients with diabetes and it can avoid a significant side effect of systemic steroids. So it could be considered as an initial treatment for the SSNHL patient with diabetes.

Clinical Results and Risk Factor Analysis of Surgical Treatment for Esophageal Perforation / 대한흉부외과학회지

BACKGROUND: Esophageal perforation is an emergency that requires early diagnosis and effective treatment. A delay in diagnosis and treatment significantly increases morbidity and mortality. MATERIAL AND METHOD: Thirty-seven patients with esophageal perforation were surgically treated at our institutions between January 1990 and December 2006. We retrospectively reviewed the results of surgical treatment for esophageal perforation to understand the risk factors affecting survival in patients. RESULT: Patients ranged in age from 21 to 87 years, with an average age of 52.7+/-16.98 years. Thirty-one of the patients were men and six were women. There were 23 patients (62%) with spontaneous perforations, 10 patients (27%) with a traumatic perforation, and 4 patients (11%) with an iatrogenic perforation. The site of esophageal perforation was the cervical esophagus in 5 patients, the thoracic esophagus in 31 patients, and the abdominal esophagus in one patient. Twenty-nine patients underwent primary closure of the perforation and five patients had T-tube drainage. Exclusion-diversion procedures were performed in two patients and an esophagectomy was performed in one patient. There were six cases of mortality (16.22%) and 25 cases of postoperative complications in 15 patients (40.5%). Patients that were treated later than 24 hours after detection of the perforation showed a statistically significant high morbidity and mortality rate (p<0.05). CONCLUSION: The most important risk factor of esophageal perforation was the time interval between detection of the perforation and the initiation of treatment. A prompt diagnosis and effective treatment are necessary to decrease morbidity and mortality.