Thoracoscopic enucleation of esophageal leiomyoma in prone position and single lumen endotracheal intubation.

INTRODUCTION: Esophageal leiomyomas are the most common benign tumors of the esophagus. Surgical enucleation is warranted for symptomatic patients. Thoracoscopic enucleation is the preferable approach for being less invasive by avoiding the discomfort and complications associated to larger thoracic incisions. The purpose of this study was to review our experience with enucleation of esophageal leiomyoma using a prone-position thoracoscopy technique. METHODS: Between January 2009 and July 2012, ten patients underwent resection of esophageal leiomyoma by thoracoscopy approach in prone position. Indications for surgical treatment were symptomatic tumors (dysphagia). All patients were followed postoperatively for at least 3 months with contrast x-ray of the esophagus. After single-lumen endotracheal intubation (nonselective intubation) in supine, patients were placed in prone position. Pneumothorax was kept at 6 to 8 mmHg using CO2 insufflation. A myotomy was performed over the tumor using hook cautery carefully protecting the mucosa from injuries. The myotomy was closed with continuous sutures. RESULTS: The procedures were completed in the prone position in all cases, without any conversion. Mean operative time was 89.2 ± 28.7 minutes. Bleeding was negligible, and there were no intraoperative or postoperative complications. No intensive care unit support was needed for any patient. Chest x-ray in the first postoperative day showed no significant changes in any patient. The mean hospital stay was 3.2 days. Contrast x-ray of the esophagus was normal in all patients at 3 months postoperatively. CONCLUSIONS: Thoracoscopic enucleation of esophageal leiomyoma is a feasible, simple, and safe procedure. Thoracoscopy in the prone position with CO2 insufflation allows the use of usual technique of intubation and also provides optimal operative field. The advantages of the thoracoscopic approach are less postoperative discomfort and lower risk of complications from open thoracotomy (especially pulmonary).

[Comparative study of 3 portasystemic shunts following 65% hepatectomy in the dog. Evaluation of 2 specific functions of the liver]. / Etude comparative de trois shunts porto-systémiques après hépatectomie de 65% chez le chien. Evaluation de deux fonctions spécifiques du foie.

Three types of porto-systemic shunt were performed in the dog following 65% hepatectomy with the aim of determining the best porto-systemic shunt for the maintenance of hepatic function during regeneration of the liver: terminolateral portocaval shunt, mesenterico-caval shunt and spleno-pancreatico-caval shunt. The hepatic functions studied were the hydroxylation of vitamin D and proaccelerin synthesis. These functions were unaffected by the mesenterico-caval shunt whilst they were depressed to the same extent by both other types of shunt.

[Terminolateral portacaval shunt does not prevent hepatic regeneration after 65% hepatectomy in the dog. Value of parenteral nutritional support]. / Le shunt porto-cave termino-latéral n'empêche pas la régénération hépatique après hépatectomie de 65% chez le chien. Intérêt du support nutritionnel parentéral.

Lack of portal blood supply to the liver induced by end to side porto-caval shunt leads to liver atrophy but does not prevent hepatic regeneration after 65% hepatectomy in the dog. This work demonstrates the usefulness of parenteral nutritive support with a branched-chain amino acids enriched essential amino-acids solution in helping hepatic function restoration by comparison of three groups of animals which were fed either parenterally (two groups) or per os (1 group).

Limpeza mecanica e antissepsia do colon. uso do manitol a 10% associado a eritromicina e neomicina. / Mechanical cjeansing and antissepsis of the colon. Use of a 10% manitol solution associated with eryhtromicin and neomicin

Os autores relatam a experiencia no preparo do colon pelo uso de manitol a 10%, associado a eritromicina e neomicina. Foram estudados 116 pacientes no periodo de agosto de 1979 a julho de 1980.Sao discutidos a tecnica de administracao, e os resultados quanto a tolerancia, duracao do efeito, balanco de agua, perda de peso, balanco ionico, vacuidade do colon, estudo bacteriologico, complicacoes do metodo e complicacoes pos-operatorias. Concluem que houve reducao do tempo de internamento, boa tolerancia, facilidade do metodo e reducao da populacao bacteriana. A vacuidade do colon foi excelente em 80% e boa em 15% segundo criterios de Hollender