ABSTRACT
Hepatic hydrothorax is an uncommon complication in patients with end-stage liver disease. It may result in dyspnoea, hypoxia and infection, and carries a poor prognosis. Initial treatment is based on a sodium-free diet together with diuretics. In case of recurrent hydrothorax, a transjugular intrahepatic portosystemic shunt (TIPS) or liver transplant should be considered. Here we describe an 80-year-old woman with decompensated liver cirrhosis related to NASH who presented with refractory hepatic hydrothorax. Treatment with CPAP resulted in a marked improvement in her pleural effusion. LEARNING POINTS: Hydrothorax is uncommon, occurring in up to 4-6% of all patients with cirrhosis and in up to 10% of patients with decompensated cirrhosis.Hepatic hydrothorax can be refractory to diuretics and salt restriction.CPAP may be an interesting alternative treatment.
ABSTRACT
Esophagogastrectomy is generally considered to be the treatment of choice for resectable tumors of the esophagus. Although many approaches and techniques have been advocated, since April 1983 we have used a left thoracophrenotomy approach for most lesions of the lower two thirds of the esophagus and gastric cardia. Stapling instruments have been used for mobilization of the stomach and fashioning of the esophagogastric anastomosis. One-hundred fifteen patients undergoing resection of malignant tumors with this technique were retrospectively reviewed. Perioperative mortality was 8.7% (10/115). The rate of anastomotic leakage was 1.7% (2/115), and benign narrowing of the anastomosis requiring dilation developed in 16 patients. The rate of recurrent anastomotic tumor was 4.3%. Eighteen patients had complications, and the mean postoperative hospital stay was 13 days. Survival at 3 years was 22.1%. During the period of study, 22 patients underwent esophageal resection by some other approach; the reasons for this are described. The advantages of the left thoracophrenotomy approach are discussed.
Subject(s)
Esophagus/surgery , Gastrectomy/methods , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/mortality , Diaphragm/surgery , Esophageal Neoplasms/mortality , Esophageal Neoplasms/pathology , Esophageal Neoplasms/surgery , Female , Humans , Length of Stay , Male , Middle Aged , Neoplasm Staging , Retrospective Studies , Surgical Staplers , Survival Rate , ThoracotomySubject(s)
Aspergillus/isolation & purification , Lung Diseases, Fungal/complications , Lung Diseases/microbiology , Rheumatoid Nodule/microbiology , Humans , Lung/pathology , Lung/surgery , Lung Diseases/complications , Lung Diseases/pathology , Lung Diseases, Fungal/microbiology , Lung Diseases, Fungal/pathology , Male , Middle Aged , Rheumatoid Nodule/complications , Rheumatoid Nodule/pathologyABSTRACT
This is a comparative study of two methods to relieve postoperative thoracotomy pain. Continuous thoracic epidural infusion of fentanyl produced superior analgesia when compared with cryo-analgesia of the relevant thoracic nerves. Linear analogue pain scores were consistently lower in the epidural group reaching significance (p less than 0.05) at 32 and 40 hours after operation. All 36 patients in the cryo-analgesia group required additional analgesia, while 12 out of the 32 patients in the epidural group did not. This difference was significant at p less than 0.001. Respiratory and cardiovascular measurements were similar in both groups and the only side effect attributable to the epidural fentanyl was itching but this was not a problem.
