ABSTRACT
Eight patients with achalasia were treated using laparoscopic esophagomyotomy and anterior (Dor) fundoplication. The procedures were done on patients with clinical, radiological, and manometric diagnoses of achalasia. All procedures were completed laparoscopically. Seven (88%) of the patients were eating by the 3rd postoperative day. The average hospital stay was 4.1 days (2-11 days); analgesic use was minimal. All myotomies were complete, with no patient requiring reoperation or dilation. The only complication was a mucosal laceration in one patient; this was successfully repaired laparoscopically. Follow-up from 8 to 20 months shows that swallowing is excellent in 88 per cent and good in 12 per cent of patients, and no patient requires antireflux medication. These results support minimally invasive surgical myotomy as the treatment of choice for symptomatic achalasia.
Subject(s)
Esophageal Achalasia/surgery , Laparoscopy , Adult , Aged , Aged, 80 and over , Esophagus/surgery , Humans , Laparoscopy/adverse effects , Middle Aged , Treatment OutcomeSubject(s)
Osteomyelitis/surgery , Ribs/surgery , Adolescent , Humans , Male , Osteomyelitis/etiology , Staphylococcal Infections/complicationsABSTRACT
The plan for cervical lymph node biopsy should include special maneuvers for recognition of patients with lymphadenitis due to atypical mycobacteria, since these children need extensive operations. The diagnosis should be suspected in children less than 3 yr old with lymphadenopathy present for several months and no exposure to cats (or with negative cat scratch skin tests). Wide local excision of all visibly involved nodes is recommended; acid-fast touch preparations should be done and interpreted during operation in any suspicious case. Limited operations should be avoided in children with mycobacterial lymphadenitis. The illness may be more common than previously suspected.
Subject(s)
Lymphadenitis/surgery , Mycobacterium Infections, Nontuberculous/surgery , Mycobacterium Infections/surgery , Cat-Scratch Disease/diagnosis , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Lymph Node Excision , Lymphadenitis/diagnosis , Lymphadenitis/etiology , Male , RecurrenceABSTRACT
In a review of 72 cases of trauma to the colon we have demonstrated that a 51 per cent primary closure rate can be obtained if the following considerations are used: 1) anatomic location of colon injury, 2) degree of fecal contamination, 3) number of associated organs injured. Considering these factors individually or in combination we were able to perform primary closure in 51 per cent of our patients, without colostomy and without increasing morbidity and mortality. As a result, the number of hospital days and surgical procedures have been reduced.
