ABSTRACT
BACKGROUND: The aim of this study was to investigate tracheal acid aspiration after oesophagectomy and to determine whether it is influenced by nasogastric (NG) drainage. METHODS: Thirty-four patients undergoing oesophagectomy were randomized to one of three methods of NG drainage: a single-lumen tube with free drainage and 4-hourly aspiration, a sump-type tube on continuous suction drainage, or no NG tube. A tracheal pH probe was used to collect information on acid aspiration for 48 h after surgery. A pH < 5.5 was considered abnormal (normal pH 6.8-7.2). Total time with tracheal pH < 5.5, number of reflux episodes and longest reflux time were compared between groups. RESULTS: There was significant and persistent tracheal acid aspiration in all patients. Patients with a sump-type tube had a significantly shorter total time with tracheal pH < 5.5 than those in the other groups (sump-type tube versus single-lumen tube, P = 0.0069; sump-type tube versus no tube, P = 0.0071). Patients randomized to no NG tube experienced more respiratory complications after surgery than those who had either single-lumen or sump-type tubes (seven of 12 versus four of 22 patients; P = 0.023). Insertion of a NG tube was necessary in the first week after surgery in seven of 12 patients in this group. CONCLUSION: Routine NG drainage after oesophagectomy is necessary. A sump-type NG tube is better at preventing tracheal acid aspiration and may reduce the incidence of respiratory complications.
Subject(s)
Acids/analysis , Drainage/methods , Esophageal Neoplasms/surgery , Esophagectomy/methods , Trachea/chemistry , Female , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/etiology , Humans , Hydrogen-Ion Concentration , Length of Stay , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/etiologyABSTRACT
The anatomy of the thoracic duct varies considerably. This can make it difficult to locate during oesophageal surgery, especially in the fasted patient. We describe the technique of administering cream orally before primary oesophageal surgery, to aid in the identification of the thoracic duct. The duct along with other lymphatic channels can then be ligated as appropriate, helping to reduce the incidence of post-operative chylothorax.
Subject(s)
Chylothorax/prevention & control , Dairy Products , Esophagectomy , Administration, Oral , Humans , Postoperative Complications/prevention & control , Thoracic Duct/anatomy & histologySubject(s)
Mediastinitis/therapy , Sternum/surgery , Surgical Wound Infection/therapy , Humans , Mediastinitis/etiology , Polyurethanes , SuctionABSTRACT
Contained rupture of the left ventricle is uncommon; rupture secondary to a myocardial abscess is exceedingly rare. A case is presented of a contained rupture of a myocardial abscess in a patient with Staphylococcus aureus septicemia. The rupture was repaired surgically, and the patient survived.
Subject(s)
Abscess/surgery , Endocarditis, Bacterial/surgery , Heart Rupture/surgery , Heart Ventricles/surgery , Staphylococcal Infections/surgery , Abscess/pathology , Adult , Aneurysm, False/pathology , Aneurysm, False/surgery , Endocarditis, Bacterial/pathology , Female , Heart Aneurysm/pathology , Heart Aneurysm/surgery , Heart Rupture/pathology , Heart Ventricles/pathology , Humans , Sepsis/pathology , Sepsis/surgery , Staphylococcal Infections/pathology , Substance Abuse, Intravenous/complicationsABSTRACT
A 32-year-old male presented with a painful, rapidly enlarging chest wall mass. A malignant chest wall neoplasm was suspected. A CT scan was performed which showed a mass extending from under the scapular and an exostosis arising from the anterior surface of the scapular. The mass and exostosis were resected resulting in complete resolution of symptoms. Histological examination showed the mass to be a reactive bursa, with no evidence of neoplasia.
