Jejunostomy tube feeding in patients undergoing esophagectomy.

BACKGROUND: Surgical jejunostomy tubes are a routine part of elective esophagectomies in patients with carcinomas and provide a route for nutritional support in those who experience complications. We wished to determine how frequently oral intake is delayed and the amount of nutrition delivered via the jejunostomy tube. METHODS: We reviewed the charts of all adults undergoing esophagectomy for carcinoma between January 2000 and June 2008. We determined the proportion of patients unable to resume oral nutrition after 8 days and the amount of nutrition delivered in each of the 8 days. RESULTS: In all, 111 patients underwent elective esophagectomy for carcinoma, and 103 had a jejunostomy tube placed. The mean age was 67 ± 10.8 years. The median time to oral intake was 7 (interquartile range 7-11) days. Seventy-four (67%) patients resumed oral intake within 8 days. The mean nutrition delivered by jejunostomy within the first 8 days as a percentage of the target was 45.6% (95% confidence interval 41.2%-49.9%). Six (5.4%) patients experienced complications attributable solely to the jejunostomy tube; 3 (2.9%) required surgery. Forty (38.8%) patients had abdominal issues serious enough to warrant delaying the progression of feeding. CONCLUSION: Two-thirds of patients undergoing elective esophagectomy were tolerating oral intake by the end of the eighth postoperative day, and less than half of the target nutrition was delivered over the first 8 days. We now selectively place surgical jejunostomy tubes in patients undergoing elective esophagectomies.

CONTEXTE: Des cathéters de jéjunostomie chirurgicale sont d'emblée posés lors des oesophagectomies non urgentes chez les patients atteints de cancer et procurent une voie d'administration du soutien nutritionnel chez les patients qui présentent des complications. Nous avons voulu déterminer la fréquence à laquelle la prise orale est retardée et la quantité de solution pour nutrition parentérale administrée par le cathéter de jéjunostomie. MÉTHODES: Nous avons analysé les dossiers de tous les adultes soumis à une oesophagectomie pour un cancer entre janvier 2000 et juin 2008. Nous avons calculé la proportion de patients incapables de recommencer à se nourrir par la bouche après 8 jours et la quantité de solution administrée à chacun des 8 jours. RÉSULTATS: En tout, 111 patients ont subi une oesophagectomie non urgente pour un cancer et on a posé un cathéter de jéjunostomie à 103 d'entre eux. L'âge moyen était de 67 ± 10,8 ans. L'intervalle médian avant le début des prises orales a été de 7 jours (fourchette interquartile de 7­11). Soixante-quatorze patients (67 %) ont recommencé à s'alimenter par la bouche en l'espace de 8 jours. La quantité moyenne de solution pour nutrition parentérale administrée par jéjunostomie au cours des 8 premiers jours en pourcentage de l'objectif cible a été de 45,6 % (intervalle de confiance [IC] de 95 %, 41,2 %­49,9 %). Six patients (5,4 %) ont présenté des complications attribuables uniquement au cathéter de jéjunostomie; 3 (2,9 %) ont eu besoin d'une chirurgie. Quarante patients (38,8 %) ont présenté des symptômes abdominaux suffi - samment graves pour retarder la progression de l'alimentation. CONCLUSION: Les deux tiers des patients soumis à une oesophagectomie non urgente toléraient la prise orale à la fin du huitième jour postopératoire et moins de la moitié de la nutrition cible a été administrée au cours des 8 premiers jours. Nous plaçons maintenant des cathéters de jéjunostomie chirurgicale de façon sélective chez les patients qui subissent des oesophagectomies non urgentes.

Leiomyoma of the trachea.

Primary tracheal tumors are rare. Approximately 1% of them are leiomyoma. Given the rarity of these lesions, optimal management has not been defined. Bronchoscopic, local surgical excision and partial tracheal resection have all been described. One report of recurrence after resection has been published. The incidence of recurrence following local excision is unknown. We report a case of an incidental tracheal leiomyoma diagnosed and treated with a combined approach.

Effect of maintenance azithromycin on established bronchiolitis obliterans syndrome in lung transplant patients.

BACKGROUND: Bronchiolitis obliterans syndrome (BOS), the main cause of late mortality following lung transplantation, is defined as an irreversible decline in forced expiratory volume in 1 s (FEV1). Previous studies using azithromycin for BOS in lung transplant patients have demonstrated a potential reversibility of the decline in FEV1. OBJECTIVES: To examine whether initiating azithromycin reverses decline in FEV1 in lung transplant recipients with established BOS of at least three months. METHODS: Pulmonary function tests were performed every three months in seven lung transplant recipients with established BOS of at least three months. FEV1 was recorded at six and three months before initiation, at time of initiation, and three, six, nine and 12 months postazithromycin initiation. The primary end point was change in FEV1. During the study, no immunosuppressive medication changes or acute rejection episodes occurred. RESULTS: Mean time from transplant to azithromycin initiation was 64 months (range 17 to 117 months). Mean time from BOS diagnosis to azithromycin initiation was 22 months (range three to 67 months). Rate of FEV1 decline from six months before azithromycin initiation, and rates of FEV1 increase from initiation to three and 12 months post-treatment initiation, were not statistically significant (P=0.32, P=0.16 and P=0.18, respectively). Following a trend toward improvement in the first three months after treatment initiation, FEV1 tended to stabilize. DISCUSSION: Although several studies address the possible benefit of maintenance azithromycin in lung transplant patients with BOS, the role of the drug remains unproven in these patients, and would best be addressed by a large randomized controlled trial.