ABSTRACT
Spontaneous rupture of the esophagus (Boerhaave's syndrome) has a dismal survival rate without prompt surgical management. A variety of surgical regimens have achieved survival of 70% or greater; however, the postoperative course is frequently complicated by fistula, would infection, empyema, and sepsis. We report an unusual postoperative chest wound infection of clostridial myonecrosis, which presumably originated from the patient's gastric microflora. He was treated with immediate surgical debridement of all involved tissue, prolonged ventilation, total parenteral nutrition, and frequent dressing changes. The remaining defect was closed with a skin graft. Anaerobic wound infections of the chest wall and their management are discussed.
Subject(s)
Clostridium Infections/etiology , Esophageal Diseases/complications , Muscular Diseases/etiology , Pectoralis Muscles/pathology , Surgical Wound Infection/etiology , Clostridium Infections/pathology , Clostridium perfringens , Esophageal Diseases/surgery , Humans , Male , Middle Aged , Muscular Diseases/pathology , Necrosis , Rupture, Spontaneous , Surgical Wound Infection/pathology , SyndromeABSTRACT
A 50-year-old fireman was found to have multiple endobronchial polyps when investigated for hemoptysis two months after acute thermal inhalation injury. Biopsy was obtained and the histology demonstrated benign granulation tissue. The polyps spontaneously regressed, without specific treatment, six months after the accident. Tracheal bronchial polyposis appears to be another complication of heat and smoke inhalation.
Subject(s)
Bronchial Neoplasms/etiology , Burns, Inhalation/complications , Polyps/etiology , Tracheal Neoplasms/etiology , Bronchial Neoplasms/pathology , Hot Temperature/adverse effects , Humans , Male , Middle Aged , Polyps/pathology , Tracheal Neoplasms/pathologyABSTRACT
Ninety-nine patients with Stage I or II lung carcinoma that was other than the small cell type and who survived for more than 30 days after a "curative" resection were followed for five years or until death if it occurred prior to the five-year anniversary. Recurrent disease developed in 44 patients. Clinical data and data from postmortem examination were reviewed in these 44 patients in an attempt to classify each recurrence as either initially local or distinct metastatic disease. The site of the first documented recurrence was local in 18 patients and distance metastases in 26. When the patients with recurrence were separated into TNM categories, it was apparent that in those patients without lymph nodes metastases demonstrated in the resected specimen (N0), the initial recurrence tended to be a distant metastases, whereas in those with such involvement (N1), the initial occurrence was more often local. In light of these data, selection of appropriate initial adjuvant therapeutic modalities may be different for each type of patient.
Subject(s)
Lung Neoplasms/surgery , Neoplasm Recurrence, Local , Female , Follow-Up Studies , Humans , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Male , Neoplasm Metastasis , Neoplasm Staging , PrognosisABSTRACT
One hundred patients, ultimately proved to have chest malignancies, were evaluated prospectively with conventional chest tomography and computed tomography. In 58 patients with primary malignancies, conventional tomograms were more useful in evaluation of the hilus than CT scans. The mediastinum was better assessed by CT. Thus, evaluation of the presence of neoplasia is better accomplished by conventional examination, while extent of disease is best assessed by CT. Thoracotomy for curative resection was not attempted (in the latter cases of this series) based on CT findings of mediastinal involvement. In 42 patients with metastases to the chest, CT scans of the lung parenchyma were more sensitive than whole lung tomography but had little additional impact on patient treatment. Nevertheless, in 18 patients the results of CT or whole lung tomography directly affected patient therapy.
