The influence of the transposed stomach through the posterior mediastinum on the respiratory forced expiratory volume and forced vital capacity in patients with resected esophageal cancer.

Although the use of the posterior mediastinum and the stomach as a reconstruction option after esophagectomy has large acceptance all over the world, there are concerns about the potential respiratory impairment it could cause. We prospectively studied 35 patients regarding the forced expiratory volume and vital capacity. The patients were studied preoperatively and between the 45th and 60th postoperative days. The value of both parameters decreased, although they were still within normal clinical ranges. We concluded that this type of reconstruction does not harm the patients regarding the respiratory flow rates.

Perfusional evaluation of postesophagectomy gastroplasty with a radioisotopic study.

SUMMARY: Anastomotic fistula represents one of the frequent causes of postoperative morbidity and mortality following transhiatal esophageal resections. The main etiological factor is the ischemia of the gastric tube created for digestive transit reconstruction. Evidence suggests that per operative hypoperfusion can be maintained or even impaired after the surgery. Several methods have been employed in an attempt to assess the blood perfusion of the gastric flap, but they all pose limitations. However, there is a chronological relationship between perfusion assessments, which are almost exclusively performed per operatively, and the occurrence of a leak, which commonly appears several days after the surgery. The authors have developed a method of gastric perfusion evaluation by single photon emission computed tomography scintigraphy, which corrects that temporal matter, allowing the estimation of postoperative gastric perfusion. It is noninvasive, low cost, and may be applied by the time frame when most fistulas occur. High correlation between the event fistula and the low radiotracer uptake in the group of studied patients could be demonstrated. A role in the research of perfusion evaluation of different types of esophageal reconstruction is suggested.

Influence of transposed stomach on cardiac function in patients with resected esophageal cancer.

Although the use of the posterior mediastinum and the stomach as a reconstruction option after esophagectomy has wide acceptance, there are concerns about the potential cardiac impairment it could cause. We prospectively studied 27 patients regarding the function and the systolic diameter, diastolic diameter, shortening fraction, ejection fraction and the presence of extrinsic compression. The patients were studied preoperatively and between the 45th and 60th postoperative days. The parameters were still within normal clinical ranges. We concluded that this type of reconstruction does not harm the patients in terms of their cardiac function.

Thoracoscopic enucleation of a leiomyoma of the upper thoracic esophagus.

The authors present two cases of leiomyoma of the upper esophagus. Both of the cases presented with dysphagia, and one patient complained of pyrosis. An upper gastrointestinal endoscopy showed midesophageal narrowing without mucosal irregularity, suggestive of leiomyoma. The patients were successfully treated by thoracoscopic enucleation of the leiomyoma, using four thoracic trocars. In one patient (Case 1), the azygus vein had to be divided. Both of the patients are asymptomatic in the late-postoperative period.

Comparative anatomical study of the anterior and posterior mediastinum as access routes after esophagectomy.

Esophagectomy is the main option for treatment of esophageal cancer. Among the subjects of surgical interest is the use of anterior versus posterior mediastinum to permit reconstruction of the alimentary tract. We performed postmortem measurements in order to analyze the lengths of both routes. For each route (anterior and posterior) we performed two measurements. The first one was called anatomical route and the second was named as surgical route. Both routes begin at the cricoid cartilage. The anatomical route goes to the celiac axis and the surgical route goes to the gastroduodenal artery. Our results show that in both routes the posterior mediastinum is a shorter way to reach the cervical region.

The influence of the transposed stomach through the posterior mediastinum on the respiratory forced expiratory volume and forced vital capacity in patients with resected esophageal cancer.

Although the use of the posterior mediastinum and the stomach as a reconstruction option after esophagectomy has large acceptance all over the world, there are concerns about the potential respiratory impairment it could cause. We prospectively studied 35 patients regarding the forced expiratory volume and vital capacity. The patients were studied preoperatively and between the 45th and 60th postoperative days. The value of both parameters decreased, although they were still within normal clinical ranges. We concluded that this type of reconstruction does not harm the patients regarding the respiratory flow rates.

Colecistite aguda em compartimento distal de vesicula bilobada com septacao transversal. / Acute cholecystitis in distal compartment of bilobate gallbladder with transversal septation

Trata-se de um caso raro, num menino de 10 anos que apresentava crises de dor no hipocondrio direito e epigastrico, em consequencia de colecistite aguda. No entanto os exames habitualmente realizados nesta situacao, revelaram-se normais. A suspeita diagnostica de anomalia de forma de vesicula so foi possivel na ocasiao pelo estudo laparoscopico, com o diagnostico definitivo atraves de cirurgia e estudo radiologico transoperatorio. Estes confirmaram a presenca de vesicula com septacao transoperatorio. Estes confirmaram a presenca de vesicula com septacao transversal, com formacao consequente de dois compartimentos isolados e com colecistite aguda no distal. Este tipo de anomalia de forma e extremamente raro. Mais raro ainda e a instalacao concomitante de colecistite aguda. Na literatura existe um caso descrito de colecistite aguda, mas em vesicula dupla