Re-operations for failed anti-reflux surgery. Lessons from the past and prospects for the future.

Objective: The total number of re-operations for failed antireflux surgery is increasing dramatically worldwide. We reviewed our experience of re-operations for failed anti-reflux surgery to identify the factors contributing to unsuccessful re-operation which can be used in the era of laparoscopic surgery.

Method: One hundred twenty one patients were re-operated.

Changing dogmas: history of development in treatment modalities of traumatic pneumothorax, hemothorax, and posttraumatic empyema thoracis.

Development of treatment modalities for chest wounds and traumatic empyema thoracis is reviewed in the light of war experience. Mortality from thoracic injury was more than 50% before World War I and was about 25% during World War I. It came down to 10% in World War II and was about 5% during the Korean War.

The influence of age on gastro-oesophageal reflux: a re-appraisal of the DeMeester scoring system.

Objective: The statistical evaluation of the influence of age on the pattern of gastro-oesophageal reflux (GOR) identified by prolonged pH monitoring in asymptomatic subjects. Re-appraisal of the DeMeester scoring system for GOR.

Method: Prolonged pH monitoring was performed on 45 asymptomatic elderly adults with normal contrast oesophagogram, manometry and endoscopy.

Revisional surgery after colon interposition for benign oesophageal disease.

Although the short-term results of colon interposition for replacement of the oesophagus in part or as a whole are known to be satisfactory, there have been several reports of functional problems associated with total replacement in the long-term follow-up of patients. We have retrospectively studied patients who have required revisional surgery for anatomical and functional sequelae over a 7- to 38-year period. Although the short-segment colon interpositions have been relatively trouble free, several mechanical and functional problems requiring revisional surgery have been encountered in the long-term follow-up of patients who underwent long-segment colon interposition.

Bronchoplasty for malignant and benign conditions: a retrospective study of 44 cases.

Objective: To study the different operative techniques employed, the problems encountered and the outcome in bronchoplastic procedures both during and after surgery.

Patients And Methods: Forty-four patients with a mean age of 51.6 years (range 15-80 years) underwent bronchoplastic procedures in the period from 1976 to 1998.

Massive intrathoracic extrapleural haemangiopericytoma: deployment of radiotherapy to reduce vascularity.

Haemangiopericytoma is a rare, highly vascular, slow-growing tumour which has both malignant and benign varieties. We report a case of a 63-year-old man in whom it was treated by initial radiotherapy followed by complete surgical excision. The preoperative radiotherapy markedly reduced the vascularity of the tumour.

Functional and mechanical sequelae of colon interposition for benign oesophageal disease.

Objective: In an attempt to estimate the incidence and severity of the functional and mechanical problems associated with colon interposition for benign oesophageal disease, a retrospective analysis of a single centre experience was undertaken.

Methods: Between 1961 and 1990, a total of 365 patients who survived the postoperative stay in hospital were followed up over 7-38 years and form the basis for this study. Upper gastro intestinal symptoms in these patients were investigated clinically, radiologically, endoscopically and in the oesophageal laboratory.

Pedunculated intraluminal oesophageal fibrolipoma. A case report.

Benign tumours of the oesophagus are rare. A patient with a pedunculated intraluminal tumour presented with dysphagia of recent onset and the tumour resected at open operation and histology was confirmed as a benign vascular fibrolipoma. We discuss the management and review the relevant literature.

Solitary fibrous tumour of the diaphragm.

Solitary fibrous tumours are uncommon neoplasms that have been described as occurring in the pleura, peritoneum, lung, mediastinum, pericardium, nose and paranasal sinuses. This report describes the first known case of a solitary fibrous tumour of the diaphragm, occurring in a 60 year old woman with a two year history of respiratory symptoms. The lesion was initially misdiagnosed as an elevated left hemidiaphragm.

The relevance of abnormal motility patterns in intra-mural oesophageal leiomyomata.

Objective: Abnormal oesophageal motility patterns of the obstructive type in patients with gastro-oesophageal reflux without clinical evidence of obstruction raise the possibility of some co-existing problem.

Methods: In order to elucidate the relevance of such motility we studied two patients who were diagnosed as manifesting gastro-oesophageal reflux without herniation on full oesophageal investigations including radiology, ambulatory pH metry and endoscopy. In both patients leiomyomata were enucleated from the gastro-oesophageal junction at the time of surgery for reflux and subsequent oesophageal motility studies showed a return to near normal patterns.

Pharyngo-oesophageal dysphagia: surgery based on clinical and manometric data.

High or pharyngo-oesophageal dysphagia (PD) is defined as difficulty in initiating the act of swallowing within 1s. It involves the mechanisms controlling the tongue, pharynx and upper oesophageal sphincter (UOS) and is associated with a wide variety of local, neurologic and muscular disorders, and can also occur after surgery in the area and in response to gastro-oesophageal reflux (GOR). Our study aims at defining the criteria for surgery in PD and to evaluate the clinical results of such treatment.

Oesophageal epiphrenic diverticulum: an unusual presentation and review.

Epiphrenic pulsion diverticula are rare and often asymptomatic. We describe a case presenting in an unusual fashion, and review the controversy over the management of this condition with regard to the requirement for myotomy and antireflux surgery. We believe that both procedures are necessary, but believe that both procedures are necessary, but optimal management strategies are unlikely to be resolved as the rarity of the condition precludes largescale prospective studies.

Pathophysiologic basis for operation on Zenker's diverticulum.

An increased resistance to bolus flow through the upper esophageal sphincter has in the past been considered the main cause of increased pharyngeal contraction and the subsequent development of Zenker's diverticulum (ZD). Our study was designed to elucidate the pathophysiologic characteristics of the swallowing mechanism and its possible role in the development of ZD. Fourteen patients with radiologically proved ZD and a matched control group of healthy volunteers with no gastrointestinal symptoms were investigated with esophageal manometry using the station pull-through technique.

Ambulatory motility patterns of the transposed short segment colon.

Ambulatory manometry and pH-metry were performed on 10 asymptomatic patients who had undergone lower oesophageal replacement with the left hemicolon between two and 20 years previously. Recording of the ambient pH in the intrathoracic colon was carried out simultaneously. In every patient the recording, which lasted approximately eight hours, included upright, supine, prandial, and post-prandial periods.

Thoracoplasty in the context of current surgical practice.

Although widely employed for well over a century as a procedure for reducing the capacity of the thoracic cavity, thoracoplasty in current practice has become a rarity. A retrospective analysis of 37 patients (29 men, 8 women) who underwent the procedure under the care of one thoracic surgeon in a 16-year period provides the basis for this presentation. Ages ranged from 23 to 82 years with a mean age of 58 +/- 12.

Pericardioperitoneal shunt for persistent pericardial effusions: a new drainage procedure.

We report a pericardioperitoneal shunt procedure in 2 patients with persistent pericardial effusions in which the classic surgical methods of shunting were inappropriate.

Preoperative computed tomography of the brain in non-small cell bronchogenic carcinoma.

Background: Computed tomography of the brain is the most accurate diagnostic investigation for detecting intracranial tumours. A prospective study was undertaken to try to maximise the cost effectiveness of computed tomography of the brain in the preoperative evaluation of non-small cell lung cancer.

Methods: All patients with non-small cell lung cancer who were free of neurological symptoms and were thought to be free of metastases from the results of routine investigations were subjected to computed tomography of the brain in the 12-24 hours immediately before surgery.

Carcinoma developing in the neo-oesophagus following gastroplasty.

Carcinoma developing after gastroplasty and fundoplication has been documented in only five cases. We report a further case occurring in a patient 4 years after initial surgery. The tumour originated in the newly created tubular extension.

Cervical esophageal diverticulum associated with an impacted denture: a case report.

The authors describe the case of a 19-year-old man who had swallowed his three-toothed radiolucent upper denture 2 years before the current admission. Although radiologic examination of the soft tissues of the neck and the results of barium meal examination were reported as normal immediately after the event, a barium meal examination 2 years later revealed formation of a cervical esophageal pouch, within which the denture was found at operation. The swallowing and possible impaction of a foreign body within the esophagus should prompt upper gastrointestinal endoscopy despite a negative result of a barium meal examination.

Randomized trial of one-dose versus six-dose cefazolin prophylaxis in elective general thoracic surgery.

The objective of this study was to compare the efficacy of one to six doses of cefazolin as prophylaxis in general thoracic surgery using a randomized, double-blind design. Two-hundred eight consecutive patients admitted to a regional thoracic surgery unit for elective thoracotomy and lung resection were eligible for the trial. There were no wound infections in the one-dose group and two in the six-dose group (95% confidence intervals [CI]: -0.

Limited thoracoplasty in the management of complicated pulmonary aspergillomas.

Complicated pulmonary aspergilloma is a life threatening condition. Indications for surgery are few and the procedures conservative. Three patients were successfully treated with limited thoracoplasty.