Esophagogastrectomy for carcinoma in cirrhotic patients.

Esophagogastrectomy for carcinoma of the esophagus or cardia has been performed in 32 patients with histologically proven hepatic cirrhosis. Thirty-one esophagogastrectomies were performed through a separate abdominal and right thoracic approach in 25 patients, a left thoracoabdominal approach in five patients, and without thoracotomy in two patients. One patient had a colon interposition.

[X-ray computed tomography and percutaneous drainage change the indications for reoperation after digestive surgery].

In order to assess the major clinical biological and radiological signs of an intra-abdominal abscess following digestive surgery as well as the place of automatic reoperation, this retrospective study analysed 79 patients requiring intensive therapy for such a complication since 1982. Surgery consisted in oesophagectomy (n = 38), hepatectomy or cholecystectomy (n = 12), pancreatic surgery (n = 17) and colectomy (n = 12). A postoperative abdominal abscess was recognized in 75 patients consisting in intrathoracic or intra-abdominal oesophageal fistulas (n = 31), pancreatic abscesses and fistulas (n = 17), peri- or intrahepatic abscesses (n = 11), colonic fistulas (n = 12) and acalculous cholecystitis.

[A surgical etiology of respiratory distress in necrotizing pancreatitis: pancreato-bronchial fistula. 3 cases].

Adult respiratory distress syndrome (ARDS) is a frequent feature in acute pancreatitis, but précise etiology of hypoxemia remains unclear. Determinations of lipase and amylase levels are made in samples of bronchial secretion, in three intubated patients receiving assisted ventilation for severe hypoxemia occurring in the course of pancreatitis. This determination appeared to be valuable to incriminate the responsibility of a pancratico-bronchial fistula.

[Postoperative agitation. A new cause].

Thirty-three patients, operated on between 1981 and 1986, and presenting post-operative confusion and restlessness are analyzed. Two groups are identified: group 1 are patients who regularly received BZD before their present hospitalization; in group 2 patients were given high-dose BZD in the early postoperative period. Symptoms were anxiousness in 15 patients, restlessness in 14, myoclonia in 14, delirium in 3, coma and seizures in 1.

[Aseptic tracheobronchial aspiration].

Nosocomial lung superinfection is a frequent feature in ICU hospitalized patients. Up to 60 per cent of these patients may develop pneumonia, depending on the severity of their underlying disease. Necessary tracheobronchial irrigations and succions expose patients requiring mechanical ventilation to a risk of bacterial contamination by water containing infections particles.

[Acute respiratory distress caused by pancreatico-bronchial fistula in acute pancreatitis. Apropos of 2 cases].

The adult respiratory distress syndrome (ARDS) is a frequent feature of acute pancreatitis. Amylase and lipase values were determined in samples of bronchial secretions in two patients with endotracheal intubation and under supportive ventilation for severe hypoxemia occurring during the course of acute pancreatitis. A pancreatico-bronchial fistula was suggested in both cases.

Results of esophagogastrectomy for carcinoma in cirrhotic patients. A series of 23 consecutive patients.

Esophagogastrectomy for carcinoma of the esophagus or cardia has been performed in 23 patients with histologically proven hepatic cirrhosis. All but two patients were classified as Child's class A and all but three had a prothrombin time over 60% of normal values. Twenty-two esophagogastrostomies were performed through a separate abdominal and right thoracic approach in 15 patients, a left thoracoabdominal approach in five patients, and without thoracotomy in two patients.

Radicality in esophageal cancer surgery.

This study concerns a series of 355 carcinomas of the thoracic esophagus treated over a six-year period. 5 points of the pre operative work up are discussed: total endoscopy, respiratory and hepatic function as most of the patients were heavy smokers and alcoholics, nutritional status and C.T.

[pH and the bacteriology of gastroplasties after esogastric resection].

A study of pH of digestive fluid in 24 patients six days after esophagogastric resection (EGR) showed conservation of acidity (pH: 3 or less) in one-thirds of cases. Immediate postoperative course was invariable with respect to incidence of pneumopathy and fistulae. Fungal infection is almost a constant finding in digestive grafts together with microbial pullulation, with a linear relation to pH.

[Pulmonary complications after gastrografin inhalation during radiographic control of esophageal anastomosis].

Tracheal penetration of water soluble contrast media (gastrografin) for X-ray control, after gastro-oesophageal anastomosis, resulted in acute pulmonary oedema in two patients. In this type of surgery, mediastinal dissection was responsible for recurrent nerve injury. Inhalation was due to this recurrent nerve palsy.

Surgical implications of malnutrition and immunodeficiency in patients with carcinoma of the oesophagus.

A nutritional and immunological assessment was respectively performed in 75 patients with squamous cell carcinoma of the oesophagus. Abnormal nutritional and/or immunological values were present in 37 patients (50 per cent) and absent in 38. The tumour was resectable in 27 patients (71 per cent) with normal values and only in 11 among the 37 (29 per cent) with abnormal values (P less than 0.

[Current treatment of thoracic oesophageal carcinoma (author's transl)].

Always severe and increasingly frequent carcinoma of the thoracic oesophagus now ranks among the most worrying malignancies. However, the authors' experience concur with recent publications to demonstrate that an a priori pessimistic attitude is no longer justified. The considerable progress achieved in pre- and post-operative care and surgical techniques has reduced to 10% the operative mortality rate and has made surgery the best prospect of comfortable and, possibly, prolonged survival.

[Should undernutrition be corrected prior to surgery in patients with cancer of the oesophagus or cardia? (author's transl)].

A prospective study of 40 patients with cancer of the oesophage or cardia considered for surgery showed that 27 had no evidence of protein or calorie deficiency, while 13 had undernutrition. The 18 patients who benefited from ablative surgery belonged to the group with normal nutritional status; none of the undernourished patients could have benefited from resection. Only controlled studies will show whether or not correcting undernutrition is advantageous, but the number of people with both resectable tumour and corrigible undernutrition is probably very small.

EEA stapler and omental graft in esophagogastrectomy: experience with 30 intrathoracic anastomoses for cancer.

Experience with the EEA stapler device used in 30 esophagogastric resections for cancer with intrathoracic anastomosis, is reported. The mortality rate was 13.3%.

Respiratory function is impaired less by transverse than by median vertical supraumbilical incisions.

Respiratory function in the first four days after elective cholecystectomy has been compared in 15 women in whom abdominal incision was transverse and 15 in whom it was median vertical. Ventilatory function (vital capacity and forced expiratory volume in one second) and blood gas tensions (partial pressures of oxygen and of carbon dioxide in arterial blood, arterial whole-blood carbon dioxide, and alveolo-arterial oxygen tension difference) were determined on the day before operation and on the first, second and fourth postoperative days. Ventilatory function was depressed postoperatively in all the patients, but the depression was significantly less, and of significantly shorter duration, after the transverse than after the median vertical approach.

[Hemothorax during subclavian catheterization. Risk factors not be neglected].

In the post operative course of a peritonitis, the need for a central venous catheter. A 800 ml hemothorax in the left pleura occurred. It could not be relieved with a chest-tube, and had to be evacuated through a thoracotomy.

[Acute post-operative hemolysis related to a G6DP deficiency. Report of one case (author's transl)].

Many drugs used during resuscitations, are mighty oxidants able to induce intravascular hemolysis in patient with G6PD deficiency. Reversible and not immediately recurrent, hemolysis should be avoided by systematic (prevention) using specific blood tests. This paper was suggested by the case of a 37-year-old (Malgache) patient, with no history sustaining an acute hemolysis with kidney failure, appearing after intra-operative phenothiazine injection.

[Clinical study of massive transfusions (108 cases)].

Amongst 108 surgical patients receiving massive transfusions, 60 died. Study of the aetiology of the haemorrhage, the circumstances of the transfusion, and the role of massive transfusions in the transmission of infectious diseases, disturbances in haemostasis, immunological, respiratory and metabolic complications led to the determination of certain simple criteria of gravity which may restrict their use:age over 60 years; the number of units used, if it exceeds 30; the existence of cirrhosis, of an acute lesion as the source of bleeding, or of peroperative haemorrhage. By contrast, the transmission of hepatitis, coagulation disturbances, immediate or delayed incompatibility accidents and variations in pH, blood potassium and calcium levels and arterial pO2 had little influence on mortality.

[Pulmonary complications of esophagectomy for carcinoma of the middle third of the esophagus].

The authors studied 20 patients undergoing operation for a carcinoma of the middle third of the oesophagus during the period January 1972 to April 1975. Postoperative pulmonary complications are extremely common in such patients. All the patients had pulmonary function study results which were compatible with this type of surgery.