High-Dose Intravenous Octreotide Is Safe and May Be Superior to Surgery in Managing Severe Postesophagectomy Chylothorax in High-Risk Patients.

Postesophagectomy chylothorax is a relatively rare but potentially lethal complication. Management can be challenging, especially of patients after radiotherapy. Chest tube drainage, bowel rest, total parenteral nutrition, and adequate fluid replacement are the preferred first-line treatment. Thoracic duct band ligation is the approach of last resort; however, surgical reexploration is often not an option in these patients. The use of octreotide to control chylothorax in adults has been reported, but mainly when given in low subcutaneous doses. We report the successful use of high intravenous doses of octreotide to manage large postesophagectomy chylothorax in an adult after failed band ligation.

Oesphageal stenting for palliation of malignant mesothelioma.

Dyspahgia in patients with malignant mesothelioma is usually due to direct infiltration of the eosophagus by the tumour. It can be distressing for the patient and challenging for the physician to treat. We describe three cases in which this condition has been successfully palliated with self expanding esophageal stents.

Elevated oxygen fraction reduces cilial abundance in explanted human bronchial tissue.

The effect of hyperoxia on ciliary abundance in cultured explants of adult human bronchus was investigated. Bronchus samples were removed during surgery from patients receiving pneumonectomy or lobectomy for malignancy. Part or all of each of these samples was used for measurement of cilial abundance by scanning electron microscopy (SEM); in many cases the remainder was subdivided and cultured at 37 degrees C in DMEM medium, maintaining an air interface at the ciliated surface of each segment. Cultured segments were exposed to normoxia or hyperoxia (95% O(2)), and a segment was removed every other day for quantification of cilial abundance by SEM. There was a significant inverse relationship between smoking history and abundance (p = .017; ANOVA); mean values for nonsmokers, ex-smokers, and smokers were 98.2% (n = 6), 97.0% (n = 17), and 84.02% (n = 9), respectively. There was some loss of cilia on explant segments cultured under normoxia, but the rate of loss from segments cultured under hyperoxia was significantly greater (W test, p = .00011); rate constants (means +/- SE) for cilial loss of 0.0208 +/- 0.0044 day(-1) and 0.0880 +/- 0.0179 day(-1) were found for explant segments exposed to 21 and 95% O2, respectively (n = 20).

Fibrin sealant treatment of splenic injuries during oesophagectomy.

The incidence of 'accidental' splenectomy during oesophagectomy varies from 4 to 42% and leads to an increase in sepsis, anastomotic leakage and mortality. Therefore, preservation of the spleen should be the aim of treatment whenever splenic injury occurs. We describe the use of fibrin glue delivered as a thin film by a spray applicator for rapid and definitive haemostasis of grades 1 and 2 splenic injuries in patients undergoing oesophagectomy.

Dissecting intramural haematoma of the oesophagus.

Dissecting intramural haematoma of the oesophagus (DIHO) is a rare condition, which has an excellent prognosis when managed conservatively. Awareness of this condition is vital to guide subsequent investigations and avoid inappropriate treatment or unnecessary surgical intervention. We describe an unusual case of massive DIHO causing left atrial compression presenting with pericarditic electrocardiographic changes and document the utility of endoscopic ultrasound/computed tomography to make the diagnosis.