Esophageal perforation during attempted endotracheal intubation.

Perforation of the cervical esophagus in the course of attempted intubation of the trachea is a very rare accident, or at least rarely reported. Over the past 11 years, 12 patients ranging in age from 44 to 72 years were treated in our unit. If suspected, esophageal perforation is easy to diagnose when intubation has been difficult or when the patient complains of dysphagia and neck pain. Subcutaneous cervical emphysema appears early. All the patients who were operated upon early made an uneventful and prompt recovery. In those subjected to delayed operation (more than 12 hours) or nonoperative treatment, the mortality rate was 56 percent and recovery was achieved only after long and difficult treatment.

[Peroperative circulatory arrest during excision of an unrecognized thoracic pheochromocytoma]. / Arrêt circulatoire per-opératoire au cours de l'exérèse d'un phéochromocytome thoracique méconnu.

The authors present a case of thoracic phaeochromocytoma responsible for cardio-circulatory arrest during thoracotomy for mediastinal tumour. In such cases, hypertension must be controlled with phentolamine or sodium nitroprusside, cardiac arrhythmia with lignocaine, and collapse with volaemic expansion. The medical literature concerning thoracic phaeochromocytoma is briefly reviewed.

[Acute hyperparathyroidism, diagnosis and treatment. 10 recent cases]. / L'hyperparathyroïdie aiguë, diagnostic et traitement. A propos de dix observations récentes.

The authors report 10 observations of acute hyperparathyroïdism crisis cases operated without death. They draw their conclusions from their own experience and from published cases. The evolution on the medical treatment is invariably mortal. The logical treatment is surgery. The operation is a true emergency, preceded by a brief but intensive medical treatment which checks dehydratation up and bring the blood calcium level down.

[Intensive care and diet in cases of caustic esophageal stenosis after the first eight days]. / Réanimation et alimentation des sténoses caustiques de l'oesophage en dehors des huit premiers jours.

On the basis of 12 cases of caustic burns of the oesophagus, the authors describe the technique of alimentation, once the acute phase of the first eight days has passed. From the 8th to the 15th days, calories and provided parenterally. An upper GI series is carried out on the 15th day: if the stomach is healthy, the authors fashion an alimentation gastrostomy, if the stomach is damaged, they carry out gastrectomy with alimentation gastrostomy or jejunostomy. In all cases, continuity is re-established by coloplasty two months later.

[Perforations of the cervical esophagus in attempted tracheal intubation. A report of 12 cases]. / Les perforations de l'oesophage cervical par tentative d'intubation trachéale (12 observations).

The authors underline the factors favouring perforation of the oesophagus during intubation in the light of 12 personal cases: difficulty in intubation, use of an introducer, inexperienced operator. Such a perforation may result in mediastinitis and should be treated early with massive polyvalent antibiotics and a surgical suture left at rest for approximately one week.