Retrosternal gastric bypass for inoperable esophageal cancer: a report of 71 patients.

Palliative substernal gastric bypass was performed in 71 patients with unresectable cancer of the intrathoracic esophagus. Fifty-six patients (78.9%) left the hospital, 53 eating normally and 3 on a soft diet. There were 15 hospital deaths (21%), 8 due to respiratory failure and pulmonary sepsis with tracheoesophageal fistulization. The remaining 7 deaths were due to aspiration and respiratory failure in 2 patients, anastomotic leakage with sepsis in 2, subphrenic abscess and septicemia in 1, mediastinitis in 1, and intestinal obstruction in 1. Anastomotic leakage occurred in 17 patients (23.9%), 5 of whom died. Wound infections developed in 28 patients (39.4%), 3 with mediastinal esophagocutaneous fistulas. Reestablishment of unimpeded swallowing, relief of respiratory aspiration, isolation of cancerous tracheobronchial infiltration, and freedom from incident-prone endoesophageal tubes were achieved in all patients leaving the hospital. Information is presented on 25 patients who were available for follow-up.

Normovolaemic haemodilution using dextran 70 in thoracic surgery.

Normovolaemic haemodilution was undertaken in 10 patients requiring elective thoracic surgery. The resultant blood loss, cell loss, use of donor blood and acid-base changes were compared with those in 10 patients undergoing similar procedures who were anaesthetized in the standard manner. Normovolaemic haemodilution reduces the use of donor blood and provides more satisfactory acid-base status than that in controls. The known antithrombotic effect of dextran 70 (Macrodex; Saphar) did not affect the crude clotting time. The technique is a feasible alternative to use of donor blood, especially when difficulties in supply exist or there is a high risk of disease transmission.

Sporotrichosis following a rodent bite. A case report.

A ten year old boy developed lymphocutaneous sporotrichosis following a wild rodent bite. The infection was successfully treated with potassium iodide. Sporotrichosis in humans has followed bites, pecks and stings inflicted by a variety of animals, birds and insects. Many species of animals are susceptible to infection by Sporothrix schenkii, but transmission from infected animals to man is uncommon.

The operative management of post-intubation tracheal strictures. Case reports.

The presentation and treatment of 2 patients with post-intubation tracheal strictures are reported. There was one subglottic and one supracarinal stricture, and they were treated by resection and anastomosis. The surgical procedures and special techniques for the facilitation of anastomosis are discussed, as is the subsequent management.