Intractable dysphagia following placement of Angelchik prosthesis for reflux esophagitis.

In 1979, Angelchik and Cohen [1] reported a series of 46 patients in whom a Silastic prosthesis was used to control gastroesophageal reflux. The initial results were good, and to date, no long-term complications have been noted. We discuss a patient whom severe dysphagia developed following placement of an Angelchik prosthesis. Preoperative evaluation revealed no motor abnormality and no stricture, but there was acute angulation of the gastroesophageal junction. The prosthesis was removed through a left thoracotomy, and a Belsey repair resulted in good relief of symptoms.

The cervical approach to esophageal leiomyomas.

Intramural leiomyoma is the most common benign esophageal tumor. The treatment of choice is enucleation without mucosal encroachment. Esophageal resection with reconstruction is rarely necessary, obviating the need for wide exposure. This report demonstrates the technical simplicity of the cervical approach to leiomyomata of the proximal thoracic esophagus. The operative technique avoids the morbidity of the commonly employed thoracotomy incision and deserves consideration in the treatment of accessible lesions.

Correlation of preoperative pulmonary function testing with clinical course in patients after pneumonectomy.

Postoperative morbidity and mortality were correlated with the preoperative results of three widely used tests of pulmonary function in 90 patients who underwent pneumonectomy for carcinoma of the lung. Factors analyzed following operation included thirty-day mortality, the incidence of arrhythmias, the frequency of respiratory complications, and the number of individuals requiring prolonged mechanical ventilation. Fourteen patients had a forced vital capacity (FVC) of 70% or less of predicted normal value. Eleven had a one-second forced expiratory volume (FEV1) of 1.5 liters or less, and 32 had an FEV1 of less than 2 liters. Twenty-six had an FEV1/FVC ratio of 0.6 or less. There were no differences in morbidity or mortality between these individuals and the patients whose test scores exceeded these criteria. As a general rule, decisions regarding operability and extent of resection cannot be made solely on the basis of the three spirometry tests reviewed.

Perforated neonatal appendicitis.

We present a case of perforated appendicitis with peritonitis in a premature 920 gm neonate who survived. The incidence, etiology, and presenting signs and symptoms of appendicitis in the newborn are discussed.

An unusual complication of naso-enteral feeding with small-diameter feeding tubes.

The occurrence of nasotracheal intubation with feeding tubes of various types is well known but poorly documented. The small-diameter feeding tubes currently available for enteral hyperalimentation may be more prone to this complication because of their small size and the rigid guide wire which is required for placement. A high index of suspicion when placing these tubes in patients at risk, use of the wire guide to pass the nasopharynx only, and x-ray verification of tube location prior to usage should avert this potentially life-threatening mistake.

Extrapleural exclusion of esophageal perforations.

Perforations of the esophagus require prompt treatment. We have described a patient in whom extrapleural exclusion of a primary repair was used. This procedure, which has not been previously reported, is not technically difficult and is similar to the approach used in the treatment of tracheoesophageal fistula. It allows good mediastinal drainage and prevents pleural soilage by providing an effective buttress to the esophageal repair.

Bilateral pneumothoraces secondary to latrogenic buffalo chest. An unusual complication of median sternotomy and subclavian vein catheterization.

Pneumothorax following subclavian venipuncture is a well-known risk. Less well recognized is the potential for life-threatening bilateral pneumothoraces occurring at the time of subclavian vein catheterization in patients who have previously undergone median sternotomy. Inadvertent bilateral pleural entry at the time of sternotomy may result in a common pleural space which subsequently places the patient in special jeopardy when the complication of pneumothorax occurs. This report documents the successful management of this important sequence of complications associated with now widely applied therapeutic interventions.