Mucoepidermoid and adenoid cystic carcinomas of the esophagus.

Four case reports of patients with tumors of the esophagus resembling those of salivary gland origin are presented with a review of the cases published to date. These tumors arise in the submucosal glands in the esophagus and are histologically similar to adenoid cystic and mucoepidermoid carcinomas of the salivary glands. The mucoepidermoid variety occurs more frequently in men than in women, and the adenoid cystic carcinomas are equally distributed between the sexes. In most of the cases reported the tumors were resectable but the overall survival rate is poor and is similar to the rates found with the more frequent squamous cell cancer of the esophagus.

Hemothorax associated with endometriosis.

Fifteen cases have been reported of pleural effusion associated with endometriosis. Common characteristics that may aid in the diagnosis are discussed and an additional case is presented.

Sternotomy infection after harvesting of the internal mammary artery.

Use of the internal mammary artery for coronary revascularization does not increase the incidence of postoperative median sternotomy wound infection. When infection does occur in these patients, however, successful treatment is more likely to require more aggressive surgical manipulation, such as the use of vascularized muscle pedicle grafts, to eventually close the sternal defect.

Right ventricular myxoma.

This report describes a patient with right ventricular myxoma in whom two-dimensional echocardiography was the sole means of diagnosis and provided sufficient justification for surgical intervention without further invasive workup. A review of the literature also is presented.

Surgical technique in the management of patent ductus arteriosus in the elderly patient.

The successful surgical treatment of a patent ductus arteriosus in a 68-year-old man is presented. A review of current methods for repair is discussed, with emphasis on the simple and safe technique described here.

Oxygen transfer efficiency of three microporous polypropylene membrane oxygenators.

The purpose of this investigation was to compare the oxygen transfer efficiency of three different membrane oxygenators, each utilizing microporous polypropylene as its gas transfer material. Gross oxygen transfer was compared for each membrane with their performance when differences in surface area were taken into account. It was found that when hollow fibres were used, with blood flow around the fibres, efficiency was maximized. Our study technique offers an additional objective approach in the evaluation of oxygen transfer for membrane oxygenators.

Barium peritonitis.

A case of generalized peritonitis, secondary to a rupture of the rectosigmoid portion of the colon is presented. The surgical management is discussed, a basic part of which is the use of a Baker tube to splint the small intestine while adhesions form in a pattern along the tube, as a substitute method for a Nobel plication, to prevent chronic small intestinal obstruction. Extensive lavage of the peritoneal cavity should also be carried out. Energetic fluid replacement with careful monitoring of the fluid and electrolyte balance is essential before, during and after the surgical procedure. Adequate broad spectrum antibiotic coverage is important. We believe that the management of these cases should be by surgical intervention and institution of the above mentioned measures and not by expectant therapy and treatment of complications.

A comparison of two oxygen transfer strategies: Bentley Univox and the Bard HF 5000.

The purpose of this study was to evaluate the oxygen transfer performance of two membrane oxygenators: Bentley Univox and the Bard HF 5000. This evaluation was based on the comparison between: (1) the oxygen transfer slope; (2) the gas phase-arterial oxygen gradients; (3) the degree of blood shunting; (4) the maximum oxygen transfer; and (5) the diffusing capacity calculated for each membrane. The data were examined at both absolute values and relative to each device's membrane surface area. In absolute terms, the HF 5000 performed better than the Univox in each category. However, when surface area was taken into account, the Univox was clearly more efficient with regard to oxygen transfer. We conclude from this evaluation that the Univox does not offer a satisfactory oxygen transfer 'buffer' for larger, more metabolically active patients (297 ml/min for the Univox and 447 ml/min for the HF 5000). The trade-offs that were made between design and performance features, with the Univox, were unacceptable.

Oxygen transfer performance of a new Sarns membrane oxygenator.

Oxygen transfer performance of the SMO 2, a new hollow-fibre membrane oxygenator from Sarns/3M, was evaluated. The maximum oxygen transfer of the SMO 2 (504 ml 0 2/min) was 57% higher than that for the SMO. This was true even though the membrane surface area increased by only 11% (1.8 m 2 to 2.0 m 2). The average gas phase-arterial oxygen gradient and the average shunt fraction was decreased by 35% and 30% respectively. The diffusing capacity of the SMO 2 was increased by 74% over the SMO. The oxygen transfer performance compared favourably, not only to the SMO, but to five other previously evaluated membrane oxygenators. It performed better in each category regardless of whether the result was expressed in absolute terms or relative to membrane surface area.

Lung carcinoma arising in bronchopulmonary sequestration.

A squamous cell carcinoma arising in intralobar bronchopulmonary sequestration of the right lower lobe is described in a 69-year-old man. One other reported case was found. Other complications of bronchopulmonary sequestration include nonspecific infections and tuberculosis.

Paraduodenal hernias.

Paraduodenal hernias comprise approximately 50% of all internal hernias. The clinical diagnosis of this condition is analyzed. Two cases are presented and two theories for the embryological development of these malformations and their surgical management are discussed.

Transcutaneous pacing in patients undergoing coronary artery bypass grafting: effect of previous cardiac surgery.

Temporary transcutaneous pacing thresholds were measured in 10 patients undergoing primary coronary artery bypass grafting (CABG) operations and 10 patients having reoperative CABG operations 7 months to 14 years after their previous cardiac surgery. All surgeries were performed via median sternotomy. After anesthetic induction using either fentanyl or sufentanil in combination with enflurane, the pacing stimulation thresholds were determined. There was no significant difference (P less than 0.05) between the pacing thresholds of the reoperative group and the primary procedure group (78.2 +/- 6.2 v 79.2 +/- 4.8 mA, respectively). Transcutaneous pacing was successful in all 20 patients. Therefore, transcutaneous pacing thresholds appear unaffected by previous cardiac surgery.