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Biomedical subjects

D Van Raemdonck

Publications and source records attributed to D Van Raemdonck.

At least 55 records · Page 3Linked to original sources
PubMed1997

Induction therapy for clinical T4 oesophageal carcinoma; a plea for continued surgical exploration.

OBJECTIVE: Complete resection of a locally advanced oesophageal carcinoma is not always feasible when invading mediastinal structures. The use of induction therapy prior to surgical exploration in patients with these clinical T4 tumours is anticipated to improve the resectability rate. METHODS: Patients, 18, who presented with a carcinoma of the thoracic oesophagus with clinical invasion into the carina (n = 6), trachea (n = 5), aorta (n = 4), lung (n = 2) and diaphragm (n = 1) were treated with concurrent chemotherapy and radiotherapy followed by surgical exploration. Follow-up was complete (mean of 17 +/- 3 months in all patients and 27 +/- 2 months in surviving patients). RESULTS: All patients completed the induction therapy with acceptable toxicity and no mortality. Subjective improvement in dysphagia was substantial in 11 patients (in 8/11 patients (73%) however, there was still viable tumour in the resected specimen), it was minimal in six patients and absent in one patient. Objective response on imaging was complete in one patient, partial in eight patients and minimal in nine patients [in two of these nine patients (22%) nevertheless, the primary tumour had disappeared completely in the resected specimen (pT0)]. Resection was complete (R0) in 14 patients (78%) and incomplete (R1) in one patient (5%). Resection of the primary tumour was impossible (R2) in three patients (17%) because of macroscopic airway (n = 2) and hilar (n = 1) invasion on exploration. In these three patients the tumour was bypassed using a retrosternal split stomach. One patient was proven at the time of surgery to have a previously unidentified lung metastasis. In three patients (17%), no residual tumour cells were found in the resected oesophagus nor in the lymph nodes (pT0N0M0). There have been no in-hospital deaths. Actuarial 3 year survival was 43% in all patients, 55% in completely resected patients and 100% in sterilized patients (pT0N0M0). Median survival was 18 months in all patients. CONCLUSIONS: Chemo/radiotherapy followed by surgery in patients with a clinical T4 oesophageal carcinoma is feasible with acceptable toxicity and no treatment-related mortality. Operability and resectability rate were high (100 and 83%, respectively) compared with historical controls. The primary tumour disappeared completely (pT0N0-1M0-1) in 28%. Tumour sterilization rate was 17%. Survival looks promising compared with historical controls. Subjective neither objective response following induction therapy clearly correlated with the final pTNM staging. This indicates that, in the absence of tumour progression, neither the patient nor the treating physician should jeopardize the chance for ultimate cure by denying surgical exploration following induction therapy.

Actuarial Analysis↗
PubMed1996

Tumors of the esophagogastric junction. Long-term survival in relation to the pattern of lymph node metastasis and a critical analysis of the accuracy or inaccuracy of pTNM classification.

From 1983 to 1989, 95 patients with carcinoma of the esophagogastric junction underwent resection. Overall hospital mortality rate was 6.2% (6/95). Actuarial survival analysis showed 5- and 10-year survivals of 33% and 31%, respectively. Five- and 10-year survivals of patients according to TNM stages were as follows: stage I (n = 13), 90% at both 5 and 10 years; stage II (n = 13), 70% at both intervals; stage III (n = 28), 28% at both intervals; and stage IV (n = 40), 11% and 8%, respectively. For patients with undiseased nodes (n = 26), 5- and 10-year survivals were 72% and 72%, compared with 18% and 16% for patients with diseased nodes (n = 68; p < 0.005). In patients who had involvement of both the abdominal and thoracic lymph nodes (n = 28), 5- and 10-year survivals were 13% and 13%, compared with 26% and 26% if metastases were confined to the abdomen (n = 37; p > 0.05). Grouping patients with diseased intrathoracic nodes together with patients with N2 abdominal nodes showed survivals of 14% at both 5 and 10 years. When tumors were staged as an esophageal carcinoma, classification of individual patients changed, as did the 5- and 10-year survivals. Five- and 10-year survivals were as follows: stage I (n = 8), 100% for both 5 and 10 years; stage II (n = 18), 68% for both 5 and 10 years; stage III (n = 27), 37% for both 5 and 10 years; and stage IV (n = 41), 10% for 5 years and 6% for 10 years. These data indicate that tumors of the esophagogastric junction tend to spread to both abdominal and thoracic nodes. However, reasonably good 5- and 10-year survivals can be obtained even in patients with nodal metastases in both areas. We suggest that N2 labeling be included for thoracic node metastases instead of the actual M+Ly label, because the N2 label better reflects the potential for curative surgery. Finally, staging tumors as gastric or esophageal carcinoma makes no significant difference in survival analysis, which raises the question whether these tumors behave more like esophageal carcinoma than gastric carcinoma.

Adenocarcinoma↗
PubMed1996

Surgery for non-small cell lung cancer with unsuspected metastasis to ipsilateral mediastinal or subcarinal nodes (N2 disease).

OBJECTIVE: Although the results after surgery for N2 disease are disappointing, there seems to be a subgroup of patients which may benefit from primary resection. These patients have clinically unrecognized N2 involvement that is discovered only at the time of thoracotomy (unsuspected or unforeseen N2 disease). It was the aim of this retrospective study to analyze the survival after resection for unforeseen N2 disease and to evaluate different prognostic factors. We were interested to see whether our strategy of rigorous staging of the mediastinum with mediastinoscopy or anterior mediastinotomy had an effect on the resectability rate and survival of unsuspected N2 disease. METHODS: Between 1985 and 1990, 859 patients with potentially operable non-small cell lung cancer were referred to our surgical department. Despite rigorous preoperative staging with computed tomography scan and cervical mediastinoscopy and/or anterior mediastinotomy, 103 patients (14.5%) had unsuspected N2 disease at thoracotomy. The tumor could be completely resected in 90 patients (87.5%). RESULTS: The 5-year survival after complete resection was 22%. Histology of the tumor, number of involved levels and extent of nodal disease had no effect on survival. CONCLUSION: We conclude that resection is justified in patients with unforeseen N2 disease. Rigorous staging of the mediastinum by cervical mediastinoscopy or anterior mediastinotomy results in a high resectability rate and avoids unnecessary thoracotomies. Mediastinoscopy plays a central role in the staging of patients with carcinoma of the lung.

Actuarial Analysis↗
PubMed1996

Esophagocoloplasty for congenital, benign and malignant diseases. Surgical and long-term functional results.

OBJECTIVE: Aim of this report is to evaluate the results of 100 consecutive esophagocoloplasties performed for congenital, benign and malignant diseases. METHODS: From 1982 until 1993 one hundred consecutive esophagocoloplasties were performed. Fifty eight for benign diseases: 22 congenital atresias (group A), 36 acquired benign lesions (group B), and 42 for malignancy (group C). As 72% of the patients had undergone previous gastric or esophageal surgery, coloplasty had to be performed in 48 patients by necessity. In 85 patients the colon graft was vascularized by the ascending branch of left colic artery and in 95 the reconstruction was fashioned in isoperistaltic way. RESULTS: Fifty one complications occurred in 42 patients resulting in a hospital mortality of 8%. However, for all benign diseases (group A + B) mortality rate was 0, being 19% in malignancy (group C). Morbidity was significantly higher in group A + C as compared to group B (p < 0.0009). Anastomotic leak was the most frequent complication occurring in 13 patients however healing spontaneously in 11 patients (84.6%). Early revisional surgery was performed in 11 patients. Functional results were evaluated according to a new grading system, including the four main symptoms (dysphagia, pain, regurgitations, diarrhoea) and weight status, the latter for adult patients. Fifty one patients from group A and B were followed for at least one year and evaluated. The were divided in two groups: 25 pediatrics (0.18 years). Anastomotic stenosis occurred in 19 patients but resolved after one or more dilatations in 16 at final follow-up. Dysphagia decreased from 43.1% 3 months postoperatively to 17.6% at last follow-up (p < 0.01). In adult patients there was a strong correlation between dysphagia and weight loss (p < 0.02). This correlation was not found in children. No differences were detectable when comparing preoperative mean weight of adult patients with mean weight of adult patients with mean weight at last follow-up. Of all 51 patients, 82.3% had an excellent (grade 1) or very good (grade 2) result at final evaluation versus 49% at 3 months follow-up (p < 0.0001). Only one patient had an unsatisfactory final result. CONCLUSIONS: Esophagocoloplasty is a valuable and for some patients an essential technique in reconstruction of esophageal continuity. Mortality can be kept very low, especially in benign diseases, guaranteeing satisfactory results in the majority of patients, despite an initial substantial perioperative morbidity.

Adolescent↗
PubMed1994

Surgical treatment of Barrett's carcinoma. Correlations between morphologic findings and prognosis.

Barrett's carcinoma occurred in 66 of 331 patients with adenocarcinomas of the esophagus or gastroesophageal junction. Only 32 (46%) of these patients had a history of gastroesophageal reflux. A history of alcohol and tobacco abuse was absent in 50% and 47.5%, respectively. The mean length of Barrett's metaplasia was 7.37 cm. Operability was 98.5% and resectability 95.5%. No postoperative or hospital deaths occurred. Pathologic staging was as follows: stage 0 and I, 38.3%; stage II, 20.6%; stage III, 22.2%; and stage IV, 19%. Overall survivals were 80.5% at 1 year, 62.7% at 2 years, and 58.2% at 5 years. Five-year survival for patients with stage I disease was 100%; for stage II, 87.5%; for stage III, 22.2%; and for stage IV, 0%. Thirty-four (51.5%) patients were under surveillance for a related or unrelated condition before diagnosis of their carcinoma; only nine (26.5%) had diseased lymph nodes. In 32 the diagnosis was made at their first medical contact, and 78% of them had diseased lymph nodes. Five-year survival without nodal metastasis was 85.3% and significantly better than for patients with metastasis, 38.3% (p = 0.0033). Of the 66 patients, 19 (28.7%) had a biopsy-proved history of Barrett's metaplasia before malignancy developed. Mean time interval between diagnosis of metaplasia and degeneration was 3.8 years (89.5% > 1 year). Over the surveillance period, the length of metaplastic Barrett's esophagus remained unchanged in all patients. Barrett's ulceration was present from the beginning in 14 patients, and three patients never had an ulcer. Intestinal metaplasia was seen in 18 patients. Resected specimens revealed severe dysplasia in 16 patients. Of the 19 patients, 73.7% had stage I disease. Our data suggest that close endoscopic monitoring and systematic biopsies of the smallest irregularities in the metaplastic mucosa may result in early detection of carcinoma. In this respect, patients with an ulcer within a zone of intestinal metaplasia seem to be at risk. Early detection increases substantially the chances for cure by diminishing the risks of lymph node involvement. Resection remains the treatment of choice in Barrett's adenocarcinoma including high-grade dysplasia, because mortality can be kept low with excellent to very good functional results in the majority of the patients provided the intervention is performed by experienced teams.

Adenocarcinoma↗
PubMed1993

[Functioning of the tube stomach following esophagus resection for carcinoma].

A retrospective study was made of the functional results of the tube stomach created in 80 patients after oesophageal resection because of carcinoma to restore the continuity. The study concerned patients who had survived the operation for longer than 18 months without indications of tumour recurrence or metastases and of whom clinical and endoscopical data of 3 months and one year after the operation were available. The functional results of the tube stomach may be regarded as good because one year postoperatively 86% of the patients were classified as excellent or very good according to the modified Visick classification. Dumping (18%), a sensation of fullness (26%) and diarrhoea (28%) were frequent complaints, occurring mostly soon after the operation. After one year these complaints are almost completely gone. Three months postoperatively, 19% of the patients had a stenosis of the anastomosis that required one or more dilatations. Reflux oesophagitis is the major late complication, leading to late stricture of the anastomosis. Reflux oesophagitis was encountered in 43% of the patients with an intrathoracic anastomosis and in only 6% of those with a cervical anastomosis; the difference is statistically significant. After one year, a stenosis due to reflux was encountered in four of the 30 patients (13%) with an intrathoracic anastomosis and in only one of the 50 patients (2%) with a cervical anastomosis. These results show that from the functional point of view, as well, the stomach is a good substitution organ after oesophageal resection, provided the anastomosis is created in the neck.

Adult↗
PubMed1992

Fibrin glue in the treatment of dorsal hand burns.

This paper analyses two groups of patients with only dorsal hand burns: groups I contains patients with a total of 15 burned hands and group II patients with 12 hand burns. The patients in group I were all treated by full sheet skin grafts using a two-component fibrin glue. Patients in group II underwent the traditional operative treatment without fibrin glue and the same postoperative physical therapy programme. After follow-up periods of 6-11 months (group I) and 12-21 months (group II), we investigated in both groups, grip strength, key pinch, mobility, two-point discrimination and with the Semmes-Weinstein monofilaments. Our results prove that after the respective follow-up periods group I patients developed far better results for two-point discrimination, touch recognition and mobility.

Adolescent↗
PubMed1992

Surgical strategies in esophageal carcinoma with emphasis on radical lymphadenectomy.

From 1975 through 1988, 257 patients with carcinoma of the thoracic esophagus have been treated in our department. Operability was 90% (232/257); overall resectability, 77% (198/257), and for the operated group, 85% (198/232). Hospital mortality rate was 9.6% but decreased to 3% over the period 1986 to 1988. There were 65% squamous cell epitheliomas and 35% adenocarcinomas. Tumor, nodes, and metastases (pTNM) staging was as follows: stage I, 11.6%; stage II, 23.2%; stage III, 37.9%; stage IV, 27.3%. Overall survival rate was 62.5% at 1 year, 42.4% at 2 years, and 30% at 5 years. According to the pTNM staging, 5-year survival was 90% for stage I, 56% for stage II, 15.3% for stage III, and 0 for stage IV. There were no statistically significant differences according to tumor localization, pathologic type, sex, or age. Introducing extensive resection and extended lymphadenectomy seems to improve significantly survival in patients in whom an operation with curative intention was performed, the 1 year survival rate being 90.8% versus 72%; 2-year survival, 81% versus 46%; and 5-year survival, 48.5% versus 41% for radical and nonradical resections, respectively. Based on multivariate Cox regression analysis, only TNM stage and presence or absence of lymph nodes are important factors in predicting survival: stage 1 tumors have lower risk, and involvement of lymph nodes creates higher risk. Using this analysis, there was only for the patients with involved lymph nodes (N1) a significantly better prognosis when a radical lymph node dissection was performed (p = 0.0055). Barrett adenocarcinomas have no worse prognosis than other esophageal carcinomas, with a 5-year survival rate of 91.5% if lymph nodes are negative, and a 54% overall 5-year survival rate. Functional results after restoration of continuity with gastric tubulation were judged excellent to very good in 86.5% at 1 year, but infra-aortic anastomoses have a much higher incidence of peptic esophagitis: 53% versus 8% for cervical anastomoses. From this study it can be concluded that in experienced hands surgery today offers the best chances for optimal staging, potential cure, and prolonged high-quality palliation.

Adenocarcinoma↗
PubMedDate not supplied

Advanced esophageal carcinoma.

From 1976 until 1990 a total of 212 patients with squamous cell carcinoma of the thoracic esophagus were referred for surgical treatment. Resectability was 84.1% (161 of 191). Actuarial 5-year survival in patients with negative lymph nodes was 51.2% versus 12.4% in lymph node-positive patients. Therefore advanced carcinoma was defined to compromise all patients with involved regional (N1) or distal lymph nodes (M+Ly) as well as patients with T4 tumors or solid organ metastasis (M+org) irrespective of their lymph node status. Comparing complete (R0) versus incomplete (R1-R2) resections for stage III and IV carcinoma revealed 20% and 0% five-year survivals, respectively. There was no 5-year survival in the stage IV group. When excluding solid organ metastasis, the median survival shifted from 8.5 months after incomplete (R1-R2) to 20 months after complete (R0) resection. In 1991 three-field lymphadenectomy was initiated that included bilateral cervical lymphadenectomy. Thirty-seven patients have been treated so far (23 squamous cell carcinoma, 14 adenocarcinomas). Cervical lymph nodes were positive in 24.3% with an incidence up to 28.5% for distal-third carcinoma. Subsequently, 6 patients (16%) moved from M0 to M+Ly status. Our results confirm the key role of surgery not only in improving survival and locoregional tumor control but in refining the accuracy of staging advanced carcinomas provided complete resection is possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Sleeve lobectomy for non-small cell lung cancer.

UNLABELLED: Sleeve lobectomy is a procedure in which the involved lobe with part of the main stembronchus is removed. The remaining lobe (s) is reimplanted on the main stembronchus. This procedure is indicated for central tumors of the lung as an alternative to pneumonectomy. It is the aim of this study to describe the technique of sleeve lobectomy and to analyse the early postoperative results and late results (survival-recurrence) after sleeve lobectomy for non-small-cell lung cancer. MATERIAL AND METHODS: Between 1985 and 1999, 77 sleeve lobectomies for bronchogenic carcinoma were performed at the University hospitals Leuven. The most common performed sleeve lobectomy is the right upper lobe sleeve lobectomy (67.5%). In 6 patients a combined sleeve resection of the pulmonary artery was performed. The operative mortality was 3.9%. Two patients developed a broncho-pleural fistula. The five-year survival rate was 45.6%. In 5 patients, an anastomotic suture developed which required a completion pneumonectomy in 2. Thirteen patients developed local tumor recurrence. CONCLUSION: We conclude that sleeve lobectomy can be performed with an acceptable mortality and morbidity. Long term survival rate and recurrence rate are as good as after pneumonectomy. The operative mortality is lower when compared to pneumonectomy, exercise tolerance and quality of life are much better after sleeve lobectomy compared to pneumonectomy. For central tumours we believe that sleeve resection is the procedure of choice.

Adult↗
PubMedDate not supplied

Modification of the arterial anastomotic technique improves survival in porcine single lung transplant model.

BACKGROUND: Lung transplantation is a valuable therapeutic option for selected patients with end-stage pulmonary disease. However, this treatment is complicated by ischaemia-reperfusion injury (IRI) of the lung in 10-20% of the recipients. We developed an unilateral porcine lung transplant model to study IRI and describe our experience with two different arterial anastomotic techniques. MATERIAL & METHODS: Twenty four domestic pigs [n = 6 x (donor + recipient)/group] were used in this study. Donor lungs were harvested using an antegrade flush with cold Perfadex and stored in the same solution for +/- 8 hours. Recipient animals underwent a left thoracotomy. After native pneumonectomy, the left donor lung was transplanted in the following order: 1. left atrial cuff; 2. bronchus; 3 pulmonary artery. 2 The outcome in recipients from historical groups differing in anastomotic technique was compared. An end-to-end anastomosis on the left pulmonary artery was performed in group I versus a patch anastomosis on the main pulmonary artery in group II. One hour after reperfusion, the right pulmonary artery and main bronchus were ligated forcing the recipient to survive on the transplanted lung only. The animals were further observed for 6 hours. RESULTS: Survival 6 hours after exclusion of the right lung was 33% (2/6) in group I versus 83% (5/6) in group II. Animals in group I died of right heart failure manifested by acute dilation of the right ventricle following ligation of the hilum of the right lung. CONCLUSION: Single lung transplantation with exclusion of the contralateral native lung is a critical model. Arterial end-to-end anastomosis resulted in an increased right ventricular afterload. The use of a patch technique improved the compliance of the arterial anastomosis and decreased early mortality. This transplant model is currently used in our laboratory to assess new methods for pulmonary preservation.

Anastomosis, Surgical↗
PubMedDate not supplied

Lung volume reduction surgery (LVRS) for emphysema: initial experience at the University Hospital Gasthuisberg. Leuven LVRS Group.

Emphysema is a disabling disease, for which there is no curative therapy available today. Lung transplantation offers a valuable option for a very selected number of patients, however, due to the enormous organ shortage, only few patients can be offered such a therapy. Recently there has been important resurgence of interest in lung volume reduction surgery and as a consequence, we have embarked in such a program since may 1997. We have now performed unilateral lung volume reduction surgery in 29 emphysema patients (25 on the right and 4 on the left side). Twenty-four patients were already discharged home. There has been no perioperative mortality. The mean hospital stay was 19.8 +/- 11.4 days (range, 8-47 d). Twenty patients of whom we already have follow-up data during 6 months (m) form the further basis of this report. Six weeks after the procedure the FEV1 increased from 0.82 +/- 0.28 L (28 +/- 8%) to 1.05 +/- 0.39 L, a mean increase of 28%. There was a further increase of the FEV1 to a maximum of 1.06 +/- 0.42 L at 6 m, a mean maximum increase of 29% (p = 0.0046, ANOVA). Similarly, the FVC increased from 2.80 +/- 1.10 L to 3.15 +/- 1.00 L, a mean increase of 12.5%. A further increase was also obtained at 6 m and was 19.6% (3.35 +/- 1.05 L, p = 0.014, ANOVA). The maximum decrease in RV was obtained at 3 m (from 5.91 +/- 1.37 L to 4.37 +/- 0.85 L (p = 0.0001, ANOVA), a mean decrease of 26%. The maximum TLC decrease was demonstrated at 3 m (from 8.71 +/- 1.71 L to 7.60 +/- 1.56 L (p = 0.002, ANOVA), a mean decrease of 12.8%. Afterwards there was again a gradual raise of the TLC. The six minute walking distance increased from 231 +/- 31 m to 272 +/- 34 m (p = NS) after pulmonary rehabilitation and to 416 +/- 77 m at 3 m and 415 +/- 18 m at 6 m (p = 0.0002, ANOVA) after the operation. The quality of life (measured with a standardized questionnaire, the Nottingham Health Profile) improved significantly in several domains (e.g. mobility, pain, energy, emotions and social) at 3 m postoperatively. There was one late death (at 6 m) due to an unknown cause. The actuarial survival rate was therefore 100% at 3 m and 95% at 12 m. In conclusion, unilateral thoracoscopic lung volume reduction surgery is a new and safe treatment modality for patients suffering from severe end-stage emphysema. The objective and subjective improvement is marked and the mortality is very low. Rigid selection criteria are, however, necessary to be able to guarantee an optimal result.

Actuarial Analysis↗
PubMedDate not supplied

Reflections on three field lymphadenectomy in carcinoma of the esophagus and gastroesophageal junction.

BACKGROUND/AIMS: One of the most controversial questions in the surgical treatment of carcinoma of the esophagus and gastroesophageal junction (GEJ) is the extent of lymph node dissection, in particular the value of the cervical lymph node dissection (the so-called third field). METHODOLOGY: This study reflects a single institution's experience with this extensive lymphadenectomy, the technique of which is described in detail. RESULTS: Adding the third field to the lymph node dissection markedly improved accuracy of staging. Unforeseen involvement of lymph nodes in the neck was found in 30%. In T3N+ tumors of the GEJ, as much as 16.6% of positive lymph nodes were detected in the neck. Locoregional recurrence without distant metastasis was found in 6 patients (17.8%) out of a group of 37 patients with a minimum follow-up of 5 years. All 6 patients had stage IV disease because of distant lymph node metastasis (M+Ly). In 3 of these patients, locoregional recurrence occurred only after 3 years or more. In a subsequent series of 100 esophagectomies performed between 1992 and July 1993 no difference in outcome between radical versus standard resection was noticed for early stage I and II. However, there is a tendency towards a better estimated 5-year survival in favor of radical dissections (21%) versus standard resection (12%) in stage III and IV. CONCLUSIONS: Extensive three field lymphadenectomy can be safely performed without increasing hospital mortality (0%) and morbidity. Improved accuracy of staging, prolonged disease-free survival and potential increased cure rate are confirmed by our experience. Survival obtained with this technique has to be compared with survival obtained by other, multimodality treatment forms.

Adenocarcinoma↗
PubMedDate not supplied

Pharyngo-oesophageal diverticulum (Zenker's). Clinical, therapeutic and morphological aspects.

In a series of 100 surgically treated patients, Zenker's diverticulum (ZD) appeared mostly as a typical geriatric disorder (50% over 70 years) in which not only oesophageal symptoms but also pulmonary symptoms (37%) may lead to a life-threatening situation. In 60% of the patients, associated upper gastrointestinal pathology was observed, most frequently being gastro-oesophageal reflux (30 patients). In 30% of the manometric studies of the oesophageal body and lower oesophageal sphincter, clear pathological patterns were observed. Morphological examinations, enzymohistochemistry, immunohistochemistry showed clear pathological changes not only at the level of the cricopharyngeal muscle but also at the level of the striated muscles of the cervical oesophagus. These clinical, manometric and morphological changes suggest that ZD is one expression of a more complex neurogenic disorder. They also justify the extramucosal myotomy of the cricopharyngeal wall and the striated muscle wall of the cervical oesophagus as well, as the cardinal step of operation. This myotomy was combined with a diverticulopexy resulting in no post-operative mortality and a minimum of morbidity. The mean longterm follow-up in this series is 4 years, showing excellent and very good results in 96% of the patients for the oesophageal symptoms and in 92% for the full spectrum of oesophageal and pulmonary symptomatology. With this single step operation, no recurrence has been seen seen as opposed to the endoscopic procedure.

Adult↗
PubMedDate not supplied

Treatment of postpneumonectomy empyema with or without bronchopleural fistula.

Bronchopleural fistula with empyema is an uncommon but tragic complication after pulmonary resection. The possible therapeutic procedures are discussed. The patient often requires multiple surgical interventions and prolonged hospitalisation. According to the literature, open window thoracostomy (OWT) and even mutilating interventions such as myoplasty or thoracoplasty have to be performed when simple chest-tube drainage and antibiotic therapy do not suffice as illustrated by the present case.

Bronchial Fistula↗
PubMedDate not supplied

[Surgery of foreign bodies in the esophagus in case of failure of noninvasive extraction technics].

In the period 1957-1987, 240 corpora aliena in the esophagus were treated. The foreign body could be extracted under endoscopy in 228 cases (95%). In 12 cases the non-invasive extraction technic failed, so we have to remove the foreign body surgically. The most difficult bodies to extract by endoscopic way are the big, the sharp or pointed ones. On the surgical point of view, the way of approach depends on the level of the impacted body. The problem of post-operative fistula and abscess formation after surgery, can be avoided by a correct technic, exclusion of underlying pathology, an adequate drainage and consequent infection treatment.

Adult↗