Biomedical subjects
Publications and source records attributed to K Jeyasingham.
We report a pericardioperitoneal shunt procedure in 2 patients with persistent pericardial effusions in which the classic surgical methods of shunting were inappropriate.
Carcinoma developing after gastroplasty and fundoplication has been documented in only five cases. We report a further case occurring in a patient 4 years after initial surgery. The tumour originated in the newly created tubular extension. There was no evidence of a columnar lining in the true oesophagus prior to surgery. The development, technique and complications of gastroplasty and partial fundoplication are discussed with special mention of the diagnostic problems when a tumour develops in a patient who has undergone this procedure.
BACKGROUND: Computed tomography of the brain is the most accurate diagnostic investigation for detecting intracranial tumours. A prospective study was undertaken to try to maximise the cost effectiveness of computed tomography of the brain in the preoperative evaluation of non-small cell lung cancer. METHODS: All patients with non-small cell lung cancer who were free of neurological symptoms and were thought to be free of metastases from the results of routine investigations were subjected to computed tomography of the brain in the 12-24 hours immediately before surgery. RESULTS: Of 158 such patients, five showed positive evidence of metastases, confirmed on craniotomy and excision biopsy; one of these patients was found to have a non-metastatic tumour (false positive). Five patients with a negative scan who underwent lung resection returned within 12 months with neurological defects and positive findings on further computed tomography (false negative). The predominant cell type in patients with positive and false negative scans was adenocarcinoma or adenosquamous carcinoma (7/10); the majority had nodal state N2. CONCLUSIONS: Computed tomography of the brain should be carried out if mediastinal disease is suspected or confirmed in non-small cell lung cancer before proceeding to surgery.
The objective of this study was to compare the efficacy of one to six doses of cefazolin as prophylaxis in general thoracic surgery using a randomized, double-blind design. Two-hundred eight consecutive patients admitted to a regional thoracic surgery unit for elective thoracotomy and lung resection were eligible for the trial. There were no wound infections in the one-dose group and two in the six-dose group (95% confidence intervals [CI]: -0.008, +0.048 [The positive number refers to the largest possible difference in favor of the one-dose group and the negative number, the largest possible difference in favor of the six-dose group]). Each group had eight postoperative chest infections (CI: -0.075, +0.077) and three empyemas (CI: -0.004, +0.050). Thirty-day mortality was 5% in the one-dose group and 4% in the six-dose group (CI: -0.053, +0.069). Postoperative duration of hospital stay, requirement for antibiotics, and the need for reoperation were comparable. These results suggest that six doses of cefazolin do not confer clinically important benefit beyond that obtained from a single dose for prophylaxis of wound infection in elective general thoracic surgery.
The authors describe the case of a 19-year-old man who had swallowed his three-toothed radiolucent upper denture 2 years before the current admission. Although radiologic examination of the soft tissues of the neck and the results of barium meal examination were reported as normal immediately after the event, a barium meal examination 2 years later revealed formation of a cervical esophageal pouch, within which the denture was found at operation. The swallowing and possible impaction of a foreign body within the esophagus should prompt upper gastrointestinal endoscopy despite a negative result of a barium meal examination. Endoscopic removal is the treatment of choice, but surgery is appropriate in selected cases.
Complicated pulmonary aspergilloma is a life threatening condition. Indications for surgery are few and the procedures conservative. Three patients were successfully treated with limited thoracoplasty. Limited thoracoplasty in combination with other conservative measures may provide effective palliation in selected cases.
Tracheal injuries secondary to blunt trauma are not common and complete tracheal transection is even more unusual. Because the incidence of these treatable, but often lethal, injuries is increasing, more surgeons will encounter them. A report of the treatment of a case of tracheal transection due to blunt trauma with emphasis on avoiding unnecessary tracheostomy is presented, with a review of the literature.
Pulmonary sequestration is an uncommon congenital abnormality in which nonfunctioning lung tissue is supplied by an anomalous systemic artery. Both the extralobar and intralobar forms probably develop from an accessory lung bud from the primitive foregut. Both forms are situated on the left side in about two-thirds of patients. The anomalous arterial supply usually originates from the descending thoracic aorta, and there may be a large left-to-left or left-to-right shunt through the sequestration. The sequestration may have a fistulous communication with the upper gastrointestinal tract. Congenital anomalies, particularly diaphragmatic hernia, are frequently associated with the extralobar form. Intralobar sequestration occasionally is an incidental finding on roentgenograms of the chest in an asymptomatic patient; however, the disorder is usually symptomatic and the most common presentation is recurrent pulmonary infection. Presentation may be characterized by gastrointestinal symptoms, congestive heart failure, hemoptysis or hemothorax. Extralobar sequestration is usually an incidental finding on routine roentgenograms of the chest or during the management of some other congenital anomaly. Infrequently, extralobar sequestration presents with symptoms similar to those seen with the intralobar form. Roentgenograms of the chest, upper gastrointestinal series and arteriography are the most helpful diagnostic aids. The usual treatment is resection of the sequestration by removal of only the sequestration in patients with the extralobar form and by lobectomy or segmental resection in patients with the intralobar form. The reported results of operation have generally been excellent.