Cancer of the oesophagus -- quo vadis?
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Adenocarcinoma↗
Biomedical subjects
K M De Groot
Publications and source records attributed to K M De Groot.
Excision of a giant hydatid cyst of the lung under thoracic epidural anaesthesia.
We present a patient with a large pulmonary hydatid cyst compressing underlying lung, with previous pulmonary tuberculosis, who presented in respiratory failure. After institution of thoracic epidural anaesthesia employing 0.25% bupivacaine, 1% lignocaine and fentanyl, the patient was placed in the sitting position and the hydatid cyst excised and drained after a limited rib resection. An air leak persisted until the 16th postoperative day. A marked improvement in symptoms as well as in spirometly and arterial blood gases occurred, and the patient was discharged on the 20th day. Thoracic epidural anaesthesia may be a safer method than general anaesthesia for removal of a hydatid cyst in a patient with severe respiratory compromise.
Adjuvants, Anesthesia↗
Inoperable esophageal carcinoma.
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Carcinoma↗
Syphilitic aortic aneurysm eroding through the sternum.
Syphilitic aortic aneurysms are uncommon today. A syphilitic aneurysm eroding through the anterior chest wall with successful surgical treatment is reported. The large size these aneurysms reach, in conjunction with the overlying pressure-induced skin necrosis necrosis can represent a technical challenge to the surgeon, both in the method of repairing the aneurysm as well as reconstructing the chest wall. Syphilitic aortic disease is also briefly reviewed.
Anastomosis, Surgical↗
Intramuscular haemangioma of the chest wall. A case report.
Intramuscular haemangiomas of thoracic skeletal muscle are uncommon tumours. They are locally invasive and tend to recur if not completely and widely excised. This report illustrates the diagnosis and management of a 25-year-old man with an intramuscular haemangioma of the chest wall. A literature report on the aetiology and management of these tumours is also given.
Hemangioma↗
Spinal cord protection in the absence of collateral circulation: meta-analysis of mortality and paraplegia.
A meta-analysis of paraplegia complicating aortic surgery on patients having neither intercostal nor spinal collaterals, epitomized by patients with acute traumatic aortic rupture, was done. Index Medicus and Medline were searched for all suitable English publications between 1972 and 1992. New paraplegia occurred in 9.9% of 1492 patients who underwent surgery. However, 19.2% of patients undergoing surgery with only simple aortic cross-clamping developed paraplegia, in contrast to 6.1% if distal aortic perfusion was augmented by either "passive" or "active" methods (p < 0.00001). The risk of paraplegia increased progressively as cross-clamp times lengthened if simple aortic cross-clamping was used (p < 0.00001), but only once did the cross-clamp time exceed 30 minutes (p < 0.05). Paraplegia occurred in 8.2% of patients with "passive" shunts from the ascending aorta (p < 0.001 vs simple cross-clamping). Shunts from the left ventricular apex, however, had an incidence of paraplegia of 26.1% and, therefore, did not decrease the risk of paraplegia. "Active" augmentation of distal perfusion had the lowest risk of paraplegia: 2.3% (p < 0.00001 vs simple cross-clamping or "passive" shunts). Mortality, however, was higher in these potentially polytraumatized patients when they were perfused distally using methods requiring full systemic heparinization (18.2%), compared to mortality with methods not requiring heparin (11.9%; p < 0.01). In conclusion, simple aortic cross-clamping has a high risk of paraplegia if the cross-clamp time extends beyond 30 minutes. "Active" modalities of augmenting distal perfusion provide optimal spinal protection.
Aorta, Thoracic↗
Intrinsic obstruction of the Procter-Livingstone tube.
Four instances of intrinsic obstruction of a Procter-Livingstone tube inserted for oesophageal carcinoma are described. The exact cause of the blistering is unknown, but it is thought to occur by absorption through the latex. It is suggested that if this complication is found, relief of obstruction may be obtained by perforation of the blister.
Equipment Failure↗
p53 gene mutants expression, cellular proliferation and differentiation in oesophageal carcinoma and non-cancerous epithelium.
An immunohistochemical study of 155 squamous cell carcinomas of the oesophagus, squamous epithelium adjacent to the tumour (n = 80), dysplastic epithelium (n = 16) and controls (n = 23) indicates that Ki67 and p53 expression is frequently present in premalignant oesophageal lesions and their related squamous cell carcinomas. Positive expression of both antibodies in apparently normal epithelium can signify early steps of malignant transformation of oesophageal epithelium and can serve in the detection of early precancerous lesions. The expression of growth factors EGF and TGF-alpha was higher in carcinomas and dysplastic lesions than in apparently normal squamous epithelium. EGF expression was unevenly distributed according to histological grade, indicating a lack of EGF immunoreactivity in poorly differentiated oesophageal carcinomas.
Carcinoma, Squamous Cell↗