Journal of surgical oncology
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The incidence of anastomotic leakage after esophagectomy for cancer and reconstruction with the stomach was analyzed with respect to the presence of coexistent atrophic chronic gastritis (ACG). Of a total of 28 operated esophageal cancer patients with ACG, 6 patients developed an anastomotic leak at the cervical esophagogastrostomy (21%). ⋯ The ACG positive and the ACG negative patients were found to be well matched for age, sex, type of operation, transplant route, level of the anastomoses, and suture technique, and all were operated on by the same surgeons. The difference in leakage rate did not reach statistical significance.
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Review Case Reports
Wilms' tumor in horseshoe kidney: presentation due to ureteropelvic junction obstruction.
Children with horseshoe kidney usually develop urinary tract symptoms and often require operative correction of the anomaly. The incidence of Wilms' tumor in horseshoe kidney is higher than that for the general population. We present the case of a child whose Wilms' tumor was diagnosed early because of ureteropelvic junction obstruction secondary to a horseshoe kidney. A high index of suspicion should be maintained for Wilms' tumor in any child with a horseshoe kidney.
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Serum neuron-specific enolase (NSE) has been measured in 28 patients with small cell lung cancer (SCLC) and 90 patients with other forms of lung cancer (NSCLC), i.e., 28 with adenocarcinoma and 62 with squamous cell carcinoma. Increased NSE (greater than 12.0 micrograms/liter) was found in 71.4% of SCLC patients and in 22.2% of NSCLC patients. ⋯ AHL values in excess of 20 days suggest that the tumour is not in full remission. We believe that measurement of serum NSE and calculation of the AHL and DT are valuable in identifying the effectiveness of chemotherapy in patients with SCLC.
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Seventy-five patients underwent gastric transposition for replacement of the pharyngoesophagus. These patients had primary or recurrent malignant tumors of the hypopharynx, postcricoid region, and cervical esophagus. The operative procedure consisted of a transhiatal esophagectomy and gastric pull-up to establish gastrointestinal continuity, with a unilateral or bilateral neck dissection where indicated. ⋯ The average hospital stay of uncomplicated cases was 18 days and for complicated cases was 40 days. Immediate restoration of oral intake was achieved in 70.6% of patients. We conclude that gastric transposition after circumferential laryngopharyngeal excision is a procedure with low mortality and acceptable morbidity leading to early relief of dysphagia.
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From May 1984 through July 1988, 67 patients have been treated with intraoperative radiation therapy (IORT) at LDS Hospital. We conducted a detailed evaluation of the morbidity and mortality related to our intraoperative experience. Major complications were classified as those requiring reoperation or resulting in death. ⋯ Nonfatal complications included anastomotic leak (5), wound dehiscence (1), gastric outlet obstruction (1), and bowel obstruction (1). When compared with historical controls undergoing comparable surgery at this institution prior to the availability of IORT, complication rates were similar. We feel in our institution, intraoperative radiotherapy has not added to morbidity of aggressive abdominal surgery.