Surgery today
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A nationwide retrospective 5-year survey was conducted, examining the surgical treatment of cancer of the esophagus and the esophagogastric junction in Hungary. The population of Hungary is at low risk of developing esophageal cancer, with an associated mortality rate of 5.84 per 100,000 in 1992. During the 5 years between 1988 and 1992, a total of 1197 resections were performed for cancer of the esophagus and cardia, with 817 for esophageal cancer (in the cervical area in 40, the upper and midthoracic areas in 436, and the lower third in 341), and 380 for cancer of the cardia. ⋯ Transhiatal blunt esophagectomy was performed in 264 patients, representing 22.0% of all resections. The overall leakage rate was 21%, occurring in 251 patients, and the overall mortality rate was 13.5%, or 162 patients. A very strong correlation existed between the experience of the departments where surgery was performed and the mortality rate.
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We report herein the cases of two patients who suffered tracheal disruption, both of whom underwent successful surgical treatment. The first patient was a 48-year-old truck driver who suffered severe dyspnea after jamming his neck in a truck door. An endotracheal tube was unable to be inserted due to bleeding and thus, an emergency tracheostomy was performed. ⋯ On admission, marked subcutaneous emphysema in the neck and paradoxical movement of the trachea were noted. Tracheal disruption was confirmed by a lateral neck X-ray and CT, and a similar operation to that of the first patient was performed. This type of injury is rare; however, lateral neck X-ray, CT, and fiberscopy proved extremely useful for making an accurate diagnosis following which successful emergency surgery was able to be performed, achieving good long-term results.
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Interleukin-1 (IL-1), a cytokine released from macrophages by endotoxin stimulation, has been shown to upregulate the genetic expression of the hepatocyte growth factor (HGF). The present study was conducted to determine whether plasma HGF is increased in patients with systemic inflammatory response syndrome (SIRS). The plasma levels of HGF, endotoxin, and beta-glucan were measured in 41 surgical patients without hepatic diseases, 18 of whom had been diagnosed with sepsis, and 33, with nonseptic SIRS. ⋯ No significant correlations were observed between the plasma levels of HGF and endotoxin (r = 0.02) or beta-glucan (r = -0.05) in any of the patients; however, plasma HGF was significantly correlated with the WBC count (r = 0.34, P < 0.05) and with total bilirubin (r = 0.45, P < 0.01). Plasma HGF was also strongly correlated with alanine transaminase (ALT) in 8 patients with ALT levels higher than 50 U/l (r = 0.70), but there was no such correlation in 33 patients with ALT levels of 50 U/l or less (r = 0.30). Thus, although the clinicopathologic significance of HGF is not well understood, the present findings indicate that plasma HGF increases in response to infection or inflammation.
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Comparative Study
Surgical stress and transient postoperative psychiatric disturbances in aged patients studied using the Yamaguchi University Mental Disorder Scale.
Psychiatric disturbances often occur in aged patients after surgery, but there is no easy or precise method of predicting their occurrence. We devised an easy mental test, the Yamaguchi University Mental Disorder Scale (YDS), based on the surgical perspective. Using both this new method and the Hasegawa mental disorder scale (HDS), we examined 106 patients who had undergone general anesthesia. ⋯ On the YDS examination, the relationship between surgical stress and transient postoperative psychiatric disturbances was clearly indicated, as was the case with HDS. Postoperative delirium was seen in a significant proportion of patients with low preoperative scores on YDS (P < 0.05), while no significant difference was observed between the mean preoperative scores on HDS and postoperative delirium. In the preoperative evaluation using YDS, postoperative delirium was found to be predictable, and YDS is thus considered to be a more valuable tool in managing aged patients.
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Case Reports
Transient hepatofugal portal blood flow after hepatectomy in a patient with cirrhosis: report of a case.
We report herein the case of a 60-year-old man who developed hepatic failure with simultaneous transient hepatofugal portal blood flow after undergoing hepatectomy for hepatocellular carcinoma accompanied by cirrhosis with a splenorenal shunt. The transient hepatofugal portal blood flow was detected by color Doppler ultrasonography. Following this case report, the possibility of a relationship between hepatofugal portal blood flow, portal-systemic shunts, and postoperative hepatic failure is discussed.