Primary mediastinal tumours: review of 74 cases.
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Biomedical subjects
Publications and source records attributed to P Nandi.
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Between July 1968 and June 1977, in the University of Hong Kong Department of Surgery, 1,083 patients underwent operations via a median sternotomy using a Y incision. Of these patients, 1,070 had open heart surgery, eight had total thymectomy and in five patients pericardectomy was carried out. The overall wound complication rate was 2.31%, with a wound infection rate of 1.24%. The main advantage of a Y incision is that it leaves a better cosmetic appearance than the usual vertical incision because the upper end of the scar is at a much lower level. The incidence of subcutaneous haematoma and subsequent wound infection is much lower with the Y incision, whereas the T incision is associated with a high rate of both these complications due to the large upper flap that one has to create and mobilize to expose the suprasternal area. While using the Y incision, one only requires a small V-shaped upper flap to obtain access to the suprasternal space.
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A total of 2394 patients with a foreign body in the oesophagus was treated in our unit between 1965 and 1976, including 343 children in whom fish bones (146) and coins (134) were most commonly responsible; in adults, bones (fish and chicken) were commonest. Most of the foreign bodies were impacted in the cervical oesophagus. Pharyngoscopy and oesophagoscopy were carried out under general anaesthesia in all cases except those in which the foreign body was ejected spontaneously or when the patient refused the examination. Oesophageal perforation due to a foreign body was encountered in only one child. Two patients in the series developed the fearsome complication of oesophagoaortic fistula.
Sixty-four cases of coexistent bronchogenic carcinoma and active pulmonary tuberculosis were diagnosed between 1969 and 1976. The majority were male chronic cigarette smokers in their fifth and sixth decades. Human bacilli were isolated in 48 patients (88.9 percent) and atypical bacilli in six patients (11.1 percent). All of the atypical bacilli and 8.3 percent of the human bacilli were found to be resistant to the first line antituberculous drugs. All patients, except two who died following resection, were given a course of antituberculous drugs with 93.8 percent successful sputum conversion. Uncontrolled or disseminated tuberculous infection was not observed. Forty-five patients (70.3 percent) underwent pulmonary resection. Median survival time of those who had curative resection was 14.3 months with a 5 year survival rate of 13.2 percent. Median survival times of those treated by palliative resection plus anticancer chemotherapy and by anticancer chemotherapy alone were 8.3 months and 11.1 months, respectively. None of these patients survived more than 30 months. It appears that, clinically, each disease runs its own course with little effect on the other.
One hundred and forty-one patients have undergone mediastinoscopy in the Hong Kong University Surgical Unit since March 1974. Among these there were 109 cases of bronchogenic carcinoma. In approximately 50% of these patients the carcinoma had already spreed to involve the mediastinal lymph nodes at the time of examination. Mediastinoscopy may be the only source of positive histological proof of the diagnosis in bronchogenic carcinoma as well as in other types of intrathoracic disease such as tuberculosis. We believe that mediastinoscopy reduces the number of unnecessary exploratory thoracotomies.
Since mid-1973 29 cases of isolated patent ductus arteriosus were treated in the Hong Kong University surgical unit with a new technique of suture and division. This technique has almost eliminated the problem of intraoperative haemorrhage and its consequences.
This is the first report of an unusual fatal complication associated with the Starr-Edwards prosthetic aortic valve holder. The patient died 51 days after replacement of his aortic valve with a Starr-Edwards prosthetic aortic valve. The cause of death was coronary arterial embolus caused by a fragment broken off of the prosthetic aortic valve holder.
Between July 1968 and December 1975, 821 patients underwent open heart operations. In 596 cases the pericardium was left open and in 225 the pericardium was closed. Forty-one patients in the open pericardium group required reoperation and 23 of these had tamponade. Four patients in the closed pericardium group had reoperation but there was not a single case of tamponade. In most cases that required reoperation the bleeding was from extrapericardial sources. Absence of tamponade in the closed pericardium group can be explained by the fact that blood from extrapericardial sources of bleeding cannot collect round the heart because the pericardium is closed. Thus closure of pericardium helps to prevent tamponade. Reoperations some months or years after the original operation are technically easier and less hazardous if the pericardium has been closed because the closed pericardium prevents the heart from becoming adherent to the back of sternum and also because there are fewer adhesions in the pericardial cavity.
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