[Our experience with gas gangrene].
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Adult↗
Biomedical subjects
T Lerut
Publications and source records attributed to T Lerut.
[Post-traumatic gas crepitation as a sign of pseudo-gas gangrene].
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Adult↗
Sleeve lobectomy for non-small cell lung cancer.
UNLABELLED: Sleeve lobectomy is a procedure in which the involved lobe with part of the main stembronchus is removed. The remaining lobe (s) is reimplanted on the main stembronchus. This procedure is indicated for central tumors of the lung as an alternative to pneumonectomy. It is the aim of this study to describe the technique of sleeve lobectomy and to analyse the early postoperative results and late results (survival-recurrence) after sleeve lobectomy for non-small-cell lung cancer. MATERIAL AND METHODS: Between 1985 and 1999, 77 sleeve lobectomies for bronchogenic carcinoma were performed at the University hospitals Leuven. The most common performed sleeve lobectomy is the right upper lobe sleeve lobectomy (67.5%). In 6 patients a combined sleeve resection of the pulmonary artery was performed. The operative mortality was 3.9%. Two patients developed a broncho-pleural fistula. The five-year survival rate was 45.6%. In 5 patients, an anastomotic suture developed which required a completion pneumonectomy in 2. Thirteen patients developed local tumor recurrence. CONCLUSION: We conclude that sleeve lobectomy can be performed with an acceptable mortality and morbidity. Long term survival rate and recurrence rate are as good as after pneumonectomy. The operative mortality is lower when compared to pneumonectomy, exercise tolerance and quality of life are much better after sleeve lobectomy compared to pneumonectomy. For central tumours we believe that sleeve resection is the procedure of choice.
Adult↗
Modification of the arterial anastomotic technique improves survival in porcine single lung transplant model.
BACKGROUND: Lung transplantation is a valuable therapeutic option for selected patients with end-stage pulmonary disease. However, this treatment is complicated by ischaemia-reperfusion injury (IRI) of the lung in 10-20% of the recipients. We developed an unilateral porcine lung transplant model to study IRI and describe our experience with two different arterial anastomotic techniques. MATERIAL & METHODS: Twenty four domestic pigs [n = 6 x (donor + recipient)/group] were used in this study. Donor lungs were harvested using an antegrade flush with cold Perfadex and stored in the same solution for +/- 8 hours. Recipient animals underwent a left thoracotomy. After native pneumonectomy, the left donor lung was transplanted in the following order: 1. left atrial cuff; 2. bronchus; 3 pulmonary artery. 2 The outcome in recipients from historical groups differing in anastomotic technique was compared. An end-to-end anastomosis on the left pulmonary artery was performed in group I versus a patch anastomosis on the main pulmonary artery in group II. One hour after reperfusion, the right pulmonary artery and main bronchus were ligated forcing the recipient to survive on the transplanted lung only. The animals were further observed for 6 hours. RESULTS: Survival 6 hours after exclusion of the right lung was 33% (2/6) in group I versus 83% (5/6) in group II. Animals in group I died of right heart failure manifested by acute dilation of the right ventricle following ligation of the hilum of the right lung. CONCLUSION: Single lung transplantation with exclusion of the contralateral native lung is a critical model. Arterial end-to-end anastomosis resulted in an increased right ventricular afterload. The use of a patch technique improved the compliance of the arterial anastomosis and decreased early mortality. This transplant model is currently used in our laboratory to assess new methods for pulmonary preservation.
Anastomosis, Surgical↗
Lung volume reduction surgery (LVRS) for emphysema: initial experience at the University Hospital Gasthuisberg. Leuven LVRS Group.
Emphysema is a disabling disease, for which there is no curative therapy available today. Lung transplantation offers a valuable option for a very selected number of patients, however, due to the enormous organ shortage, only few patients can be offered such a therapy. Recently there has been important resurgence of interest in lung volume reduction surgery and as a consequence, we have embarked in such a program since may 1997. We have now performed unilateral lung volume reduction surgery in 29 emphysema patients (25 on the right and 4 on the left side). Twenty-four patients were already discharged home. There has been no perioperative mortality. The mean hospital stay was 19.8 +/- 11.4 days (range, 8-47 d). Twenty patients of whom we already have follow-up data during 6 months (m) form the further basis of this report. Six weeks after the procedure the FEV1 increased from 0.82 +/- 0.28 L (28 +/- 8%) to 1.05 +/- 0.39 L, a mean increase of 28%. There was a further increase of the FEV1 to a maximum of 1.06 +/- 0.42 L at 6 m, a mean maximum increase of 29% (p = 0.0046, ANOVA). Similarly, the FVC increased from 2.80 +/- 1.10 L to 3.15 +/- 1.00 L, a mean increase of 12.5%. A further increase was also obtained at 6 m and was 19.6% (3.35 +/- 1.05 L, p = 0.014, ANOVA). The maximum decrease in RV was obtained at 3 m (from 5.91 +/- 1.37 L to 4.37 +/- 0.85 L (p = 0.0001, ANOVA), a mean decrease of 26%. The maximum TLC decrease was demonstrated at 3 m (from 8.71 +/- 1.71 L to 7.60 +/- 1.56 L (p = 0.002, ANOVA), a mean decrease of 12.8%. Afterwards there was again a gradual raise of the TLC. The six minute walking distance increased from 231 +/- 31 m to 272 +/- 34 m (p = NS) after pulmonary rehabilitation and to 416 +/- 77 m at 3 m and 415 +/- 18 m at 6 m (p = 0.0002, ANOVA) after the operation. The quality of life (measured with a standardized questionnaire, the Nottingham Health Profile) improved significantly in several domains (e.g. mobility, pain, energy, emotions and social) at 3 m postoperatively. There was one late death (at 6 m) due to an unknown cause. The actuarial survival rate was therefore 100% at 3 m and 95% at 12 m. In conclusion, unilateral thoracoscopic lung volume reduction surgery is a new and safe treatment modality for patients suffering from severe end-stage emphysema. The objective and subjective improvement is marked and the mortality is very low. Rigid selection criteria are, however, necessary to be able to guarantee an optimal result.
Actuarial Analysis↗
Carbon dioxide pneumoamnios causes acidosis in fetal lamb.
Recently developed techniques of video-endoscopic surgery may offer new hope for the future of fetal surgery. To allow this approach, the amniotic cavity has to be temporarily enlarged, either by carbon dioxide (CO2) insufflation or by amnioinfusion. In 6 anesthetized ewes, CO2 insufflation of the amniotic cavity produced severe fetal hypercapnia (from 57.6 +/- 1.6 to 87.0 +/- 7.0 torr) and acidosis (from 7.22 +/- 0.03 to 7.11 +/- 0.08) despite normal maternal CO2 pressure and pH. CO2 pneumoamnios does not therefore appear to be an ideal working medium. Fetal endoscopic surgery through amnioinfusion of physiologic fluid may be a safer alternative.
Acidosis↗
Pattern of AMP degradation in ischemic rabbit lung tissue.
Because adenine nucleotide catabolites may be important during postischemic lung reperfusion, we examined the pathway of adenosine monophosphate (AMP) degradation in ischemic lung tissue. Once the pattern of degradation is known, pharmacological interventions can be considered, offering new methods of reducing lung reperfusion injury. For this purpose we used the isolated rabbit lung. Rabbit lungs were flushed in situ with a modified Krebs Henseleit solution (60 ml/kg). The lungs were removed and stored deflated, immersed in saline solution at 37 degrees C. At regular times, biopsies were taken, and adenine nucleotides, nucleosides, and bases were measured in these biopsies using high performance liquid chromatography (HPLC). During lung ischemia, a very significant increase of inosine monophosphate (IMP) was found. Adenosine levels on the other hand did not increase. Hypoxanthine was the major end catabolite of ischemic lung tissue (constituting 92% of the nucleoside and purine base fraction at 4 hours ischemia). To further determine the pathway of AMP degradation, 400 mM of the adenosine deaminase inhibitor erythro-9-[2-hydroxy-3-nonyl]adenine (EHNA) was added to the lung flush solution. During ischemia, adenosine triphosphate (ATP) breakdown was unaltered but adenosine became the major catabolite (2.8 times the concentration of hypoxanthine at 4 hours ischemia). These data suggest that: 1) in rabbit lung tissue, dephosphorylation of AMP to adenosine is more important than deamination to IMP; 2) hypoxanthine is the major end catabolite of ischemic lung tissue. By inhibiting the enzyme deaminase, reduced hypoxanthine levels and increased adenosine levels were obtained. Pharmacological interventions are now available to interfere with the formation of adenine nucleosides and bases in ischemic lung tissue. The importance of adenine nucleotide catabolites to postischemic lung reperfusion injury is discussed.
Adenine↗
Reflections on three field lymphadenectomy in carcinoma of the esophagus and gastroesophageal junction.
BACKGROUND/AIMS: One of the most controversial questions in the surgical treatment of carcinoma of the esophagus and gastroesophageal junction (GEJ) is the extent of lymph node dissection, in particular the value of the cervical lymph node dissection (the so-called third field). METHODOLOGY: This study reflects a single institution's experience with this extensive lymphadenectomy, the technique of which is described in detail. RESULTS: Adding the third field to the lymph node dissection markedly improved accuracy of staging. Unforeseen involvement of lymph nodes in the neck was found in 30%. In T3N+ tumors of the GEJ, as much as 16.6% of positive lymph nodes were detected in the neck. Locoregional recurrence without distant metastasis was found in 6 patients (17.8%) out of a group of 37 patients with a minimum follow-up of 5 years. All 6 patients had stage IV disease because of distant lymph node metastasis (M+Ly). In 3 of these patients, locoregional recurrence occurred only after 3 years or more. In a subsequent series of 100 esophagectomies performed between 1992 and July 1993 no difference in outcome between radical versus standard resection was noticed for early stage I and II. However, there is a tendency towards a better estimated 5-year survival in favor of radical dissections (21%) versus standard resection (12%) in stage III and IV. CONCLUSIONS: Extensive three field lymphadenectomy can be safely performed without increasing hospital mortality (0%) and morbidity. Improved accuracy of staging, prolonged disease-free survival and potential increased cure rate are confirmed by our experience. Survival obtained with this technique has to be compared with survival obtained by other, multimodality treatment forms.
Adenocarcinoma↗
Curative management of adenocarcinoma of the oesophagus and oesogastric junction--current recommendations of the Belgian Working Group.
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Adenocarcinoma↗
Pharyngo-oesophageal diverticulum (Zenker's). Clinical, therapeutic and morphological aspects.
In a series of 100 surgically treated patients, Zenker's diverticulum (ZD) appeared mostly as a typical geriatric disorder (50% over 70 years) in which not only oesophageal symptoms but also pulmonary symptoms (37%) may lead to a life-threatening situation. In 60% of the patients, associated upper gastrointestinal pathology was observed, most frequently being gastro-oesophageal reflux (30 patients). In 30% of the manometric studies of the oesophageal body and lower oesophageal sphincter, clear pathological patterns were observed. Morphological examinations, enzymohistochemistry, immunohistochemistry showed clear pathological changes not only at the level of the cricopharyngeal muscle but also at the level of the striated muscles of the cervical oesophagus. These clinical, manometric and morphological changes suggest that ZD is one expression of a more complex neurogenic disorder. They also justify the extramucosal myotomy of the cricopharyngeal wall and the striated muscle wall of the cervical oesophagus as well, as the cardinal step of operation. This myotomy was combined with a diverticulopexy resulting in no post-operative mortality and a minimum of morbidity. The mean longterm follow-up in this series is 4 years, showing excellent and very good results in 96% of the patients for the oesophageal symptoms and in 92% for the full spectrum of oesophageal and pulmonary symptomatology. With this single step operation, no recurrence has been seen seen as opposed to the endoscopic procedure.
Adult↗
The Belsey Mark IV antireflux procedure: indications and long-term results.
UNLABELLED: From 1977 to 1990, a Belsey Mark IV antireflux procedure was performed in 177 patients. The primary indication was gastro-oesophageal reflux (GOR) resistant to medical treatment in all but 5 patients presenting themselves with a complicated para-oesophageal hernia. Ninety-eight patients (53.5%) had some form of additional pathology or complication: grade III oesophagitis: 26, grade IV: 6, Barrett's oesophagus: 38, reintervention: 14, concomitant duodenal ulcer requiring highly selective vagotomy: 14, bleeding: 23, small benign tumours: 2. There was one postoperative and one late mortality. At one year an objective evaluation was made in all patients operated on since this interval (N = 147), consisting in endoscopy: 121, Barium-swallow: 113, 24 hour oesophageal pH-monitoring: 81, manometry: 69. A recurrence was documented in 11 patients (7.4%). The mean follow-up of these 147 patients is 4.4 years with a range from 1 to 13 years. Over the entire follow-up period 17 patients (11.5%) had symptoms suggestive of recurrent reflux. Subjective and objective recurrence rate was 13%. Undesired gastrointestinal side effect were seen in 13 patients (8.8%), whereas post-thoracotomy pain was equally noticed in 13 patients (8.8%). The final score combining recurrence rate and side effects showed excellent to very good results in 77.5% of the patients, good results in 7.5% and bad results in 15%. CONCLUSION: Candidates for surgical treatment of GOR often present themselves with a variety of reflux related complications or additional pathology. Long term follow-up shows good reflux control in 87% of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Omphalocele: mode of management. A case report and review of literature.
Management of "giant" omphaloceles has always been a challenge to pediatric surgeons. The primary goal is to minimize the mortality and morbidity by creating an optimum protection of the exposed viscera. The ideal approach of this congenital defect has not yet been found. Over the years, a number of authors have introduced new and modified techniques to solve the problem. Some results are encouraging. Selection of management method should always be based on complete evaluation of the individual characteristics of each case.
Eosine Yellowish-(YS)↗
[Surgery of foreign bodies in the esophagus in case of failure of noninvasive extraction technics].
In the period 1957-1987, 240 corpora aliena in the esophagus were treated. The foreign body could be extracted under endoscopy in 228 cases (95%). In 12 cases the non-invasive extraction technic failed, so we have to remove the foreign body surgically. The most difficult bodies to extract by endoscopic way are the big, the sharp or pointed ones. On the surgical point of view, the way of approach depends on the level of the impacted body. The problem of post-operative fistula and abscess formation after surgery, can be avoided by a correct technic, exclusion of underlying pathology, an adequate drainage and consequent infection treatment.
Adult↗
[Paraduodenal hernia: an unusual cause of intestinal obstruction].
Paraduodenal hernia. The paraduodenal hernia is the most common type of intraabdominal hernia. There exists a right and left variety, both of them with their own specific pathogenesis. The clinical manifestations range from intermittent and mild digestive problems to acute intestinal obstruction. An exact preoperative diagnosis is seldom made. The knowledge of their pathogenesis and the anatomical characteristics is very important for a successful surgical treatment.
Adult↗
[Intramural bronchogenic esophageal cyst: an uncommon event in esophageal surgery].
Intramural bronchogenic cysts of the esophagus are uncommon. These benign esophageal tumors result from a wrong cleavage of the primitive gut in the 4 weeks old embryo. Symptoms are often absent or atypical. By roentgenography and esophagoscopy, the diagnosis of benign tumor can be made. Even CT-scan can't give absolute certainty about the exact nature of the lesion. An exploratory thoracotomy, with enucleation of the tumor, is needed in all cases for definite diagnosis and treatment. The cysts are lined by columnar ciliated epithelium of the respiratory type. The presence of hyaline cartilage within the wall of the cyst allows to make the difference for sure between an esophageal cyst of bronchogenic origin and a cyst of enterogenous origin.
Bronchogenic Cyst↗
[Problems of wound healing during kidney transplantation (author's transl)].
Infection of the transplant bed caused an important morbidity and mortality. Meticulous preoperative preparation and surgical technique, the local irrigation of the transplant site with local antibiotics as well as the barrier-nursing of these high risk patients are all equally important factors to limit infectious complications in the transplant population. Since the use of the barrier-nursing principle, infection rate fell down from 8.1% to 3.6% for primary transplant wounds. The infection rate of the potentially contaminated wounds is much better than the pourcentage obtained in analogous interventions in general surgery. Nevertheless, despite these measures, re-intervention on a transplant still remains much more susceptible to infection because of the high technical difficulty of these interventions.
Belgium↗
[Pathology of the colon in renal transplantation].
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Adult↗
A report of two cases of congenital abnormal rightsided high insertion of the diaphragm.
The authors report two cases of congenital abnormal rightsided high insertion of the diaphragm. Though there was no acute respiratory distress in the neonatal period, both presented other congenital deformities that required further investigation. At one month of age, both children developed severe respiratory problems, leading to a semi-urgent surgical intervention, that revealed the final diagnosis of high insertion. The discussion, following the embryological development, underlines the rarity of this anomaly.
Abnormalities, Multiple↗