Int Surg
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Blunt transhiatal esophagectomy is largely performed in selected cases of esophageal cancer according to the experience of Mark Orringer. We have recently performed eleven consecutive videolaparoscopy assisted transhiatal esophagectomies in order to help esophageal dissection and to avoid injuries to mediastinal structures. In our experience the routine use of laparoscopic assistance during transhiatal esophageal dissection improves the safety of this technique and lowers postoperative complications. The results of neoadjuvant treatments (radio-chemotherapy) recently reported emphasize the role of transhiatal esophagectomy for cancer.
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From April 1991 till December 1995, Split University Hospital played a major role as a third échelon war hospital during the war in Croatia and Bosnia and Herzegovina. Among 2856 treated battle casualties in general, 70 patients with penetrating thoraco-abdominal war injuries were treated at the Department of Surgery. Explosive wounds were present in 38 (54%), gunshot wounds in 32 (45%) and puncture wounds in four (5.70%) patients. ⋯ The treatment of respiratory insufficiency and hemorrhagic shock, and prevention of infection are the basis of the management of these injuries. Treatment success depends on emergency first-aid, quick transportation, early diagnosis, resuscitation, surgical therapy and intensive care.
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During the past 4 years, 48 cases of cardiac arrest occurred during anesthesia among a total of 104,600 cases of anesthesia at Mackay Memorial Hospital in Taipei. ⋯ The incidence of cardiac arrest was thus about 0.046% (48/104,600), with the causative factors being anesthetic related in 21% (10/48) of cases, surgical factors in 19% (9/48) of cases and patient's pathological factors in 60% (29/48) of cases. Of these 48 patients, 34 died and 14 survived after cardiopulmonary resuscitation (CPR). Anesthesia contributed to death in 3 cases of a total of 104,600 cases of anesthesia giving an approximate incidence of 3/100,000. Two of these 3 cases were avoidable.
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Primary esophageal motility disorders include achalasia, diffuse and segmental esophageal spasm, nutcracker esophagus and hypertensive lower esophageal sphincter. Failed medical therapy frequently precedes the presentation of these patients for surgical intervention. Both laparoscopic and thoracoscopic techniques have been developed to successfully treat these spastic disorders of the esophagus. Laparoscopic and thoracoscopic operative techniques are described.