A series of 57 esophageal perforations from the period 1963-1982 is reported. They comprised 42 iatrogenic, instrumental perforations and 15 non-iatrogenic, mainly spontaneous and postemetic ruptures. The clinical manifestations were mostly pain, fever, subcutaneous and mediastinal emphysema, pleural effusion and pneumothorax. Esophageal leak was demonstrated in 73% of contrast studies. The overall mortality rate was 25%. It was 21% in cases with primary suture closure and 50% when treatment consisted of drainage. The mortality rate was 19% when treatment was begun within 24 hours and 35% when there was longer delay. Other factors influencing the mortality rate seemed to be type and location of the perforation and age of the patient. Early surgical intervention is advocated for perforation or rupture of the intrathoracic esophagus. Data in the literature and our own findings indicate that also in cervical esophageal perforations early surgical repair is justifiable.
In a retrospective study of 44 cases of suspected primary pulmonary cancer with pleural involvement, the diagnostic value of pleural biopsy a.m. Abrams was evaluated. Biopsy specimens in 20 patients showed malignancy, which in 16 cases provided an adequate diagnosis, while 4 patients needed pleural biopsy by means of operation. In a total of 24 cases showing biopsy specimens without malignancy there were 4 false-negative ones. Among the patients under study, closed pleural biopsy combined with pleural fluid cytology proved malignancy in 96% of the cases in which neoplastic disease of the lungs and pleura was otherwise diagnosed. These findings indicate the value of using both fluid cytology and closed pleural biopsy at an early stage of the diagnostic procedure in cases of suspected pulmonary cancer with pleural involvement.
Twenty-eight cases of dissecting aneurysms of the thoracic aorta in patients with hypertension, syphilis, Marfan's syndrome and with unknown aetiology are analyzed with regard to the origins and extent of the dissection angiographically. The most common symptoms and evident radiological findings of the plain radiographs of the chest are stressed. The prognosis depends on the type of dissection.
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