No abstract

The effects of the Angelchik prosthesis on esophageal and gastric function were investigated in 17 patients (11 men and six women; median age, 57 years; age range, 36 to 88 years) who underwent surgery for treatment of gastroesophageal reflux disease. All patients demonstrated unequivocal reflux, either at endoscopy or 24-hour pH testing. There was a significant increase in lower esophageal sphincter pressure after surgery, and no patient demonstrated abnormal reflux on pH testing. Gastric emptying of liquids and solids was not altered by surgery. Six months after surgery, all symptoms except dysphagia had significantly improved. Thirty-three months after surgery, six patients described symptoms as severe as or worse than those before surgery. Four patients had the prosthesis removed, two because of dysphagia alone, one because of reflux and dysphagia, and one because of flatulence and bloating. The patients who required removal of the prosthesis because of dysphagia had gross delay of esophageal emptying. We conclude that the Angelchik prosthesis is an effective antireflux device, but it interferes with esophageal function in some patients, requiring removal of the prosthesis. We think the rate of removal of the prosthesis is too high for its routine use in the treatment of gastroesophageal reflux disease.

Percutaneous transcholecystic cholangiography can be performed readily without special equipment. It provides valuable anatomical information in 85% of cases before commencing dissection of the cystic duct.

The aim of this study was to assess a newly developed computerized tomography (CT)‐based splenic injury index in predicting the outcome of splenic injury. Twelve patients with isolated splenic injuries were studied. Splenic parenchymal injury was graded from 1 to 4 based on CT. The splenic injury index was obtained by multiplying the parenchymal score by the volume of haemoperitoneum, which was measured on the CT scanner. The 12 patients with CT‐proven splenic injuries had a mean injury index of 193.5 ± 191 (mean ± s.d.). The 3 patients who failed conservative management had a mean index of 475 ± 50, compared with an index of 99.5 ± 100 in the nine managed non‐operatively (P < 0.001). This new CT‐based splenic injury index allows morphological assessment of splenic injury and may predict the outcome of splenic trauma.

Background. Comorbid long segment congenital tracheal stenosis and congenital cardiovascular abnormalities in children pose significant challenges with regard to repairing these abnormalities simultaneously or in stages. The aim of this study was to explore whether this combination of abnormalities needs a staged approach for surgical repairs.Methods. All children who underwent both tracheal and cardiac surgical procedures at a tertiary hospital from 1995 to 2018 were analyzed retrospectively for mortality, ventilation days, postoperative intensive care unit days, mediastinitis, and unplanned reoperation by dividing them into simultaneous repairs (group 1), staged repairs within the same admission (group 2), and staged repairs during different admissions (group 3).Results. Of 110 patients included in the study (group 1, 74; group 2. 10; and group 3, 26 patients), there was no significant difference in mortality (P [ .85), median ventilation days

Dieulafoy's disease is a rare vascular lesion characterized by presence of large aberrant arteries within the submucosa of gastrointestinal tract or respiratory tract with a potential to cause life-threatening hemorrhage. Treatment includes bronchoscopy ablation, angiographic embolization or surgery. We report management of 7-year old girl with Dieulafoy's disease in the airway who presented with recurrent hemoptysis. Bronchial angiography revealed multiple feeding vessels to the lesion. Considering the potential risk of recurrence with embolization, sleeve resection of bronchus offered complete resolution. This case demonstrates the usefulness of bronchial angiography as part of multi-faceted approach before surgery in the management of Dieulafoy's disease.

A female infant (33 weeks' gestation) was delivered by emergency caesarean section because of hydrops foetalis. No cause was identified initially; haemoglobin, liver and renal functions were normal and there was no evidence of sepsis or significant myocardial dysfunction or arrhythmia. There was initial improvement with conventional management but bilateral pleural effusions persisted, which became overtly chylous after institution of enteral formula feeds on day 4. At 5 weeks of age, an obstruction at the superior caval vein/right atrial junction was confirmed at angiography and dilated with resolution of all remaining oedema and fluid collections. Repeat venography at 9 months of age showed a normal superior caval vein and she remains well at 15 months.

This incidence of bar fracture is unexpectedly high, although the literature on this topic is sparse. The high fracture rate is alarming, because of its unpredictability and lack of clear aetiological factors. The operation is done (largely) for psychosocial and cosmetic reasons, and therefore, we must have complete confidence in the quality of the bars used in teenage pectus patients. We raise the issue to warn other units and encourage them to report bar fracture rates.