Amebic Perforation of the Colon: Rare and Frequently Fatal Complication

Amebic colitis perforation is a rare clinical form of amebiasis characteristically associated with high morbidity and mortality. We here present our series of eight patients with amebic colitis perforation. These patients represent 5% of 150 patients hospitalized during the same period for chronic amebic colitis. Only 50% of our patients had a correct preoperative diagnosis, and signs of generalized peritonitis such as rebound tenderness or muscular rigidity were not as common as might have been expected. Our mortality rate was 50% despite aggressive surgical treatment. Every effort should be made to have an early diagnosis, which would lead to early treatment with antiamebic agents, earlier and more limited surgery, and improved survival of these patients.     

Chylous Leak: A Rare Complication after Axillary Lymph Node Dissection

The authors present a case of a chylous leak after axillary lymph node dissection. Although this case has been treated conservatively, the authors discuss different treatment approaches.     

A Rare Complication after Thyroidectomy: Perforation of the Oesophagus: a Case Report

Perforation of the cervical oesophagus after thyroidectomy is an exceptionally rare complication. Total thyroidectomies, particularly for recurrent cases might possess an increased risk. Although rare, it has high mortality and morbidity. A patient that developed oesophagus perforation after a total thyroidectomy in a peripheral hospital for recurrent nodular goitre was treated and followed-up in our clinic. This well-documented case is discussed in conjunction with the information presented in the literature.     

心肌间隔切除术矫治肥厚梗阻型心肌病及围术期治疗策略

目的总结心肌间隔切除术治疗肥厚梗阻型心肌病(Hypertrophic obstructive cardiomyopathy,HOCM)的临床经验,探讨围术期治疗策略。方法1996年10月至2009年6月我科收治了62例HOCM患者,男41例,女21例;年龄6～68岁,平均年龄34.05岁。手术在全身麻醉低温体外循环下完成,按常规经主动脉切口行室间隔心肌切除术(经典或改良Morrow技术),同期行冠状动脉旁路移植术5例,二尖瓣置换术12例,二尖瓣成形术9例,主动脉瓣置换术4例,三尖瓣成形术2例,动脉导管闭合术2例。围术期常规行心脏超声心动图或经食管超声心动图、心电图或动态心电图及胸部X线片检查,评价超声心动图检查指标、二尖瓣的结构和功能改变。结果全组体外循环时间104.23±47.14min,主动脉阻断时间66.76±36.32min,气管内插管时间13.23±11.76h,术后住监护室时间42.53±37.41h。全组死亡4例,病死率6.45%(4/62),死于感染性休克合并急性肾功能不全1例,顽固性心律失常、心室颤动、心房扑动合并低心排血量综合征1例,急性肾功能衰竭1例,Ⅲ°房室传导阻滞合并低心排血量综合征1例。术后左心房内径(34.56±6.45mmvs.43.46±7.21mm,t=6.948,P=0.000),左心室舒张期末内径(37.14±6.31mmvs.42.03±6.23mm,t=3.145,P=0.020),左心室流出道压差(23.54±17.78mmHgvs.103.84±44.04mmHg,t=13.618,P=0.000),室间隔厚度(17.12±5.67mmvs.26.93±5.23mm,t=10.694,P=0.000)与术前比较均减小或降低。二尖瓣关闭好或仅有轻度反流,二尖瓣前向运动(SAM)征基本消失。术后发生的主要心律失常包括完全性左束支传导阻滞、室内传导阻滞、完全性房室传导阻滞和心房颤动等。58例生存患者均痊愈出院,随访53例,随访时间3个月～12年,失访5例。随访期间无远期死亡、并发症及再次手术患者,症状均明显减轻,心功能I～II级,生活质量明显提高。结论HOCM心肌间隔切除术可充分疏通左心室流出道,消除二尖瓣SAM征,满意的缓解左心室流出道梗阻,改善患者症状。术后主要心律失常表现为传导束传导异常和心房颤动。精确的手术技术和及时有效的药物治疗可获得满意的疗效。