Predicting adverse events in patients undergoing hepatectomy—validation of preoperative nomogram and risk score

Background/Purpose

Much research exists on preoperative measures of postoperative mortality in the surgical treatment of liver malignancies, but little on morbidity, a more common outcome. This study aims (i) to validate the published calculations as acceptable measures of postoperative mortality and (ii) to assess the value of these published measures in predicting postoperative morbidity.

Palliative intubation in the management of esophageal carcinoma

Intubation for unresectable esophageal carcinoma has been analyzed from a collective review of 2,459 patients covering the period of 1960 to 1971.The overall hospital mortality (including a technical mortality of 4.5%) was 13.9%. For the two most commonly used pull-through tubes (Celestin and Mousseau-Barbin) the hospital mortality was 23.5% and the technical mortality 6.6%. For the push-through tube, mortality was, in general, less and was least for the Souttar tube; hospital mortality ranged from 3.6 to 11%, and technical mortality was less than 2%.The overall complication rate was 25.4%. The most common complications were tube dislodgment and tube obstruction. Dislodgment occurred most frequently with the Souttar tube. The average survival period was 4.2 months after intubation. Though not perfect, this mode of treatment provides satisfactory palliation for patients whose survival is limited. The best results were recorded for the Celestin and Souttar tubes.     

Traumatic diaphragmatic hernia: a continuing challenge

Traumatic diaphragmatic hernia is an uncommon but important problem in the patient with multiple injuries. Since diaphragmatic injuries are difficult to diagnose, those that are missed may present with latent symptoms of bowel obstruction and strangulation. From 1957 to 1982, we treated 41 patients with traumatic diaphragmatic hernias. In 39 patients (95%), diaphragmatic hernia followed blunt trauma. The herniation occurred on the right side in 14 patients and on the left side in 29; it was bilateral in 2. Twenty-four patients had diagnostic chest radiographs, and an additional 11 had abnormal but nondiagnostic studies. Peritoneal lavage was of little value in making the preoperative diagnosis. Twenty-three patients underwent laparotomy only, 13 required thoracotomy alone, and 5 had combined laparotomy and thoracotomy. There were 7 deaths (17%) from associated injuries. Only one missed injury was encountered; a second delayed hernia, initially treated elsewhere, was repaired 45 years after the original trauma. Traumatic diaphragmatic hernia should be suspected on the basis of an abnormal chest radiograph in the trauma victim with multiple injuries. Right-sided injuries occur more commonly than previously thought and often require dual incisions (laparotomy and thoracotomy) for diagnosis and treatment. The organization of emergency care for such patients is critical in avoiding the potential of long-term sequelae.     

Value of colonoscopy in patients with rectal blood loss unexplained by rigid proctosigmoidoscopy and barium contrast enema examinations

Total colonoscopy is the procedure of choice for patients with any amount of rectal blood loss unexplained by proctosigmoidoscopy and barium contrast enema examinations. In 168 endoscopic examinations, 46 unsuspected lesions in 39 patients (23 percent) were detected, 50 percent of which were 1 cm or greater in diameter. Considering that 30 percent of all unsuspected lesions, 100 percent of angiodysplastic abnormalities and 40 percent of unsuspected carcinomas were located proximal to the splenic flexure, emphasis is placed on the importance of examining the entire colon to the cecum.