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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Tracheoesophageal fistula is a complication of endotracheal canulas with pressure balloon during mechanical ventilation, for which treatment is surgical closure. There are approximately 80 reported cases in the world literature. Here we report our experience at the National Institute of Respiratory Diseases of Mexico. We performed surgical treatment of 7 patients (4 males, 3 females, 17 to 65 years of age) with tracheoesophageal fistula from 1991 to 1995, referred from other hospitals. Six had a history of prolonged orotracheal intubation, and the seventh had a traumatic lesion of the neck. Preoperatory management varied from 1 to 8 weeks, with treatment of malnutrition and infections. Esophagus was sutured with polyglactin 000 in two layers, the inner with interrupted, and the superficial with continuous sutures. The area was covered with a muscle strap. In six patients, simple suture of trachea was performed. In the seventh, due to an extensive tracheal defect, we decided to use a second muscle strap to occlude it. Six patients have had a follow up of 15 months to 5 years with satisfactory evolution. One patient died due to abdominal sepsis. We conclude that this technique provides a good prognosis for this disorder.
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PMID:[Surgical treatment of non-malignant tracheoesophageal fistula]. 978 84

The objective of this study was to evaluate the therapeutic usefulness of chemoradiotherapy (CRT) followed by surgery in patients with clinically T4 (cT4) esophageal cancer involving adjacent organs such as the trachea, main bronchi, and large vessels. Thirty-seven patients with cT4 squamous cell carcinoma of the thoracic esophagus were enrolled in this study. The CRT regimen comprised cisplatin (70 mg/m2) on day 1, 5-fluorouracil (700 mg/m2) on days 1-4 and external irradiation (200 cGy/day, total 30 Gy) on either days 8-26 (sequential schedule, n=15) or days 1-19 (concurrent schedule, n022). Two courses of CRT were given. The results of CRT were complete response in nine patients, partial response in 19, no change in three (minor response in two), and progressive disease in six patients. The median response duration in all responders was 172 days (range: 56-2469, n=19). After CRT, 13 patients received surgery. In 12 of these patients, tumors were completely resected. Histopathologic examination of the resected specimen revealed a discrepancy between clinical response and histopathologic effect. The median duration of survival and the 1-, 2- and 5-year survival rates were 304 days (84-3155), 45%, 35% and 23% in all patients, respectively, 866 days (190-3155), 83%, 83% and 57% in the 13 patients whose tumors were resected, and 187 days (84--2630), 25%, 5% and 5% in the 24 patients whose tumors were not resected. Grade 3 toxicity, especially hematological reactions, was noted in 13.5% (5/37) of the patients. There was one toxicity-related death (sepsis). A good outcome may be obtained with CRT, followed by surgery when feasible. However, CRT can cause toxic reactions, and close monitoring of patients is required.
Dis Esophagus 2001
PMID:Chemoradiotherapy followed by surgery for thoracic esophageal cancer potentially or actually involving adjacent organs. 1186 19

Prompt diagnosis and effective treatment are important for thoracic esophageal perforations. The decision for proper management is difficult especially when diagnosed late. However, there is an increasing consensus that primary repair provides good results for repair of thoracic esophageal perforations, which are not diagnosed on time. Primary repair for thoracic esophageal perforations was applied in 20 out of 25 consecutive patients. The time interval between perforation and repair was less than 24 h in six patients (group I), and more than 24 h in 14 patients (group II). The remaining five patients underwent esophagectomy with simultaneous or staged reconstruction because of incorrectable underlying esophageal pathology. Group I had much more iatrogenic causes (P < 0.05). Preoperative sepsis occurred only in group II (P=0.05) and was highly associated with Boerhaave syndrome (P=0.001). Regional viable tissue was used to reinforce the sites of primary repair (n=15, 75%). All of the postoperative morbidity (n=9, 45%) including esophageal leaks (n=6, 30%) and operative death (n=1, 5%) occurred in group II. In patients with postoperative leaks, five eventually healed, but one became a fistula that required reoperation. Primary healing with preservation of the native esophagus was achieved in all 19 patients except one operative death. In addition, the increased incidence of leak and morbidity did not lead to an increase in mortality. In the esophagectomy group, there was no mortality, but one minor suture leak. Regardless of the time interval between the injury and the operation, primary repair is recommended for non-malignant, thoracic, esophageal perforations, but not for anastomotic leaks. Reinforcement that may change the nature of a possible leak is also useful. For incorrectable underlying esophageal pathology, esophagectomy with simultaneous or staged reconstruction is indicated.
Dis Esophagus 2002
PMID:Surgery in thoracic esophageal perforation: primary repair is feasible. 1244 91

Perforations of the esophagus are uncommon complications of flexible gastrointestinal endoscopy. Perforations after endoscopy are likely to occur in the cervical esophagus, where fiber insertion is difficult anatomically. The diagnosis should be made as soon as possible, because mediastinitis and sepsis frequently develop following esophageal perforations. The surgical strategies are dependent on the location of the perforations and the condition of the patients. For a successful outcome, surgery is a preferred treatment for most perforation cases, and non-operative treatment, such as antibiotics, parental nutrition, and no food intake by mouth, should be applied carefully.
Dis Esophagus 2002
PMID:Successfully treated case of cervical abscess and mediastinitis due to esophageal perforation after gastrointestinal endoscopy. 1244

The aim of this study was to critically evaluate acute and long-term complications of hand-sewn and semimechanical cervical esophagogastric anastomosis following resection of primary esophageal adenocarcinoma. Between February 1991 and 2001, 91 consecutive patients underwent subtotal esophagectomy (transthoracic, n=49; transhiatal, n=42), transposing a gastric tube based on the right gastroepiploic artery. All esophagogastric anastomoses were performed in the left neck using a hand-sewn technique (n=53) and, from September 1997, a side-to-side semimechanical technique (n=38). Outcomes evaluated were anastomotic leak rates, length of stay, and development of strictures. Postoperative mortality was 4.4% (all cardiopulmonary causes). Fifty-eight patients (63.7%) had an uncomplicated postoperative course, with a median postoperative length of stay of 10 days (vs. 20 days with associated morbidity; P </= 0.001). Anastomotic leaks were the leading cause of postoperative morbidity (16.5%, 15/91), and were classified into four types based on severity. The semimechanical anastomotic technique was associated with a reduced leak rate compared with the hand-sewn technique (7.9%, 3/38 vs. 22.6%, 12/53; P=0.08), although different patterns of anastomotic failure were seen following semimechanical anastomoses, with increased mediastinal and pleural sepsis. Anastomotic strictures developed in nine (17.0%) hand-sewn and three (7.9%) semimechanical anastomoses. Our conclusion was that a semimechanical technique for cervical esophagogastrostomy is associated with reduced anastomotic leak rates compared with hand-sewn anastomoses, resulting in a shorter postoperative stay. Patterns of anastomotic failure varied between each technique, possibly as a consequence of a longer cervical esophageal segment required for construction of a semimechanical anastomosis. The association between anastomotic technique and stricture development was not clear from this study.
Dis Esophagus 2002
PMID:Evolution and critical appraisal of anastomotic technique following resection of esophageal adenocarcinoma. 1247 75

We herein report about a case of perforation of the cervical esophagus by an artificial denture, which had been swallowed by the patient after a horse-related-injury. Impactation of the foreign body at the level of the upper esophageal sphincter was followed by its penetration through the esophageal wall, causing severe infection of the cervical soft tissue, mediastinitis and sepsis. We discuss the well-known phenomena of prosthesis ingestion and frequently delayed diagnosis, as well as our treatment strategy of cervical esophageal perforation with placement of a T-tube into the cervical esophagus and mediastinal drainage.
Dis Esophagus 2002
PMID:Cervical esophageal perforation with severe mediastinitis due to an impacted dental prosthesis. 1247 85

Rupture of the esophagogastric anastomosis is potentially lethal if untreated. We report a case of esophagogastrostomy disconnection after an upper partial gastrectomy for strangulated paraesophageal hernia. The patient, a 50-year-old woman, developed systemic sepsis due to rapid manifestation of suppurative mediastinitis followed by peritonitis and was admitted to the intensive care unit 8 days after the primary operation. The patient underwent a staged surgical treatment and survived after a prolonged hospital stay. Initial reoperation consisted of emergent laparotomy and right thoracotomy for drainage and debridement completed with excision of the anastomosis, gastric stump exclusion and subcutaneous presternal transposition of the esophagus performed through a left cervical incision. Delayed restoration of the continuity of the gastrointestinal tract was re-established using jejunum. The final result achieved was a successful esophagojejunal anastomosis with both organs transposed in a subcutaneous presternal canal. The patient regained normal swallowing function. The 'subcutaneous esophageal transposition' procedure enables the easy performance of an extrathoracic esophagojejunal anastomosis and results in a safe gastrointestinal tract reconstruction in cases with esophagogastric anastomotic leakage.
Dis Esophagus 2005
PMID:Subcutaneous esophagojejunal reconstruction in the management of esophagogastric anastomotic leak: a staged procedure. 1619 38

High-mobility group box chromosomal protein 1 (HMGB-1) has recently been shown as an important late mediator of endotoxin shock, intra-abdominal sepsis, and acute lung injury. However, its role in the systemic inflammatory response syndrome after major surgical stress, which may lead to multiple organ dysfunction syndrome, has not been thoroughly investigated. We hypothesized that serum HMGB-1 participates in the pathogenesis of postoperative organ system dysfunction after exposure to major surgical stress. A prospective clinical study was performed to consecutive patients (n = 24) with carcinoma of the thoracic esophagus who underwent transthoracic esophagectomy with three field lymph node resection between 1998 and 2003 at Keio University Hospital, Japan. Serum HMGB-1 concentrations were measured by enzyme-linked immunosorbent assay. Preoperative serum HMGB-1 levels correlated with postoperative duration of SIRS, mechanical ventilation, and intensive care unit stay. Three of the 24 patients had serious postoperative complications: sepsis in two, and acute lung injury in one. Serum HMGB-1 levels in patients without complications increased within the first 24 h postoperatively, remained high during postoperative days 2-3, and then decreased gradually by postoperative day 7. In patients with serious complications, serum HMGB-1 was significantly higher than that found in patients without postoperative complications at every time point except postoperative day 2. Preoperative serum HMGB-1 concentration seems to be an important predictor of the postoperative clinical course. Transthoracic esophagectomy induces an increase in HMGB-1 in serum even in patients without complications. Postoperative serum HMGB-1 concentrations were higher in patients who developed complications, and may be a predictive marker for complications in this setting.
Dis Esophagus 2006
PMID:Serum concentrations of high-mobility group box chromosomal protein 1 before and after exposure to the surgical stress of thoracic esophagectomy: a predictor of clinical course after surgery? 1636 36

We report a late onset, benign, tracheoesophageal fistula in a 51-year-old man, due to an accidentally swallowed denture. In view of the extensive peri-esophageal sepsis and fibrosis, he was managed by a subtotal esophagectomy and a cervical esophagogastric anastomosis. The tracheal defect was closed with the help of an intercostal muscle flap. This report also highlights the difficulty in identifying swallowed prosthetic dental material radiologically, when no metallic component is present. This fact was also responsible for the delay in diagnosis, eventually leading to the rare complication of a tracheoesophageal fistula.
Dis Esophagus 2006
PMID:A missing denture's misadventure! 1636 46

Dr. Herman Boerhaave (1668-1738) first described esophageal rupture and the subsequent mediastinal sepsis based upon his careful clinical and autopsy findings and hundreds of references have since been written about Boerhaave's syndrome. Several fine historical accounts of this brilliant scientist have been published over the years and he has received appropriate credit for his valuable contributions. But what about that unfortunate propositus that Dr. Boerhaave attended to, performed necropsy upon, and subsequently received acclaim with? Medical history pays inadequate regard to the Baron Jan Gerrit van Wassenaer heer van Rosenberg, Prefect of Rhineland and Grand Admiral of the Dutch Fleet. This figure was a nobleman and war hero at the peak of the Dutch Golden Age who played his role in steering the course of European history. Without this nobleman's heroic contemporaneous account, Boerhaave's celebrated impact on medical science would never have been realized. Therefore, we offer an overdue recitation of Admiral van Wassenaer's biography. Based on found precedent we propose that spontaneous rupture of the esophagus be henceforth referred to as the 'Boerhaave-van Wassenaer's syndrome'.
Dis Esophagus 2006
PMID:Honoring the Admiral: Boerhaave-van Wassenaer's syndrome. 1672 90


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