[A clinical study of cefoperazone in surgery. Prevention of postoperative infections and transfer into pleural effusion]

A clinical study of cefoperazone (CPZ) in the surgery (on the prevention postoperative infections and transfer into pleural effusion) was conducted to obtain results as follows. As for the blood concentration after a 30-minute drip infusion of CPZ 2 g, it was 115.6 +/- 19.88 micrograms/ml (Mean +/- S.E.) 1 hour after completion of the administration. The biological half-life was 2.16 hours. The pleural effusion concentration of CPZ showed 33.3 +/- 7.86 micrograms/ml 2 hours after completion of the administration, which was enough to inhibit the growth of bacteria isolated from sputum and pleural effusion. The excretion was very slow. As for the effectiveness of CPZ for prevention of postoperative infection, CPZ proved effective in all of 8 cases. Specific side-effects were not observed. Thus, the usefulness of this preparation was confirmed.

Wound amylase levels as an early indicator of orocutaneous fistulae

The formation of an orocutaneous fistula following ablative head and neck surgery is a common complication. Early fistula detection could permit prompt management, hopefully preventing further wound breakdowns. Amylase is quantitatively the most prominent enzyme in saliva. This study prospectively evaluated whether the amylase content of wound drainage could predict the formation of an orocutaneous fistula earlier than clinically evident. Patients undergoing procedures that required postoperative wound drainage represented the study population. Baseline serum and salivary amylase determinations were obtained. The drainage was assayed for amylase content twice daily. Wound amylase values were then correlated with the patient's clinical course. Results showed wound amylase had a downward trend in uncomplicated postoperative courses. An upward trend of wound amylase was correlated with early fistulization. No pattern was identified in patients with delayed fistulae.

Localized amyloidosis of the head and neck and upper aerodigestive and lower respiratory tracts

Seven cases of localized amyloidosis limited to structures of the head and neck and upper aerodigestive and lower respiratory tracts evaluated and treated at Boston University Hospitals in a recent 7-year period were reviewed. Negative Congo red staining of abdominal adipose aspiration biopsy or rectal biopsy specimens established that the amyloidosis was not systemic. Localized amyloidosis occurred in discrete masses in a variety of sites in the aerodigestive tract including the orbit, nasopharynx, lips, floor of mouth, tongue, larynx, and tracheobronchial tree. Five patients required surgical excision because of significant airway obstruction or organic dysfunction. Amyloid deposits completely excised with the carbon dioxide laser have not recurred, though other amyloid masses may appear elsewhere within the same organ or region. Amyloidosis may occur primarily or secondarily to other disease states. Localized amyloidosis has not been chemically identified but is usually defined by the absence of systemic features. While rare, amyloidosis must be recognized and understood by the otolaryngologist/head and neck surgeon to allow appropriate diagnostic and therapeutic planning.

Lasers in medicine and surgery

The laser produces an intense beam of pure monochromatic light. The wavelength of the light determines its effects on body tissues, and this defines the clinical role of each laser. The carbon dioxide laser is absorbed by water and it is used as a high precision, bloodless, 'light scalpel'. The blue/green argon laser beam is absorbed by structures which have its complementary colour red, and it can coagulate vessels through the without damage to clear, normal tissues. The neodymium: YAG laser is deeply absorbed in the tissues, and is used both for vessel coagulation and thermal tissue destruction. The tunable dye laser is used to photoactivate intra-tumour haematoporphyrin derivative in the treatment of many forms of malignant disease by photoradiation therapy. Lasers should only be used when they offer significant advantages over established conventional techniques, and this paper attempts to define the areas in which lasers offer these advantages.

[Endoscopic surgery of the upper aerodigestive tract in children]

In the treatment of congenital and acquired diseases in the newborn, infant and older children, increasing use is being made of endoscopic surgery in the nose, paranasal sinuses and nasopharynx, and endolaryngeal microsurgery in the larynx and pharynx. In recent years new technical developments in the field of endoscopy, together with the use of various types of laser, have either made endoscopic surgery possible in the first place, or have facilitated and improved it.

Complications of CO2 laser surgery of the aerodigestive tract: experience of 4416 cases

The CO2 laser was first introduced for surgery of the aerodigestive tract in 1971. Since that time, great advances in application have been made in both the adult and pediatric population. Recent reports of isolated complications have appeared in the literature. However, a realistic complication rate in a large series of patients has yet to be reported. This report relates the combined experience of the authors in a total of 4416 cases during the 11-year period from 1971 to 1982. There were nine instances of complications, representing a complication rate of 0.2%. These complications provided a unique learning experience for the authors, and led to the establishment of certain basic principles that should be followed in all laser operations. This survey indicates that the CO2 laser is a safe, extremely useful surgical modality in the aerodigestive tract.

Medical diseases in surgical patients in Hong Kong

The incidence of medical diseases in surgical patients was assessed using data gathered from 5944 consecutive anaesthetics. Medical disease which might affect anaesthetic management was present in 23.2% of patients. The commonest diseases were hypertension, anaemia, chronic obstructive airway disease, diabetes mellitus, and pulmonary tuberculosis. No significant difference was detected in sex incidence for ischaemic heart disease and cerebrovascular disease. There was a disproportionate preponderance of males with respiratory diseases. It is suggested that anaesthetics should be administered only by qualified anaesthetists, that the establishment of anaesthetic outpatient clinics is desirable, and that internal medicine should be included in anaesthetic training.

Characteristics and surgical management of respiratory complications accompanying pathologic lesions of the brain stem

Three life-threatening respiratory complications are regularly encountered in patients who survive the initial insult from a diffuse brain stem lesion--central alveolar hypoventilation, upper airway obstruction, and aspiration pneumonitis. From treating 13 patients who did survive, a surgical plan for managing the respiratory sequelae of such injuries has evolved and consists of: 1)Diaphragm pacing to correct hypoventilation; 2) tracheostomy for bypass of the upper airway obstruction; 3) gastrostomy for bypass of the impaired structures of swallowing; 4) surgical closure of the larynx to prevent aspiration. All 13 patients manifested central apnea, which was controlled in five by bilateral phrenic nerve stimulation and in eight by unilateral stimulation. All patients required tracheostomy to provide an airway for artificial ventilation and for secretion removal. In ten patients aspiration necessitated gastrostomy. The spontaneous recovery of the ability to swallow allowed closure of the gastrostoma in three but in others aspiration remained a serious complication. One patient died of massive aspiration after discharge from the hospital. Three patients had surgical closure of the larynx to prevent aspiration. Seven patients are alive; six of them are leading productive lives, though several have severe disability due to paresis or ataxia. Six died after discharge from the hospital. Three deaths were not related to the basic problem but the three others may have been.

Management of malignant esophagorespiratory fistula

Esophagorespiratory communication developed in 46 patients among 570 with esophageal cancer. Therapy was basically palliative and aimed at mechanical interruption of the fistula, restoration of esophageal continuity, and avoidance of external tubes and appliances. Supportive therapy, gastrostomy, tracheostomy, and esophageal exclusion and diversion procedures resulted in little prolongation of life and poor palliation of the patient. Permanent endoesophageal intubation with tubes of the Celestin variety resulted in best palliation with minimal operative risk for most terminal patients. Colon bypass and occasional resection can accomplish the same goal and possibly provide long-term survival in good-risk, young patients with small tumors.