The nonoperative approach to esophageal perforation due to celestin tube placement

Perforation of the esophagus during placement of esophageal tubes for palliation of obstructing inoperable cancer is a well-known complication that may preclude satisfactory amelioration of symptoms. Experience with two such patients suggests that the complication can best be treated by proper placement of the tube so that it seals the leak and bypasses the obstruction. Judicious use of antibiotics is beneficial. Drainage of the mediastinum may also be necessary. Resectional or extensive operative therapy is probably not wise in these ill and debilitated patients, particularly if the cancer is incurable.

A community-wide experience with jejunoileal bypass for obesity

The records of seventy-nine patients who had jejunoileal bypass operations for morbid obesity were reviewed. The data represent the entire experience of surgeons in the Louisville, Kentucky metropolitan area for the period studied. Retrospective evaluations of criteria for selecting patients for bypass operation, type of shunt done, and clinical results were recorded. Sixty-eight patients (86 per cent) weighed more than 100 pounds over ideal weight. Operative mortality was 5 per cent. Only 31 patients (47 per cent) were judged as having satisfactory results. Two patients died of hepatic failure and five required restoration of intestinal continuity. Comparison of this community experience with published data supports the concept that these operations are best confined to those institutions where there is special interest in the full range of medical and surgical care of obese patients.