RESUMEN
At the department of surgery of the university of Cologne-Lindenthal, 184 patients (142 with squamous cell carcinoma of the esophagus, 42 with adenocarcinoma of the gastroesophageal junction) underwent blunt dissection of esophageal cancer between 1983 and 1991. Tumor expansion classified by the pathologist was stage I in 13.6%, stage II in 31.0%, stage III in 41.8%, and stage IV in 13.6% of all cases. Histological tumor differentiation was graded well in 4.3%, moderate in 71.7%, and poor in 19.6%. Principally a gastric tube was used for esophageal replacement (96.3%), while interposition of the large bowel was performed in 5 cases. All the patients were prospectively monitored for perioperative complications. 64.7% fared without any complications intraoperatively. The most frequent intraoperative complications were damage of the pleura parietalis (16.3%), rupture of the tumor during dissection (13.0%), and lesion of the spleen (11.4%). 29.9% of the patients had a postoperative course without any complications. Pleural effusion (38.6%) and insufficiency of the cervical anastomosis (22.8%) were the most frequent complications seen postoperatively. Hospital mortality amounted to 6.0%. Six months after the operation most patients deemed their quality of life satisfying or excellent, respectively. The cumulative survival rate (without hospital mortality) was 78.3% after the first year, 24.7% after the third year and 20.6% after the fifth year.
Asunto(s)
Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esófago/cirugía , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica/métodos , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Cardias/patología , Cardias/cirugía , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Esófago/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Tasa de Supervivencia , Técnicas de SuturaRESUMEN
In this paper we present a method we used to provide quantitative description of the systolic and diastolic temporal function of the left ventricle (LV). Additional parameters, such as peak filling and ejection rates, times to end systole and end diastole, and temporal changes in slow and fast filling are obtained. The volumes associated with these parameters are also calculated. Correlation between LV volume changes during the cardiac style and corresponding "density" variations was confirmed. Time-density curves were obtained from selected cardiac cycles in each study. We used the polynomial fitting technique to fit the time density curves and developed a computer algorithm for deriving the relevant parameters. Data from a total of 18 patients with ischemic heart or valvular diseases, who underwent I.V. ventriculography was analysed using our method. Some of these patients were forwarded for repeated digital subtraction angiography (DSA) examination before and after intervention therapy to evaluate the effectiveness of treatment. In comparison to the geometric method for the analysis of LV performance, our method is generally faster and simpler to employ. The method was effective in detecting variations in the peak ejection and filling rates in our group of patients before and after interventional therapy.