OBJECTIVETo investigate the feasibility of a new mode to diagnose and treat intrathoracic gastroesophageal anastomotic leak.

METHODSFrom January 2007 to December 2014, fifty-five patients were confirmed intrathoracic gastroesophageal anastomotic leak among those were performed surgical operation due to esophageal or cardiac carcinoma in the First Affiliated Hospital of Soochow University. To retrospectively analyze the clinical data of these patients, thirty-six male and nineteen female were included with the ages from 49 to 81 years (average age of (67±6)years). Among them, forty-two were middle esophageal carcinoma, eleven were lower esophageal carcinoma and two were cardiac carcinoma. According to the differences of diagnosis and treatment methods for anastomotic leak, fifty-five patients were divided into two groups. Thirty-one patients distributed from January 2007 to November 2011 were received conventional management (conventional group): to definitively diagnose by contrast swallow when suspected to be developing anastomotic leaks, to place an esophageal stent when the drainage was sufficient and the infection was controlled. Twenty-four patients distributed from March 2011 to December 2014 were received new-mode management (new-mode group): to perform a anastomotic radioscopy under digital subtraction angiography -guidance instantly when suspected anastomotic leak and find out the fistula, search the shape and size, place a drainage tube into the fistula to drain or lavage the vomica according to the exploration results, pull back the tube gradually and close the leak by clips under endoscope later. The pathoclinical features, the confirmation time (time from clinical signs emergence to leak confirmation), the hospital duration after confirmation, the incidence of severe complications and total mortality were compared between the two groups by t-test and χ(2) test or Fisher's exact test.

RESULTSThere was no significant statistical differences in pathoclinical features between two groups (P>0.05). The confirmation time was significantly reduced in new-mode group than that in conventional group ((1.2±0.8) d vs. (3.6±2.2) d, t=5.212, P=0.000), and so was the hospital duration after confirmation ((26±12) d vs. (55±25) d, t=4.992, P=0.000) and the incidence of severe complications (16.7% vs. 48.4%, χ(2)=6.019, P=0.014), although there was no statistical differences in total mortality (4.2% vs. 22.6%, P=0.119).

CONCLUSIONThe new mode of early interventional diagnosis, early fistula drainage through nose and clipping under endoscope later is able to shorten diagnosis and treatment period, reduce incidence of severe complications.

Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Anastomotic Leak ; diagnosis ; surgery ; Angiography, Digital Subtraction ; Carcinoma ; surgery ; Drainage ; Esophageal Fistula ; surgery ; Esophageal Neoplasms ; surgery ; Esophagectomy ; Female ; Fluoroscopy ; Heart Neoplasms ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents

Adenocarcinoma ; surgery ; Candidiasis ; etiology ; Cardiac Tamponade ; diagnosis ; etiology ; Echocardiography ; Electrocardiography ; Esophageal Fistula ; complications ; diagnostic imaging ; Fever ; etiology ; Gastrectomy ; Haemophilus Infections ; etiology ; Heart Diseases ; complications ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Pericardial Effusion ; diagnostic imaging ; etiology ; Pericarditis ; diagnostic imaging ; etiology ; Postoperative Complications ; diagnostic imaging ; Staphylococcal Infections ; etiology ; Stomach Neoplasms ; surgery ; Streptococcal Infections ; etiology ; Tomography, X-Ray Computed

The clinical data for a patient with sick sinus syndrome was retrospectively analyzed. The patient was treated because of his heart palpitations and the increased chest pain. The patient admitted to the hospital under consideration for the left atrial tumor dependent on the echocardiography findings. After the CT scan and the dynamic ECG examination, the patient successfully underwent the left atrial tumor resection, atrial septal repair and cardiac pacing lead installation. The postoperative pathological diagnosis showed that the infective endocarditis and left atrial thrombus in left atrium was cured. The patient was discharged after postoperative anti-inflammatory therapy. By analyzing the reasons for misdignosis before or during surgery, the possible mechanisms for left atrial subendocardial thrombus have been found. This study suggests that it is necessary to combine imaging diagnosis and clinical observations to distinguish tumor from excrescence.
Anti-Inflammatory Agents ; therapeutic use ; Arrhythmias, Cardiac ; etiology ; surgery ; Atrial Septum ; surgery ; Computed Tomography Angiography ; Diagnosis, Differential ; Diagnostic Errors ; Echocardiography ; Endocarditis ; diagnosis ; therapy ; Heart Atria ; diagnostic imaging ; surgery ; Heart Diseases ; etiology ; surgery ; Heart Neoplasms ; complications ; diagnostic imaging ; surgery ; Humans ; Male ; Pacemaker, Artificial ; Retrospective Studies ; Sick Sinus Syndrome ; etiology ; surgery ; Thrombosis ; etiology ; surgery

Pathologic diagnosis of a cardiac mass is vital in determining the proper treatment modality. Open heart surgery or transesophageal echocardiography guided biopsy can be feasible methods to confirm the pathology. However, the former is highly invasive and both methods require general anesthesia. The introduction of intracardiac echocardiography (ICE) can provide good anatomic information of heart and does not require general anesthesia. In this report, we present two cases of cardiac tumors which were confirmed by percutaneous biopsy under the guidance of an ICE. The patients underwent cardiac biopsy without any complications.
Anesthesia, General ; Biopsy* ; Diagnosis ; Echocardiography* ; Echocardiography, Transesophageal ; Heart ; Heart Neoplasms ; Humans ; Ice ; Pathology ; Thoracic Surgery

Myxomas are uncommon primary cardiac tumours that usually affect the left atrium. We herein report the case of a patient who presented with right heart failure and proteinuria, leading to the diagnosis of atrial myxoma. Surgical resection resulted in resolution of the patient's symptoms.
Adult ; Female ; Heart Atria ; surgery ; Heart Failure ; diagnosis ; Heart Neoplasms ; diagnosis ; surgery ; Humans ; Myxoma ; diagnosis ; surgery ; Proteinuria ; diagnosis

We herein report a witnessed cardiopulmonary collapse of a patient with difficult mask ventilation and near-impossible laryngoscopy-cum-intubation in the critical care unit. The airway was successfully rescued with a laryngeal mask airway Supreme™, followed by an open, crash tracheostomy by the otolaryngologist.
Airway Management ; methods ; Critical Care ; Heart Arrest ; therapy ; Humans ; Laryngeal Masks ; Larynx ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Oropharyngeal Neoplasms ; diagnosis ; Trachea ; surgery ; Tracheostomy ; Treatment Outcome

Cardiac papillary fibroelastoma (CPF) is a rare and benign primary cardiac neoplasm of unknown prevalence. The incidence of CPF in the left ventricle is lower than that in other parts of the heart. A 65-year-old female was referred to our cardiology department for evaluation of a cardiac mass of the left ventricle. Transthoracic echocardiography revealed a 1.8 x 1.7 cm highly mobile round mass attached by a stalk to the apical inferior wall of the left ventricle with an echolucent area. The mass was successfully removed without any postoperative complications and was identified as a CPF.
Aged ; Biopsy ; Cardiac Surgical Procedures ; Echocardiography ; Female ; *Fibroma/diagnosis/surgery ; *Heart Neoplasms/diagnosis/surgery ; Heart Ventricles/pathology ; Humans ; Tomography, X-Ray Computed ; Treatment Outcome

We report a case of intraocular lymphoma in a 65-year-old man, 15 months after cardiac transplantation. On Magnetic Resonance (MR) images, the iris and the anterior chamber of the right eye were found to be involved with an enhancing soft-tissue lesion. To our knowledge, this is the first case of post-transplantation intraocular lymphoma evaluated with MR imaging.
Cardiomyopathies/surgery ; Diabetes Mellitus, Type 2/complications ; Diagnosis, Differential ; Eye Neoplasms/*diagnosis ; Fatal Outcome ; Heart Transplantation ; Humans ; Lymphoma/*diagnosis ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged

Brain Infarction ; diagnosis ; etiology ; therapy ; Cerebral Angiography ; Child ; Echocardiography, Doppler, Color ; Heart Atria ; Heart Neoplasms ; complications ; diagnosis ; surgery ; Humans ; Intracranial Embolism ; diagnosis ; etiology ; therapy ; Male ; Myxoma ; complications ; diagnosis ; surgery ; Pulmonary Edema ; diagnosis ; etiology ; therapy ; Thrombosis ; diagnosis ; etiology ; therapy

12E7 Antigen ; Antigens, CD ; metabolism ; Cell Adhesion Molecules ; metabolism ; Diagnosis, Differential ; Fibrosarcoma ; metabolism ; pathology ; Heart Neoplasms ; genetics ; metabolism ; pathology ; surgery ; Humans ; Male ; Mesothelioma ; genetics ; metabolism ; pathology ; Middle Aged ; Mucin-1 ; metabolism ; Oncogene Proteins, Fusion ; metabolism ; Pericardiectomy ; Pericardium ; pathology ; Sarcoma ; metabolism ; pathology ; Sarcoma, Synovial ; genetics ; metabolism ; pathology ; surgery ; Translocation, Genetic ; Vimentin ; metabolism