Gil Hauer Santos

The Subxiphoid Approach in the Treatment of Pericardial Effusion

Subxiphoid pericardiotomy for diagnosis and treatment of pericardial effusion is a safe procedure. Not only does it appear to be safer than aspiration, but it yields more information because of its ability to obtain pericardial tissue. The recurrence rate of pericardial effusion is lower using subxiphoid pericardiotomy. For these reasons it is the technique of choice for diagnosis and treatment of nontraumatic pericardial effusion.

Percutaneous drainage of lung abscess

Most lung abscesses are successfully treated with antibiotics. However, occasional patients with lung abscesses that drain poorly, causing persistent fever and toxic symptoms, may require surgical intervention. Lobectomy is the most frequent surgical procedure. Some patients are debilitated and have underlying medical conditions such as heart disease, chronic pulmonary disease, or liver disease that may render surgical intervention risky. Recently there have been reports of percutaneous drainage of lung abscess with good results. We have successfully carried out percutaneous drainage of lung abscess in 4 patients and an infected bulla in 1. All patients had failed to respond to therapy with antibiotics and postural drainage. There was prompt disappearance of the fluid level in the cavity, decline in temperature, and abatement of toxic symptoms with drainage. The cavities closed gradually over the next 6–12 weeks. The patients tolerated the chest tube well and there were no side effects from the tube drainage. Percutaneous tube drainage is the surgical treatment of choice in the medically complicated patient with a poorly draining lung abscess.

Traumatic Pulmonary Pseudocysts

Abstract Pulmonary contusion and pulmonary hematoma are observed frequently in patients who sustain closed chest injuries. A lesion seen less often in these circumstances is localized disruption of the lung parenchyma that produces cystlike cavities. This should not be confused with extensive disruption of the pulmonary parenchyma, usually accompanied by extensive bleeding and shock. A review of the literature and three case reports are presented as well as a discussion of the pertinent symptoms and the clinical and radiological findings. The different nomenclatures used to define these lesions are reviewed briefly.

Chest trauma during the Battle of Troy: ancient warfare and chest trauma

The Iliad is the story of the events related to the siege and battle of Troy presenting an unsurpassed view of the strengths and weaknesses of its main characters. And what a revelation it is to see that the human element that ignites and sustains the flames of war did not change through the centuries and was 3,000 years ago the same as it is today! An added source of fascination in Homers work is his peculiar description of the injuries suffered by the combatants. That, as well as the presence of physicians in the battlefield, is of special interest for us surgeons.

Late volume changes in retrosternal colon bypass

Esophageal obstruction by malignancy, chemical burns, or other less common entities presents a challenge for the surgeon. Either for esophageal substitution after esophageal resection or as a bypass for the obstructed esophagus, colon interposition is often the best available option. Massive colonic enlargement requiring resection of the interposed dilated colon developed recently in 2 of our patients who had a colon bypass 22 and 10 years earlier, respectively.

Operative complications of abdominal vagotomy

To assess the incidence of operative complications, mortality, and accuracy of vagotomy in transabdominal vagotomy, 733 cases were reviewed. Statistics are compared with those of other authors. A loose comparison of patients operated on by resident surgeons versus those operated on by attending surgeons is also made. Our preference for immediate microscopic examination of vagotomy specimens is stressed. One unusual complication is described.