A patient with carcinoma of the cardia underwent Ivor-Lewis oesophagogastrectomy. He developed right chylothorax postoperatively, which is a rare complication. Attempts to treat the chylothorax by conservative means and thoracoscopic ligation failed. Finally, pleurodesis using bleomycin successfully sealed the leak and he was discharged.
We report our experience with intralesional injection of bleomycin in the treatment of neck lymphangioma. From May 1995 to April 1998, 11 patients aged between 6 to 22 months were treated with intralesional bleomycin injection. Ultrasonography and computed tomography were used to assess and select the cases suitable for sclerotherapy. Patients with lesions encasing the internal jugular vein and the carotid artery were chosen. With the patient under sedation and using ultrasound guidance, the cysts were aspirated and bleomycin was injected at a dose of 0.5 mg/kg body weight. The number of procedures varied from 1 to 4 over a period of 8 months to 1 year. Patients were initially followed-up 3 monthly, then 6 monthly and subsequently yearly. In 4 patients, the neck mass was no longer visible (excellent response). In 5 patients, the neck mass had reduced to a size (more than 50% reduction) that was cosmetically acceptable (good response). There were 2 failures (poor response). There were no complications. Our results suggest that intralesional injection of bleomycin can be effectively used to treat selected cases of neck lymphangiomas.
We report five patients who presented with seminoma of an undescended testis to highlight the importance of dealing with adult cryptorchidism. On the basis of the literature review and our experience, we advocate orchidectomy for post-pubertal cryptorchid patients of any age because follow-up may be difficult, and treatment for the tumour may be unsuccessful.
Patients at high risk of recurrence or metastases following radical surgery for Stage 1B and 2A cervical carcinoma include those with pelvic node metastases, lymphatic or vascular space permeation in the cervix by tumour cells, large size of the primary tumour, involvement of the full thickness of the cervix and parametrial spread. We report the initial results of adjuvant chemotherapy using a combination of cisplatinum, bleomycin and vinblastine in 22 patients who had undergone Wertheim radical hysterectomy and were thought to be at high risk of developing recurrence. The mean duration of follow-up was 23 months. All are alive after follow-up ranging from 13 to 43 months. Three patients developed recurrences--one in the pelvis, another at the posterior aspect of the urethral meatus and the third developed pulmonary secondaries at 20 to 23 months after surgery. Toxicity from the chemotherapy was acceptable.