Some investigators have postulated that patients with primary achalasia have a generalized upper gastrointestinal motility disorder. To evaluate gastric emptying in patients with primary achalasia, four patients were studied prospectively after successful brusque dilation. Gastric emptying of liquids and solids was normal in all patients. There is no defect in gastric emptying in patients with primary achalasia.

BACKGROUND Preoperative supplementation with immunonutrients, including arginine and n-3 fatty acids, has been shown in a number of systematic reviews to reduce infectious complications in patients who have undergone gastrointestinal surgery. Limited information, however, is available on the benefits of nutritional supplementation enriched with arginine and n-3 fatty acids in patients undergoing liver resection. AIM To evaluate the effects of preoperative nutritional supplementation enriched with arginine and n -3 fatty acids on inflammatory and immunologic markers and clinical outcome in patients undergoing liver resection. METHODS Thirty-four patients undergoing liver resection were randomized to either five days of preoperative Impact ® [1020 kcal/d, immunonutrition (IMN) group], or standard care [no supplementation, standard care (STD) group]. Nutritional status was measured at study entry by subjective global assessment (SGA). Functional assessments (grip strength, fatigue and performance status) were carried out at study entry, on the day prior to surgery, and on postoperative day (POD) 7 and 30. Inflammatory and immune markers were measured at study entry, on the day prior to surgery, and POD 1, 3, 5, 7, 10 and 30. Postoperative complications were recorded prospectively until POD30. RESULTS A total of 32 patients (17 IMN and 15 STD) were analysed. All except four patients were SGA class A. The plasma ratio of (eicosapentaenoic acid plus docosahexaenoic acid) to arachidonic acid was higher in IMN patients on the day prior to surgery and POD 1, 3, 5 and 7 ( P < 0.05). Plasma interleukin (IL)-6 concentrations were elevated in the IMN group ( P = 0.017 for POD7). No treatment effect was detected for functional measures, immune response (white cell count and total lymphocytes) or markers of inflammation (C-reactive protein, tumour necrosis factor-α, IL-8, IL-10). There were 10 patients with infectious complications in the IMN group and 4 in the STD group ( P = 0.087). Median hospital stay was 9 (range 4–49) d in the IMN group and 8 (3-34) d in the STD group ( P = 0.476). CONCLUSION In well-nourished patients undergoing elective liver resection, this study failed to show any benefit of preoperative immunonutrition.

Patients undergoing delayed liver resection for CRLM have a survival advantage that is lost during long-term follow-up.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was which method of tracheostomy had fewer complications, the surgical or percutaneous technique. A total of 264 papers were identified of which 13 provided the best evidence to answer the question. The author, journal, date and country of publication, patient group, relevant outcomes and weaknesses were tabulated. We conclude that both percutaneous and surgical tracheostomy have overall a low incidence of complications. There is a lower incidence of procedural complications when inserted surgically. There is a lower incidence of post-procedural complications when inserted via the percutaneous route.

Splenic artery aneurysms are rare. We discuss a case of a 58-year-old gentleman presenting with collapse and shock secondary to spontaneous splenic artery aneurysm rupture. Patient underwent laparotomy and splenectomy then discharged home within a week of presentation.