ABSTRACT
Central nervous system arteriovenous malformations are uncommon in hereditary hemorrhagic telangiectasia. Identical twins are described with hereditary hemorrhagic telangiectasia and concordance for central nervous system arteriovenous malformations identified by angiography. One twin had a central nervous system hemorrhage in the seventh month of pregnancy and also had a pulmonary arteriovenous malformation. The other was asymptomatic. A previously reported association between HLA type A2 BW17 and hereditary hemorrhagic telangiectasia was not confirmed. Two recombinations were identified between the loci for HLA and hereditary hemorrhagic telangiectasia. The loci for HLA and hereditary hemorrhagic telangiectasia are not closely linked. Stroke in a young person should prompt an inspection for manifestations of hereditary hemorrhagic telangiectasia.
Subject(s)
Diseases in Twins , Intracranial Arteriovenous Malformations/etiology , Telangiectasia, Hereditary Hemorrhagic/complications , Adult , Female , Genetic Linkage , HLA Antigens/genetics , Humans , Intracranial Arteriovenous Malformations/genetics , Pedigree , Pregnancy , Telangiectasia, Hereditary Hemorrhagic/genetics , Twins, MonozygoticABSTRACT
Some patients with cancer and others with benign lesions which obstruct the central airways (larynx, trachea, major bronchi) can be treated with a laser. Ninety-nine patients were considered for treatment during the first 18 months of experience with a YAG (yttrium aluminum garnet) laser at Henry Ford Hospital; 55 patients were treated 82 times. Results were satisfactory (surgery was avoided) in eight of ten patients with benign lesions. Satisfactory results (doubling of airway size with relief of dyspnea/drainage of obstructive pneumonia) were obtained in 12 of 13 patients with bronchogenic carcinoma managed initially with the laser, and in 22 of 32 (69 percent) patients with recurrent malignancies. There were five minor and seven major complications, including two deaths. We conclude that laser treatment can relieve central airways obstruction with its associated symptoms of dyspnea and infection. Avoidance of complications requires a skillful approach, careful anesthetic management, and availability of back-up posttreatment intensive care.
Subject(s)
Carcinoma, Bronchogenic/surgery , Laser Therapy , Lung Neoplasms/surgery , Anesthesia, Endotracheal/adverse effects , Carcinoma, Bronchogenic/mortality , Humans , Laryngeal Diseases/surgery , Lasers/adverse effects , Lung Neoplasms/mortality , Neoplasm Recurrence, Local/surgery , Pneumonia/etiology , Pulmonary Edema/etiology , Tracheal Diseases/surgery , Tracheoesophageal Fistula/etiologyABSTRACT
An 85-year-old woman presented with a broncholith in the intermediate bronchus that could not be extracted with either flexible or rigid bronchoscopes. A YAG laser was used to fragment this broncholith so that it could be removed in pieces through a bronchoscope. Chemical composition and morphology of the broncholith were determined. Fragmentation of the large, impacted broncholith with the laser eliminated the necessity for a thoracotomy in this elderly woman.
Subject(s)
Bronchial Diseases/therapy , Calculi/therapy , Laser Therapy , Lithotripsy, Laser , Lithotripsy/methods , Aged , Bronchial Diseases/metabolism , Bronchoscopy , Calculi/metabolism , Durapatite , Female , Humans , Hydroxyapatites/analysis , Microscopy, Electron, ScanningABSTRACT
Patients presenting with inoperable non-small cell carcinoma of the lung and major symptomatic bronchial obstruction were treated initially with debulking of the airways by YAG laser, followed by conventional external-beam radiotherapy. The former method was used to minimize postobstructive pneumonitis or respiratory failure (or both) that often complicates major brochial obstruction and also to lessen the burden of tumor to be treated by radiotherapy. The preliminary results of 19 patients treated in this manner are reported, emphasizing the impact of this combined method on morbidity and mortality.