Graft failure prior to discharge after coronary artery bypass surgery: a prospective single-centre study using dual 64-slice computed tomography.

AIMS: The purpose of this study was to assess the incidence and predictors of graft failure prior to discharge. Multi-slice computed tomography has the ability to evaluate graft patency in a non-invasive way. METHODS AND RESULTS: Of 145 consecutive patients who were screened, 73 were included in the study (78% male, mean age 65 years). A total of 206 grafts were analysed (2.8±0.9 grafts/patient). Of the 206 grafts, 126 were venous, 72 were left internal mammary, five were right internal mammary and three were radial grafts. We evaluated 100% of proximal anastomoses sites and 92% (190/206) of the distal anastomoses. We identified five patients (6.8%) who had at least one occluded graft. A total of seven out of 206 (3.4%) grafts were occluded. Independent predictors of successful graft outcome were left anterior descending artery as a recipient artery, good distal run-off as assessed by a surgeon and vessel size larger than 2 mm. CONCLUSIONS: The results demonstrate that the in-hospital acute graft failure rate is 3.4% (6.8% of patients). Multi-slice computed tomography is a robust technique to assess novel therapies to reduce the rate of graft attrition further, and might be clinically useful in patients with persistent or early recurrence of symptoms after CABG.

Successful management of bulky osseous metastasis of renal cell carcinoma with selective arterial embolization and radiofrequency ablation: a case report.

The case of a 64-year-old male patient who presented with a bulky osseous tumor metastasis from renal cell carcinoma is reported. The metastatic lesion extended from the acetabulum of the left iliac bone into the iliosacral joint.Treatment plan included selective arterial embolization followed by transdermal radiofrequency ablation, followed by consolidation irradiation. This sequence resulted in considerable necrosis of the bulk of the tumor and creation of a large tissue deficit, which healed over the period of several months despite anti-angiogenetic systematic treatment. The patient remains in good state of health, 20 months after the procedure. This case illustrates the usefulness of the embolization-ablation sequence in controlling large osseus metastasis.

Comparative evaluation of 99mTc-depreotide and 201Tl chloride single photon emission tomography in the characterization of pulmonary lesions.

PURPOSE: To compare (99m)Tc-depreotide and (201)Tl chloride SPET in the characterization of pulmonary lesions. METHODS: Fifty-seven pulmonary lesions from 33 patients suspected of malignancy in computed tomography, were assessed by (99m)Tc-depreotide and (201)Tl early and delayed SPET imaging. Images were visually assessed and the tumour-to-normal (T/N) lung activity ratio for early (ER) and delayed (DR) scans and the retention index (RI), were calculated in every lesion. A final diagnosis was reached for all lesions, based either on histology or prolonged clinical and radiological follow-up. RESULTS: Twenty-three lesions were characterized as malignant and 34 benign. In visual analysis, all malignant lesions accumulated both tracers resulting in sensitivity and negative predictive values of 100%. However, false positive interpretations resulted in a specificity of 64.7% and 67.6% for (99m)Tc-depreotide and (201)Tl, respectively. ER and DR of both agents and the RI of (99m)Tc-depreotide were significantly higher in malignant, compared to benign lesions. In defining thresholds of abnormality from ROC analysis, a significant increase in specificity was observed for both tracers in both scan phases (91.2% for all), as compared to visual analysis (P<0.01). There was no significant difference in the diagnostic performance between (99m)Tc-depreotide DR and (201)Tl DR, although the former provided the highest T/N ratio. CONCLUSION: This study demonstrates that (99m)Tc-depreotide and (201)Tl SPET are equally effective and may be useful in the non-invasive determination of lung malignancy. The specificity of both techniques is significantly improved by quantifying radiopharmaceutical accumulation in pulmonary lesions.

Aggressive angiomyxoma of the vulva extending into the pelvis: report of two cases.

Aggressive angiomyxoma is a rare soft-tissue neoplasm found mainly in the female pelvis. Approximately 130 cases have been reported in the literature to date. In most cases treatment consists of surgical resection, but local recurrence rates remain high (36-72%). Therefore, long-term follow up is necessary and magnetic resonance imaging seems to be the preferred method for detecting recurrence. We report our experience of a primary and a recurrent aggressive angiomyxoma.