ABSTRACT
About 2 years after right lower lobectomy for anadenocarcinoma in the right lung, an 80-year-old man had a reccurent tumor in tracheocarinal lymph nodes. Although concurrent chemoradiotherapy was performed, there was no change (NC) and the tumor grew back slowly. He was admitted to our hospital with exertional dyspnea and stridor 2 years later. The bronchoscopic microwave coagulation therapy was performed in the right main bronchus. After potassium titanyl phosphate (KTP) laser therapy had been performed in the tracheocarinal lumen, an expandable metallic stent was performed. The postopertive course was uneventful.
Subject(s)
Electrocoagulation , Laser Therapy , Lung Neoplasms/pathology , Microwaves/therapeutic use , Stents , Tracheal Stenosis/surgery , Adenocarcinoma/secondary , Adenocarcinoma/therapy , Aged , Aged, 80 and over , Humans , Lung Neoplasms/therapy , Lymph Nodes/pathology , Lymphatic Metastasis , Male , Phosphates , Titanium , Tracheal Stenosis/etiologyABSTRACT
The aim of this study was to define short- and long-term results of coronary artery bypass grafting (CABG) in dialysis patients. A retrospective review was carried out on 73 consecutive patients dependent on chronic dialysis who underwent CABG. In 63 isolated CABGs, 9 operations were performed under normal beating heart because of severe atherosclerotic changes in the ascending aorta or carotid arteries. The operative mortality (30 days' mortality) was 4.1%, and causes of death were closely related to cardiopulmonary bypass use. In the last 29 operations after introduction of the beating heart bypass, no hospital deaths occurred. The actual survival rates dropped to 45% at 70 months mainly for noncardiac late death. CABG for dialysis patients as undertaken with an acceptable operative risk. Extended application of beating heart bypass to these patients may produce further positive early results.
Subject(s)
Coronary Artery Bypass , Renal Dialysis , Adult , Aged , Aged, 80 and over , Coronary Artery Bypass/methods , Coronary Artery Bypass/mortality , Female , Humans , Male , Middle Aged , Postoperative Care , Postoperative Complications , Preoperative Care , Retrospective Studies , Survival RateABSTRACT
The effects of intravenous administration of tissue plasminogen activator (t-PA) followed by elective percutaneous transluminal coronary angioplasty (PTCA) were compared to those of direct PTCA (d-PTCA) in patients with acute myocardial infarction using dobutamine stress echocardiography 1 week and 1 month after the acute episode. There were 12 patients in the t-PA group and nine patients in the d-PTCA group. Dobutamine was infused at incremental doses (5 micrograms/kg/min for each 5 min step). Wall motion changes were classified during infusion into four patterns, improvement, biphasic, worsening and no change. One week after the acute episode, seven of 12 patients in the t-PA group showed biphasic the pattern and five showed the improvement pattern. The biphasic pattern was observed in three patients in the d-PTCA group, worsening in one and improvement in five. One month later, the biphasic pattern in five patients in the t-PA group changed to the improvement pattern. No patients in the d-PTCA group showed changes in the wall motion pattern. There was no difference between the two groups in the frequency of the change of wall motion patterns 1 week and 1 month after infarction, but the improvement pattern was significantly increased from five to 10 patients in the t-PA group after 1 month (p < 0.05). The sensitivity, specificity and accuracy of the biphasic pattern in the t-PA group for indicating remnant coronary stenosis were 78%, 100% and 83%, respectively. Evaluation of wall motion pattern by dobutamine stress echocardiography is useful for assessment of reperfusion therapy for acute myocardial infarction. The administration of t-PA followed by elective PTCA has similar efficacy to d-PTCA.