Coronary Endarterectomy or Patch Angioplasty for Diffuse Left Anterior Descending Artery Disease.

BACKGROUND: Coronary endarterectomy and patch angioplasty for the left anterior descending (LAD) artery have been shown to be effective adjunct techniques to surgical revascularization for severe coronary lesions. The objective of this study is to review the short- and long-term results of these two methods in our institution. METHODS: We retrospectively reviewed 166 consecutive patients who underwent internal thoracic artery grafting to the LAD, with either adjunct endarterectomy (95 patients) or patch angioplasty (71 patients) between 2002 and 2014. We compared the early and late outcomes between groups. RESULTS: The endarterectomy patients were older than the patch angioplasty patients (71 vs. 67 years, p = 0.007) and had lower rates of recent myocardial infarction (25% vs. 45%, respectively, p = 0.008). Median pulmonary bypass times and aortic cross clamp times were significantly longer in the endarterectomy group compared with the patch angioplasty group by 47 minutes (p < 0.001) and 42 minutes (p < 0.001), respectively. Median follow-up time was 6.9 years. No significant differences in operative mortality, perioperative myocardial infarction, and long-term survival were found. Freedom from percutaneous coronary intervention at 1 and 5 years was significantly higher in the endarterectomy group compared with the patch angioplasty group (p = 0.002). CONCLUSIONS: Endarterectomy and patch angioplasty are comparable methods to reach complete revascularization for highly selected patients with diffuse atherosclerotic disease in the LAD. Compared with patch angioplasty, complete extraction of the atherosclerotic plaque with an endarterectomy leads to similar short-term outcomes and long-term survival while significantly reducing the need for further interventions in the future.

Mycetoma (Madura Foot) in Israel: Recent Cases and a Systematic Review of the Literature.

AbstractMycetoma is a chronic soft tissue infection caused by fungal or bacterial pathogens, and is endemic in tropical and subtropical regions. Cases in developed countries outside the mycetoma belt are rare and usually imported by immigrants. Sporadic cases have been reported in Israel. Unpublished cases in the participating medical centers are reported. In addition, a systematic review of the literature was performed. All published mycetoma cases diagnosed in Israel were included with relevant variables collected. Twenty-one cases of mycetoma were diagnosed in Israel between 1942 and 2015, including four unpublished cases and 17 published cases. The mean age at diagnosis was 42 years (range 23-73), and 16 of the patients were male. The foot was the primary involved organ. Fifteen patients were immigrants from Yemen, Ethiopia, and Sudan. Five cases were autochthonous. One case was travel related. Among patients who developed symptoms after immigration, the mean time from exposure to symptom onset was 5.6 years (range 1-10 years). The mean time from symptom onset to diagnosis was 6.6 years (range 0.2-35 years). The autochthonous cases demonstrate that Israel is endemic of mycetoma. The immigrant population represents two distinct waves of immigration to Israel in the past century. Two unpublished cases of Ethiopian immigrants are the first reported cases of mycetoma acquired in Ethiopia. The diagnostic and therapeutic challenges along with the epidemiological data emphasize the need of raising the awareness of physicians to this devastating condition even in developed countries.