ABSTRACT
Introduction@#In 1987 Jerome Ritchie, David Auth and colleagues first introduced rotational atherectomy (rotablation) as a technique for the endovascular treatment of obstructive atherosclerotic disease. Rotational atherectomy covers 3-5% of all procedures in big PCI centers, while <1% in smaller centers. By study of Warth DC et al. in 1994, at early period when it was first introduced, procedure complication of rotablation was about 40%, those with coronary dissection 29%, coronary artery occlusion 11.2%, side branch occlusion 1.8%, distal occlusion 0.9%, no relow phenomenon 6.1%, severe vasospasm 13.8% and vascular perforation 1-2%. </br> By advanced techniques and technologies that kind of complications reduced significantly, it occurs as same as other PCI procedures. </br> In our country PCI procedure was first introduced in Third State Central Hospital in 2000, since then 20 years has passed. During this period coronary intravascular diagnosis and treatment developed progressively performing 14751 PTCA procedures, of those 8355(56,6%) PCI cases. By statistics of 2017, myocardial infarction occurred 1145.6 in 10000 population, showing sharp increase, and cardiovascular mortality became number one cause and has tendency to increase further.</br> To inform first outcome of rotational atherectomy of atherosclerosis that is severely calcified and unavailable to introduce balloon catheter or stent. To conduct atherectomy treatment methods, accustoming professionals, order and get ready the treatment materials for necessity.</br> We successfully performed rotablation in severely calcified mLAD of 56 years of male patient by staged PCI, whose infarct related artery Lcx was revascularized 3 months previously. As a result the patient was fully revascularized, the balloon catheter passed through the narrowing and stent was implanted successfully.
ABSTRACT
Introduction: We began treatment ofmulti drug resistant tuberculosis first from2003. At that time there was a 1960 cases andmost of the cases were from Ulaanbaatar,Darkhan, Selenge, Tuv, Dornod provinces.From all the cases only 62% or 1058 caseswere included in treatment. From that 336patient or 19% deceased, 296 patient or 18%didn’t get a treatment. We did this studybecause there were never done any researchor study of surgical treatment of multi drugresistant tuberculosis in Mongolia.Materials and Methods: We studiedcases of patients who undergone lobectomy,since 2007. There were 48 cases of 46patients, 2 patients surgery were done onboth sides. Respondents aged between 14-45, 25 male (52%), 23 female (48%), allpatients got a first - line anti-tuberculosistreatment, such as cat-1, cat-1+cat-2 and 10variants of these drugs. It was done basedon sputum culture test results of NCCDTB surveillance and research department’slaboratory.Results: From the all patients only77.08% had undergone surgery within thefirst 3 years. 92% patients were diagnosedwith multi drug resistance TB only with thesputum and sputum culture test results, andthe rest of the patients were diagnosedusing a tissue analyses on the above tests.It was revealed that HR resistant -91.66%,HR+(Z,E,S) -3 drugs resistant -18.78%,HR+(ZSE)-4 or 5 drugs resistant. In thepatients TB lesion locations was on the rightupper lobe 54%, left upper lobe 31%, ona both upper lobes 85%, cavernous fibrosistubercles 60%, combined TB lesions 77%,tubercles 21%.87.5% of total patientsreceived a multi - drug resistant TB treatmentbetween 7 - 24 months prior surgery.All 48 patients had a totally 69 surgeries.Surgeries included 9% pneumonectomy,28% lobectomy, 30% Wedge resection,23% pleurectomy decortication, 7% Wedgeresection on both sides, one bilobectomy.There were no complications during thesurgery but 5 of patients had an empyemaafter surgery. No fatal cases.Three patientsout of 5 who had a surgery due to pulmonaryhemorrhage developed an empyema aftersurgery. Drainage tubes were taken afterthe surgery within 2-3 months.Therewere nocomplication and escalations in the patientswho received a surgical treatment, after thesurgery from 6 months to 5 years.Conclusion: In study it shows that surgicaltreatment is effective to do after 6 monthsof anti-tuberculosis drug treatment in multi -drug resistant TB patients.Also it shows thatcombining of medical and surgical treatmentis healing up to 98% in the patients whowere rightly chosen according to surgicalindications.This research result shows that inour country multi - drug resistant TB surgicaltreatment complication is only 10.41%,which is below in the other countries whohave same anti-tuberculosis drug treatment.
ABSTRACT
Introduction: We began treatment of multi drug resistant tuberculosis first from 2003. At that time there was a 1960 cases and most of the cases were from Ulaanbaatar, Darkhan, Selenge, Tuv, Dornod provinces. From all the cases only 62% or 1058 cases were included in treatment. From that 336 patient or 19% deceased, 296 patient or 18% didn’t get a treatment. We did this study because there were never done any research or study of surgical treatment of multi drug resistant tuberculosis in Mongolia. Materials and Methods: We studied cases of patients who undergone lobectomy, since 2007. There were 48 cases of 46 patients, 2 patients surgery were done on both sides. Respondents aged between 14- 45, 25 male (52%), 23 female (48%), all patients got a first - line anti-tuberculosis treatment, such as cat-1, cat-1+cat-2 and 10 variants of these drugs. It was done based on sputum culture test results of NCCD TB surveillance and research department’s laboratory. Results: From the all patients only 77.08% had undergone surgery within the first 3 years. 92% patients were diagnosed with multi drug resistance TB only with the sputum and sputum culture test results, and the rest of the patients were diagnosed using a tissue analyses on the above tests. It was revealed that HR resistant -91.66%, HR+(Z,E,S) -3 drugs resistant -18.78%, HR+(ZSE)-4 or 5 drugs resistant. In the patients TB lesion locations was on the right upper lobe 54%, left upper lobe 31%, on a both upper lobes 85%, cavernous fibrosis tubercles 60%, combined TB lesions 77%, tubercles 21%.87.5% of total patients received a multi - drug resistant TB treatment between 7 - 24 months prior surgery. All 48 patients had a totally 69 surgeries. Surgeries included 9% pneumonectomy, 28% lobectomy, 30% Wedge resection, 23% pleurectomy decortication, 7% Wedge resection on both sides, one bilobectomy. There were no complications during the surgery but 5 of patients had an empyema after surgery. No fatal cases.Three patients out of 5 who had a surgery due to pulmonary hemorrhage developed an empyema after surgery. Drainage tubes were taken after the surgery within 2-3 months.Therewere no complication and escalations in the patients who received a surgical treatment, after the surgery from 6 months to 5 years. Conclusion: In study it shows that surgical treatment is effective to do after 6 months of anti-tuberculosis drug treatment in multi -drug resistant TB patients.Also it shows that combining of medical and surgical treatment is healing up to 98% in the patients who were rightly chosen according to surgical indications.This research result shows that in our country multi - drug resistant TB surgical treatment complication is only 10.41%, which is below in the other countries who have same anti-tuberculosis drug treatment.