Clinical comparative study of postoperative early enteral nutrition and parenteral nutrition in elder patients with esophageal and cardiac cancer / 肠外与肠内营养

Objective:To compare the clinical value of early enteral nutrition(EEN) with total parenteral nutrition(TPN) in postoperative elder patients with esophageal and cardiac cancer. Methods: 102 cases of postoperative elder patients with esophageal and cardiac cancer were randomly divided into EEN group(n=51)and TPN group(n=51).The weight loss,serum albumin, prealbumin,liver function were measured before operation and on the eighth day after operation. The anal exsufflation time, infectious complication, duration of hospital stay and treatment cost were observed. Results: The weight loss in EEN group were less than those of TPN group(P<0.05). The levels of ALT, AST, BIL and GGT in EEN group on the eighth day after operation was lower than those in TPN group(P<0.05). The anal exsufflation time and duration of hospital stay in EEN group were shorter than those of TPN group(P<0.05). The treatment cost of EEN group was significantly less than that of TPN group(P<0.05). The infectious complication rate of EEN group was lower than that of TPN group(P<0.05). Conclusion: EEN in postoperative elder patients with esophageal and cardiac cancer can decrease the postoperative infectious complication and the treatment cost, shorten the duration of hospital stay, improve nutritional status and recovery of gastrointestinal function with less side effects of liver function.

Anesthetic Management of the Excision of Left Ventricular Papillary Fibroelastoma : A case report

We present a rare case of movable mass which attached to chordae and papillary muscle of anterior leaflet of mitral valve in left ventricle discovered preoperative echocardiography. The mass had risks of mechanical obstruction and hemodynamic instability. The patient underwent excision of mass and mitral valve replacement. The diagnosis of papillary fibroelastoma was confirmed by histologic examination. The surgery was done without any complications by safe and cautious anesthetic management without any complications.

An Intraluminal Cardiac Growth Identified as a Spreading Thymus Cancer in a Patient with Dyspnea

A 72-year-old man presented with aggravating dyspnea and swelling of the face due to thymic carcinoma, which was diagnosed based on a transfemoral biopsy specimen. Chest computed tomography and transthoracic echocardiogram showed a mediastinal mass that invaded the superior vena cava and the right atrium. The patient underwent successful chemotherapy with multimodal regimens including cyclophosphamide, vincristine and the dyspnea, facial edema improved. Here, we present a case of spreading thymic carcinoma identified as an intraluminal growth spreading from the mediastinum into the superior vena cava and cardiac cavity.

An Intraluminal Cardiac Growth Identified as a Spreading Thymus Cancer in a Patient with Dyspnea

A 72-year-old man presented with aggravating dyspnea and swelling of the face due to thymic carcinoma, which was diagnosed based on a transfemoral biopsy specimen. Chest computed tomography and transthoracic echocardiogram showed a mediastinal mass that invaded the superior vena cava and the right atrium. The patient underwent successful chemotherapy with multimodal regimens including cyclophosphamide, vincristine and the dyspnea, facial edema improved. Here, we present a case of spreading thymic carcinoma identified as an intraluminal growth spreading from the mediastinum into the superior vena cava and cardiac cavity.

A case of malignant fibrous histiocytoma with invasion into great vessels and heart which was confused with benign myxoma / 대한내과학회지

Cardiac tumors are rare. Benign myxoma is the most common among them. Malignant fibrous histiocytoma is a tumor originating from primitive mesenchymal cell and found most commonly in four extremities. Since this disease was first described by Shah in 1978, there have been a lot of case reports of cardiac malignant fibrous histiocytoma. If originating in the heart, it is usually found in left atrium which is unusual for malignant cardiac tumor. Since the advent of the echocardiography as a diagnostic tool in the cardiac disease, a lot more cases of cardiac tumor have been reported. Here, we report a case of cardiac malignant fibrous histiocytoma in a 67 year old man presenting with dyspnea who, at first sight, seemed to have benign myxoma but turned out to have malignant fibrous histiocytoma. However, strictly speaking,the case we found is a cardiac invasion of the retroperitoneal malignant fibrous histiocytoma.

Clinical observation of cardiac myxoma / 대한내과학회지

BACKGROUND: Cardiac myxoma is uncommon, even though accounts for 50% of primary cardiac tumor, histologically benign disease but may be lethal because of its strategic position. It has diverse clinical manifestations mimicking various diseases, which can be described under the three headings: constitutional, obstructive and embolic and the diagnosis can be easily missed unless clinician has high index of suspicion. A correct diagnosis is made before operation with the development of echocardiography. We reviewed our clinical experience in diagnosis and management of 21 cases of myxomas from 1985 to 2000. METHODS: There were 4 males (19%) and 17 females (81%). Their ages ranged from 17 to 66 years (mean 42.2 years). All the patient's medical records on their clinical features, laboratory findings, chest X-rays, electrocardiograms, echocardiographic findings, operative findings and postoperative follow-up were reviewed. RESULTS: Seventeen cases (81%) of the myxomas originated in left atrium and four (19%) in right atrium. Most common symptom was that of intracardiac obstruction such as dyspnea or dyspnea on exertion (62%). Fatigue which accounted for most of the constitutional symptom found in 38% of the 21 patients while embolism accounted for 38%. In all patients, echocardiography was used for diagnosis and the diagnostic accuracy of echocardiography was 100%. All patients received surgical treatment and immediate postoperative complications occurred in seven patients (33%). Among them, serious complications were found in two cases and one expired due to congestive heart failure. Follow-up duration ranged from 2 months to 15 years. There was no recurrence or other problem in all patients during the follow-up period. CONCLUSION: Although clinical suspicion is difficult due to the nonspecific presentation of myxoma, the diagnosis can be made easily with echocardiographic examination in all cases and surgical excision of myxoma may be curative with good long-term result.

Detection of telomerase activity and cytology in the diagnosis of cardiac cancer / 中国实用内科杂志

Objective To investigate the diagnostic significance of cytology and telomerase activity in the exfoliated cells of cardia obtained from endoscopic brushing in the cardiac cancer.Methods The technique of the qualitative TRAP siver staining and quantitative TRAP PCR ELISA were employed to detect telomerase activity in the exfoliated cells of cardiac obtained from endoscopic brushing in 72 cases with cardial lesions,cytological diagnosis was made at the same time.Results Telomerase activity with cardiac cancer group(1^521?0^192)was significantly higher than that with cardialitis group(0^065?0^014).Positive rate of telomerase activity detected in cardiac cancer group(88^89%)was significantly higher than that with cardialitis group(11^11%).Positive rate of telomerase activity detected in cardiac cancer group(88^89%)was significantly higer than cytological examination(77^78%).The diagnostic rate of cardiac cancer was improved to 93^33% if telomerase activity and cytology were examined at the same time.Conclusion Results show that the combination of cytology and telomerase activity in the exfoliated cardiac cells may be an effective and sensitive method in the diagnosis of cardiac cancer.This research can be a basis for the mass screening of cardiac cancer.