RESUMO
BACKGROUND: There are several modalities of coronary artery revascularization for multivessel coronary artery disease. Hybrid coronary revascularization (HCR) with minimally invasive direct coronary artery bypass grafting was introduced for high-risk patients, and recently, many centers have been using it. Limited incisional full sternotomy coronary artery bypass (LIFCAB) involves left internal thoracic artery (LITA)-to-left anterior descending coronary artery (LAD) anastomosis through a sternotomy with a minimal skin incision; it could be considered another technique for minimally invasive LITA-to-LAD anastomosis. Our center has performed HCR using LIFCAB, and in this paper, we report our short-term results, obtained in the past 3 years. METHODS: The medical records of 38 patients from May 2010 to June 2013 were analyzed retrospectively. The observation period after HCR was 1 to 37 months (average, 18.3+/-10.3 months). The patency of revascularization was confirmed with postoperative coronary angio-computerized tomography or coronary angiography. RESULTS: There were 3 superficial wound complications, but no mortalities. All the LITA-to-LAD anastomoses were patent in the immediate postoperative and follow-up studies, but stenosis was detected in 3 cases of percutaneous coronary intervention. CONCLUSION: HCR using LIFCAB is safe and yields satisfactory results from the viewpoint of revascularization for multivessel disease.
Assuntos
Humanos , Constrição Patológica , Angiografia Coronária , Ponte de Artéria Coronária , Doença da Artéria Coronariana , Vasos Coronários , Seguimentos , Artéria Torácica Interna , Prontuários Médicos , Mortalidade , Revascularização Miocárdica , Intervenção Coronária Percutânea , Estudos Retrospectivos , Pele , Esternotomia , Procedimentos Cirúrgicos Minimamente Invasivos , Ferimentos e LesõesRESUMO
We report a very rare case of surgery on gastric conduit cancer. A 67-year-old male patient underwent esophagectomy and intrathoracic esophagogastrostomy for squamous cell carcinoma of the lower thoracic esophagus 27 months ago. Upon follow-up, a gastric carcinoma at the intra-abdominal part of the gastric conduit was found on an esophagogastroduodenoscopy. We performed total gastrectomy and esophagocolonojejunostomy in the manner of Roux-en-Y anastomosis. The postoperative course was not eventful and an esophagogram on the 10th postoperative day showed no leakage or stenosis of the passage. The patient was discharged on the 17th day with no complications.
Assuntos
Idoso , Humanos , Masculino , Anastomose em-Y de Roux , Carcinoma de Células Escamosas , Constrição Patológica , Endoscopia do Sistema Digestório , Neoplasias Esofágicas , Esofagectomia , Esôfago , Seguimentos , GastrectomiaRESUMO
A primary pleural small cell carcinoma is an extremely rare disease. Because of a newly developed metastatic lesion, we performed an operation on a patient who had undergone a right upper lobe lobectomy for adenocarcinoma 3 years previously. We resected the pleural lesion and the pathology report showed that it was not a metastatic lesion, but rather, it was a primary pleural small cell carcinoma. So we reported this case and we review the relevant literature.
Assuntos
Humanos , Adenocarcinoma , Carcinoma de Células Pequenas , Pleura , Doenças RarasRESUMO
BACKGROUND AND OBJECTIVES: The speckle tracking method using 2-dimensional (2D) echocardiography is not affected by the tethering of neighboring segments and angulation. Global circumferential strain (GCS) of the left ventricle (LV) has been suggested as a systolic index and correlated with LV contractility. The purpose of this study was to investigate whether acute changes in preload affect global circumferential strain and to evaluate the usefulness of GCS by the speckle tracking method. SUBJECTS AND METHODS: 2D echocardiography was performed in 69 patients with end-stage renal disease before and after hemodialysis to measure the LV end-diastolic volume and LV ejection fraction. 2D images were acquired from the short-axis view of the mid-LV for the evaluation of GCS. RESULTS: Mean LV end-diastolic volume significantly decreased from 91.2+/-33.3 mL to 72.3+/-32.0 mL (p+/-0.05), and LV ejection fraction decreased from 63.6+/-13.1% to 60.0+/-11.2% (p=0.006) after hemodialysis. However, mean GCS showed no significant change after hemodialysis (17.2+/-5.3% vs. 16.6+/-4.7%, p=0.13). GCS was found to be well correlated with LV ejection fraction (r=0.54, p<0.05) and peak systolic mitral annular velocity (r=0.46, p=0.000), but not with LV preload (r=0.06, p=0.622). CONCLUSION: GCS using the speckle tracking method is a useful index for the evaluation of LV systolic function because it is not affected by acute preload change and is correlated with LV ejection fraction and peak systolic mitral annular velocity.
Assuntos
Humanos , Ecocardiografia , Ventrículos do Coração , Falência Renal Crônica , Diálise Renal , Entorses e Distensões , Volume Sistólico , Atletismo , Função Ventricular EsquerdaRESUMO
Background: Graves disease is an autoimmune disease caused by TSH receptor antibodies. Thyrotropin binding inhibitor immunoglobulins(TBII) are detected in most Graves patients, but some patients have no TBII activities in their sera. It is unknown whether the clinical features of TBII-positive patients are different from those of TBII-negative patients. Methods: To evaluate the prevalence of TBII-negative Graves' patients and its clinical differences from TBII-positive patients, we examined TBII by radioreceptor assay in 686 consecutive untreated Graves patients. We found 84 TBII-negative patients(15 men and 69 women, mean age ±EM: 40.9±.4 years) and compared their clinical characteristics with 87 TBII-positive patients (22 men and 65 women, mean age±EM: 39.9±.5 years) who were selected randomly from the same patients group. Results: In this study, TBII was undetectable in 12.2% of patients with Graves' disease(84 of 686). TBII-negative group had a less weight loss than TBII-positive group. However, there was no significant differences in age, sex ratio, prevalence of ophthalmopathy, duration of illness and positive rate of family history for thyroid diseases between TBII-negative and
Assuntos
Feminino , Humanos , Masculino , Anticorpos , Autoanticorpos , Doenças Autoimunes , Doença de Graves , Prevalência , Ensaio Radioligante , Receptores da Tireotropina , Razão de Masculinidade , Pertecnetato Tc 99m de Sódio , Doenças da Glândula Tireoide , Glândula Tireoide , Tireotropina , Redução de PesoRESUMO
An adequate supply of dietary iodine is essential for the synthesis of the thyroid hormons. The measurement of dietary iodine intake is important for the clinical assessment of thyroid disease, especially in areas where iodine intake is excessive or deficient.To evaluate dietary iodine intake in Korean and its effects on thyroid function, we measured urinary iodine excretion with morning urine by electrode method in 184 normal subjects, 96 postpartum women and 181 patients with thyroid disease from October 1994 to February 1995. The results were as follows;1) In normal control, the mean value of urinary iodine excretion was 3.8+-2.7mg/L (range 0.1-15.0mg/L). However, there was no sex and age differences in the urinary iodine excretion.2) In postpartum women, the urinary iodine excretion was 9.0+-10.8mg/L who were not taken high iodine diet(Miyok-Guk), the mean value was statistically higher than normal control(p<0.01) and significant increased the urinary iodine excretion after eating of high iodine diet(p<0.01).3) In volunteer, there were increase of urinary iodine excretion more than 10 folds after high iodine diet and medication.4) The urinary iodine excretion in patients with thyroid diseases was not different from normal control, and there were no significant differences of urinary iodine excretion among the patient groups. The urinary iodine excretion in the acute stage of patients with subactue thyroiditis or painless thyroiditis was significantly increased compared to the recovery stage. However, it was not significantly different from that of normal control.In conclusion, urinary iodine excretion in Korean population is very high comparing to the reported data in Western population but similar with Japanese. The urinary iodine excretion is significant increase( more than 10-folds of basal level) after high iodine diet or high iodine containing medication in postpartum women or healthy persons. As a clue of destruction induced thyrotoxicosis, the urinary iodine excretion measurement is not valid in area where iodine intake is excessive like Korea.