ABSTRACT
OBJECTIVE: Patients with extra-cardiac arterial disease (ECAD) are at high risk of coronary artery disease (CAD). Prevalence of silent, significant CAD in patients with stenotic or aneurysmal ECAD was examined. Early detection and treatment may reduce CAD mortality in this high-risk group. MATERIALS AND METHODS: ECAD patients without cardiac complaints underwent computed tomography (CT) for calcium scoring, coronary CT angiography (cCTA) if calcium score was 1,000 or under, and adenosine perfusion magnetic resonance imaging (APMR) if there was no left main stenosis. Significant CAD was defined as calcium score over 1,000, cCTA-detected coronary stenosis of at least 50% lumen diameter, and/or APMR-detected inducible myocardial ischemia. In cases of left main stenosis (or equivalent) or myocardial ischemia, patients were referred to a cardiologist. RESULTS: The prevalence of significant CAD was 56.8% (95% CI 47.5 to 66.0). One-hundred and eleven patients were included. Eighty-four patients (76%) had stenotic ECAD, and 27 (24%) had aneurysmal disease. In patients with stenotic ECAD, significant coronary stenosis was present in 32 (38%) and inducible ischemia in eight (12%). Corresponding results in aneurysmal ECAD were eight (30%) and two (11%), respectively (p for difference >.05). Sixteen (19%) patients with stenotic and six (22%) with aneurysmal ECAD were referred to a cardiologist, with subsequent cardiac intervention in seven (44%) and three (50%), respectively (both p >.05). CONCLUSIONS: Patients with stenotic or aneurysmal ECAD have a high prevalence of silent, significant CAD.
Subject(s)
Asymptomatic Diseases , Coronary Artery Disease/diagnosis , Peripheral Arterial Disease/epidemiology , Adenosine , Aged , Coronary Angiography , Coronary Stenosis/diagnosis , Female , Humans , Magnetic Resonance Angiography , Male , Middle Aged , Prevalence , Prospective Studies , Referral and Consultation , Tomography, X-Ray Computed , Vascular Calcification/classification , Vasodilator AgentsABSTRACT
OBJECTIVE: To evaluate the use of colorectal stents. DESIGN: Retrospective. METHOD: Data were collected on all patients treated at the Deventer Hospital, the Netherlands, between 1 April 1996 and 31 December 2003 in whom the placement of a self-expanding colorectal stent was attempted. Each patient's physician was contacted to inquire about the patient's status, including quality of life with the stent in situ. RESULTS: Stent placement was attempted in 57 patients as palliation (n = 45) or before elective surgery (n = 12). Of the 57 patients, 29 were men and 28 were women, and the mean age was 71 years (range: 46-94). All patients had colorectal carcinoma, except 1 patient with stenosis following ischaemic colitis. Passage of air and faeces occurred immediately after stent expansion in 55 of the 57 patients (96%). Perforation during stent placement occurred in 2 patients, who subsequently underwent colostomy. 4 additional patients required a colostomy due to stent migration within a few hours or days after placement (n = 3) or obstruction by tumor growth after 65 days (n = 1). Patients in the palliative group had an acceptable quality of life. Those who received a stent before elective surgery were able to undergo resection, did not require colostomy, and had no postoperative complications. One patient did not undergo surgery because of extensive metastases. CONCLUSION: A colorectal stent can be used in the palliative treatment of terminal patients with colorectal carcinoma before colostomy is considered. Experiences with stents before elective surgery were also positive.
Subject(s)
Colorectal Neoplasms/surgery , Stents , Aged , Aged, 80 and over , Colostomy , Elective Surgical Procedures , Female , Humans , Male , Middle Aged , Palliative Care/methods , Postoperative Complications , Retrospective Studies , Treatment OutcomeABSTRACT
Treatment modalities for patients with an obstruction due to an irresectable malignant stenosis of the colon are: a palliative colostomy proximal of the obstruction, radiotherapy, laser therapy, cryosurgery, and photodynamic therapy. In 4 patients, 3 men and 1 woman of 70, 66, 74, and 38 years respectively with obstruction ileus caused by an irresectable distal colonic carcinoma, a self-expanding wallstent was successfully placed endoscopically in the stenosis of the latter three as a palliative measure, resulting in the unimpeded passage of faeces and intestinal gas.
Subject(s)
Colonic Diseases/therapy , Colonic Neoplasms/complications , Intestinal Obstruction/therapy , Stents , Adult , Aged , Colonic Diseases/diagnostic imaging , Colonic Diseases/etiology , Colonoscopy/methods , Female , Humans , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/etiology , Male , Palliative Care , RadiographyABSTRACT
A case is presented in which a Pagetoid lesion was demonstrated as a photon-deficient area (cold spot) on the bone scan. This area changed into a hot spot 3 years after its discovery. Clinical and radiological observations provide evidence that a scintigraphically photon-deficient area may represent a precursor of active Paget's disease.
