ABSTRACT
A 75-year-old woman with a small calcified aortic root, severe aortic stenosis and triple vessel coronary artery disease developed angina at rest. Aortic valve decalcification and quadruple aorto-coronary bypass were done as her aortic root was too small and calcified to do anything else. Postoperative clinical and hemodynamic results have been excellent. Literature review supports application of this therapy in selected patients with trileaflet senescent aortic stenosis.
Subject(s)
Aortic Valve Insufficiency/surgery , Calcinosis/surgery , Coronary Artery Bypass , Coronary Disease/surgery , Aged , Aortic Valve/physiopathology , Aortic Valve/surgery , Coronary Disease/complications , Female , HumansSubject(s)
Coronary Artery Bypass , Coronary Disease/surgery , Postoperative Complications/mortality , Aged , Humans , Prognosis , Risk FactorsSubject(s)
Coronary Disease/epidemiology , Coronary Disease/mortality , Female , France , Humans , Male , Risk Factors , United StatesSubject(s)
Aortic Aneurysm/microbiology , Campylobacter Infections/complications , Acute Disease , Aorta, Abdominal/diagnostic imaging , Aorta, Abdominal/microbiology , Aortic Aneurysm/diagnostic imaging , Campylobacter fetus/isolation & purification , Humans , Inflammation/microbiology , Male , Middle Aged , Tomography, X-Ray ComputedSubject(s)
Myocardial Infarction/therapy , Calcium/antagonists & inhibitors , Cardiology , Clinical Trials as Topic , Congresses as Topic , Coronary Artery Bypass , Europe , Fibrinolytic Agents/therapeutic use , Humans , Male , Middle Aged , Myocardial Infarction/drug therapy , Myocardial Infarction/surgerySubject(s)
Tracheal Neoplasms/pathology , Calcinosis , Humans , Male , Middle Aged , Ossification, Heterotopic , Trachea/pathologyABSTRACT
Based on 417 itemized bills from 45 American hospitals that responded to a randomized, geographically stratified survey covering January to June, 1976, the middle 50% of hospital charges for cardiac operations ranged between $5,914 and $10,315. Nonitemizing hospitals submitted lower, but less accurate, estimates. As 60% of the itemized bill consisted of high charge/cost items such as laboratory and pharmacy fees, total charges were not lowered merely by increasing case load or decreasing operating room times. Careful individualization of services in 1 hospital, however, reduced charges up to 16%. Charge per day was a poor index of efficiency because patients staying longer had lower average daily charges. The variation in hospital charges and lack of accounting uniformity preclude meaningful quantitation of either the "typical" charge or the numerator of the cost/benefit ratio for cardiac operations.
Subject(s)
Cardiac Surgical Procedures/economics , Cost-Benefit Analysis , Economics, Hospital , Fees and Charges , Humans , United StatesABSTRACT
As of 1975, forty-nine cases of adenocarcinoma arising in the columnar-lined lower esophagus (CLLE) were reported in the literature. We add three more cases, including the youngest male to our knowledge. All survived esophagogastrectomy and radiotherapy, but each had metastatic disease and a guarded prognosis. Review of the literature revealed a male/female ratio of 3:1 for this disorder with a mean age for men of 53 years, less than that for women, (61 women). Columnar-lined lower esophagus is seen in up to 11% of patients with reflux esophagitis and probably does not regress, once present. Adenocarcinoma later develops in 2.4% to 8.5%. The CLLE is not rare and should be followed up as carefully as any other premalignant lesion.
Subject(s)
Adenocarcinoma , Esophageal Neoplasms , Precancerous Conditions , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Adult , Age Factors , Esophageal Neoplasms/pathology , Esophageal Neoplasms/surgery , Esophagus/pathology , Humans , Male , Middle Aged , Neoplasm Metastasis , Precancerous Conditions/pathology , Precancerous Conditions/surgery , Sex FactorsABSTRACT
As therapy for leukemia and lymphoma has improved, secondary pulmonary disease has become a major cause of death. In this review of 225 patients with leukemia or lymphoma, six possibly preventable deaths resulted because progressive pulmonary infiltrates were treated without tissue diagnosis. Four other patients died of undiagnosed second primary lung tumors. When pulmonary infiltrates were diagnosed by open lung biopsy examination, appropriate therapy in nine patients resulted in seven survivals from potentially lethal infections. Of six patient with either primary lung tumor, leukemic infiltrate, or lymphomatous nodule, bronchoscopy and brush biopsy examination revealed bronchogenic tumors, leading to appropriate surgical therapy and survival in three. In three others, bronchoscopy and mediastinoscopy suggested exacerbation of the primary disease, which was treated satisfactorily by radiotherapy. Thus, when pulmonary disease develops in patients with leukemia or lymphoma, aggressive therapy based on tissue diagnosis may avert untimely death.
Subject(s)
Leukemia/complications , Lung Diseases/diagnosis , Lung Neoplasms/diagnosis , Lymphoma/complications , Adult , Child , Child, Preschool , Diagnosis, Differential , Diagnostic Errors , Female , Humans , Lung/surgery , Lung Diseases/complications , Lung Diseases/diagnostic imaging , Lung Neoplasms/complications , Lung Neoplasms/diagnostic imaging , Male , Middle Aged , Neoplasm Metastasis , RadiographyABSTRACT
Subendocardial ischemia with consequent subendocardial necrosis is a frequent cause of death after cardiopulmonary bypass. The problem is caused by an inequity in the oxygen requirements of the subendocardium and the available blood supply. We have developed a means of detecting ischemia early in the postperfusion period. Using an analogue computer, we determine the endocardial viability ratio (EVR). This value may decrease before either systemic or central venous pressure changes. Thus the ratio can reflect early the danger of subendocardial ischemia. Another advantage is that equipment now common in coronary care units can be used to determine the EVR.
