ABSTRACT
We report a case of a 74-year-old male, who presented with an acute ST elevation posterior wall myocardial infarction (MI) 21 years following revascularization with three saphenous vein grafts (SVGs) to the left and right coronary arteries. In coronary angiography (CAG), the dilated SVG to the first marginal branch of the circumflex artery appeared only contrast enhanced in the proximal portion. The day after coronary angiography 128-slice cardiac computed tomography (CT) was performed. Cardiac CT showed a 5×3-cm incomplete thrombosed aneurysm of the proximal bypass with complete thrombotic occlusion of distal bypass grafting. With this diagnosis the patient was referred to a cardiothoracic unit for a second opinion. A surgical intervention was refused due to an increased intraoperative morbidity and occlusion of peripheral bypass portion. A follow-up CAG 10 days after infarction showed complete occlusion of the aneurysm. This case illustrates the utility of multi-slice CT to diagnose SVG aneurysm and influence clinical decisions for further treatment. This is the first report of a spontaneous SVG aneurysm thrombosis under a conservative treatment approach with recovery of the patient after MI. Clinical follow-up five months after infarction was unremarkable.
Subject(s)
Aneurysm/diagnostic imaging , Coronary Angiography/methods , Graft Occlusion, Vascular/diagnostic imaging , Myocardial Infarction/diagnostic imaging , Saphenous Vein/diagnostic imaging , Tomography, Spiral Computed/methods , Aged , Aneurysm/complications , Aneurysm/therapy , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/methods , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/surgery , Follow-Up Studies , Graft Occlusion, Vascular/complications , Graft Occlusion, Vascular/therapy , Humans , Male , Monitoring, Physiologic/methods , Myocardial Infarction/etiology , Myocardial Infarction/therapy , Saphenous Vein/pathology , Saphenous Vein/transplantation , Thrombosis/complications , Thrombosis/diagnostic imaging , Thrombosis/therapy , Time FactorsABSTRACT
PURPOSE: Quality of life (QOL) should be improved during palliative chemotherapy for end-stage recurrent head and neck cancer. Therefore, we evaluated QOL in head and neck cancer patients during palliative chemotherapy with cisplatin and docetaxel. METHODS: Thirty patients were included in a prospective study between 2003 and 2007. Response, time-to-progression, overall survival, performance, and toxicity were estimated. QOL was assessed using the EORTC QLQ-C30 and the QLQ-H&N35 questionnaires at baseline, and after each chemotherapy cycle. RESULTS: The response rate was 17%. Sixty-three percent had stable disease. The median time-to-progression was 3.5 months. The median overall survival was 9.2 months. The QLQ-C30 score constipation and the QLQ-H&N35 scores swallowing, senses problems, speech problems, coughing, weight gain showed significant improvement. CONCLUSIONS: Only some aspects of QOL are maintained or improved. The QLQ-H&N35 questionnaire seems to be more appropriate to measure QOL, but needs to be improved to account for the peculiarities of modern palliative chemotherapy.
