ABSTRACT
The authors report the cases of two young adults (25 and 27 years) presenting with congenital left ventricular aneurysm or diverticulum with healthy coronary arteries. This saccular evagination of the ventricular wall is rare. The authors describe a classification distinguishing muscular (contractile) diverticula, composed of the three cardiac tunics, fibrous diverticula and finally aneurysms with a dyskinetic wall. Although the limits of this classification are sometimes poorly defined, it presents a prognostic value, because it appears logical to propose nonsurgical management in the context of muscular diverticula and it seems legitimate to operate on fibrous diverticula and aneurysms due to the risks of rupture, extension, thrombosis or arrhythmia.
Subject(s)
Diverticulum/congenital , Diverticulum/diagnosis , Heart Aneurysm/diagnosis , Heart Defects, Congenital/diagnosis , Heart Ventricles , Adult , Arrhythmias, Cardiac/etiology , Diverticulum/classification , Diverticulum/surgery , Dyspnea/etiology , Echocardiography, Transesophageal , Electrocardiography , Heart Aneurysm/classification , Heart Aneurysm/surgery , Heart Defects, Congenital/classification , Heart Defects, Congenital/surgery , Heart Rupture/etiology , Humans , Magnetic Resonance Imaging , Male , Prognosis , Radionuclide Ventriculography , Risk Factors , Rupture, Spontaneous , Thrombosis/etiologyABSTRACT
From January to November, 1981, 28 patients with unresectable squamous cell carcinoma of the esophagus were treated with two cycles of chemotherapy combining vincristine (V), methotrexate (M), folinic acid rescue, and cisplatin (P) on days 1 and 21. Split-course radiation therapy was delivered thereafter from day 42 on. Hematologic, renal, and neurologic tolerance was acceptable, but most of the patients experienced nausea and vomiting. Results evolution at day 40 showed a 61% partial response (PR) rate and a 7% complete response (CR) rate. One month after the end of radiation therapy, 43% PR and 32% CR were obtained. Median response duration was 8 months. Median survival was 11.6 months for patients overall, yielding 12.9 months for responders and 5.9 months for nonresponders. Based on the response rate obtained with combined chemotherapy, a randomized trial of VMP initial chemotherapy is currently being undertaken by our cooperative group to study whether such an initial treatment could improve resectability and radiation-mediated local control along with survival rate.
