Cardiac revascularization using both mammary arteries

Both internal mammary arteries in combination with veins were used for revascularization of the hearth in fifty Danish patients undergoing coronary artery bypass grafting (CABG) at Gentofte Hospital during the period 1994-1996. Patients with insulin-dependent diabetes mellitus, obesity, and age over 75 years were excluded. The patients were followed for at least one month after the operation. No patients died, and the complication rate was low and comparable to standard CABG using the left mammary artery and vein grafts. It is known from the literature that 10 years after CABG only 50% of vein grafts remain patent, and half of these have severe atherosclerosis. The mammary artery is far more resistant to atherosclerosis and 15 years after the procedure fewer patients have recurrent angina when both mammary arteries have been used. Bilateral mammary artery grafts can be used in half of CABG-procedures, and are especially indicated in younger patients.     

Bovine internal mammary artery as a conduit for coronary revascularization: long-term results

Preterm infants may become apneic during immediate postoperative period. We studied prospectively postoperative apneic attack in 167 preterm infants after inguinal herniorrhaphy with nitrous oxide-halothane anesthesia. Their mean gestational age was 30 +/- 3 weeks. The mean postnatal age at operation was 14 weeks. The post-conceptual age varied between 36 and 56 weeks. The mean birth weight was 1351 +/- 395 kg. Although many of them had a risk factor of postoperative apneic attack, i.e.a young post-conceptual age (less than 41 weeks), a light weight at operation (below 3000g), only one infant who had received emergency operation had an episode of apneic attack up to 2 postoperative days. For preventing postoperative apneic attack in preterm infants after inguinal hernia, we recommend the use of halothane anesthesia and the attention until a complete awakening.     

Whipple's disease: results of long-term follow-up

AIM: To analyze clinical, diagnostic and therapeutic aspects of Whipple's disease. MATERIALS AND METHODS: Diagnostic and therapeutic data are available for 7 patients registered in 1990-1997. The diagnosis was made using intestinoscope SIF-10L ("Olympus"). Biopsies were obtained from the jejunal, duodenal and gastric mucosa. The patients received tetracycline, erythromycin, biceptol, on demand--prednisolone. RESULTS: Whipple's disease was diagnosed 6 years on the average following the first clinical symptoms. In most patients the intestinal symptoms were preceded or accompanied by such extraintestinal symptoms as enlargement of the lymph nodes, lowering of hemoglobin, hypoproteinemia, ESR increase to 40-60 mm/h. To study biopsies from the distal duodenum is the only measure needed for diagnosis of Whipple's disease. In untreated patients PAS-positive macrophages are detectable also in gastric body mucosa. The immediate treatment outcome is favorable. The recurrence was observed only in one patient who had given up taking tetracycline. CONCLUSION: Long-term antibacterial therapy brings the recovery. Primary disorder of the cellular immunity responsible for the disease onset necessitates long-term follow-up of the patients. Control biopsy should be examined once a year.     

Guepar hinge prosthesis: complications and results with two years' follow-up

Experience with the GUEPAR prosthesis in 292 cases of which 103 have been followed for more than 2 years, suggests that: implanting a hinge prosthesis is major surgery on elderly patients in whom severe complications have occurred and for this reason, the operations should be reserved for extremely damaged and unstable knees; the most important local complications have been deep sepsis for which we have noted a rate of 6.6 per cent; in the treatment of sepsis, everything must be done to preserve the prosthesis because arthrodesis is difficult to obtain; pain relief has been significant as a result of the operation. The prosthetic design allows flexion of more than 90 degrees in 85 per cent of the cases and 120 degrees in 26 per cent; after two years, the results seem relatively stable. We have not observed aseptic loosening after this period but a longer observation period is necessary to be reassured on this point; patellar pain remains a major concern because this arthroplasty has not solved the problem, and other solutions will have to be found.     

Modeling long-term parent outcomes of two universal family-focused preventive interventions: One-year follow-up results.

The present investigation extended prior work by R. Spoth, S. Redmond, and C. Shin (see record 1998-01101-018). These researchers reported findings that 2 universal family-focused preventive intervention programs each had direct effects on a proximal parenting outcome (intervention-targeted parenting behaviors) and indirect effects on 2 global and distal outcomes (parent–child affective quality and general child management) at posttesting. A replication of the previously tested parenting outcome model was conducted with 1-year follow-up data and procedures identical to those used in the earlier study. Results of the present study (N?=?404 families) indicate that statistically significant effects on parenting outcomes were sustained through a 1-year period following the posttest. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transsphenoidal microsurgery of pituitary macroadenomas with long-term follow-up results

The authors have reported on 108 patients with pituitary macroadenomas (measuring 2 cm in at least one diameter) who underwent 117 transsphenoidal operations and five craniotomies, and were followed for periods ranging from 6 months to 14 years. Vision improved in 90% of the patients. Gross total tumor removal with no evidence of residual tumor tissue demonstrable on the postoperative computerized tomography scan was accomplished in 41% of cases. However, gross total tumor removal is not synonymous with complete tumor removal. Endocrine cure was possible in 25% of prolactin-secreting and 20% of growth hormone-secreting adenomas. The incidence of recurrence was 12%, with the majority occurring from 4 to 8 years postoperatively. Both the tumors with suprasellar extension of more than 2 cm and the hard fibrotic tumors had a higher recurrence rate. Postoperative administration of radiation therapy has been associated with a significantly lower recurrence rate than when this therapy was withheld. Transsphenoidal surgery of pituitary macroadenomas confined to the extra-arachnoid space is associated with a relatively small number of complications. The operative technique used in this series is described.     

Coronary revascularization after myocardial infarction in the very elderly: outcomes and long-term follow-up

OBJECTIVE: To determine the outcome of very elderly patients who had coronary revascularization during hospitalization for an acute myocardial infarction. DESIGN: Retrospective cohort study. SETTING: Community-based tertiary-care teaching hospital. PATIENTS: A total of 1215 consecutive patients 80 years and older were hospitalized with a myocardial infarction between 1985 and 1990. The study sample included all 93 patients (8%) who had cardiac catheterization before discharge and had not been excluded from study because of the following: severe valvular disease, absence of significant coronary disease, or death before a decision about revascularization could be made. MEASUREMENTS: Survival, quality of life, and functional status at least 1 year after discharge. RESULTS: After catheterization, 41 patients had angioplasty, 18 had coronary artery bypass surgery, and 34 did not have revascularization. Among the patients alive at discharge, those who had revascularization had a high likelihood of achieving a good or excellent quality of life (angioplasty, 86% [31 of 36]; surgery, 89% [16 of 18]; medical therapy, 44% [11 of 25]) and of being able to care for themselves (angioplasty, 89% [32 of 36], surgery, 89% [16 of 18], medical therapy, 52% [13 of 25]). Mortality rates at 1 year were 24% (95% CI, 15% to 47%) for the angioplasty group, 6% (CI, 0% to 27%) for the surgery group, and 44% (CI, 27% to 62%) for the medical therapy group. In a Cox proportional hazards model that adjusted for clinical, demographic, hemodynamic, and anatomic differences between the groups, the performance of coronary revascularization was associated with increased survival (hazard ratio, 0.42; CI, 0.18 to 0.98). CONCLUSIONS: A small percentage of very elderly patients with complicated acute myocardial infarctions, selected by their physicians for invasive cardiovascular procedures, can tolerate these procedures, avoid serious complications, return to independent living, and have excellent probability of survival. Although our results suggest that coronary revascularization may have benefited these patients, the study design did not permit definite conclusions, and future studies are needed to resolve this important question.     

Surgical treatment of choledochal cyst in adults: results and long-term follow-up

BACKGROUND/AIMS: Results of the surgical management of 60 adults with choledochal cysts at Chang Gung Memorial Hospital Taipei are presented. PATIENTS AND METHODS: All patients were diagnosed and surgically managed during the period between March 1979 and December 1992. There were 47 females and 13 males, with ages ranging from 16 to 81 years (mean age = 31.9 years). Of the total, there were 41 Type I, one Type II, 14 Type IV, and four Type V choledochal cysts classified according to Todani's classification system. The definite surgical procedures were cyst excision and hepatico-jejunostomy in 43 cases in type I and IV diseases, one cyst excision in type II disease, two hepatectomy for type V disease, cyst enterostomy in seven cases, and T-tube choledochocystostomy in seven cases. RESULTS: The operative mortality rate was 3.3% and the complication rate related to the surgical procedure was 20%. Early postoperative complications include wound infection, leakage of anastomosis, acute pancreatitis, septic shock, left pleural effusion, and intra-abdominal abscessing. Reoperations were needed in the early postoperative days in two cases due to hepatico-jejunostomy leakage and intraabdominal abscess formation. Long-term surgical outcome, concerning recurrence of symptoms, was related to the following factors, excluding the factors of surgery: presence of bile duct lithiasis, common channel less than 22 mm, presence of preoperative pancreatitis and acute angle type pancreaticobiliary unions. Only common channel less than 22 mm is statistically significant. The percentage of recurrence of the symptoms after resectional surgery was 32.5% in the long term follow-up period. Most of the cases responded well to an antibiotics treatment. Three of the cases required a second operation or PTCD as well as dilatation to treat the recurrent cholangitis. CONCLUSION: Although the recurrence of symptoms is not uncommon and satisfactory explanation of the analysed factors is still the treatment of choice for adult patients with choledochal cysts.     

Tentorial and posterior cranial fossa meningiomas: operative results and long-term follow-up: experience with twenty-six cases

In spite of significant recent advancements in imaging technology, monitoring [12] and surgical techniques [1,5,7,18,21,24], complete and safe removal of tentorial and posterior fossa meningiomas remains a formidable challenge for most neurosurgeons [6,8,9,14,15,17]. This paper reviews our experience with 28 patients with tentorial and posterior fossa meningiomas.     

Myocardial bridge of the coronary arteries and its clinical significance

Myocardial bridge is a congenital anomaly of the coronary artery and appears on an angiogram as a systolic narrowing. Major coronary veins are rarely covered by myocardial bridges. The functional significance of coronary bridging remains controversial. Generally, bridging is not though to result in symptoms, as the coronary narrowing occurs during systole and most coronary flow occurs during diastole. Some authors reported this condition in association with angina pectoris, myocardial infarction, cardiac arrhythmias and sudden cardiac death. The mechanism of ischemia, connection with atherosclerosis are not clear. The symptomatic compressive myocardial bridge is in itself an indication for operation by simple section of the bridge. But if there exist associated atheromatous lesions, the surgeon should combine aortocoronary bypass with section or coronary angioplasty.     

Single-center experience with the Palmaz-Schatz intracoronary stent: the immediate results and medium- and long-term follow-up

The yeast SEC14 gene product is required for the transport of proteins from the Golgi complex. We have cloned the homologous Candida albicans SEC14 gene (CaSEC14) by functional complementation of a Saccharomyces cerevisiae thermosensitive mutant, sec14ts. Some putative TATA boxes have been identified in CaSEC14 and, contrary to S. cerevisiae SEC14, no introns were found in the Candida homologue. Sequence analysis revealed that CaSec14p is a 301 amino acid protein, 67% identical to S. cerevisiae and Kluyveromyces iactis Sec14p, and 61% identical to the 300 amino-terminal residues of Yarrowia lipolytica Sec14p. Hydrophatic profile analysis of CaSec14p suggests a soluble protein without transmembrane domains as has been described for the S. cerevisiae counterpart. While it was easy to disrupt one allele of SEC14 in C. albicans, repeated attempts to disrupt the second allele were unsuccessful, thus suggesting that the gene could be essential for vegetative growth in C. albicans.     

Childhood chronic inflammatory demyelinating neuropathies: clinical course and long-term follow-up

Chronic inflammatory demyelinating neuropathy (CIDP) is a rare disease in childhood. We reviewed the clinical characteristics, response to therapy, and long-term prognosis in 13 children (1.5 to 16 years of age) diagnosed with CIDP at Washington University Medical Center, St. Louis, and the Royal Children's Hospital, Melbourne, Australia, between 1979 and 1994. The most common presenting symptom (in 11/13 [85%]) was lower extremity weakness associated with difficulty in walking. Preceding events within 1 months of onset, mostly intercurrent infections or vaccinations, occurred in seven children (54%). The disease was monophasic in three children (23%). One relapse occurred in four (30%) and multiple relapses in six (46%). All patients had at least short-term response to steroids. Three children (23%) recovered completely during the first year. Ten children (77%) had residual weakness after an average follow-up of 6 years. There seems to be two populations of children with CIDP. One subgroup, with a favorable prognosis, progressed to peak disability over less than 3 months; these children often have a monophasic course with complete resolution of symptoms and signs and withdrawal from all medications by 1 year after onset. A second subgroup progressed for 3 months or longer; these children all required substantial does of prednisone for prolonged periods and had considerable long-term morbidity with persistent weakness.     

Trauma patients 75 years and older: long-term follow-up results justify aggressive management

BACKGROUND: Long-term survival rate and functional status after trauma for one of the fastest growing segments of the population, patients 75 years and older, is poorly documented. METHODS: Trauma patients 75 years and older who were discharged from our Level I trauma center between June 1988 and July 1992 (n = 279) were contacted by mail or phone. Public death records were used to identify patients who had died. A stepwise logistic regression analysis was performed to determine predictors of poor outcome (death within 6 months). Main outcome measures included mortality and self-assessed functional status. RESULTS: A minimum 4-year follow-up was obtained for 81% of the 279 study patients. The mean follow-up period was 5.4 +/- 1.1 years. Mean age at time of injury was 81 +/- 5 years (range, 75-101 years); mean Injury Severity Score was 9.4 +/- 7.7. At follow-up, 132 patients (47%) had died, 93 patients (33%) were contacted, and 54 patients (19%) could not be located. Twelve percent of patients survived less than 6 months after discharge. Poor survival was predicted by preexisting diseases (dementia, p = 0.001; hypertension, p = 0.02; and chronic obstructive pulmonary disease, p = 0.05) and not by age or severity of injury. The mean age of patients still living was 85 +/- 3.9 years (range, 79-99 years), and 77 of 93 patients were living in an independent setting (33 alone, 44 with spouse or family); of these, 57% reported no difficulties in performing 12 of 14 activities of daily living. CONCLUSION: Despite higher than expected mortality after discharge, aggressive management of trauma patients 75 years and older is justified by the favorable long-term outcome.     

Expandable metallic stent placement in patients with benign esophageal strictures: results of long-term follow-up

Prosthetic mandibular advancement (PMA) was applied to nine patients with obstructive sleep apnea syndrome (OSAS) and its therapeutic usefulness, mechanism of action, and clinical indication were discussed based on polysomnographic findings and serial examination of upper airway before and during PMA treatment. Apnea hypopnea index significantly decreased during PMA treatment compared with the value before treatment (P < 0.01) and the rate of the treatment responder counted 78.1%. Cephalometric variables indicated forward and inferior advancement of mandible in our subjects. Magnetic resonance imaging of the upper airway during sleep revealed a marked improvement of velophanryngeal obstruction in most subjects. In addition, intraesophageal negative pressure during sleep decreased significantly. Our results confirmed the high therapeutic efficacy of PMA for OSAS and indicated forward advancement of the mandible and decrease of negative pressure loading on upper airway with PMA might suppress velopharyngeal collapse. Thus, PMA was regarded as one of the treatments of choice for OSAS occurring based on with velopharyngeal narrowing.     

Myocardial revascularization and carotid endarterectomy: a combined approach

The approach to the patient with combined carotid and coronary artery occlusive disease has been evolving since corornary bypass procedures became feasible. When neurological and cardiac symptoms are remote, sequential procedures are adequate. Neurological symptoms or severe carotid stenoses (or both) appearing simultaneously with symptoms of myocardial ischemia present a more difficult problem. Simultaneous operation has been performed in 16 patients with 1 early death (low output) and 2 cerebral complications (1 patient with residual hand weakness and 1 without neurological risidua). The morbidity and mortality seemed unrelated to the fact that procedures were done at one operation. Therapy, however, must be tailored to the individual patient.     

Psychotherapy and bulimia nervosa: evaluation and long-term follow-up of two conflict-orientated treatment conditions

Analytic in-patient therapy (n = 32) and systemic out-patient therapy (n = 39) were applied to patients with bulimia nervosa, and the effects were evaluated 14, 26 and 38 months after the start of the treatments. Our assumptions about the general efficacy of both conflict-orientated techniques were confirmed: both therapies satisfactorily reduced the symptomatic behaviour, as well as secondary factors related to bulimia nervosa, in the long term. However, we could not identify differential effects of the two treatment regimes, which we had expected with regard to the very different therapeutic approaches. The similarities of outcome of both therapies predominate, with slightly better results in the case of the analytic in-patient treatment. The results are discussed with regard to the assumption that specific healing factors are involved in conflict-orientated treatments in addition to the "common factors' of psychotherapy.