RESUMEN
Primary cardiac sarcomas are rare tumors with a median survival of 6-12 months. Data suggest that an aggressive multidisciplinary approach may improve patient outcome. We present the case of a male who underwent resection of cardiac sarcoma three times from the age of 32 to 34. This report discusses the malignant nature of cardiac sarcoma and the importance of postoperative multidisciplinary care.
RESUMEN
BACKGROUND: Carotid artery stenosis and coronary artery disease share common risk factors and often coexist in the same patient. Currently, no consensus exists regarding the optimal treatment strategy for patients with concomitant severe coronary and carotid disease. We reviewed the results of our experience performing off-pump coronary artery bypass grafting (CABG) within 24 hours of carotid endarterectomy (CEA) in this select patient population. METHODS: In this single institution retrospective study we identified patients who underwent CEA followed by CABG from March 2001 to March 2012. Preoperative, intraoperative, and postoperative data were collected and analyzed. RESULTS: Ninety patients underwent CEA followed by off-pump CABG. The duration between CEA and CABG was 1.8±5.6 days with 80 (89%) within 24 hours. Mean age was 69±9 years, 68% male. Perioperative comorbidities included hypertension (87%), diabetes (50%), previous myocardial infarction (24%), peripheral arterial disease (20%), and strokes and transient ischemic attack (16%). Extensive aortic atherosclerosis was noted in 15 patients (17%). The average number of vessels bypassed was 3.4±1.0, and the average number of proximal vein aortotomies was 1.7±0.92. Post-CEA surgical outcomes were myocardial infarction (1%), acute embolic cerebrovascular accident (1%), left upper extremity weakness (1%), and hypoglossal nerve injury (1%). Post-CABG surgical outcomes included atrial fibrillation (34%), anemia (12%), pneumothorax (7%), and postoperative bleeding (4%). No post-CABG cerebrovascular accident was identified. Patients were discharged 7.5±3.5 days after CEA. CONCLUSIONS: Twenty-four hour staged CEA followed by CABG minimizes myocardial infarction post-CEA while minimizing cerebrovascular accident post-CABG in patients with concomitant severe coronary and carotid artery disease.
Asunto(s)
Estenosis Carotídea/cirugía , Puente de Arteria Coronaria Off-Pump/métodos , Enfermedad de la Arteria Coronaria/cirugía , Anciano , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Ecocardiografía Transesofágica , Endarterectomía Carotidea/métodos , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , New York/epidemiología , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tasa de Supervivencia/tendencias , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler DúplexRESUMEN
The purpose of this study was to assess for disparity within a cohort of patients presenting with complicated colorectal cancer. A retrospective study of 522 patients who underwent surgery for colorectal cancer at a tertiary care institution was performed. Complicated cancer was defined by perforating or obstructing colonic lesions. Statistical analysis was conducted by chi2 test and analysis of variance. Of the 522 patients, 72 patients (14%) presented with complicated colorectal cancer. Blacks in low-income brackets (36 vs 0%, P < 0.001) and those with public insurance (55 vs 16%, P < 0.05) had increased presentation with complicated colorectal cancers as compared with whites. Black (91%) and Hispanic women (86%), when compared with white women (37%) had increased incidence of complicated colorectal cancer (P < 0.05). Patients in low-income brackets, regardless of race, had increased cancer recurrence rates (57 vs 8%, P < 0.001) compared with patients in average or high-income brackets. Mortality rate was 57 per cent in Hispanic, 29 per cent in white, and 27 per cent in black patients (P = nonsignificant). Specific targeting of colorectal cancer screening, education, and follow-up programs is imperative for minority women and patients of low socioeconomic status.