Objective: To evaluate limb-salvage surgery including vascular resection for lower-extremity soft-tissue sarcomas and carcinomas for adult patients.Materials and Methods: Eight consecutive patients (median age, 59 years) who underwent vascular replacement during surgery for malignant tumors in the lower limbs between November 2006 and March 2018 were evaluated. Patient data were retrospectively obtained in a computerized database. Arterial and venous reconstructions were performed for seven patients, with one additional patient receiving venous reconstruction only. Autologous-vein (n=6) and synthetic bypasses were used for arterial repairs, whereas only autologous veins were implanted for venous repairs.Results: Morbidity was 62.5%, and in-hospital mortality was 12.5%. At a median follow-up of 24 months, the primary patency rates of arterial and venous reconstructions were 85.7% and 62.5%, respectively. Limb salvage was achieved in all cases.Conclusion: Early and mid-term bypass patency rates, the high percentage of limb salvage, and the oncologic outcome underline the efficacy of en bloc resection of soft-tissue tumors involving major vessels of the lower limbs. The anticipated need for vascular resection and reconstruction should not be a contraindication to sarcoma and carcinoma resections. However, efforts to achieve better control over systemic spread are required for long-term survival.
Conversion from peripheral extracorporeal life support (ECLS) to the central one can improve and stabilize hemodynamics in patients with refractory congestive heart failure-related multiorgan failure, whereas indication and selection of the type of the central ECLS have not been fully established. Institutional outcome of the conversion therapy was herein reviewed to verify indication and selection of three types of central ECLS. This study enrolled an institutional consecutive surgical series of 24 patients with refractory congestive heart failure under peripheral ECLS, related to fulminant myocarditis (n = 15), dilated cardiomyopathy (n = 5), or acute myocardial infarction (n = 4). They were converted to central Y-extracorporeal membrane oxygenation (ECMO, n = 6), extracorporeal ventricular assist device (EC-VAD, n = 12), or pump catheter (n = 6), dependent upon the degree of multiorgan failure. Despite the different degree of multiorgan failure prior to the conversion, improvement in end-organ perfusion and reduction in right atrial and pulmonary artery pressure were promptly achieved regardless of the type of the central ECLS. There were five in-hospital mortalities (21%) during the central ECLS, whereas mechanical support was weaned-off in 11 cases (46%) and durable LVAD was subsequently implanted for bridge to transplantation in eight cases (33%). Conversion from the peripheral ECLS to the central ones, such as central Y-ECMO, EC-VAD or pump catheter, promptly established a sufficient support with heart and lung unloading in patients with refractory congestive heart failure.
An afterglow is beneficial as an emission signal in the field of displays and imaging probes. Here, boronic acidappended and spirolactam ring-containing rhodamine dye 1 was synthesized and grafted onto the surface of roomtemperature phosphorescence-active boronate nanoparticles (BPs), composed of polymeric 3-benzo-2,4,8,10-tetraoxa-3,9diboraspiro[5.5]undecane. The resultant ensemble, 1@BP, exhibited a greenish afterglow. However, the addition of Al 3 + into the dispersion solution with 1@BP led to a change in the afterglow to grass green as a result of Förster-type energy transfer from the phosphorescent BP to the Al 3 + -interacting rhodamine dye 1 on the surface. Based on the ratio of the two emission intensities, a linear response in the concentration range of 3.8-15.2 μM was observed, with a detection limit of 4.2 μM for Al 3 + . A metal ion-dependent discernable color in afterglow was observed on a 1@BP-coated filter paper, which would be useful for not only film-based afterglow chemosensors but also encryption application.
Left ventricular free wall rupture is a complication following acute myocardial infarction or mitral valve replacement. We report the case of a 56-year-old female patient with idiopathic left ventricular rupture confirmed by contrast-enhanced computed tomography (CT). CT also showed no coronary artery obstruction and severe mitral annular calcification. Left ventricular rupture was successfully repaired internally with bovine pericardium. Mitral valve replacement with annular decalcification was also performed.
─ 231 ─ (CABG 3.8% vs. PCI 9.7% ; p < 0.0001) and repeat revascularization (CABG 13.7% vs. PCI 25.9% ; p < 0.0001) were significantly lower with CABG than PCI. A recent, randomized, non-inferiority trial compared second-generation drug-eluting stents using everolimus with CABG in patients with multivessel disease 9). At 2 years, the primary endpoint (composite of death, myocardial infarction, or target vessel revascularization) had occurred in 11.0% of PCI patients and in 7.9% of CABG patients (absolute risk difference 3.1 percentage points ; 95% confidence interval [CI]-0.8-6.9 ; p = 0.32 for noninferiority). However, at longer-term follow-up (median 4.6 years), the primary endpoint had occurred in 15.3% of the PCI group and in 10.6% of the CABG group (hazard ratio (HR) 1.47 ; 95% CI 1.01-2.13 ; p = 0.04). The rates of spontaneous myocardial infarction and new-lesion revascularization were greater with PCI than with CABG-differences that emerged early and continued to increase throughout the follow-up period. Another study using New York registry data compared shortand long-term outcomes with the propensity-score matching method between PCI with everolimus-eluting stents and CABG in patients with multivessel coronary disease 10). At a mean follow-up of 2.9 years, PCI compared with CABG was associated with a similar risk of death (PCI 3.1% per year, CABG 2.9% per year ; HR 1.04 ; 95% CI 0.93-1.17 ; p = 0.50), significantly higher risk of myocardial infarction (PCI 1.9% per year, CABG
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