One hundred patients (32 male) aged 5 months to 82 years (median 32 years) underwent 106 surgical procedures for 112 mechanical prosthetic valves obstructed by a thrombus (n = 61) or pannus (n = 7), or both (n = 44), between January 1, 1980 and December 31, 1989. The position of the obstructed prosthesis was aortic in 51 patients (48%), mitral in 49 (46%) and both aortic and mitral in 6 (6%). The types of obstructed prosthetic valves were Björk-Shiley (n = 51), St. Jude (n = 41) and Medtronic-Hall (n = 20). The time interval between valve replacement and obstruction ranged from 6 weeks to 13 years (median 4 years). Of 63% of patients in whom coagulation variables were available at the time of obstruction, 70% were receiving inadequate anticoagulant therapy. In 63% of the procedures the patient was in New York Heart Association functional class IV. Two patients underwent preoperative thrombolysis with incomplete results. Operative procedures included valve replacement (n = 81), valve declotting and excision of pannus (n = 23) and aortic valve replacement and mitral valve declotting (n = 2). The early mortality rate was 12.3% (13 patients), and there was no difference between surgery for mitral prostheses (12.2%) versus aortic prostheses (13.7%). The perioperative mortality rate was 17.5% (11 of 63 patients) in patients in functional class IV and 4.7% (2 of 43 patients) in those in functional classes I to III (p less than 0.05). For valve replacement, the mortality rate was 12% (10 of 81 patients) and for declotting of the prosthesis 13% (3 of 23 patients).(ABSTRACT TRUNCATED AT 250 WORDS)

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One thousand-six-hundred and sixty cases of laryngeal cancer were diagnosed in Israel during the years 1960-1976. In 98 of these cases another primary cancer accompanied the laryngeal carcinoma. Patients whose second primary cancer was basal or squamous cell carcinoma of the skin were not included in this study. Therefore, the results reported here deal with 84 patients. The prevalence of multiple primary cancer in patients with laryngeal carcinoma was found to be 5%. Lung cancer is the other primary tumor accompanying laryngeal carcinoma most frequently (29% of the additional tumors) followed by colorectal and bladder cancers. Most of the additional tumors (83%) appeared in a metachronic form with an average time interval of six years. In most metachronic tumors laryngeal carcinoma appeared as the first tumor (86%). Eighty percent of the patients were dead by August 1978. The majority (74%) succumbed due to the additional tumor and only 4% died of laryngeal carcinoma.

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