We reviewed our experience with endoscopically evaluated severe upper gastrointestinal hemorrhage following open heart surgery. Of 4892 patients undergoing open heart surgery, 18 (0.4%) sustained upper gastrointestinal hemorrhage requiring endoscopic evaluation. Endoscopy identified the source of bleeding in all cases. No significant complications of endoscopy were observed. Duodenal ulcers (DUs) were found in 16 (89%) of cases and were felt to be the source of bleeding in 15 (83%). Aggressive features, such as multiplicity, large size, or distal location were associated with 13 (81%) of the DU cases. Complications necessitated endoscopic or surgical therapy in eight (44%) patients with DUs. We conclude that aggressive DU disease accounts for the majority of severe upper gastrointestinal bleeding following open heart surgery.
A second generation of tissue sensitizers has been formulated for the photodynamic ablation of cancer. The photophysical and biologic properties of these agents will determine their activity and clinical use. Investigations of sensitizer properties are discussed, providing a foundation for sensitizer selection, followed by a summary of clinical reports. Tissue sensitizers may be particularly effective for the noninvasive ablation of early cancers.
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