E Barasch — Page 3 | PubMed Health

PubMedDate not supplied

Left atrial metastasis from hepatocellular carcinoma: a case report.

This is the second reported case of a patient with hepatocellular carcinoma in whom the presence of a solitary, left atrial metastatic tumor was confirmed with the aid of transesophageal echocardiography. The tumor was discovered during computed tomography scanning at a follow-up examination after a 3-month regimen of chemotherapy. The patient had exhibited no signs of cardiac involvement, which may have been the result of the relatively small size of the tumor. Surgical excision of the tumor was successfully undertaken, and the patient's postoperative course was uneventful. In this case, transesophageal echocardiography was valuable in providing information regarding the exact location of the tumor and its relation to surrounding anatomical structures.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

The relation of clinical outcome to dissection and thrombus formation during coronary angioplasty. Heparin Registry Investigators.

BACKGROUND: Although the development of thrombus or dissection during percutaneous transluminal coronary angioplasty (PTCA) increases the risk of abrupt vessel closure, the magnitude of the effect is difficult to define. OBJECTIVE: The aim of the study was to determine prospectively the effect of the development of thrombus or dissection on PTCA procedural outcome. METHODS: Data from 591 consecutive angioplasty procedures involving 756 lesions at 9 clinical centers were included in a prospective registry with a core angiographic laboratory. RESULTS: Clinical success (defined as < 50% stenosis of all target lesions assessed in a core angiographic laboratory, with no major complications of death, Q wave or non-Q wave myocardial infarction or emergency CABG) was achieved in 497 patients (84%). Major complications occurred in 45 (7.6%). Abrupt vessel closure, including both established closure (TIMI grade 0 or I flow) and impending closure (> 50% stenosis, TIMI grade 0-2 flow, plus use of additional interventions) occurred in 65 patients (11%). Angiographically visible dissections developed in 40% of lesions; more severe grades of dissection were associated with reduced success rates, and increased incidence of and abrupt vessel closure and major complication. Angiographic evidence of thrombus (filling defects) developed in 12.3% of lesions; the presence of thrombus was associated with significantly lower procedural success (61% vs. 86%) and significantly higher rates of abrupt vessel closure (28% vs 7%) and major complications (24% vs. 6%). With multivariable analysis, thrombus was identified as an independent predictor of procedural success, abrupt vessel closure, and major complications. CONCLUSIONS: The development of severe dissections or thrombus following PTCA is associated with significantly lower procedural success rates and higher rates of abrupt vessel closure and major complications. Patients who develop severe dissection or thrombus may be appropriate candidates for more aggressive forms of therapy.

Adult↗