Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Forty six patients with esophageal cancer underwent surgery between January 1986 and January 1990. In 14 patients (30.4%) distant metastases were recognized before surgery, whereas in 29 cases (63%) regional neoplastic lymph node infiltration was observed during surgery. Complications during and after surgery occurred in 32 (69.6%) patients and in 30 cases (65.2%) respectively. During the first 30 days after surgery 12 patients died. This represents a postoperative mortality of 26.1%. Among a total number of 51 variables analyzed in this study, 11 influenced the postoperative mortality: duration of intubation, previous history of toxic syndrome, presence of distant metastases before surgery, presence of neoplastic node involvement during surgery, tumor size greater than 4 cm, localization of the tumor at the middle third of the esophagus, respiratory insufficiency, cardiac failure, septic shock, and suture failure during the postoperative phase. However, multivariate analysis revealed that only three of these variables had an independent prognostic value on postoperative mortality: tumor size, presence of distant metastases, and development of respiratory insufficiency during the postoperative period.
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PMID:[Prognostic factors for postoperative mortality in cancer of the esophagus. Analysis of 46 cases]. 137

The antitumor activity of 5-fluorouracil (5-FU), combined either with bleomycin or adriamycin plus radiation, was studied in a controlled randomized clinical trial. Sixty-one previously untreated inoperable esophageal cancer patients entered the study and 56 have been evaluated: 58 male and 3 female patients with a mean age of 57 years (range 37-74). Concerning localization of the tumors in the esophagus, 2 were in the upper third, 36 in the middle third and 18 in the lower third. The length of the filling defects in the esophagogram (X-ray) was in 9 patients less than 5 cm, in 31 5-8 cm, and in 16 patients greater than 8 cm. Squamous cell carcinoma was found in 51 patients, adenocarcinoma in 3, and anaplastic (squamous cell) carcinoma in 2 patients. Modality A consisted of a combination of 5-FU (10 mg/kg i.v. 2 X weekly, 4 weeks) and bleomycin (10 mg/m2 i.v., 2 X 4 weeks) which was given concurrently with radiation (3600-4000 rad - 1000 rad weekly). In modality B the combination of 5-FU (same dose) and adriamycin (30 mg/m2 i.v. day 1, 2, 23 and 24) was applied with the same schedule and dosage of radiation. Seventy-five percent of the patients (21/28) have responded to treatment (CR + PR) in modality A, with 11 complete and 10 partial responses. In arm B, response was recorded in 64% of patients (18/28), with 2 complete and 16 partial responses. The difference in complete responses (39% vs 8%) was statistically significant (P less than 0.05). The median remission duration in complete responders was 12 months in modality A (range 6-18 months), and 6.8 months in modality B (range 3-10 months). All the responses occurred in patients with squamous cell carcinoma, except one partial response in a case of adenocarcinoma. As far as the age is concerned (less than 55 vs greater than 55 years), no significant difference in response rate was found (67% vs 71%). More favorable results were observed in the group of patients with less than 10% weight loss (79% vs 63%). Toxicity was moderate (myelosuppression, cardiotoxicity), but one treatment-related death (pulmonary fibrosis, cardiac failure) was recorded in arm A, as well as one death (rupture of aorta) in group B. Approximately 60% of patients in both modalities suffered from severe mucositis and retrosternal pain. The results of the study showed that the combination of 5-FU with adriamycin and particularly with bleomycin, given concurrently with lower radiation dosage, is an effective palliative treatment for inoperable esophageal cancer.
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PMID:The value of two combined chemoradiotherapy approaches in the treatment of inoperable esophageal cancer. 620 Sep 79

We report a 54-year-old man with a history of esophagectomy and retrosternal esophagogastric anastomosis for esophageal cancer through right thoracotomy in whom cardiac failure developed due to aortic regurgitation. He underwent aortic valve replacement through a left thoracotomy with division of two great arteries and their strong traction toward the surgeon by stay sutures. He has been well for 3 years postoperatively in New York Heart Association class I.
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PMID:Another approach for aortic valve replacement through left thoracotomy. 794 25

The prognostic significance of electrocardiographic variables was retrospectively investigated in 88 patients with dilated cardiomyopathy and with normal coronary arteriograms. During an average follow-up of 3.7 +/- 2.9 years, 43 patients died, 26 of progressive heart failure, 15 patients with sudden death, and one due to cerebral embolism. Excluding one patient, who died of esophageal cancer, the cumulative survival rate was 73% at 2 years and 60% at 5 years. By univariate life table analysis, abnormal Q-waves, a QRS duration > or = 0.12s, a cardiothoracic ratio > or = 60%, systolic blood pressure < 110mmHg, and left ventricular end-diastolic pressure > or = 15mmHg were significantly associated with increased mortality within 5 years. Multivariate analysis using Cox's proportional hazards model determined the major independent risk factors in the following order: (1) for all patients; the presence of abnormal Q-waves, left bundle branch block or intraventricular conduction disturbances, left ventricular end-diastolic pressure, systolic blood pressure and the cardiothoracic ratio; (2) for patients without left bundle branch block or intraventricular conduction disturbances; abnormal Q-waves, left ventricular end-diastolic pressure and systolic blood pressure. The present study thus demonstrated that the electrocardiogram could provide independent prognostic predictors in patients with dilated cardiomyopathy, possibly reflecting the severity of myocardial damage.
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PMID:Prognostic significance of electrocardiographic findings in patients with dilated cardiomyopathy. 845 62

A phase II study of chemoradiotherapy for advanced squamous cell carcinoma of the thoracic esophagus was carried out cooperatively by nine Japanese institutions. Forty-five patients with thoracic advanced squamous cell carcinoma, who had T4 tumor or distant lymph node metastasis (M1(LYM)), were enrolled in the study for treatment with cisplatin (70 mg/m2) on days 1 and 36, and 5-fluorouracil infusion (700 mg/m2) on days 1-4 and 36-39 sandwiched around external beam irradiation (60 Gy over 6 weeks). Of the 45 evaluable patients, 37 (84.1%) completed the treatment. The overall response rate was 64.4%, and the complete response rate 8.9%. The median duration of response was 125.0 days for patients who achieved complete and partial response. The 50% median survival time was 215 days. There was one toxicity-related death due to radiation pneumonitis. The major form of toxicity exceeding grade 2 was myelosuppression and anorexia, but grade 4 toxicity was also observed (2 pulmonary, 1 severe hypoxemia, 1 severe cardiac failure and 1 mental disturbance). The results showed that this form of chemoradiotherapy had a satisfactory effect and might be useful for treatment of inoperable advanced esophageal cancer.
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PMID:Phase II study of chemoradiotherapy for advanced squamous cell carcinoma of the thoracic esophagus: nine Japanese institutions trial. 889 70

We report on 10 patients with severe malignant "mixed-type" obstruction of the proximal trachea or distal trachea plus both main stem bronchi. They had far-advanced inoperable tumors (esophageal cancer in 4 patients, lung cancer in 3, and recurrent laryngeal, uvular, and thyroid cancers in 1 each). Emergency treatment consisted of a dilating bougie maneuver followed by the insertion of a large one-way (4 patients) or Y-shaped (6) silicone prosthesis. Subsequent to the intervention, there was long-lasting clinical improvement. The median survival from stent insertion was 8 months for all patients irrespective of tumor type; it was 5 months for lung carcinoma patients and 8 months for those with esophageal cancer. The results are in accordance with those of other studies using different therapeutic modalities. Stent exchange proved necessary in 5 patients. The main reasons were continuing tumor growth beyond the proximal and distal boundaries and recurrent productive bronchial infection. Patients died of pneumonia (4 patients), pulmonary lymphangitic spread (1), heart failure (2, one of whom also had pneumonia), and fatal hemorrhage (1). As of December 1995, 3 patients were still alive, 2, 5, and 8 months after stent implantation. As evidenced by clinical efficacy and length of palliation, endoscopic placement of silicone-based one-way and bifurcated prostheses in far-advanced tumor of the central airways is technically feasible and ethically justifiable.
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PMID:Emergency stenting of malignant obstruction of the upper airways: long-term follow-up with two types of silicone prostheses. 948 10

A 59-year-old man with a history of the thoraco-abdominal esophagus resection with retrosternal gastric tube reconstruction for esophageal cancer complicated by anastomosis leakage and purulent pericarditis was admitted for aortic regurgitation due to infective endocarditis. Floppy vegetation and worsening cardiac failure indicated aortic valve replacement. In a median sternotomy approach, the thickest adhesion between the cervical esophagus and posterior surface of the manubrium sternae was freed using an ultrasonic osteotome. Severe adhesions in the pericardium due to purulent pericarditis were found. Median sternotomy enabled minimal exposure of the aortic root, upper right atrium, and right superior pulmonary vein for instituting extracorporeal circulation and replacing the aortic valve. The patient's postoperative course was uneventful. For cardiac surgery in patients with a retrosternal gastric tube, left anterior or right thoracotomy may be considered to avoid gastric tube injury. Median sternotomy, however, is an alternative enabling safe heart exposure, and the ultrasonic osteotome was very useful in incising the sternum without injuring the cervical esophagus, which had no serosa.
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PMID:Aortic valve replacement after retrosternal gastric tube reconstruction for esophageal cancer. 1040 74

Salvage esophagectomy is performed for esophageal cancer after definitive chemoradiotherapy. The clinical significance and safety of salvage surgery has not been well established. We reviewed 14 cases of salvage esophagectomy following definitive chemoradiotherapy from 1994 through 2005 and investigated complication rates and outcomes. Seven of 14 cases were completely resected with salvage surgery. Operation time and bleeding were greater in patients who experienced incomplete resection (R1/R2). Anastomosis leakage, pulmonary dysfunction and heart failure were recognized in four, two and one patients, respectively. The postoperative complications were more frequent (71.4%) in patients with incomplete resection (R1/R2) than in patients with complete resection (R0) (28.4%). Two patients with complete resection (R0) showed long-term survival. Salvage esophagectomy may be indicated when the tumor can be resected completely after definitive chemotherapy. However, all cases of T4 cancer cannot be resected completely, resulting in a high risk for complications and poor survival.
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PMID:Salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer. 1761 78

Postero-lateral thoracotomy has many complications such as postoperative pain, limitation in the motion of the shoulder, decreasing pulmonary function from immobilization, increasing lung atelectasis from over-use of analgesia, and increasing pulmonary morbidity, especially in elderly patients. So, muscle-sparing thoracotomy appears to be a good alternative. But it has also many disadvantages such as seroma and the needs for drains, limitation of an accessible operative field, and difficulties with risky procedures. We have modified muscle-sparing vertical thoracotomy. We performed 134 procedures on 131 patients from October 2000 to September 2003, including 15 cases of esophageal cancer, 95 cases of lung cancer, and 24 cases of other disease. Operative procedures were lobectomy in 74 cases, bilobectomy in 12 cases, pneumonectomy in 10 cases, wedge resection in 8 cases, decortication in 2 cases, Ivor Lewis procedure in 13 cases, and others in 15 cases. There was no occurrence of wound infection, arrrhythmia, fibrillation, and subcutaneous seroma except the first two cases. We had seven reoperations (two postoperative bleeding, three postpoperative BPF, one EGstomy leak, one RML torsion) and four operative mortalities (one postpneumonectomy BPF, two pneumonia, one heart failure). Our muscle-sparing vertical thoracotomy can be done safely in most thoracic surgery including lung and esophageal cancer, therefore it is a feasible procedure.
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PMID:Feasibility of latissimus dorsi and serratus anterior muscle-sparing vertical thoracotomy in general thoracic surgery. 1767 Feb 86

The field of tissue engineering has yielded several successes in early clinical trials of regenerative medicine using living cells seeded into biodegradable scaffolds. In contrast to methods that combine biomaterials with living cells, we have developed an approach that uses culture surfaces grafted with the temperature-responsive polymer poly(N-isoproplyacrylamide) that allows for controlled attachment and detachment of living cells via simple temperature changes. Using cultured cell sheets harvested from temperature-responsive surfaces, we have established cell sheet engineering to create functional tissue sheets to treat a wide range of diseases from corneal dysfunction to esophageal cancer, tracheal resection, and cardiac failure. Additionally, by exploiting the unique ability of cell sheets to generate three-dimensional tissues composed of only cultured cells and their deposited extracellular matrix, we have also developed methods to create thick vascularized tissues as well as, organ-like systems for the heart and liver. Cell sheet engineering therefore provides a novel alternative for regenerative medicine approaches that require the re-creation of functional tissue structures.
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PMID:Reconstruction of functional tissues with cell sheet engineering. 1776 Dec 77


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