Long-term results and its managements after coronary bypass surgery

Between 1970 and 1985, 221 patients with coronary artery occlusive disease underwent aorto-coronary bypass (A-C bypass) and other procedures. Among these patients, 187 had A-C bypass alone and A-C bypass in addition to correction of valvular lesions or arterialization of the coronary vein, myocardial puncture by laser. The remaining 34 had surgical corrections for myocardial infarction and its complications. Subjects were 100 patients who underwent A-C bypass alone over 6 months ago and whose follow-up study could be performed in 93 survival cases [corrected]. Subsequently, 94% of the patients have met the criteria for grade I of NYHA functional capacity and have returned to normal work at a mean of 4 years and 2 months after surgery. Improved left ventricular function has been maintained postoperatively in the patients with complete revascularization. Improved operative technique, in addition to intraoperative balloon angioplasty and onlay patch grafting, have increased the patency rate (78% in 1 mm, 94% in 2 mm of coronary diameter) of the grafts with postoperative anticoagulant therapy. On the basis of our long-term observations, coronary bypass surgery, particularly in complete revascularization, provides for significant improvement in both the quality and life expectancy of patients with severe coronary heart disease. Treadmill exercise test and magnetic resonance image (MRI) were useful, non-invasive and acceptable examinations in long-term follow up.     

Patient experience with, and use of, an electronic monitoring system to assess vaccination responses

OBJECTIVE: To evaluate the user experience and acceptability of an electronic patient monitoring system. SETTING AND PARTICIPANTS: 822 Military and civilian personnel at a health clinic at a major US military headquarters used an Internet and telephone-based electronic monitoring system to report vaccination-site responses and symptoms after receiving the smallpox vaccination. Focus groups of vaccinees were conducted to help develop a survey about the experience that was distributed to 379 vaccinees (96% completion rate). RESULTS: Users of the electronic monitoring system reported that it was fast and easy to use and reported they would use a system like this again and recommend an electronic monitoring system to a friend or relative. Most users (84%) were comfortable with a physician tracking their vaccine reaction using their electronic reports, but only half (51%) were comfortable with eliminating the post-vaccination follow-up visit with their health-care provider based on their electronic reports. CONCLUSIONS: This electronic monitoring system was well received by vaccinees and allowed health-care providers to track the status of vaccinees. However, vaccinees were not comfortable replacing a physician visit with electronic monitoring, at least for the smallpox vaccination. A monitoring system like this may be useful in public health settings, such as mass vaccination or prophylaxis during a bioterrorism event, a pandemic influenza outbreak, or another public health emergency.     

Benign schwannoma of the pancreas

Reported cases of intrapancreatic schwannomas have recently increased in the literature. However, none of these cases were diagnosed clearly as schwannoma preoperatively. We herein describe the clinicopathologic findings of a solitary benign schwannoma occurring in the head of the pancreas. Additionally, the differential diagnosis versus other cystic- and solid-appearing pancreatic masses is briefly discussed.     

A pilot study of the assessment of the quality of life, functional results, and complications in patients with an ileal neobladder for invasive bladder cancer

OBJECTIVE: To assess the functional results, health-related quality of life (QOL) outcomes, and complications in patients with an ileal neobladder in comparison to those with cutaneous diversion (ileal conduit and cutaneostomy). METHODS: Between September 1992 and February 2003, we consecutively performed an ileal neobladder (the Studer method) in 30 patients and cutaneous diversion in 38 patients. In August 2004, questionnaires were mailed to 54 patients. The questionnaire included the validated health-related quality of life (QOL) questionnaire, SF-36 General Health Survey, and a urinary incontinence questionnaire. We also evaluated the functional results in patients with an ileal neobladder and the postoperative complications in patients with both urinary diversions. RESULTS: The data from 41 patients (21 ileal neobladder procedures and 20 cutaneous diversions) were available for the analysis. No differences in the overall QOL were observed between the two groups. Complete daytime and night-time urinary continence was achieved in the 21 patients (100%) and 13 patients (61.9%), respectively. The mean value of the maximum flow rate was 15 +/- 12 mL/min in the 21 neobladder patients. There were 19 early complications in 18 patients (60.0%) and seven late complications in six patients (20.0%) with an ileal neobladder. However, there were 15 early complications in 14 patients (36.8%) and eight late complications in six patients (15.8%) with cutaneous diversions. CONCLUSION: The findings regarding the health-related QOL and the frequency of complications in the neobladder group and those in the cutaneous diversion group were similar. However, the functional results and the status of urinary continence in the neobladder patients were satisfactory.     

Early Designs for the Occlusal Anatomy of Posterior Denture Teeth: Part III

Part III of this series of articles, like Part II, reviews the pioneering efforts in the 19th century to improve the quality of artificial teeth. The focus of this article, unlike that of Part II, is specifically modifications in the design of the occlusal anatomy of the 19th century denture teeth, along with the theories of mandibular movement that inspired those modifications. This article concludes the introductory phase of this project, which seeks to unravel the confusing history of the development of (posterior) denture teeth.