Houman Tavaf-Motamen

Decision making on surgical palliation based on patient outcome data

BACKGROUND Strategies for the effective application of palliative procedures are infrequently standardized and incompletely understood. The effect on patient outcome as determined by elements such as resolution of chief complaints, quality of life, pain control, morbidity of therapy, and resource utilization should predominate decisions regarding surgical palliative care. METHODS Articles published between 1990 and 1996 on the surgical palliation of cancer were identified by a MEDLINE search and reviewed for designated parameters considered important for good palliative care. RESULTS A total of 348 citations were included. Entries considered these fundamental elements: cost (2%); pain control (12%); quality of life (17%); need to repeat the intervention (59%); morbidity and mortality (61 %); survival (64%); and physiologic response (69%). Established methods for quality of life and pain assessment were sporadically utilized. CONCLUSIONS In the current surgical literature, there is uncommon reporting of the range of data required to recommend sound palliative surgical choices.

Repair of Anomalous Origin of Right Coronary Artery From the Left Sinus of Valsalva

Anomalous origin of the right coronary artery from the left sinus of Valsalva is a rare congenital anomaly but a relatively frequent cause of sudden death in the young. The medical records of 4 consecutive patients with this anomaly were retrospectively reviewed. The first 2 patients underwent coronary artery bypass and had early graft failure. The next 2 patients underwent coronary reimplantation and unroofing and have done well. This limited series suggests that bypass procedures used to treat anomalous origin of the right coronary artery from the left sinus of Valsalva are prone to early graft failure.

Isolated cardiac cysticercosis in an adolescent.

Cardiac cysticercosis is a rare and typically asymptomatic infection. We report a case of a young man from Cameroon with a left ventricular cyst discovered during a screening echocardiogram. Computed tomography and plain films did not reveal additional cysts. Serology was negative. The patient had the cyst surgically removed for suspected echinococcosis. Sectioning demonstrated a cysticercus. The literature on cardiac cysticercosis is reviewed.

Congenital bronchoesophageal fistula in the adult: a case report.

Congenital bronchoesophageal fistula is a rare anomaly that may go undiagnosed for many years. There are <200 reported cases in the literature. Patients usually present with chronic cough, a history of multiple pneumonias, and, less often, hemoptysis. The most sensitive test to diagnose a bronchoesophageal fistula is barium esophagogram. Surgical resection is the treatment of choice and is definitive in almost all cases. We present the case of a 52-yr-old woman with a history of cough and multiple pneumonias who sought medical treatment for abdominal pain. We discuss the presentation and the radiographic, endoscopic, and surgical findings, along with a review of the literature.

Chondrosarcoma Masquerading as Cardiomyopathy

A 17-year-old male patient presented to his primary care provider with heart failure symptoms and was transferred to our hospital with the diagnosis of idiopathic cardiomyopathy. His workup identified a large mediastinal mass with right ventricular outflow obstruction, which was resected. The pathology of the mass was a low-grade chondrosarcoma. The patient currently remains disease free at 4 years.

Partial anomalous pulmonary venous return presenting as pseudo-pulmonic stenosis

Partial anomalous pulmonary venous return (PAPVR) is rare condition that can be discovered incidentally or lead o significant right heart overload if untreated. We report the ase of a patient who presented with symptoms and signs of n atrial septal defect (ASD), but whose initial evaluation as remarkable only for pulmonic stenosis by Doppler chocardiography. Computed tomography (CT) eventually ssisted with making the diagnosis of an anomalous LUL ein that was surgically corrected. We discuss this case and eview the pathophysiology, diagnosis, and management of APVR.