The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 1986
Resection of thoracic and abdominal teratoma in patients after cisplatin-based chemotherapy for germ cell tumor. Late results.
Fifty-one patients with primary testicular (N = 46) or mediastinal germ cell cancer (N = 5) were treated from April, 1975, through May, 1981, and had teratoma resected from residual disease after cisplatin-based combination chemotherapy. All patients had normal serum markers before resection of pulmonary (N = 12), mediastinal (N = 5), thoracoabdominal (N = 8), supraclavicular (N = 1) or abdominal disease (N = 25). Teratoma was classified as mature teratoma (N = 29), immature teratoma (N = 15), or immature teratoma with non-germ cell elements (N = 7). ⋯ According to a multivariate analysis, primary tumor site at the mediastinum is the most significant adverse factor predictive for both relapse and survival (two of five patients survived). This study appears to support the various preclinical models that demonstrate multipotential capabilities of teratoma. Complete surgical excision of teratoma remains the most effective treatment with continued close follow-up recommended for high-risk patients (immature teratoma with non-germ cell elements, large tumor burden, or primary mediastinal tumors.
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J. Thorac. Cardiovasc. Surg. · Oct 1986
Eleven-year experience with composite graft replacement of the ascending aorta and aortic valve.
Between September, 1974, and December, 1985, 127 patients had replacement of the ascending aorta and aortic valve with a composite graft. Annuloaortic ectasia was the most common indication for operation (69 patients), followed by aortic dissection (51 patients). Twenty-four patients (19%) had the Marfan syndrome. ⋯ The actuarial survival rate at 7 years for the entire group was 65%; for the patients with annuloaortic ectasia, 70%; for those with aortic dissection, 61%; for the patients with the Marfan syndrome, 57%. Actuarial freedom from operation on the remainder of the aorta at 7 years was 89%, but it was 78% for the subgroup with the Marfan syndrome. The satisfactory results with extended follow-up support the continued use of the composite graft technique as the preferred method of treatment for patients with annuloaortic ectasia or recurrent aneurysms of the sinuses of Valsalva and for patients with aortic dissection who require aortic valve replacement.