Post-Intubation Tracheoesophageal Fistula with Posterior Glottic Web

Tracheoesophageal fistula (TEF) after prolonged intubation could present as chronic aspiration and could be mistaken as unilateral or bilateral vocal fold palsy, especially when there was combined posterior glottic synechia. We present a case of post-intubation TEF which was successfully treated with tracheal resection and anastomosis with primary esophageal closure. The accompanying posterior glottic web was treated by endoscopic technique of web lysis, with topical application of mitomycin C solution

Pilot KaVA monitoring on the M87 jet: confirming the inner jet structure and superluminal motions at sub-pc scales

We report the initial results of our high-cadence monitoring program on the radio jet in the active galaxy M87, obtained by the KVN and VERA Array (KaVA) at 22 GHz. This is a pilot study that preceded a larger KaVA-M87 monitoring program, which is currently ongoing. The pilot monitoring was mostly performed every two to three weeks from December 2013 to June 2014, at a recording rate of 1 Gbps, obtaining the data for a total of 10 epochs. We successfully obtained a sequence of good quality radio maps that revealed the rich structure of this jet from <~1 mas to 20 mas, corresponding to physical scales (projected) of ~0.1-2 pc (or ~140-2800 Schwarzschild radii). We detected superluminal motions at these scales, together with a trend of gradual acceleration. The first evidence for such fast motions and acceleration near the jet base were obtained from recent VLBA studies at 43 GHz, and the fact that very similar kinematics are seen at a different frequency and time with a different instrument suggests these properties are fundamental characteristics of this jet. This pilot program demonstrates that KaVA is a powerful VLBI array for studying the detailed structural evolution of the M87 jet and also other relativistic jets.Comment: 10 pages, 9 figures, accepted for publication in PAS

Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease 5-Year Outcomes of the PRECOMBAT Study

AbstractBackgroundIn a previous randomized trial, we found that percutaneous coronary intervention (PCI) was not inferior to coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery stenosis at 1 year.ObjectivesThis study sought to determine the 5-year outcomes of PCI compared with CABG for the treatment of unprotected left main coronary artery stenosis.MethodsWe randomly assigned 600 patients with unprotected left main coronary artery stenosis to undergo PCI with a sirolimus-eluting stent (n = 300) or CABG (n = 300). The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE: a composite of death from any cause, myocardial infarction, stroke, or ischemia-driven target vessel revascularization) and compared on an intention-to-treat basis.ResultsAt 5 years, MACCE occurred in 52 patients in the PCI group and 42 patients in the CABG group (cumulative event rates of 17.5% and 14.3%, respectively; hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 0.84 to 1.90; p = 0.26). The 2 groups did not differ significantly in terms of death from any cause, myocardial infarction, or stroke as well as their composite (8.4% and 9.6%; HR, 0.89; 95% CI, 0.52 to 1.52; p = 0.66). Ischemia-driven target vessel revascularization occurred more frequently in the PCI group than in the CABG group (11.4% and 5.5%, respectively; HR: 2.11; 95% CI: 1.16 to 3.84; p = 0.012).ConclusionsDuring 5 years of follow-up, our study did not show significant difference regarding the rate of MACCE between patients who underwent PCI with a sirolimus-eluting stent and those who underwent CABG. However, considering the limited power of our study, our results should be interpreted with caution. (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease [PRECOMBAT]; NCT00422968