Regional ejection fraction and regional area strain for left ventricular function assessment in male patients after first-time myocardial infarction.

In this work, we present a method to assess left ventricle (LV) regional function from cardiac magnetic resonance (CMR) imaging based on the regional ejection fraction (REF) and regional area strain (RAS). CMR scans were performed for 30 patients after first-time myocardial infarction (MI) and nine age- and sex-matched healthy volunteers. The CMR images were processed to reconstruct three-dimensional LV geometry, and the REF and RAS in a 16-segment model were computed using our proposed methodology. The method of computing the REF was tested and shown to be robust against variation in user input. Furthermore, analysis of data was feasible in all patients and healthy volunteers without any exclusions. The REF correlated well with the RAS in a nonlinear manner (quadratic fit-R(2) = 0.88). In patients after first-time MI, the REF and RAS were significantly reduced across all 16 segments (REF: p < 0.05; RAS: p < 0.01). Moreover, the REF and RAS significantly decreased with the extent of transmural scar obtained from late gadolinium-enhanced CMR images. In addition, we show that the REF and RAS can be used to identify regions with compromised function in the patients with preserved global ejection fraction with reasonable accuracy (more than 78%). These preliminary results confirmed the validity of our approach for accurate analysis of LV regional function. Our approach potentially offers physicians new insights into the local characteristics of the myocardial mechanics after a MI.

Endocarditis: effects of routine echocardiography during Gram-positive bacteraemia.

BACKGROUND: Despite firm recommendations to perform echocardiography in high-risk patients with Gram-positive bacteraemia, routine echocardiography is not embedded in daily practice in many settings. The aim of this study was to evaluate whether a regime including routine echocardiography results in better outcome. METHODS: A total of 115 patients with Gram-positive bacteraemia and at least one risk factor for developing metastatic infection were prospectively included. Routine echocardiography was advocated and facilitated in these patients. Results were compared with a matched historical control group of 230 patients in whom echocardiography was performed at the discretion of the attending physician. Endocarditis was diagnosed according to the Duke criteria. RESULTS: Echocardiography was performed more often in the study group (82 vs 27%, p.

Performance of two tube coagulase methods for rapid identification of Staphylococcus aureus from blood cultures and their impact on antimicrobial management.

Test parameters and clinical impact of the direct tube coagulase test (DTCT) for rapid identification of Staphylococcus aureus from blood culture were investigated. The sensitivity of the DTCT at 4 h using saline dilution was 96%, compared with 93% using serum separator tubes; specificity was 100% for both methods. Among 32 patients with S. aureus bacteraemia, treatment modifications were based on microbiology results from the primary source of infection in 12 patients, on a Gram's stain from blood culture in seven patients, and on the DTCT in nine patients. The DTCT is a valuable adjunct in the routine microbiology laboratory because of its good performance, technical simplicity and low cost.

Imaging of infectious diseases using [18F] fluorodeoxyglucose PET.

The role of fluorodeoxyglucose positron emission tomography (FDG PET) in the diagnostic localization of infectious diseases has expanded rapidly in years. In general, sensitivity of FDG PET in depicting infections compares favorably to other diagnostic modalities . It is shown to be useful in patients with suspected osteomyelitis, especially in chronic low grade infections and in vertebral osteomyelitis. although the sensitivity of FDG PET in prosthetic joint infections is very high, reported specificity varies considerably. In experienced centers, FDG uptake localized along the interface between bone and prosthesis can be used to diagnose infection with acceptable specificity. Combined leukocyte scintigraphy and bone scanning, however, remains the standard scintigraphic method for diagnosis of infected joint prostheses. FDG PET has shown promising results in vascular graft infections, in the evaluation of metastatic infectious foci inpatients with blood stream infections and in neutropenic patients, but further studies are needed before definitive conclusions can be drawn . In fever of unknown origin (FUO), FDG PET appears to be of great advantage as malignancy, inflammation and infection can be detected. Image fusion combining PET and computed tomography facilitates anatomical localization of increased FDG uptake and better guiding for further diagnostic tests to achieve a final diagnosis. In conclusion, the body of evidence on utility of FDG PET in infectious diseases and FUO is growing and FDG PET may become one of the preferred diagnostic procedures for many of these diseases, especially when a definite diagnosis cannot easily be achieved.

Complicating infectious foci in patients with Staphylococcus aureus or Streptococcus species bacteraemia.

Complicating infectious foci resulting from haematogenous or local spread of microorganisms are observed frequently in patients with Staphylococcus aureus bacteraemia (SAB) or Streptococcus species bacteraemia (SSB). The aim of this study was to compare the epidemiology of complicating infectious foci during SAB and SSB in a university hospital in The Netherlands. The charts of all adult patients diagnosed with SAB or SSB (except for Streptococcus pneumoniae bacteraemia) from July 2002 until December 2004 were reviewed retrospectively. Overall, 180 immunocompetent patients were identified, 127 with SAB and 53 with SSB. The percentage of patients with complicating infectious foci (39% of SAB patients, 25% of SSB patients) did not differ significantly between the groups. Endocarditis and cerebral involvement, however, were significantly more common in the SSB group. Of all complicating infectious foci, 32% lacked guiding signs or symptoms and 10% were detected only at autopsy. Factors associated with the development of complicating infectious foci were a delay in treatment for more than 48 h after the onset of symptoms, community acquisition, persistently positive blood cultures, congenital heart disease, and the presence of foreign bodies or prosthetic valves. Infection-related mortality was 18% in SAB patients and 11% in SSB patients and was significantly higher in patients with complicating infectious foci (29 vs. 9%). In conclusion, complicating infectious foci develop in approximately one-third of all patients with SAB and SSB. An active approach that entails searching for the complicating infectious foci is warranted in these patients, because only two-thirds of complicated infectious foci have guiding symptoms or signs, and infection-related mortality is significantly increased in patients with complicating infectious foci compared to patients without these infections.

FDG-PET for imaging of non-osseous infection and inflammation.

UNLABELLED: FDG-PET is emerging as a promising imaging technique in non-osseous infectious and inflammatory diseases, as an increasing number of reports are appearing in literature. In general, sensitivity of FDG-PET in diagnosing non-osseous infections compares favorably to other diagnostic modalities. Lower specificity due to FDG accumulation in conditions involving leukocyte activation and malignancy may be overcome by implementing FDG-PET in a diagnostic protocol. In fever of unknown origin, FDG-PET appears to be of great advantage as malignancy, inflammation and infection can be detected. Studies on standardized uptake value ratios, uptake patterns and dynamics may be helpful to increase specificity. Image fusion combining PET and CT facilitates anatomical localization of increased FDG-uptake and better guiding for further diagnostic tests to achieve a final diagnosis. More data on the utility of FDG-PET to monitor the response to treatment will be available in near future. Early reports on FDG-PET during treatment follow-up in large vessel vasculitis already showed promising RESULTS: In conclusion, the body of evidence on the utility of FDG-PET in non-osseous infection and inflammation is growing and FDG-PET may become one of the preferred diagnostic procedures for these diseases.

A patient with abdominal distension.

A 74-year-old woman was admitted to our hospital because of vomiting and abdominal pain. She had been well until 24 hours before admission, when she had had her last meal. She had not eaten anything unusual. She developed pain in the left lower abdominal quadrant, and difficulties with her bowel movements. An enema was given unsuccessfully. There was progressive distension of the abdomen. The patient started to vomit gastric and later bilious contents. No history of abdominal symptoms or weight loss was reported. She currently takes oral antidiabetic agents and an angiotensin II blocker because of hypertension. On physical examination she was not in distress and was afebrile, blood pressure 130/100 mmHg, pulse rate 88 beats/min. On auscultation increased bowel sounds with rushes of high-pitched sounds were heard. Her abdomen was distended and a large tender mass filling the whole left lower quadrant without signs of peritoneal irritation was found. There were no faeces on rectal examination. The leucocyte count was 10.2 mmol/L, haemoglobin 7.2 mmol/L, C-reactive protein 36 mg/l and lactate dehydrogenase 535 U/l. Under suspicion of a mechanical bowel obstruction without signs of peritonitis, the patient was treated with a nasogastric tube, fasting and enemas on which she improved. An abdominal X-ray in bed taken on day two showed no bowel distension (figure 1). After removing the nasogastric tube on day two the nausea returned. Abdominal examination was unchanged. An abdominal computed tomography (CT) scan after drinking oral contrast and intravenous contrast was performed (figure 2).