ABSTRACT
The core content for a medical specialty outlines the scope of the discipline as well as the categories of knowledge considered essential to practice in the field. It provides a template for the development of curricula for medical school, graduate, and postgraduate education, as well as for creating certification standards. Venous and Lymphatic Medicine (VLM) is a specialty that has benefitted from contributions from specialists from several medical disciplines. Optimally, the societies, boards, and residency review committees representing these disciplines would uniformly recognize the scope of VLM to develop education and assessment standards to allow training and identification of qualified practitioners. In order to inform the standard setting bodies and other stakeholders of the current scope of VLM, a task force of VLM experts from cardiology, dermatology, emergency medicine, general surgery, interventional radiology, vascular medicine, and vascular surgery was formed to revise a 2014 consensus document defining the core content of the specialty of VLM.
ABSTRACT
Acute bacterial endocarditis (ABE) is a rare but deadly complication following major thermal injury. Typically the presentation is silent, with persistent fever and positive blood cultures being the only consistent findings. Fibrin-platelet vegetations on the valvular endocardium are thought to be seeded during bacteremic episodes. Manipulation of the burn wound is probably the most likely source of bacteremia, with Staphylococcus aureus and Gram-negative bacilli being the most commonly implicated bacteria. In addition to causing local damage to a valve or the myocardium, infected vegetations may dislodge septic emboli systemically. Diagnosis is most easily obtained by echocardiography. Treatment usually involves prolonged administration of intravenous antibiotics. In rare circumstances, valvular resection and replacement may be indicated.
Subject(s)
Burns/complications , Endocarditis, Bacterial/etiology , Acute Disease , Adult , Anti-Bacterial Agents , Bacteremia/microbiology , Drug Therapy, Combination/administration & dosage , Drug Therapy, Combination/therapeutic use , Echocardiography , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/drug therapy , Escherichia coli/isolation & purification , Escherichia coli Infections/diagnostic imaging , Escherichia coli Infections/drug therapy , Escherichia coli Infections/microbiology , Fatal Outcome , Humans , Infusions, Intravenous , Male , Staphylococcal Infections/diagnostic imaging , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcus aureus/isolation & purificationSubject(s)
Histoplasmosis/diagnosis , Mouth Diseases/diagnosis , Mouth Neoplasms/diagnosis , Aged , Amphotericin B/therapeutic use , Chronic Disease , Diagnosis, Differential , Female , Histoplasmosis/drug therapy , Humans , Ketoconazole/therapeutic use , Maxillary Diseases/diagnosis , Maxillary Diseases/drug therapy , Maxillary Diseases/microbiology , Mouth Diseases/drug therapy , Mouth Diseases/microbiology , Ulcer/microbiologySubject(s)
Aluminum Hydroxide/therapeutic use , Calcium Carbonate/therapeutic use , Citrates/therapeutic use , Kidney Failure, Chronic/blood , Phosphates/blood , Aluminum Hydroxide/metabolism , Calcium Carbonate/metabolism , Citrates/metabolism , Citric Acid , Glomerular Filtration Rate/physiology , Humans , Kidney Failure, Chronic/metabolism , Kidney Failure, Chronic/therapy , Parathyroid Hormone/metabolism , Phosphates/metabolism , Renal DialysisABSTRACT
The increased frequency and duration of antifungal treatment with amphotericin B in immunocompromised patients has stimulated a great deal of research into the mechanisms of its nephrotoxic effects and treatment modalities designed to attenuate these effects. A review of amphotericin B-induced nephrotoxicity, the underlying pathophysiologic mechanisms, and the role of salt loading as a means of minimizing renal impairment are described. Both animal and human studies regarding the efficacy of sodium loading are presented as well as a case report describing the use of salt supplementation over a prolonged course of therapy.
Subject(s)
Amphotericin B/adverse effects , Kidney Diseases/chemically induced , Kidney Diseases/drug therapy , Kidney/drug effects , Sodium, Dietary/therapeutic use , Amphotericin B/antagonists & inhibitors , Animals , Glomerular Filtration Rate/drug effects , Humans , Immune Tolerance/drug effects , Kidney Tubules/drug effects , Male , Middle Aged , Sodium, Dietary/administration & dosageABSTRACT
Corneal epithelial erosions developed in two patients wearing gas permeable contact lenses (Boston) soon after commencing topical timolol maleate therapy. This prompted the following investigation. Forty rabbit corneas were examined by scanning and transmission electron microscopy after treatment for one month with one of the following: timolol ophthalmic solution, preservative-free timolol, contact lens, contact lens and timolol, contact lens and preservative-free timolol, contact lens and saline, or no treatment. Corneas treated with either timolol or contact lens alone showed mild to moderate edema or degeneration of epithelial and endothelial cells. However, the combined use of a contact lens and timolol produced marked alterations in both the corneal epithelium and endothelium.
Subject(s)
Contact Lenses/adverse effects , Cornea/drug effects , Corneal Diseases/etiology , Timolol/administration & dosage , Administration, Topical , Animals , Cornea/ultrastructure , RabbitsABSTRACT
Corneal epithelial dysplasia and carcinoma in situ have not been emphasized as distinct clinical conditions in the literature. Seven cases are presented with their clinicopathological correlation. Six of the patients presented primarily with corneal signs and symptoms consisting of notable visual blurring or foreign body sensations, or both. Biomicroscopic examination revealed a geographic, diffuse, greyish-white haze involving the corneal epithelium, often with; subtle thickening and irregularity of the involved areas and overlying superficial punctate keratitis. Histologic examination showed all degree of corneal epithelial dysplasia up to carcinoma in situ. The diagnosis, course and management of these conditions is discussed.
Subject(s)
Carcinoma in Situ/pathology , Corneal Diseases/pathology , Eye Neoplasms/pathology , Adult , Aged , Bowen's Disease/pathology , Cornea/pathology , Epithelium/pathology , Female , Humans , Male , Middle AgedABSTRACT
Glucose-insulin-potassium (GIK) was infused preoperatively in 30 patients scheduled for coronary artery operation. Before cardiopulmonary bypass (CPB) each patient received an intravenous infusion of 50% glucose. Myocardial protection was achieved with a cardioplegic solution containing glucose. A similar group of 30 patients received an equal volume of NaCl infused preoperatively and before CPB, and their cardioplegic solution contained no glucose. Clinically and by hemodynamic evaluation postoperatively one could not separate the two groups. Glycogen grading of the myocardium prior to bypass demonstrated no difference in glycogen levels in patients receiving glucose and those receiving NaCl. However, at the end of cardioplegic arrest only the group receiving glucose maintained normal grading of myocardial glycogen.
Subject(s)
Coronary Disease/surgery , Glucose Solution, Hypertonic/administration & dosage , Glucose/administration & dosage , Heart Arrest, Induced/methods , Biopsy , Cardiopulmonary Bypass , Glycogen/metabolism , Hemodynamics/drug effects , Humans , Hypothermia, Induced , Insulin/administration & dosage , Myocardial Contraction/drug effects , Myocardium/metabolism , Myocardium/ultrastructure , Potassium Chloride/administration & dosage , Saline Solution, Hypertonic/administration & dosageABSTRACT
In a prospective analysis of 36 biopsies from human hearts performed at the time of elective coronary operation, several morphological changes were identified in the myocardium. Some of these changes (fibrosis, vacuolation, edema, and amyloid deposition) are of clinical signficance and may affect the long-term prognosis for patients undergoing revascularization procedures. It appears, therefore, that knowledge of the morphological state of the myocardium at the time of operation can prove useful in elucidating further the long-term effects of coronary artery bypass on the left ventricular myocardium.
Subject(s)
Coronary Artery Bypass , Coronary Disease/pathology , Myocardium/pathology , Adult , Biopsy, Needle/instrumentation , Cardiomegaly/pathology , Disposable Equipment , Female , Humans , Male , Middle Aged , Myocardial Infarction/pathology , NeedlesABSTRACT
A Tru-cut disposable biopsy needle was used in 10 pigs, 3 cadavers and 63 humans to obtain transmural ventricular myocardium for diagnostic and research purposes. The technique proved simple and safe. In every case an adequate amount of full-thickness myocardium was obtained which was examined by light and electron microscopy and used for enzyme studies and glycogen measurement.
