Assuntos
Dor no Peito/etiologia , Doença da Artéria Coronariana/diagnóstico , Eletrocardiografia , Teste de Esforço , Dor no Peito/fisiopatologia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Teste de Esforço/métodos , Humanos , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Candida prosthetic endocarditis (CPE) is an uncommon disease involving less than 1 % of infective endocarditis patients and associated with high recurrence rate. Immunosuppresion, intravenous drug abuse, cardiac surgery and indwelling foreign bodies are the major risk factors for CPE. There are very few reported cases of CPE where more than one surgery was performed and there has generally been limited follow up on these cases. CASE PRESENTATION: We report a case of a 35 year old woman who had mitral valve annuloplasty complicated by recurrent episodes of CPE leading to multiple mitral valve replacements (MVR). She underwent MVR surgeries a total of four times over an eighteen year period and had good functionality during most of this time while being on antifungal suppressive treatment. This is a unique case in terms of numbers of surgeries performed, the length of the follow up and the involvement of three different Candida species. CONCLUSION: Current guidelines for the treatment of candida endocarditis recommend surgical treatment followed by long term antifungal therapy although the cure rate by all treatments is low. However we feel that based on this one case it is reasonable to consider multiple redo valve replacement surgeries in conjunction with antifungal treatment for selected patients stable enough to tolerate the surgery.
Assuntos
Antifúngicos/uso terapêutico , Candidíase/terapia , Endocardite Bacteriana/terapia , Implante de Prótese de Valva Cardíaca/métodos , Infecções Relacionadas à Prótese/terapia , Adulto , Candidíase/diagnóstico , Candidíase/microbiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Feminino , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , RecidivaRESUMO
BACKGROUND: Atrial fibrillation occurs in 20% to 40% of patients post cardiac surgery. Prophylactic amiodarone decreases the incidence of atrial fibrillation, especially in those not taking ß-blockers. Studies, however, vary in dosage, duration of treatment, and route of administration. Limited studies evaluating short duration use of oral amiodarone show conflicting results. We hypothesize that an order set for use of short duration, oral amiodarone started the night before surgery and continued for 4 to 6 days will decrease atrial fibrillation after heart surgery. METHODS: The Society of Thoracic Surgeons database was used to identify 471 patients who received amiodarone per order set and 151 patients that did not receive amiodarone. The amiodarone order set included amiodarone 600 mg the night before surgery and 400mg twice daily for 4 to 6 days post heart surgery. After propensity matching, 112 patients remained in each group. We compared outcomes for the 2 groups as a case-controlled, retrospective, study. RESULTS: Atrial fibrillation occurred in 43% (48 of 112) of the patients that did not receive amiodarone vs 23% (26 of 112) receiving prophylactic amiodarone (P=<.001). There was no increased incidence of hemodynamic, pulmonary, or other adverse outcomes observed between the 2 groups. CONCLUSIONS: This practical order set for, short duration, oral amiodarone, with or without adjunct ß-blocker therapy started the night before heart surgery and continued for up to six days post surgery, appears to be a safe and effective treatment for reducing the incidence of atrial fibrillation following heart surgery.
Assuntos
Amiodarona/administração & dosagem , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Pré-Medicação/estatística & dados numéricos , Administração Oral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Prevalência , Fatores de Risco , Resultado do Tratamento , West Virginia/epidemiologiaRESUMO
A 62-year-old man with a history of 2 previous cardiac catheterizations presented with an itchy, nontender skin lesion over his right scapula. The skin lesion had been present for >5 years. Review of the medical records found evidence of a prolonged and complicated cardiac catheterization 8 years previously. Physical examination revealed an 8 × 6 cm, well-demarcated, erythematous reticulated atrophic plaque with telangiectasias and ulceration. Biopsy confirmed histologic changes consistent with radiation dermatitis. In conclusion, the characteristic histologic findings of radiation dermatitis, along with the location over the right scapula and the history of prolonged fluoroscopic exposure during cardiac catheterization, led to the clinical diagnosis of fluoroscopy-induced chronic radiation dermatitis.
Assuntos
Cateterismo Cardíaco/efeitos adversos , Fluoroscopia/efeitos adversos , Radiodermite/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiodermite/patologiaRESUMO
A coherence theory describing the formation of a hologram by an interesting new technique is presented to improve the theoretical treatment given by Schilling and Templeton [Appl. Opt. 40, 5474 (2001)]. Properties of the hologram pattern are discussed, and some comments are made on its reconstruction.