Chest
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Tuberculosis in Oriental immigrants is likely to be resistant to therapy with certain drugs. In 73 military dependents with positive cultures for tuberculosis who immigrated from six Asian countries, the tuberculosis was found to be resistant to isoniazid in 58 percent (42 patients), to streptomycin in 36 percent (26 patients), to p-amino-salicylic acid in 14 percent (ten patients), to rifampin in 7 percent (five patients), and to ethambutol in 7 percent (five patients). ⋯ Consideration of the high incidence of drug-resistant tuberculosis should be made in planning a program of treatment for these patients. Recognition of cultural differences may also be of value in the successful treatment of this difficult group of patients.
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A young man with a typical clinical presentation of acute pericarditis, on M-mode echocardiography, was repeatedly found to have a relatively echo-free area posterosuperior to the left ventricle, disappearing as the left ventricular apex was scanned. A radioisotopic "pericardial scan" revealed pericardial fluid lateral and inferior to the heart but not at the apex. This represents an additional type of M-mode echocardiographic presentation of loculated pericardial effusion.
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A new method for nasotracheal intubation of infants and young children is described. This method offers a smooth, reliable, and rapid means of entry into these children's airways in a safe and efficient manner in a wide variety of cardiorespiratory illnesses. This technique should be reserved for well-trained physicians with adequate equipment and experience. It is an optional technique for intubation that should be available in all modern general and children's hospitals throughout the country.
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The advisability of prolonged oral or nasotracheal intubation is of continuing concern to physicians caring for patients requiring prolonged mechanical ventilatory assistance. Currently, in many health care centers, prolonged intubation is defined as being in excess of seven days. We treated a patient who required mechanical ventilatory assistance and in whom oral endotracheal intubation was maintained for two months without significant pathologic sequelae.
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To better understand the association between mitral regurgitation and secundum atrial septal defect and to clarify the evaluation and management of these patients, the records of 235 adult patients with atrial septal defect were reviewed. Ten patients (4 percent) had significant mitral regurgitation defined by clinical, hemodynamic and angiographic criteria. Three patients required mitral valve replacement at the time of closure of the atrial septal defect and four patients had closure alone, one of whom required mitral valve replacement after five years. ⋯ Three of these valves also had scattered areas of patchy myxomatous degeneration and three had areas of vascular ingrowth suggestive of rheumatic disease. Although both invasive and noninvasive studies have high-lighted the coincidence between atrial septal defect and mitral regurgitation, particularly the frequent association of mitral valve prolapse, our data indicate that this association rarely has clinical significance. Furthermore, the morphologic basis for mitral regurgitation in patients with atrial septal defect consists of leaflet and chordal thickening fibrosis and deformity rather than attenuation and ballooning as would be expected in mitral valve prolapse.