Mayo Clinic proceedings
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Staphylococcus aureus causes an acute endocarditis, often involving previously normal valves. The criteria used for diagnosis of subacute bacterial endocarditis are frequency absent, and distinguishing acute endocarditis from bacteremia without valvular involvement is difficult. ⋯ Use of two synergistic antibiotics has not been proved clinically superior to use one agent, and surgical intervention during treatment may be necessary in some cases. Despite prompt treatment recognition of complications, the morbidity and mortality associated with this infection remain high.
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Count rates observed at end-diastole and end-systole in the region of the left ventricle on gated radionuclide angiograms were correlated with corresponding estimates by biplane contrast angiography of left ventricular volumes in 37 patients. When count rates were normalized for number of cardiac cycles processed, time per frame, isotope decay, and count rate observed in venous blood after equilibrium, there was a strong correlation between normalized left ventricular count rate and contrast angiographic volume, whether the venous sample was counted in a well counter or with the use of the same gamma camera. The latter technique was judged easier and more accurate. ⋯ Interobserver variability of both the radionuclide and the contrast angiographic estimate of the left ventricular volume was similar. Changes in left ventricular stroke volume induced by sublingual administration of nitroglycerin as measured by the radionuclide method correlated reasonably with corresponding changes in stroke volume measured by the dye-dilution method. It is concluded that left ventricular volumes obtained noninvasively by the radionuclide technique were accurate and were subject to the same interobserver variability as the contrast angiographic technique.
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Mayo Clinic proceedings · Sep 1981
Case ReportsIntra-aortic balloon counterpulsation as adjunct to aneurysmectomy in high-risk patients.
Patients with severe coronary artery disease that is not amenable to coronary artery bypass surgery face formidable risks when major aortic surgery becomes necessary. In this report we present such a patient, who successfully underwent abdominal aortic aneurysm resection and graft replacement with the prophylactic use of intra-aortic balloon counterpulsation. The use of intra-aortic balloon counterpulsation at the time of surgery has the potential of improving cardiac function in patients with left ventricular dysfunction and favorably influencing the perioperative and postoperative mortality in these patients. Its use also appears worthy of trial in patients with ruptured abdominal aortic aneurysm and shock, in the hope that it will result in improved survival in these patients.