A ten-year post-surgical assessment of pulmonary hypertension in adults with patent ductus arteriosus.

The long-term follow-up was analysed for 25 patients above the age of 12 years who had patent ductus arteriosus with severe pulmonary hypertension and had undergone surgical closure. There were 11 males and 14 females (age range 12-27 years; mean 18.6 years). There were 2 early and 2 late deaths. All the 21 survivors were followed up at regular intervals for 8-10 years. They were assessed by haemodynamic study: 13 of the 21 survivors underwent a study 6 months to 1 year after surgery and another 4 patients, 8 years after surgery; 7 patients of the 13 had a second study 8-10 years after surgery. The pulmonary artery systolic and mean pressures regressed to 50% of the preoperative level in the first study for 15 patients, and in the second study 2 patients had further drop in pulmonary artery pressures; however, the pressure levels never reached normal values. The pulmonary vascular resistance did not show a correspondingly significant fall. In conclusion, the ten-year follow-up shows that the patients have benefited by the surgery though the pressures have not come down to normal levels, and that they have to be followed up closely to assess the natural history of residual pulmonary hypertension and pulmonary vascular disease and its effect on their quality of life.

A correlative study of the functional class and hemodynamic status following intracardiac repair of tetralogy of Fallot.

An attempt was made to correlate the NYHA Functional class with the hemodynamic status of 196 patients at an average of 21.2 months following the intracardiac repair of tetralogy of Fallot. 171 patients were in Functional class I (87.2%), 9 in class III (4.5%), 5 in class II (2.5%) and 11 in class IV (5.6%). Right and left heart catheterisation and cardiac angiography revealed the hemodynamic status of these patients to be excellent in 92 (46.4%), good in 37 (18.8%), satisfactory in 6 (3.0%) and unsatisfactory in 61 (31.6%). Whereas all patients in Functional class II, III and IV had unsatisfactory hemodynamic findings, patients in Functional Class I were hemodynamically heterogeneous and included excellent (53.8%), good (21.6%), satisfactory (3.5%) and unsatisfactory (21%) groups. The surgical technique did not seem to determine the functional status. While early reoperation is advisable for patients with functional disability, caution is necessary in considering reoperation for patients in Functional class I who have hemodynamic findings which are classified as unsatisfactory.

Prevalence of coagulase negative Staphylococcus species among hospital personnel and surgical patients.

Two hundred and fourteen strains of Coagulase negative Staphylococci (CNS) isolated from hospital personnel (114 strains) and patients (100 strains) were identified upto species level. The prevalence rate of CNS in relation to sex, sources and type of specimens were analysed. Most of the CNS strains belonged to S. epidermidis (49.1% among carriers and 39% in clinical isolates) and S. hominis (36% each). Besides, five more CNS species, namely S. saprophyticus, S. capitis, S. haemolyticus, S. cohnii and S. xylosus were also isolated. (0.5 to 10.3% isolation rates). Maximum S. hominis isolated were from hospital personnel and urine from patients (63.4% and 72.2%, respectively), 50.0% and 33.3% of S. hominis were found from urine and blood, respectively. The present study revealed that the leading species S. epidermidis and S. hominis may play an important role in the nosocomial infections, especially among immunocompromised hosts during their hospital stay.

Correlation between beta-lactamase production and MIC values against penicillin with coagulase negative staphylococci.

Two hundred strains of coagulase negative staphylococci (CNS) isolated from various clinical specimens (116) and healthy hospital personnel (84) were investigated for the production of beta-lactamases by means of three iodometric techniques and correlated with the minimum inhibitory concentration (MIC) values of penicillin-G by agar dilution technique and disc diffusion technique. One hundred and fifty (75.0%) of the 200 strains tested produced beta-lactamases. Seventy two per cent of the CNS were found to be beta-lactamase positive by the starch paper technique which was the most sensitive one in our study. The MIC values of penicillin against CNS ranged from less than or equal to 1.25 to greater than or equal to 2000 units. The present study indicated the higher prevalence of beta-lactamase producers with increased penicillin resistance among CNS strains isolated from healthy carriers and hospitalised patients.