Interpretation of artificial and in vivo periapical bone lesions comparing conventional viewing versus a video conferencing system.

The purpose of this study was to compare the interpretation of conventional radiographs transmitted by a video teleconferencing system to conventional viewbox interpretation for both artificial and in vivo periapical bone lesions. A total of 30 radiographic images were used in this study: 20 radiographic images of artificial lesions and 10 radiographs from actual patients. Two endodontists evaluated the 30 images by giving a "yes" or "no" response when determining whether a periapical lesion was present on the radiograph. The study was conducted in two sessions, separated by a 6-wk interval to minimize evaluator recall. Results of the study revealed no statistical difference between the ability of the evaluator to identify periapical bone lesions using conventional radiographs on a viewbox and his ability to interpret the same images transmitted on a monitor screen.

Long-term follow-up and resection of a postoperative false aortic aneurysm.

This report describes the course and operative findings in a 66-year-old man with a densely calcified false aneurysm of his ascending aorta 19 years after replacement of a severely stenosed bicuspid aortic valve with a McGovern-Chromie prosthesis. This report emphasizes the need to consider this possibility, even in patients with a very remote prior operation.

Haemophilus influenzae endocarditis.

Haemophilus influenzae endocarditis on a prosthetic valve has previously been reported only once. Routine physical and laboratory evaluation does not distinguish endocarditis from this organism from other causes of endocarditis. Our patient with prosthetic mitral valve endocarditis was successfully treated with antibiotics, but surgery was subsequently required for congestive heart failure from valve dehiscence.

Endocarditis caused by Actinobacillus actinomycetemcomitans.

Actinobacillus actinomycetemcomitans, a small, gram-negative bacillus with fastidious growth requirements, is a rare cause of endocarditis. The clinical course of this disease is characterized by long duration of symptoms before diagnosis (average of three months), prolonged incubation before growth (average of six days), and a high embolic rate. The optimal antimicrobial regimen cannot be determined from available data, but the combination of ampicillin and an aminoglycoside may offer the best chance for cure. Two cases are presented, one successfully treated. Previously reported cases are reviewed.

A comparison of coarctation resection and patch angioplasty using postexercise blood pressure measurements.

Postexercise arm-to-leg blood pressure gradients were measured in 31 patients to determine the effectiveness of two surgical techniques for treating coarctation of the aorta. The arm-to-leg postexercise mean systolic blood pressure gradient was 29 mm Hg lower in 13 patients treated with Dacron patch angioplasty than in 18 patients whose coarctation was resected (p less than 0.01). Some patients with high postexercise gradients after coarctation resection had a reduced proximal aortic lumen by angiography. The results of this study indicate that Dacron patch angioplasty is the method of choice for effectively reducing postexercise systolic pressure gradients in patients with coarctation and hypoplasia of the aortic isthmus.

Proposed mechanism of a presystolic murmur during 2:1 atrioventricular block with hyperthyroidism.

A patient who developed 2:1 AV block ten weeks after the initiation of therapy for Graves' disease demonstrated a presystolic murmur related to atrial systole of the conducted beat. The murmur mimicked a pericardial friction rub. With the return of normal conduction as the thyrotoxicosis was finally controlled, the murmur disappeared. We postulate that the murmur resulted frm atrial contraction with rapid late-diastolic inflow into an increased right ventricular volume, causing premature opening of the pulmonic valve. This phenomenon was attainable only during 2:1 AV block with long diastolic filling periods and a hyperkinetic circulatory system. The murmur may be indicative of severe hyperthyroidism. Murmurs found in other disease entities may share similar physiologic principles.

Second and third degree atrioventricular block with Graves' disease: a case report and review of the literature.

A previously healthy woman experienced Adams-Stokes attacks ten weeks after the initiation of antithyroid medication for Graves' disease. The patient manifested advanced atrioventricular (A-V) block requiring a temporary transvenous pacemaker. The site of heart block was localized to the A-V node by utilizing a His bundle electrogram. With control of the hyperthyroid state, normal A-V conduction was restored. Review of the literature identified twenty-five additional cases of second or third degree A-V block associated with Graves' disease, ten of whom had Adams-Stokes syncope or convulsive seizures. The A-V nodal block was reversible with cure of the primary endocrine disease. It is postulated that excessive thyroid hormone has a direct effect on the cardiac conduction system, specifically, the region of the A-V node and bundle of His. Recommendations are made regarding the recognition and management of patients at risk for developing heart block associated with Graves' disease.

Coronary artery narrowing in coronary heart disease: comparison of cineangiographic and necropsy findings.

Of 10 patients with fatal coronary heart disease undergoing coronary angiography 0 to 69 d (average, 21) before necropsy, the amount of narrowing in 61 coronary arteries observed angiographically (diameter reduction) during life by three angiographers was compared with that observed histologically (cross-sectional area) at necropsy. No overestimations of the degree of narrowing were made angiographically. Of 11 coronary arteries or their subdivisions narrowed 0 to 50% in cross-sectional area histologically, none were underestimated angiographically; of eight narrowed 51% to 75% histologically, seven had been underestimated, and of 42 narrowed 76% to 100% histologically, 17 were underestimated angiographically. The coronary atherosclerotic plaquing was diffuse (greater than 25% cross-sectional area narrowing) in 90% of 467 five-millimetre segments of coronary artery examined (24 cm per patient), and this diffuseness of the atherosclerotic process seems to be the major reason for angiographic underestimation of coronary narrowings.

Problems in the detection of acute severe mitral insufficiency using flow-directed catheters.

A case of acute severe mitral insufficiency is described wherein bedside Swan-Ganz right heart catheterization failed to established the diagnosis. Emphasis is given to problems inherent in recording the diagnostic large dominant V-waves with this technique, and to the necessity of resolving conflicting measurements with conventional cardiac catheterization.

Postpartum coronary artery dissection.

A 27-year-old woman experienced anterior myocardial infarction three weeks after the delivery of her second child. Coronary arteriography subsequently showed primary dissection of the left coronary artery. This patient is believed to be the second reported survivor of angiographically proven peripartal left coronary artery dissection and the only such patient to achieve and maintain asymptomatic status for a prolonged period without operative intervention.