Assuntos
Falso Aneurisma/diagnóstico , Diagnóstico por Imagem/métodos , Aneurisma Cardíaco/diagnóstico , Ventrículos do Coração/patologia , Infarto do Miocárdio/diagnóstico , Idoso , Falso Aneurisma/cirurgia , Angiografia Coronária/métodos , Ecocardiografia Doppler/métodos , Eletrocardiografia/métodos , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração/cirurgia , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Infarto do Miocárdio/cirurgia , Revascularização Miocárdica/métodos , Medição de Risco , Resultado do TratamentoAssuntos
Cardiopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/normas , Angina Pectoris/diagnóstico por imagem , Técnicas de Imagem de Sincronização Cardíaca , Contraindicações , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Técnicas Eletrofisiológicas Cardíacas , Humanos , Doses de Radiação , Encaminhamento e Consulta , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVE: The purpose of this study was to further characterize the CT findings of Clostridium difficile colitis and to provide for the first time a diagnostic sensitivity, specificity, positive predictive value, and negative predictive value to help clinicians decide whether antibiotic treatment is warranted on the basis of CT findings while awaiting stool test results (which may take as long as 48 hr). MATERIALS AND METHODS: A retrospective review covering a 4-year period was performed of the charts and CT scans of 54 symptomatic patients with stool test results positive for C. difficile and of a control group of 56 patients with antibiotic-associated diarrhea with stool test results negative for C. difficile. RESULTS: At our institution, C. difficile colitis was explicitly diagnosed at CT in these patients with a sensitivity of 52%, specificity of 93%, positive predictive value of 88%, and negative predictive value of 67%. The sensitivity can be raised to 70% with no change in specificity with more rigid adherence to diagnostic criteria of colon wall thickening of greater than 4 mm combined with any one or more findings of pericolonic stranding, colon wall nodularity, the "accordion" sign, or otherwise unexplained ascites. CONCLUSION: Although routine CT screening of antibiotic-associated diarrhea is not advocated, the 88% positive predictive value of a diagnosis of C. difficile colitis in those who are scanned may merit consideration of treatment by clinicians on the basis of the CT results alone.
Assuntos
Enterocolite Pseudomembranosa/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Estudos de Casos e Controles , Clostridioides difficile/isolamento & purificação , Enterocolite Pseudomembranosa/microbiologia , Fezes/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
The MICs and MBCs of 15 antibiotics for two strains of Staphylococcus aureus were determined in Mueller-Hinton broth (MHB) and 90% serum-10% MHB. Subsequent experiments established that highly protein-bound antibiotics (>/=80%), such as LY333328, demonstrated higher MICs and MBCs, less killing over an 8-h interval, and shorter postantibiotic effects in 90% serum-10% MHB than in MHB alone. Albumin was demonstrated to be almost solely responsible for changes in the aforementioned pharmacodynamic parameters of LY333328.
