RESUMO
Some centers in the United States continue to use (periodic) pulsed inotropic therapy in the management of severe congestive heart failure. Although there have been large, randomized, well-designed trials of oral inotropes in chronic heart failure, studies evaluating intravenous agents have been smaller and often of inferior design. Review of available intravenous inotrope studies in chronic congestive heart failure found improved clinical status with treatment. Although studies suggest clinical benefit is achieved at a cost of increased mortality, no study demonstrated a statistically significant difference. Large, randomized studies are needed to define the role of intravenous inotropic therapy in various heart failure groups, establish its safety, and explore its adjunctive use to enhance oral therapy.
Assuntos
Cardiotônicos/farmacologia , Cardiotônicos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Contração Miocárdica/efeitos dos fármacos , Coração/efeitos dos fármacos , Humanos , Pulsoterapia , Estimulação QuímicaRESUMO
Fine strands associated with prosthetic heart valves have been demonstrated with transesophageal echocardiography, but the pathologic identity of these strands is unclear. A case of a man with a prosthetic aortic Medtronic-Hall valve with prominent valve strands and recurrent strokes is discussed. The patient underwent valve replacement surgery, and histopathologic examination of the strands identified them as Lambl's excrescences.
Assuntos
Isquemia Encefálica/etiologia , Transtornos Cerebrovasculares/etiologia , Ecocardiografia Transesofagiana , Próteses Valvulares Cardíacas/efeitos adversos , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , RecidivaRESUMO
We reviewed cases of Providencia stuartii bacteremia at a large community teaching hospital during a 12-year period (1981 to 1992). None of the infections were hospital-acquired. Of the 49 patients, 47 (96%) came from a nursing home, and 45 (92%) had a long-term indwelling Foley catheter. The urinary tract was definitely proven to be the source of bacteremia in 35 patients (71%) and was the probable source in another 5 patients (11%). Polymicrobial bacteremia occurred in 25 patients (51%). The overall mortality rate during hospitalization was 25%.
