1/1046. microsporidia infection in transplant patients.BACKGROUND: microsporidia are the most common cause of chronic diarrhea in patients infected with human immunodeficiency virus. patients who have undergone organ transplantation may also be infected. The precise immune defect and the clinical picture in transplant patients have not been studied. methods: We report a case of microsporidia infection in a heart transplant patient and review three other cases reported in the literature. RESULTS: infection in three solid organ transplant patients occurred when the patients were receiving immunosuppressive therapy for rejection 1.5-3 years after transplantation. patients had chronic diarrhea, vomiting, dyspepsia, and weight loss for 1 month to 3 years. CONCLUSIONS: microsporidia may be the cause of chronic unexplained diarrhea and gastrointestinal disturbances in transplant patients. Defects in cell-mediated immunity probably play a role in maintaining the chronicity of this infection. Specific screening requests should be made to the microbiology laboratory when microsporidia infection is suspected.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
2/1046. Unaccountable severe hypercalcemia in a patient treated for hypoparathyroidism with dihydrotachysterol.This report describes a forty-seven-year-old female patient with a complex medical history. She was suffering from an unspecified interstitial lung disease, papillary thyroid carcinoma which had been treated, hypoparathyroidism after thyroidectomy for which she was receiving dihydrotachysterol and calcium, and atrial fibrillation and congestive heart failure as a result of mitral stenosis. Shortly after mitral valve replacement she developed a severe hypercalcemia (serum calcium 5.95 mmol/l) during a febrile illness. At that time anti-tuberculous agents were also being administered for presumed tuberculosis. The possible mechanisms for this severe elevation of the calcium level are discussed. immobilization, while Paget's bone disease was present, and perhaps enhanced activation of dihydrotachysterol by rifampicin, could have led to increased calcium-release into the circulation. Continuous supplecation of calcium and vitamin d, provoked dehydration and the mechanism of the milk-alkali syndrome also contributed to this extremely high calcium level. It is concluded that hypoparathyroid patients being treated with vitamin d and calcium should be carefully monitored in the case of an intercurrent illness or a change in medication.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
3/1046. Fatal cardiac ischaemia associated with prolonged desflurane anaesthesia and administration of exogenous catecholamines.PURPOSE: Four cardiac ischaemic events are reported during and after prolonged anaesthesia with desflurane. CLINICAL FEATURES: We have evaluated desflurane in 21 consecutive patients undergoing advanced head and neck reconstructive surgery. Four deaths occurred which were associated with cardiac ischaemic syndromes either during or immediately after operation. All patients in the study received a similar anaesthetic. This comprised induction with propofol and maintenance with alfentanil and desflurane in oxygen-enriched air. Inotropic support (either dopamine or dobutamine in low dose, 5 micrograms.kg.min-1) was provided as part of the anaesthetic technique in all patients. Critical cardiovascular incidents were observed in each of the four patients during surgery. These were either sudden bradycardia or tachycardia associated with ST-segment electrocardiographic changes. The four patients who died had a documented past history of coronary heart disease and were classified American Society of Anesthesiologists (ASA) II or III. One patient (#2) did not survive anaesthesia and surgery and the three others died on the first, second and twelfth postoperative days. Enzyme increases (CK/CK-MB) were available in three patients and confirmed myocardial ischaemia. CONCLUSION: These cases represent an unexpected increase in the immediate postoperative mortality for these types of patients and this anaesthetic sequence.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
4/1046. Repair of a pseudoaneurysm of the ascending aorta after aortic valve replacement.An elderly woman underwent an aortic valve replacement and 5 months later developed a pseudoaneurysm from the anterior aspect of the proximal ascending aorta (AA). The pseudoaneurysm was approached through a redo-median sternotomy, on cardiopulmonary bypass (CPB), mild hypothermia, and a beating heart, with a temporary fingertip occlusion of its ostium, and repaired successfully using mattress monofilament sutures enforced by pledgets. The standard approach to such pseudoaneurysms is a CPB and hypothermic circulatory arrest (HCA) prior to mid-sternotomy, and replacement of the AA. But, when a pseudoaneurysm arises from a narrow ostium on the anterior aspect of the AA, as in this case, it can be sutured closed with pledgets under CPB with a mild hypothermia and a beating heart.- - - - - - - - - - ranking = 2keywords = heart (Clic here for more details about this article) |
5/1046. cardiomyoplasty and implantable cardioverter defibrillator: efficacy and safety of concomitant device implantation: sudden death and cardiomyoplasty.Sudden death represents a common event in the natural history of patients affected by chronic heart failure. Such an outcome also has been shown to characterize the follow-up of the cardiomyoplasty procedure. We report two cases of patients who had cardiomyoplasty and experienced witnessed episodes of ventricular arrhythmia at variable times after surgery (2 years and 2 months, respectively). In the first case, an implantable cardioverter defibrillator (ICD) was implanted subsequent to the arrhythmic episode, whereas the second patient had a combined cardiomyoplasty and ICD implantation procedure. In particular, this patient underwent a modified wrapping technique, herein described, because of a large left ventricular dilatation. In both cases, ventricular defibrillation did not affect the correct functioning of the implanted cardiomyostimulator. Our article confirms that ventricular arrhythmia is common in cardiomyoplasty patients. The combined use of a skeletal muscle stimulator and implantable defibrillator may therefore be effective in preventing arrhythmia-related sudden death without any concurrent effect on the correct functioning of the wrapped muscle/heart circuit, with likely benefit on long-term cardiomyoplasty patient survival.- - - - - - - - - - ranking = 2keywords = heart (Clic here for more details about this article) |
6/1046. Donor-to-recipient transmission of bacteria as an unusual cause of mediastinitis in a heart transplant recipient.We present a 54-year-old male heart transplant recipient who developed mediastinitis caused by klebsiella oxytoca and veillonella species. culture of the donor's bronchus also grew K. oxytoca and a veillonella species. Pulsed-field gel electrophoresis revealed that the K. oxytoca isolates had identical banding patterns. This case illustrates transmission of pathogenic bacteria via a contaminated organ.- - - - - - - - - - ranking = 5keywords = heart (Clic here for more details about this article) |
7/1046. thrombosis of mitral valve prosthesis presenting as abdominal pain.A 67-year-old woman presented with abdominal pain, anemia, and leukocytosis. Five years previously, the patient had undergone mitral valve replacement with a St. Jude bileaflet mechanical prosthesis. After her admission, echocardiography confirmed an immobile leaflet of the prosthetic valve. At urgent surgery, thrombosis and pannus, obstructing the disc, were found, and the mechanical valve was replaced with a bioprosthesis. The incidence of mitral valve thrombosis is low, ranging from 0.1% to 5.7% per patient per year. patients who receive inadequate anticoagulation, particularly with valve prostheses in the mitral position, have an increased risk for thrombus or pannus formation. Presentation varies, from symptoms of congestive heart failure or systemic embolization, to fever or no symptoms. New or worsening symptoms in a patient with a prosthetic heart valve should raise concerns about prosthetic dysfunction. Aggressive investigation and, if indicated, urgent or emergency surgery for treatment can be lifesaving.- - - - - - - - - - ranking = 2keywords = heart (Clic here for more details about this article) |
8/1046. Mitral regurgitation after pericardiectomy for constrictive pericarditis.We report a case of constrictive pericarditis in which trace mitral valve regurgitation was detected preoperatively and temporarily worsened after a pericardiectomy was performed. The early postoperative data suggested that the increased mobility of the lateral wall, in conjunction with an increase in the left ventricular volume, might be one of the causes of the perioperative mitral valve dysfunction. The mitral valve function returned to the preoperative baseline thirteen months after the pericardiectomy.- - - - - - - - - - ranking = 332.43602904129keywords = constrictive pericarditis, constrictive, pericarditis (Clic here for more details about this article) |
9/1046. Extracorporeal right to left atrial bypass to treat right ventricular failure.Graft right ventricular failure after heart transplantation, secondary to preoperative functional pulmonary hypertension, was successfully managed in a 49-year-old patient using an extracorporeal right to left atrial bypass. We comment on the case and discuss the type of mechanical assistance used.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
10/1046. Reversion to sinus rhythm 11 years after surgically induced heart block.A patient is presented in whom the heart reverted spontaneously to sinus rhythm 11 years after surgical closure of a ventricular septal defect complicated by complete heart block. It seems unlikely that regeneration of fibres in the bundle of his, if these had indeed been destroyed, could account for the restoration of sinus rhythm after so long an interval.- - - - - - - - - - ranking = 6keywords = heart (Clic here for more details about this article) |
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