Candida tropicalis endocarditis in idiopathic hypertrophic subaortic stenosis.
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Biomedical subjects
Publications and source records attributed to A Nasrallah.
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Clinical and angiographic features simulating acute massive pulmonary embolism, the result of compression of the right and main pulmonary arteries by a dissecting hematoma, are described in a 52-year-old white woman.
Runaway pacemaker has been encountered in 7 patients during the past 7 years at the Texas Heart Institute. In this series, 4 patients with fixed-rate pacemakers experienced pacemaker arrhythmias because of battery depletion, and 3 had arrhythmias because of component failure. Battery deterioration was heralded by an increase in cardiac rate. Ventricular tachycardia, rapidly followed by ventricular fibrillation, occurred in 2 patients. Prompt surgical exteriorization of the failing pulse generator and connection to an external pacemaker resulted in prompt recovery in all patients. Elective generator change should be performed routinely after 24 to 30 months unless reliable serial observations of ventricular rates can be attained. This at least will reduce the lethal complications attributed to battery exhaustion. Increasing developments in the design of generators and sources of power, as well as data from pacemaker clinic follow-up and telephone pulse transmittal, are expected to decrease the frequency of this complication.
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Logistic regression was used to determine the association between clinical variables and outcome at discharge in a sample of 438 manics hospitalized at a tertiary care facility. In the total sample, and for males, treatment with electroconvulsive therapy (ECT) and lithium carbonate were positively associated with good outcome. Among females, ECT was positively associated and comorbidity negatively associated with good outcome. Comorbidity appears to be a potentially useful variable in predicting immediate response to treatment.
Using a naturalistic study design, we compared 76 depressed patients having a DSM-III personality disorder (PD) to a control group of 152 depressed patients with no personality disorder. The patients with major depressive disorder (MDD) and a PD were more likely to have had a younger age of onset, to have had prior hospitalizations, to have a longer duration of episode, to have reported more suicidal thoughts, and to have had more suicide attempts both before and after discharge. Patients with MDD and PD were also more likely to have a family history of alcoholism or antisocial personality and less likely to have dexamethasone nonsuppression, although the latter was not statistically significant. Patients with MDD and PD were less likely to receive electroconvulsive therapy (ECT), equally likely to have received antidepressants, and more likely to receive neither ECT nor antidepressants. Patients with MDD and PD had a poorer response to 'adequate' antidepressants, but a similar response to ECT and 'inadequate' antidepressants. Overall, 91 (60%) of MDD patients and 32 (42%) of MDD plus PD patients were recovered at hospital discharge (X2 = 6.43, P less than 0.025). We conclude that the presence of PD in patients with MDD is associated with a different clinical presentation, family history, and poor recovery at hospital discharge.
This article reports the first case of a patient presenting with acute myocardial infarction in whom a repeated dose of tissue plasminogen activator (t-PA) was able to achieve successful thrombolysis after a first dose of t-PA itself failed to do so. This case report presents an alternative approach for the treatment of patients who fail thrombolysis after an initial dose of t-PA, an approach that might be particularly useful in hospitals that do not have immediate access to advanced interventional services.