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Biomedical subjects

E R Giuliani

Publications and source records attributed to E R Giuliani.

At least 37 records · Page 2Linked to original sources
PubMed1982

Treatment of penicillin-sensitive streptococcal infective endocarditis.

Patients with infective endocarditis caused by penicillin-sensitive streptococci (minimal inhibitory concentration less than or equal to 0.1 microgram/ml of penicillin) may be treated successfully with one of the following three regimens: (1) aqueous penicillin G administered intravenously for 4 weeks, (2) aqueous penicillin G administered intravenously for 4 weeks in combination with streptomycin for the first 2 weeks of therapy, or (3) parenterally administered penicillin plus streptomycin for 2 weeks. No substantial difference in the relapse rate exists among the three regimens, and a cure rate of at least 98% may be anticipated with each of the three forms of therapy. The major advantage of the 2-week regimen is that it is more cost-effective than 4 weeks of hospitalization and therapy. The major disadvantage of the 2-week regimen and the 4-week regimen that uses streptomycin is the relatively low risk of streptomycin-associated vestibular toxicity. Patients unable to tolerate penicillin may be treated with vancomycin or a cephalosporin administered parenterally for 4 weeks.

Adult↗
PubMed1982

Prosthetic valve endocarditis.

Prosthetic valve endocarditis is an infrequent but serious complication of cardiac valve replacement. The overall frequency of prosthetic valve endocarditis is approximately 2%. The frequency of early-onset and late-onset infections is 0.78% and 1.1%, respectively. Staphylococci are the most common isolate from patients with early-onset infection, accounting for 47.5% of the total number of isolates. Staphylococcus epidermidis causes 27% of these staphylococcal infections. Among patients with late-onset infection, streptococci are the predominant microorganism, constituting 42% of the total number of isolates from patients in this group. The overall mortality among patients with prosthetic valve endocarditis is high--59%; the mortality among patients with early- or late-onset infections is 77% and 46%, respectively. Most patients with staphylococcal prosthetic valve endocarditis should undergo cardiac valve replacement in addition to antimicrobial therapy. Closely monitored anticoagulant therapy should be cautiously continued in patients with prosthetic valve endocarditis.

Anti-Bacterial Agents↗
PubMed1981

Hypertrophic obstructive cardiomyopathy and lentiginosis: a little known neural ectodermal syndrome.

Eleven patients, 10 male, with classic hypertrophic obstructive cardiomyopathy and lentiginosis are described. Physical examination showed differences from the few previously reported cases in that (1) this condition was not confined to children; (2) mental retardation, sensorineural deafness and gonadal and somatic infantilism were either rare or absent; and (3) detailed family studies provided no evidence that this condition was inherited. Nine patients underwent cardiac catheterization and left ventricular angiography; all had left ventricular outflow obstruction and three had concomitant right ventricular outflow obstruction with a pressure gradient in excess of 100 mm Hg. Ten of the 11 patients were severely symptomatic, and 7, each with a left ventricular pressure gradient of more than 70 mm Hg, underwent successful septal myotomy/myectomy that resulted in marked symptomatic improvement that was maintained after long-term follow-up.

Adolescent↗
PubMed1981

The natural history of idiopathic dilated cardiomyopathy.

Between 1960 and 1973, a total of 104 patients at the Mayo Clinic had a diagnosis of idiopathic dilated cardiomyopathy on the basis of clinical and angiographic criteria; these patients were followed up for 6 to 20 years. Twenty-one percent of the patients had a history of excessive consumption of alcohol, 20 percent had had a severe influenza-like syndrome within 60 days before the appearance of cardiac manifestations and 8 percent had had rheumatic fever without involvement of cardiac valves several years before; thus, possible etiologic risk factors of infectious-immunologic type may be important. Eighty patients (77 percent) had an accelerated course to death, with two thirds of the deaths occurring within the first 2 years. Twenty-four patients (23 percent) survived, and 18 of them had clinical improvement and a normal or reduced heart size. Univariate analysis at the time of diagnosis revealed three factors that were highly predictive (p less than 0.01) of the clinical course: age, cardiothoracic ratio on chest roentgenography and cardiac index. Systemic emboli occurred in 18 percent of the patients who did not receive anticoagulant therapy and in none of those who did; thus, anticoagulant agents should probably be prescribed unless their use is contraindicated.

Alcohol Drinking↗
PubMed1981

M-mode and two-dimensional echocardiographic features in cardiac amyloidosis.

Twenty-eight patients with cardiac amyloidosis were studied by echocardiography -- 26 by M-mode and 13 by two-dimensional (2D) studies. All had heart failure and biopsy-proved amyloidosis, M-mode features included (1) normal left ventricular (LV) dimension in all; (2) thickened ventricular septum (88%), LV posterior wall (77%), and right ventricular (RV) anterior wall (79%); (3) decreased thickening of ventricular septum (96%) and of LV posterior wall (65%) and reduced LV global function (62%); (4) left atrial enlargement (50%); and (5) pericardial effusion (58%). Two-dimensional echocardiography provided additional features: (1) thickened papillary muscles (five of 13); (2) thickened valves (four of 13); (3) better appreciation of thickened RV wall; and (4) a characteristic "granular sparkling" appearance of thickened cardiac walls -- presumably secondary to the amyloid deposit -- which was noted in 12 of 13 patients. Thus, M-mode echocardiography is helpful in the recognition of cardiac amyloidosis. However, the better appreciation with 2D echocardiography of thickened cardiac walls with a "granular sparkling" appearance in patients with unexplained cardiac failure is virtually diagnostic of cardiac amyloidosis.

Adult↗
PubMed1981

Two-dimensional echocardiography in patients with focal cerebral ischemia.

To assess the use of two-dimensional (2D) echocardiography in demonstrating a cardiac source for cerebral embolization, we studied 138 patients with one or more recent episodes of focal cerebral ischemia, in whom either a cardiac mechanism was suspected or no probable mechanism of ischemia was identified. Intracardiac thrombus was found in nine patients (6.5%); 32 (23.2%) had other cardiac disorders possibly related to the ischemia; and the remaining 97 (70.3%) had study results that were normal or added nothing to the clinical findings. Thus, 2D echocardiography was of limited value in patients with no clinical cardiac disease or hypertension only, and of greater value in patients with known cardiac disease, especially atrial fibrillation. Although 2D echocardiography can demonstrate a wide range of disorders that may be associated with ischemia, the overall low yield does not warrant routine use of this study in all patients with unexplained cerebral ischemic events.

Adult↗
PubMed1980

Use of the cardiac-catheterization laboratory in a defined population.

We evaluated trends in the use of the cardiac-catheterization laboratory from 1973 through 1977 in a well-circumscribed population in southeastern Minnesota. A total of 346 patients (248 male and 98 female patients) underwent coronary arteriography, left ventriculography, or cardiac catheterization, and there were 369 visits to the catheterization laboratory. The total number of catheterization-laboratory visits per 10,000 population increased from 4.3 in 1973 to 11.5 in 1977. According to individual category, the rates for coronary arteriography increased more than fourfold during the five-year period, whereas the rates for cardiac catheterization period, whereas the rates for cardiac catheterization showed no substantial change. On the basis of the 1977 rate for all visits to the catheterization laboratory and under conditions similar to those in this community, a population of approximately 230,000 would be required to ensure use of a catheterization laboratory at the suggested minimum level of 300 adult examinations per year.

Angiography↗
PubMed1980

CNS embolism due to atrial myxoma: clinical features and diagnosis.

The records of 40 patients with pathologically verified atrial myxoma identified during the period 1957 to 1977 were studied. The patients ranged in age from 17 to 77 years; women predominated by a ratio of 3:1. Thirty-five patients had left atrial myxoma, three patients had right atrial myxoma, one patient had bilateral myxomas, and one patient had a right atrial myxoma and subsequent removal of a left atrial myxoma. Ten of the 37 patients (27%) with left atrial myxoma had at least one neurologic event suggesting ischemia secondary to embolization. Transient or permanent ischemic events were noted in the cerebral hemispheres, brainstem, cerebellum, retina, and spinal cord. Although some patients were seen at the initial evaluation with primarily neurologic events, cardiac and constitutional symptoms dominated the clinical picture. Echocardiography and sector scanning provide a practical method for early clinical diagnosis.

Adolescent↗
PubMed1980

Subsequent neurological events in patients with atrial myxoma.

Review of 35 patients from the Mayo Clinic with histologically proved atrial myxomas (7 with prior neurological events) who were followed for 12 to 235 months revealed that none had subsequent delayed neurological events attributable to their atrial myxomas.

Adult↗
PubMed1980

The role of echocardiography in the selection of mitral valve prosthesis.

Assessment of the left ventricular outflow tract was made echographically in 70 patients who subsequently received a mitral prosthesis. Group A (44 patients) had normal left ventricular outflow tract width (greater than 20 mm.); 13 received the Starr-Edwards prosthesis and nine received the Braunwald-Cutter prosthesis. There were two patients with low cardiac output syndrome and no hospital deaths. Group B (26 patients) had a narrow left ventricular outflow tract (less than 20 mm.). Thirteen patients received the Starr-Edwards prosthesis. One patient had low cardiac output syndrome, and there were no hospital deaths. We conclude that the use of the ball-and-cage prosthesis in the mitral position in patients with a narrowed left ventricular outflow tract (less than 20 mm.) measured echographically is not associated with an increased surgical risk.

Adult↗
PubMed1980

Left ventricular function in Friedreich's ataxia. An echocardiographic study.

Left ventricular function was assessed in seven patients with Friedreich's ataxia using computer-assisted analysis of the left ventricular echocardiograms and compared with those of 45 normal children matched for age and sex. The left ventricle in Friedreich's ataxia was symmetrically hypertrophied, cavity dimension was normal or small, and septal motion and peak velocity of circumferential shortening were normal in all patients. In diastole the duration of rapid filling was normal, peak rate of increase in left ventricular dimension was reduced in two patients, mitral valve opening was delayed with respect to minimum cavity dimension in seven, and there were significantly greater than normal increases in left ventricular dimension during the isovolumic period to mitral valve opening in seven, indicating abnormal and incoordinate relaxation. Peak rates of posterior wall systolic thickening and diastolic thinning were reduced in four and six patients, respectively, whereas peak rates of septal systolic thickening and diastolic thinning were reduced in one and four, respectively, suggesting a disproportionately greater impairment of the posterior wall than of septal function. The absence of asymmetric septal hypertrophy and mid-systolic closure of the aortic valve, the presence of normal septal motion, and the greater reduction in posterior wall than in septal dynamics are inconsistent with previous ideas that the heart disease of Friedreich's ataxia is identical to hypertrophic cardiomyopathy. Computer-assisted analysis of echocardiograms permits recognition of heart disease in Friedreich's ataxia before the onset of cardiac symptoms or development of clinical signs of heart disease.

Adolescent↗
PubMed1980

Evaluation of cardiac murmurs.

We have attempted to review the evaluation of cardiac murmurs as we approach the patient in the office setting. It is obvious that although the character and location of the murmurs themselves are a clue to the genesis of the murmur, it is only by combining the history with a complete cardiovascular examination that we can truly establish the origin of the murmur in virtually every patient. If we combine these findings with selective noninvasive tests, then we will need to resort to the more expensive and invasive studies only on a selective basis.

Adolescent↗