Biomedical subjects
Publications and source records attributed to J Blumenthal.
Recommendations concerning nutrition and physical activity are an important part of health care in the elderly. There is increasing evidence that diet and exercise influence the development and progression of cardiovascular disease in the elderly as well as the young. Decreases in coronary risk factors can be achieved in the elderly by attention to proper diet and exercise.
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Mycotic aneurysms of the extracranial internal carotid artery are rare; they usually appear as an enlarging pulsatile neck mass with associated pain, tenderness, and fever. This case report illustrates the need for prompt diagnosis and urgent surgical intervention. The most common organisms found with these aneurysms have been Staphylococcus aureus and Streptococcus pyogenes. We report a case of a mycotic internal carotid artery aneurysm resulting from Salmonella enteritidis. A 20-year review of both the foreign and English language literature revealed only one other case of a mycotic carotid aneurysm resulting from Salmonella infection. The cornerstone of therapy in the past had been proximal ligation. More recently, primary reconstructive procedures with either an end-to-end anastomosis or an interposition vein graft have been described. The present case was managed with an end-to-end technique with the use of a Pruitt-Inahara shunt.
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Infective endocarditis is a dynamic disease for which various infective organisms may be responsible in different patient populations. Antimicrobial therapy should be directed against the specific organism after it has been identified by blood culture. An agent with a spectrum that includes the enterococci should be given in the meantime. Prophylactic use of a bactericidal agent is necessary for patients with valvular or congenital heart disease. Recent advances in microbiologic and cardiac diagnostic procedures offer the clinician various methods of following the activity of the disease, and immunobiology has provided new insights into its pathogenesis.
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A study was performed in five normal men in whom left ventricular volume was measured by thermodilution in the supine and 60 degrees head-up postures, in the control state, and then during steady-state response to isoproterenol. The mean rate of circumferential shortening of the left ventricle was calculated for each of the postures in both inotropic states and was found to remain constant in the control state at 12.5 +/-0.6 cm/sec in the supine posture and 13.3 +/-0.5 cm/sec in the tilted posture. Similarly, mean rate of circumferential shortening remained constant in response to the positive inotropic effect of isoproterenol at 20.9 +/-0.5 cm/sec in the supine position and 20.7 +/-0.5 cm/sec in the tilted posture. It is concluded that the constancy of mean rate of circumferential shortening over the relatively broad physiologic range of left ventricular end-diastolic volume and mean force of ejection during a given state of myocardial contractility represents the coupled reciprocal influences of ventricular wall tension and myocardial fiber length on the velocity of ventricular wall shortening. Unlike stroke work, stroke power, and mean rate of left ventricular ejection, which are volume-dependent parameters of myocardial performance, the mean rate of circumferential shortening appears to be a reasonable index of left ventricular contractility, which in steady-state conditions is independent of left ventricular end-diastolic volume and mean ventricular wall force of ejection. In this study, changes in mean rate of circumferential shortening associated with changes of heart rate were small and variable.
An acquired aorta-to-pulmonary artery shunt from rupture of a thoracic aortic aneurysm in an elderly patient is reported. The diagnosis was suspected clinically and was confirmed by special cardiac studies. Surgical intervention was refused by the patient who died shortly after admission to the hospital.
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