Adherence of candida species to intravenous catheters.
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Candida↗
Biomedical subjects
J E Edwards
Publications and source records attributed to J E Edwards.
Adaptation in chronic illness: an eclectic model for nurses.
The growing prevalence of chronic illness is due, in large part, to the control and/or eradication of infectious diseases as well as, in North America, the increasingly aged population and overall lengthening life span. Although the trajectory of chronic illness is in a generally downward direction, the rate of progression may vary as plateaux an remissions occur. As these changes occur, the individual and his family move through a process of continual adjustment. This paper presents a conceptual model of the process of adaptation in chronic illness. The primary concept in the model is appraisal (Lazarus, 1966) and the thought that continuous appraisal/reappraisal of the individual's progress toward the goal of adaptation is required by the individual, his family, and the nurse. The focus of the model is the chronically ill individual and his family. The goal is movement toward adaptation to the illness and its ramifications. The process is caring, which facilitates movement towards the goal. The model and its interpretation are outlined in the paper. Finally, some strategies for nurses, and others, are suggested as ways in which the concepts may be applied and implemented in practice.
Adaptation, Psychological↗
The myxomatous mitral valve and sudden death.
The clincopathologic features of 14 cases of sudden death attributable to dysrhythmias associated with the myxomatous mitral valve are described. The patients were 14-59 years old (mean 27 +/- 11 years). Eleven were female and three male. Of the seven ECGs available, none showed prolongation of the QT interval, but two showed repolarization abnormalities. The material was classified according to the degree of prolapse in the pathologic specimen. When obvious prolapse was found, the expected auscultatory findings had been documented. In three cases there was minimal prolapse, casting some doubt on the hypothesis that traction on the papillary muscles or diastolic dumping of the leaflets may be implicated in the pathogenesis of the dysrhythmias. In one of the cases with minimal prolapse there was a strong family history of sudden death. Endocardial friction lesions were present in 11 cases, including two of the three with minimal prolapse. In five cases there was a thrombotic lesion in the angle between the posterior leaflet and the left atrial wall containing fibrin and platelets. These abnormalities may be important in the pathogenesis of the ventricular dysrhythmias.
Adolescent↗
Experimental hematogenous endophthalmitis due to Cryptococcus neoformans.
New Zealand white female rabbits injected with 6 X 10(7) to 5.5 X 10(8) CFU of Cryptococcus neoformans into the right carotid artery developed three types of clinically detectable eye lesions. These eye manifestations included: (1) iritis that had distinctive 1-3 mm white nodules; (2) white vitreous lesions with ill-defined borders, and (3) focal and diffusely infiltrative lesions of the optic nerve radiations. Most of the eye lesions appeared between 1 to 3 weeks after intracarotid injection and resolved almost completely by 10 weeks. Their clinical appearance resembled some of the eye lesions described from human cases. Predominantly a mononuclear leukocyte response with scattered cryptococcal organisms were seen in the iris and optic nerve lesions. Serial quantitative cultures from eye tissues, brain, and kidney indicated that the clearance of viable cryptococci was slowest from the eye tissues. Among the three diagnostic techniques (India Ink mount, culture, and cryptococcal polysaccharide antigen (CPA) determination), the CPA determination was the most sensitive test to detect C. neoformans in the aqueous and vitreous humors of clinically involved eyes. This rabbit model may be useful for further studies on hematogenous cryptococcal endophthalmitis.
Animals↗
Anomalies of the left atrium and mitral valve: cords, flaps, and duplication of valve.
We studied seven hearts with abnormalities of the atrial septum of the mitral valve. Three had abnormalities of the atrial septum, characterized by a flap or a diaphragm within the left atrium. Another three cases had abnormal cords extending from the atrial septum to the anterior or the posterior mitral leaflets. A seventh case had a duplicated mitral valve. Grossly, the specific conditions among these seven hearts appeared very different: however, we believe that the origin of each anomaly can be explained by one of three developmental aberrations or a combination thereof. Although only one case was associated with severe cardiac disease, such structures may be seen during cardiac imaging or operation.
Adult↗
Left-sided anomalies in Ebstein's malformation of the tricuspid valve.
A review of 34 autopsied cases with classical Ebstein's malformation of the tricuspid valves revealed 8 cases with left-sided anomalies. Among these, appearing in 1 case each, were aortic atresia and persistent common atrioventricular canal. The latter 2 conditions were dominant clinically. In the remaining 6 cases the left-sided anomalies were not apparent clinically and probably of no functional significance. These conditions were parachute mitral valve, bicuspid aortic valve, cor triatriatum and pulmonary stenosis, cleft mitral valve, stenosis of individual pulmonary veins, and prolapse of mitral valve.
Adolescent↗
Aortic valvular atresia. Associated cardiovascular anomalies.
The pathological anatomy of 109 specimens of aortic valvular atresia was reviewed for the purpose of identifying the cardiovascular anomalies associated with that condition. We found the most commonly associated anomaly to be coarctation of the aorta, which was present in 71 percent of our cases and judged to be hemodynamic significance in one-third of the involved cases. Other associated anomalies, in order of decreasing frequency, were mitral atresia, anomalous systemic and pulmonary venous connections, abnormalities of branching of the aortic arch, and ventricular septal defect. The study demonstrated that aortic atresia is associated with a significant incidence of other cardiovascular anomalies. Additional anomalies, when present, may complicate emerging attempts at surgical correction of this condition.
Aorta↗
Interruption of the aortic arch with right descending aorta. A rare condition and a cause of bronchial compression.
Four cases of interruption of the aortic arch with the rare association of right ductus arteriosus and right descending aorta are described. Three different variations in subclavian arterial origin are described. Each represents a mirror image of anatomic arrangements previously reported for interruption of the aortic arch with left descending aorta. One of the cases demonstrated massive emphysema of the right lung resulting from compression of the right main bronchus by the enlarged right ductus arteriosus. Another case documented unusually long survival (26 years) of a patient with interruption of the aortic arch and ventricular septal defect.
Adult↗
Congenital cardiac, pulmonary, and vascular malformations in oculoauriculovertebral dysplasia.
Three cases of oculoauriculovertebral dysplasia (OAV) with associated cardiac, pulmonary, and facial malformations are described. One patient had a rare condition: isolation of the left innominate artery. All 3 had pulmonary anomalies ranging from minor (incomplete lobulation) to major (hypoplasia of the left lung). When pulmonary hypoplasia occurs, it is usually on the same side of the body as the facial anomalies. Forty-five reported cases of OAV with associated cardiac, vascular, and pulmonary abnormalities are reviewed. Tetralogy of Fallot and ventricular septal defect account for half of the cardiac malformations. In the remaining cases, a wide variety of cardiovascular malformations are present. It is suggested that the facial malformations in OAV may result from a perfusion abnormality. An isolated left innominate artery (as in one of our cases) could produce abnormal vascular supply to the external carotid artery and the facial structures that it supplies.
Arteriovenous Malformations↗
Interruption of the aortic arch with aorticopulmonary septal defect. An anatomic review.
Interruption of the aortic arch may occur with aorticopulmonary septal defect (APSD) as part of a developmental complex. The anatomic details of 46 cases of interruption of the aortic arch with APSD revealed the following characteristics: (1) type A interruption of the aortic arch occurred nearly six times more commonly than type B interruption; (2) the APSD was variable in size and position, conforming to the types previously described; (3) the ventricular septum was usually intact, but a ventricular septal defect was present in six cases and occurred more frequently with type B interruption of the aortic arch; (4) subaortic stenosis was not present in any of the 16 cases in which adequate details were available to make a judgment. The association of APSD with interruption of the aortic arch in infancy is not uncommon. Evaluation of infants with APSD should thus include evaluation of the aortic arch. The occurrence of interruption of the aortic arch with an intact ventricular septum is distinctly unusual. In such cases an APSD should be suspected and sought.
Aorta↗
Symposium on Postoperative Congenital Heart Disease in Adults: Epilogue: the pathologist.
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Adult↗
The mechanism of angioplasty. Dilatation of iliac cadaver arteries with intravascular pressure control.
A model was developed which allows the dilatation of iliac cadaver arteries under normal blood pressure conditions (mean pressure 100 mmHg). Segments of the iliac artery were put under pressure and dilated with balloons under similar conditions as in clinical practice. Purposely oversized balloons were used because most of the arteries did not contain severely stenotic plaques and consequently the commercially available balloons had no effect because of their comparatively small diameter. In spite of the use of oversized balloons, the cadaver arteries could not be significant dilated. Rupture of the intima and media was almost invariably present. Leakage of distending fluid through the adventitia occurred commonly. The "therapeutic range" between minimal dilation and partial or total rupture in postmortem studies is small.
Adolescent↗
Detection of fungemia obscured by concomitant bacteremia: in vitro and in vivo studies.
Our recent clinical experience suggested that bacteremia may interfere with the detection of concomitant fungemia when standard blood culture methods are used. To determine the extent to which bacteria may interfere with fungal isolation from blood cultures, an in vitro model simulating blood cultures taken during concomitant fungemia and bacteremia was created. Each of six bacteria (Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus faecalis, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) was combined with each of three pathogenic yeasts (Candida albicans, Candida tropicalis, and Torulopsis glabrata) in vented blood culture bottles containing enriched brain heart infusion broth and fresh normal human blood. Blood culture bottles were analyzed at 1, 2, and 7 days of incubation. Gram strains and subcultures onto chocolate and MacConkey agars failed to detect fungi in 37.0, 66.7, and 100% of samples, respectively. However, subcultures onto Sabouraud dextrose agar failed in only 13% of the samples (occurring only with P. aeruginosa). In a rabbit model of concomitant fungemia with C. albicans and bacteremia with P. aeruginosa, no yeasts were recovered from blood cultures despite 100% detection of P. aeruginosa. Therefore, the usual microbiological techniques may be inadequate to detect fungemia when concomitant bacteremia is present.
Animals↗
Angio-pathological appearances of pulmonary valve in pulmonary atresia with intact ventricular septum. Interpretation of nature of right ventricle from pulmonary angiography.
Correlative angiographic-anatomical studies in 19 cases of pulmonary atresia with infarct ventricular septum showed the following relations between the angiographic appearance of the pulmonary valve and the morphology of the right ventricle. (1) Doming of the pulmonary valve was associated with a nearly normal-sized right ventricle and a wide infundibulum patent to the level of the pulmonary valve. (2) A fixed valve was associated either with (a) pronounced hypoplasia of the ventricular changer and stenosis of the infundibulum or (b) less commonly, a massive right ventricle and Ebstein's malformation of the tricuspid valve. (3) An intermediate type valve was associated with a small right ventricle and a small infundibulum which was, however, patent to the level of the pulmonary valve. It is suggested that the configuration of the pulmonary valve is a result of haemodynamic stresses placed upon it. These stresses, in turn, are determined by the morphological nature of the right ventricle. Thus, the nature of the pulmonary valve as seen angiographically may ve used as an index of right ventricular morphology.
Heart Defects, Congenital↗
Clinical and pathologic features of metastatic neoplasms of the pericardium.
Of 60 cases with pericardial metastatic disease, 26 had significant effects on the cardiovascular system. Pericardial metastases were suspected in 18 of these cases before death. The most common features reported were dyspnea on exertion and pleural effusion. While these were nonspecific for circulatory disturbance, ECG features of ST-T changes and low voltage QRS complexes were helpful in suspecting pericardial metastases. Thoracic roentgenograms were not helpful unless there was a large pericardial effusion. Echocardiography reported in one case promises a higher incidence of suspicion in the future.
Adult↗
Congenital aneurysms adjacent to the anuli of the aortic and/or mitral valves.
The unusual occurrence of non-infected submitral and aortic aneurysms developing sequentially in an adult prompted us to review the pathogenesis of congenital aneurysms adjacent to the aortic and mitral valves. The findings support the suggestion that subvalvular aneurysms, like aortic sinus aneurysms, are a result of a congenital defect at the valve anulus. Submitral aneurysms occur only subjacent to the posterior leaflet. Whereas aortic sinus aneurysms may arise from any of the three sinuses, subaortic aneurysms occur only under the intermediate portion of the left aortic sinus. In the absence of rupture, the clinical presentation of these aneurysms results from valvular insufficiency or compression of the left coronary artery or of the conduction system.
Aortic Aneurysm↗
Systolic collapse of an ascending aortic graft: an angiographic sign of perigraft hematoma communicating with the left ventricle.
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Adult↗