Gonococcal endocarditis.
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Biomedical subjects
Publications and source records attributed to J V Jurica.
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A mail survey of upper Midwest family practice and internal medicine residency program directors was performed to determine the prevalence and characteristics of exercise stress test training. Two mailings provided a 68% response rate for the 184 programs surveyed. Internal medicine programs were significantly more likely to offer exercise stress test training than family practice programs (57% vs 34%). Overall, an estimated 31% of family practice and internal medicine residency graduates are performing exercise stress tests in their practice. Programs provided an average of 7.3 hours of didactic instruction and 32.7 stress tests per resident. A minority (43%) had an established minimum number of exercise stress tests recommended for competency. Programs with and without exercise stress test training did not differ significantly with respect to age, size of program, or size of community. There were some interstate differences in the extent of exercise stress test training provided by family practice residency programs. Internal medicine programs were more likely to require a minimum number of treadmill tests. Otherwise there were few differences between family practice and internal medicine program instruction in exercise stress test training. Family practice program directors were more likely to believe that their residents should be taught this procedure and to include family physicians in their panel of instructors. Specific guidelines should be created to assure adequate stress test training for interested residents.
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Maternal Chlamydia trachomatis infections have been associated with premature rupture of the membranes, preterm labor, premature birth, and fetal wastage. Women with acute infection may be at particular risk. We report the case of an unexplained second trimester spontaneous abortion with serologic evidence of recent infection with C. trachomatis. Serum IgG antibody titer ultimately exceeded 1:10,240. This patient also had an incidental finding of appendiceal carcinoid tumor. While treatment of asymptomatic chlamydial infections in early pregnancy is controversial, we suggest that delaying treatment may result in fetal loss.
Despite the increasing incidence of gonococcal urethritis and cervicitis, endocarditis has become an infrequent consequence of infection with Neisseria gonorrhoeae. However, we recently had the opportunity to diagnose and treat a patient with this uncommon infection. He presented with febrile illness and a history of dysuria. After six days of incubation, cultures of blood yielded an isolate of N. gonorrhoeae. Treatment with penicillin plus streptomycin led to rapid resolution of the fever. Sequelae included left ventricular dilatation and aortic valve insufficiency. The latter was corrected by surgery. Our experience with this patient, as well as the 33 other cases reported in the literature since 1949, indicate that the diagnosis of gonococcal endocarditis should be suspected for any sexually active adult who presents with fever and a heart murmur.
Traditionally, screening for gestational diabetes mellitus (GDM) has been done only for those women with identifiable risk factors. To determine the value of screening all pregnant women, 363 consecutive patients were tested for GDM using a glucose challenge test (GCT). The test measured plasma glucose 1 hour after administration of a 50-gram oral glucose load. Those patients with a plasma glucose greater than 140 mg/dL were given a standard 3-hour glucose tolerance test (GTT) using 100 g of oral glucose. Patients with risk factors were compared with those without risk factors. There was no significant difference between the two groups for number of abnormal 3-hour GTTs. We conclude that in order to identify GDM, all pregnant patients must be screened. Universal screening was found to be simple and cost effective.
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