[Non-bacterial thrombotic endocarditis of the aortic valve in a young woman].

A 40-year-old woman without heart disease suffered two embolic episodes in both legs due to a thrombus of the aortic valve. Transesophageal echocardiography performed after the first episode was considered normal, but a second study performed after the second embolism demonstrated a thrombus in the non-coronary leaflet that failed to resolve with the intravenous administration of heparin for two weeks. Surgical excision of the mass revealed a thrombus on an otherwise healthy aortic valve.

Syncope in acute aortic dissection: diagnostic, prognostic, and clinical implications.

Background: Syncope is a well-recognized symptom of acute aortic dissection, often indicating the development of dangerous complications such as cardiac tamponade.

Subjects And Methods: We identified consecutive patients with acute aortic dissection at 18 referral centers in six countries. Data on key clinical findings and outcomes were collected via extensive questionnaires.

Possible involvement of hMLH1, p16(INK4a) and PTEN in the malignant transformation of endometriosis.

Endometriosis is a common gynecologic disease, which generally follows a benign course. Notwithstanding, several clinical and histologic studies as well as molecular data show that endometriosis could be a precursor of sporadic endometrioid and clear cell carcinomas at extrauterine loci. Several reports have implicated alterations of the hMLH1 and p16(ink4a) (p16) genes, in particular hypermethylation of the promoter region, and of the PTEN gene, principally genetic mutations, in endometrial and ovarian cancers and have indicated that these alterations are already present in precancer conditions.

Transesophageal echocardiography in the diagnosis of acute aortic syndrome.

In recent years, technological advances in echocardiography have led to improvements in the diagnosis of acute aortic disease. With transesophageal echocardiography (TEE) and, particularly, bi- and multiplane probes, the physiopathologic understanding of these diseases has widened. Thus, new entities such as penetrating ulcer and intramural hematoma have been described and differentiated from classical aortic dissection.

In vitro activity of levofloxacin against contemporary clinical isolates of Legionella pneumophila, Mycoplasma pneumoniae and Chlamydia pneumoniae from North America and Europe.

Objective: To assess the activities of levofloxacin and the comparator agents erythromycin, clarithromycin, azithromycin and doxycycline against atypical respiratory pathogens.

Methods: One hundred and forty-six Legionella pneumophila, 41 Mycoplasma pneumoniae and nine Chlamydia pneumoniae isolates were procured from various culture collections in North America and Europe and tested for susceptibility to the above agents by broth microdilution. The isolates came primarily from clinical sources and were collected from patients between 1995 and 1999.

Susceptibility to fluoroquinolones among commonly isolated Gram-negative bacilli in 2000: TRUST and TSN data for the United States. Tracking Resistance in the United States Today. The Surveillance Network.

From January to May 2000, as part of the Tracking Resistance in the United States Today (TRUST) surveillance initiative, clinical isolates of Enterobacteriaceae (n=2519) and non-fermentative Gram-negatives (n=580) were prospectively collected from 26 hospital laboratories across the United States. Isolates were tested for susceptibility to three fluoroquinolones (ciprofloxacin, levofloxacin, gatifloxacin) and seven other agents. In addition, data for the same period were collected from The Surveillance Network (TSN) Database-USA, an electronic surveillance network that receives data from more than 200 laboratories in the US.

Regional trends in antimicrobial resistance among clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the United States: results from the TRUST Surveillance Program, 1999-2000.

The ongoing TRUST (Tracking Resistance in the United States Today) study, which began monitoring antimicrobial resistance among respiratory pathogens in 1996, routinely tracks resistance at national and regional levels. The 1999-2000 TRUST study analyzed 9499 Streptococcus pneumoniae, 1934 Haemophilus influenzae, and 1108 Moraxella catarrhalis isolates that were prospectively collected from 239 laboratories across the 9 US Bureau of the Census regions. Penicillin-resistant S.

Prevalence of single mutations in topoisomerase type II genes among levofloxacin-susceptible clinical strains of Streptococcus pneumoniae isolated in the United States in 1992 to 1996 and 1999 to 2000.

Levofloxacin resistance in Streptococcus pneumoniae is rare, requiring at least two mutations in the quinolone resistance-determining region (QRDR) of topoisomerase IV and DNA gyrase. The prevalence of single QRDR mutations in these genes is unknown. Of 9,438 levofloxacin-susceptible pneumococci from the TRUST 4 surveillance study (1999-2000), 528 strains (MICs of 0.

Role of Doppler echocardiography in the assessment of portopulmonary hypertension in liver transplantation candidates.

Background: Portopulmonary hypertension is a severe complication of liver cirrhosis that carries a high risk for posttransplantation mortality. We aimed at evaluating the utility of Doppler echocardiography in screening for portopulmonary hypertension in liver transplantation candidates.

Methods: One hundred seven cirrhotic patients candidates for liver transplantation were studied by Doppler echocardiography and subsequently, by cardiac catheterization at transplantation.

[Endovascular treatment of aneurysms of the descending thoracic aorta--a new therapeutic perspective].

Endovascular treatment of aneurysmal disease of descending thoracic aorta and infra-renal abdominal aorta, has become an accepted technique, in selected cases due to the reduction of neurological morbidity, paraparesis or paraplegic and renal ischemia, associated with conventional surgery. The authors describe the first case performed in Portugal of a 75-year-old female with an expanding thoracic aneurysm managed by endovascular exclusion of the aneurysm with an EXCLUDER endoprosthesis, without any complications or evidence of endoleak, achieving complete exclusion of the aneurysm.

[Echocardiography in Spain. Survey of the Working Group of the Echocardiography and other Imaging Techniques of the Spanish Society of Cardiology].

Introduction And Objectives: Echocardiography has become the technique of choice in the diagnosis of most heart diseases, but results are considerably influenced by the experience of the echocardiographer and quality of the equipment. The Work Group of Spanish Echocardiography has conducted a survey to ascertain the activity and technical and human resources of echocardiography in Spain.

Methods: The survey was sent by mail to the 420 members of the Work Group and to the 120 echocardiographic laboratories of hospitals with more than 300 beds.

Strategy for optimal aortic regurgitation quantification by Doppler echocardiography: agreement among different methods.

Background: Although different Doppler methods have been validated for aortic regurgitation quantification, the benefit of combining information from different methods has not been defined.

Methods: Our study included 2 phases. In the initial phase (60 patients), Doppler parameters (jet width, short-axis jet area, apical jet area, regurgitant fraction from pulmonary and mitral flow, and deceleration slope) were correlated with angiography; range values for each severity grade were defined and intraobserver and interobserver and intermachine variability were studied.

[Guidelines of the Spanish Society of Cardiology on aortic diseases].

Acute aortic pathology is an urgent clinical situation, of which prognosis mainly related to prompt and accurate diagnosis as well as a quick treatment. In this paper we review the aortic pathology, specially focused on aortic dissection. We review its etiology, clinical presentation and diagnostic methods.

The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.

Context: Acute aortic dissection is a life-threatening medical emergency associated with high rates of morbidity and mortality. Data are limited regarding the effect of recent imaging and therapeutic advances on patient care and outcomes in this setting.

Objective: To assess the presentation, management, and outcomes of acute aortic dissection.

Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: implications for the diagnosis of cardiac tamponade.

Background: Clinical data are of unquestionable value for management purposes in cardiac tamponade, whereas the precise value of Doppler echocardiographic findings is not yet fully understood. We aimed to prospectively assess the correlation between clinical and Doppler echocardiographic signs in the diagnosis of cardiac tamponade in a large series of patients with pericardial effusion.

Methods: During a 2-year period, all patients with moderate and large pericardial effusion were prospectively assessed.

Aortic dissection: diagnosis and follow-up with helical CT.

Acute aortic dissection is a cardiovascular emergency that requires prompt diagnosis and treatment. Helical computed tomography (CT) allows diagnosis of acute aortic dissection with a sensitivity and specificity of nearly 100%. With helical CT, a dissection involving the ascending aorta (type A in the Stanford classification) can be differentiated from one distal to the left subclavian artery (type B).

[The first-choice technic for assessing myocardial viability. Stress echocardiography].

Myocardial viability can be studied by different techniques. Although PET is considered to be the technique of choice, both isotopes and stress echocardiography have demonstrated their usefulness in clinical practice. While the former has high sensitivity, the latter has better specificity.

Heart failure after aortic valve replacement for aortic regurgitation: prospective 20-year study.

Background: The objective of this study was to assess the probability of development of heart failure during a long-term follow-up in patients submitted for aortic valve replacement for aortic regurgitation on the basis of preoperative findings.

Methods And Results: Eighty-seven consecutive patients with pure aortic regurgitation and normal coronary arteries were submitted for aortic valve replacement and prospectively followed up. Clinical examination, echocardiography, and radionuclide ejection fraction were performed before surgery and at 1, 2, 5, and 10 years after surgery.

[Quantification of left-to-right shunt in atrial septal defect using oximetry, isotopes, and Doppler echocardiography. Is there a method of reference?].

Introduction: Determination of pulmonary to systemic blood flow ratio (QP/QS) is considered to be important for the management of patients with atrial septal defect. The QP/QS provides information on shunt severity and is usually determined by three methods: oximetry, first-pass radionuclide angiocardiography and Doppler echocardiography. The aim of the present study was to assess the accuracy and concordance level of these three methods in QP/QS quantification in atrial septal defects.