Cardiac murmurs: echocardiography in the assessment of patients requiring antibiotic prophylaxis for dental treatment.

Background: Traditionally patients who indicate that they have a heart murmur or who indicate that they have had rheumatic fever are given antibiotic prophylaxis for dental treatment. This is commonly done without further assessment of the patient's actual endocarditis risk. Echocardiography is a non-invasive method of assessing cardiac valve function and haemodynamics.

Antibiotic prophylaxis for endocarditis: time to reconsider.

Some cardiac conditions require antibiotic prophylaxis for some types of dental treatment to reduce the risk of infective endocarditis (IE). All medical and dental practitioners are familiar with this practice but tend to use different regimens in apparently similar circumstances. Generally, the trend has been to prescribe antibiotics if in doubt.

Ongoing clinical trials of anti-platelet agents in the management of acute ischaemic coronary syndromes.

Acute ischaemic coronary syndromes, the clinical sequelae of thrombosis over a fissured atherosclerotic plaque within the coronary circulation, are the leading cause of death and hospitalisation in Western countries. Platelets are fundamental for the initiation and continuation of thrombosis, and currently available anti-platelet agents such as aspirin significantly improve the clinical outcome of patients with these syndromes. Therapeutic success with available therapy is however not universal, and adverse clinical event rates remain high.

Fibrinolysis for Acute Myocardial Infarction in the Elderly Patient: Is it Effective or Too Dangerous?

The incidence of myocardial infarction, and the subsequent mortality and morbidity increases markedly with age. Randomized placebo-contolled trials of fibrinolytic therapy have lacked adequate statistical power due to the relatively small numbers of older patients enrolled, but nevertheless have strongly suggested a mortality benefit in the older age group. Despite this, fibrinolytic therapy remains under-utilized in older patients, largely due to a perception that the risk, particularly of intracranial hemorrhage, outweighs any potential benefit of treatment.

Relationship between corrected TIMI frame counts at three weeks and late survival after myocardial infarction.

Objectives: To evaluate the corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (CTFC) as a predictor of late survival after myocardial infarction.

Background: Thrombolysis in Myocardial Infarction flow grades predict late survival after myocardial infarction. The CTFC provides a more reproducible measurement of infarct-related artery blood flow than the TIMI flow grade, and has been linked to 30-day outcomes, but it has not yet been established how the CTFC correlates with late survival.

ST-Segment recovery adds to the assessment of TIMI 2 and 3 flow in predicting infarct wall motion after thrombolytic therapy.

Background: Early resolution of ST-segment elevation (ST-segment recovery) is associated with an improved outcome after infarction. Whether this relation is present in patients with Thrombolysis In Myocardial Infarction (TIMI) grade 2 or 3 flow (ie, patent) infarct-related arteries is not known.

Methods And Results: To examine the associations between time to achieve stable 50% ST-segment recovery assessed by continuous ECG monitoring, infarct artery flow, and infarct zone wall motion (at 48 hours), we studied 134 patients who underwent angiography at 99 (interquartile range 92 to 110) minutes after commencing streptokinase, initiated within 12 hours of onset of symptoms of myocardial infarction.

Four-year survival of patients with acute coronary syndromes without ST-segment elevation and prognostic significance of 0.5-mm ST-segment depression.

We prospectively evaluated all patients admitted to our coronary care unit during 1993 with ischemic chest pain but without ST-segment elevation on the presenting electrocardiogram, and determined the influence of the extent of ST-segment depression, measured using calipers and blinded to the outcome, on 4-year survival. The presenting symptoms of 367 patients (mean age 64 years) were coded according to the Braunwald classification, 86% being in class IIIB (primary unstable angina with rest angina within 48 hours) and 7.4% in class IIIC (postinfarction angina).

Angiographic frame counts 90 minutes after streptokinase predict left ventricular function at 48 hours following myocardial infarction.

Objective: To assess whether the 90 minute corrected thrombolysis in myocardial infarction frame count (CTFC) in the infarct related artery predicts left ventricular function at 48 hours in patients with myocardial infarction treated with aspirin, streptokinase, and either heparin or Hirulog.

Design And Setting: Analysis of 251 patients with acute myocardial infarction enrolled in the international, multicentre Hirulog early reperfusion/occlusion (HERO-1) trial, who underwent both 90 minute coronary angiography and 48 hour left ventriculography.

Main Outcome Variables: The CTFC was determined in the infarct related artery 90 minutes after starting intravenous streptokinase (1.

Morphological classification of retinal ganglion cells in adult Xenopus laevis.

Retrograde transport of horseradish peroxidase (HRP) was used to characterise the soma and dendritic arborization of retinal ganglion cells in adult Xenopus laevis toad. HRP was administered to the cut end of the optic nerve and the morphological characteristics of HRP-filled ganglion cells were analysed in retinal wholemount preparations using computer assisted morphometry. Ganglion cells were classified according to their soma size, dendritic branching pattern, dendritic field and the number of shaft dendrites.