Biomedical subjects
Publications and source records attributed to A Jagetia.
Clostridial endocarditis is rare. We describe, to our knowledge, the first case of Clostridium innocuum endocarditis. The fatal case involved the tricuspid and pulmonary valves and was associated with multiple pulmonary emboli. We review the literature, which suggests the varied presentations and outcomes of clostridial endocarditis. Penicillin is the treatment of choice for this disease.
BACKGROUND AND OBJECTIVES: In order to reduce the surgical stress on the heart, anesthesiologists frequently use regional anesthesia in patients with coronary artery disease. METHODS: Two patients underwent reconstructive peripheral vascular surgery under continuous epidural anesthesia with bupivacaine. During the surgery and later in the recovery room, they received continuous electrocardiographic (ECG), invasive arterial blood pressure, and oxyhemoglobin saturation monitoring. RESULTS: In both patients, the anesthetic course during surgery was uneventful, but while recovering from the anesthesia, they developed ECG changes consistent with myocardial ischemia, followed by malignant dysrhythmias and cardiac arrest. The clinical pictures, ECGs, coronary angiogram, and (in one patient) autopsy findings suggested coronary artery spasm as the cause of the malignant dysrhythmias and cardiac arrests. CONCLUSIONS: It is possible that the coronary spasms were caused by an altered balance between sympathetic and parasympathetic nervous activity during recovery from epidural anesthesia. Therefore, patients with coronary artery disease must be closely monitored for signs and symptoms of myocardial ischemia during the entire recovery period from epidural anesthesia.
BACKGROUND: Volvulus of the sigmoid colon is associated with high mortality and high recurrence rate following nonoperative decompression of the colon. Therefore definitive surgery is required for its management. AIM: To evaluate the outcome following sigmoidopexy (tube sigmoidostomy) as a definitive surgical procedure to prevent recurrence of disease. METHODS: Seventeen patients with sigmoid volvulus who presented with features of large gut obstruction were studied; 12 patients underwent elective and 5 underwent emergent exploratory laparotomy. Malecot catheter fixed to the sigmoid colon and abdominal wall acted as fixator for the colon and rent for drainage of fecal matter. RESULTS: Sigmoidostomy started functioning the day following surgery and the stoma remained patent for approximately 12 days, although discharge started decreasing by the 5th postoperative day. No recurrence was noted over a period of 18 (5) months (range 13-23). CONCLUSIONS: Tube sigmoidostomy is an alternative effective procedure to prevent recurrence of sigmoid volvulus in patients who present without gangrene.