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Biomedical subjects

I R Gray

Publications and source records attributed to I R Gray.

15 recordsLinked to original sources
PubMed1991

Rational approaches to the treatment of culture-negative infective endocarditis.

The microorganism responsible for infective endocarditis may not be grown on blood culture in as many as 25% of cases. While this is to be expected with such relatively uncommon organisms as Coxiella burnetti, in most cases failure to grow the organism is likely to be due to either a low concentration of bacteria in the blood or because antibiotics were given before blood was taken for culture. The antibiotic treatment of culture-negative cases should be based on the assumption that the organisms responsible are the same as those found in cases with positive cultures, covering the most likely possibilities in such different circumstances as spontaneous infections of natural valves, endocarditis following cardiac surgery, early and late prosthetic valve endocarditis and infections associated with intravenous drug abuse.

Anti-Bacterial Agents↗
PubMed1985

Recurring cardiac myxoma.

Of a series of 14 patients surviving operation for atrial myxoma, two developed signs of recurrence of the tumour. In both cases the patients underwent two further separate operations for recurrent lesions. The time before the second recurrence was nearly 11 years and four and a half years. In neither case did histological examination show malignant change. These two cases of recurrent atrial myxoma, together with four other reported cases, indicate that a second recurrence may occur in about 25% of patients with a first recurrence. Multiple foci of tumour growth is probably the explanation for recurrence in most cases.

Adult↗
PubMed1976

Significance of angina pectoris in aortic valve stenosis.

Of 60 patients aged 45 to 66 years with aortic valve stenosis, 28 (47 per cent) had angina pectoris. Significant coronary arterial obstruction was shown by selective coronary cineangiography in 14 of them. Systolic pressure gradients across the aortic valve were lower in patients with angina than in those without. In those with angina, systolic gradients were higher in those with normal coronary arteriograms than in those with demonstrable coronary arterial disease. Aortic valve replacement relieved the angina in all patients who had normal coronary arteriograms. When valve replacement was combined with coronary bypass grafting in those with coronary arterial disease, surgical mortality was higher and symptomatic relief less predictable. Incapacitating angina in patients with aortic stenosis was nearly always associated with significant coronary disease. In those with less severe angina it was impossible to predict the state of the coronary arteries. Two patients, who did not have angina and who did not undergo coronary arteriography, died after aortic valve replacement and were found at necropsy to have unsuspected severe coronary disease. We, therefore, suggest that coronary arteriography should be carried out in all patients over the age of 40 years in whom surgery is being considered for aortic stenosis.

Adult↗
PubMed1975

The choice of antibiotic for treating infective endocarditis.

The bacteriological spectrum of infective endocarditis is very different when the disease occurs spontaneously from when it follows shortly after cardiac surgery or is associated with narcotic abuse or haemodialysis. It is therefore suggested that two categories of the illness, naturally occurring and extraneous, are recognized. The great majority of cases of naturally occurring infective endocarditis are caused by organisms highly sensitive to penicillin. Oral therapy is nearly always effective in such cases and amoxycillin given with probenecid is recommended as the regime of choice. Extraneous infective endocarditis is most often caused by staphylococci, with Gram-negative bacilli and fungi also quite frequent infecting agents. Intravenous and oral therapy with a variety of antibiotics is discussed in the management of this group.

Adolescent↗