Biomedical subjects
Publications and source records attributed to M Sheahan.
Clostridium difficile-associated pseudomembranous colitis (PMC) is a common affliction of postoperative patients. Risk factors include antibiotic therapy, recent surgery, and hospitalization (1,2,3). We present a case of PMC in a diverted colon and its treatment using vancomycin enemas.
Two-dimensional contrast echocardiography has been shown to enable the evaluation of myocardial perfusion abnormalities. However, its ability to quantify a regional myocardial mass is limited. The goal of this study was to examine the quantitative value of 3-dimensional echocardiography (3DE) in the estimation of myocardial mass at risk, salvaged mass, and residual infarct mass after intravenous injection of contrast. We created acute coronary occlusion, followed by reperfusion in 10 dogs. Three-dimensional echocardiographic data were acquired at the end of each stage, and the perfusion defect mass and dysfunctional mass were measured. The true mass at risk and infarct mass were determined by anatomic methods. The anatomic mass at risk (x) (27.1+/-14.6 g or 23.8%+/-9.7% of the left ventricle [%LV]) correlated well with the 3DE-determined perfusion defect mass (y) during coronary occlusion (y = 0.5x+8.9; r = 0.90; P<.001; mean difference -4.8+/-8.1 g; or y = 0.7x + 6.5; r = 0.83, P<.01; mean difference -0.1+/-5.4 %LV). Good correlation was also found between the anatomic infarct mass (x) (9.3+/-8.1 g or 9.1+/-8.8 %LV) and the 3DE perfusion defect mass after reperfusion (y) (y = 1.2x+1.2; r = 0.93; P<.001; mean difference 2.3+/-4.0 g; or y = 1. 3x, r = 0.98, P <.0001; mean difference 2.7+/-3.7 %LV). The salvaged mass was 13.6 +/-11.0 %LV from anatomic methods and 14.2+/-13.0 %LV by 3DE. To conclude, with the use of intravenous contrast, 3DE could quantify the actual mass at risk during acute ischemia, and in the setting of reperfusion, the residual infarct mass and salvaged mass.
Echocardiographic evaluation for the recognition of intravascular and left atrial appendage thrombus remains a difficult problem. A thrombus-specific ultrasonographic contrast agent has the potential for an alternative approach for their delineation. The aim of this study was to investigate the usefulness of thrombus-specific contrast agent MRX-408A1 for the detection of acute experimentally created intravascular and intracardiac thrombus. In the first study, we created inferior vena cava thrombus in 9 dogs. With the use of fundamental 2-dimensional echocardiography imaging, we recorded images of the inferior vena cava thrombus at baseline (n = 9), with the thrombus-specific contrast agent MRX-408A1 (n = 9), and with nonspecific contrast agent MRX-113 (n = 6). In the second study, we created a left atrial appendage thrombus in 8 dogs. We imaged left atrial appendage thrombus at baseline and during MRX-113 and MRX-408A1 infusion. Thrombus was successfully created in all dogs in study 1 and in 6 of 8 dogs in study 2. MRX-408A1 produced a visually apparent increase in ultrasonographic contrast enhancement of the thrombus in all cases in which thrombus was found on autopsy. In both studies, MRX-408A1 increased the videointensity of the thrombus significantly compared with baseline images and images obtained during MRX-113 infusion. The size of the visually detectable thrombus on the image was also significantly larger during MRX-408A1 infusion than at baseline and during MRX-113 infusion. These data provide in vivo demonstration of the efficacy of a thrombus-specific contrast agent, MRX-408A1, in the detection of acute intravascular and intracardiac thrombus. It has the potential to improve the diagnostic accuracy of ultrasonography for the detection of acute thrombi at various cardiovascular sites in the clinical setting.
The Australian Council on Healthcare Standards (ACHS) Evaluation and Quality Improvement Program (EQuIP) calls on healthcare organizations to increase their focus on patients by using leadership to coordinate, and continuous improvement to guide, care delivery. At a large acute care private facility in Melbourne, a program has been developed to create a 'care partnership', characterized by shared decision making, collaboration and conciliation. This program enhances patient care through the coordination of three strategies, a patient communication strategy, an evaluation strategy and a quality improvement strategy. The program has resulted in patient guided reforms such as redesign of a patient information booklet, a hospital-wide discharge planning improvement initiative and a hospital-wide strategy to improve pain management. Through the creation of a care partnership, this program helps an acute care hospital focus its services and processes on one of its key customer groups, patients.
Malabsorption of fermentable material in a variety of foods was assessed by measurement of breath H2 excretion. Breath H2 increased well above that observed in fasting subjects after ingestion of 100 g of carbohydrate in oats, whole wheat, potatoes, corn, and baked beans. Rice caused only a minimal increase in H2 excretion and hamburger was associated with no increase. We estimated the malabsorption of fermentable material by comparing the H2 excretion for 9 h after ingestion of various complex carbohydrates with that after 10 g of lactulose. The mean malabsorption of fermented material after 100-g carbohydrate meals was 20 g for baked beans; 7-10 g for wheat, oats, potatoes, and corn; and 0.9 g for rice. Whole oats or whole wheat resulted in 2-5 times more H2 than did the refined flours. As purified fiber appeared to be a poor substrate for H2 production by fecal homogenates, we conclude that most complex carbohydrates, with the exception of rice, contain a good deal of fermentable material that escapes small bowel absorption and it seems likely that this fermentable material is malabsorbed starch.
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One hundred healthy women were examined prospectively during their annual physical examination for any of the preliminary criteria of systemic lupus erythematosus (SLE). No patient had more than three of the criteria; 50 (50%) had none. The preliminary criteria were effective in excluding normal patients. Three of 19 patients taking oral contraceptives had serum antinuclear antibody (ANA), whereas only one of 81 non-pill users had serum ANA (P less than .05). None of these patients with positive ANA had clinical evidence of SLE.
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Since the initial report of the murine monoclonal antibody OKT3 for acute kidney rejection, a significant body of information has been collected regarding the efficacy of OKT3 in reversing acute allograft rejections in kidney, liver, and heart transplant recipients. The use of OKT3 therapy for the reversal of cardiac allograft rejection in patients in whom other therapeutic alternatives have failed or are contraindicated is described. Treatment with OKT3 reversed acute heart rejection in 102 of 113 patients (90%). Complete reversal was achieved in 63 patients, and partial reversal in 39 patients. At 2 years, graft and patient survival rate was 77% and 65%, respectively. No significant differences were noted in reversal rate and in 12-month graft and patient survival rates between those patients experiencing one rejection episode and those patients experiencing two or more rejection episodes. Comparable reversal rates and graft and patient survival rates were achieved in patients whether OKT3 was administered as the primary rejection therapy or as rescue therapy. Adverse events were common in the first 2 days of therapy, but they were well tolerated in most patients. Infectious complications occurred in 49% of patients in whom most infections were not serious. On the basis of this experience, OKT3 appears highly effective in reversing acute cardiac allograft rejection.