Biomedical subjects
Publications and source records attributed to M T Foster.
The diagnosis of cystic adventitial degeneration (CAD) is difficult. We present the first case in which intravascular ultrasound (IVUS) correctly identified CAD of the popliteal artery when duplex sonography and angiography were inconclusive.
Despite improvements in catheter-based revascularization outcomes, coronary interventionalists face difficult challenges in the treatment of the thrombus-laden coronary lesion. In this report, we describe the use of the Acolysis device, which utilizes high-frequency (41.9 kHz) ultrasonic energy to vibrate a small metal tip at the end of a 4.5 Fr catheter to treat two thrombotically occluded saphenous vein grafts in two patients. In both cases, the Acolysis device provided normalization of flow with angiographically evident dissolution of thrombus and excellent acute angiographic and clinical results. We conclude that in these two selected cases the Acolysis device was used safely and effectively for thrombus debulking as an adjunct to stenting in diseased saphenous vein bypass grafts.
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Slow or no reflow is a serious problem complicating catheter-based revascularization of degenerated saphenous vein bypass grafts. We examined the efficacy of rapidly delivered, high-velocity injections of intracoronary adenosine to reverse 11 slow-flow events complicating stenting of diseased bypass grafts. Ten of 11 events were rapidly improved to TIMI 3 flow by this technique within 3.8+/-1.6 min of the initial adenosine injection. In an ex vivo model, 3-ml syringes created higher peak pressures and velocities than 10- and 20-ml syringes. We conclude that rapid and repeated high-velocity intragraft administration of adenosine is a promising new approach to promptly reverse no-reflow events complicating PTCA and stenting of diseased saphenous vein grafts. Ex vivo studies demonstrate a potentially important mechanical advantage with the use of small syringes for injection. Further randomized studies will be required to better define the mechanism(s) and efficacy of this approach for treating no reflow, including its use in native vessels.
This study describes the detailed histopathologic appearance of human coronary arteries at 3 weeks, and 3 and 7 months after stent implantation in a cardiac transplant recipient. There was modest arterial injury associated with stent implantation, and immunocytochemistry staining provided evidence that a proliferative response from the adventitia contributes to neointimal hyperplasia.
Antiarrhythmic drugs remain the first line of therapy in patients with sustained ventricular arrhythmias. Although success with class Ia antiarrhythmic medications has been limited, there is evidence that the addition of a class Ib agent may improve results. A total of 110 consecutive patients referred for electrophysiologic evaluation who had inducible sustained ventricular arrhythmias resistant to a class Ia agent underwent repeat electrophysiologic study after the addition of a class Ib drug. Patients with ejection fraction >40% and ventricular fibrillation inducible in the baseline study had an 80% response rate, whereas those with inducible ventricular tachycardia and ejection fraction < or = 40% responded 11% of the time. Responders demonstrated marked prolongation of ventricular refractoriness and slight shortening of the QRS, whereas nonresponders had QRS prolongation and a more modest increase in ventricular refractoriness. Thus, the efficacy of class Ia/Ib combination therapy in patients with inducible sustained ventricular arrhythmias refractory to a class Ia drugs alone can be predicted by baseline variables. Marked prolongation of ventricular refractoriness in the absence of QRS prolongation appears to be a key factor in the success of this combination.
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Ceftriaxone is generally recognized as safe and effective when used as a single drug in the therapy of septicemia and other serious infections involving bacteremia in both adults and children. An advantage of ceftriaxone over other third-generation cephalosporins is its long serum half-life, which allows the drug to be given every 12 hours in children or less frequently in adults.
A comprehensive drug-use review (DUR) program based on established criteria for use of each drug is described. The DUR program was developed to promote cost-effective drug therapy and satisfy Joint Commission on Accreditation of Hospitals standards for drug-use evaluation. Antibiotic and ambulatory-care drug-use subcommittees composed of physicians, pharmacists, nurses, and clinical laboratory personnel were formed as advisory groups to the pharmacy and therapeutics (P&T) committee. The subcommittees review overall drug-use patterns in their respective areas monthly and investigate the use of specific problem drugs. Drug-use reviews have been facilitated by the implementation of a mandatory antibiotic order form and pharmacy computer systems. Nonformulary drug use is monitored. The procedure for adding drugs to the formulary was modified to require the submission of specific criteria for appropriate drug use; when a drug is added to the formulary, the criteria for use are also adopted. The program has been successful in curtailing inappropriate drug use, reducing drug expenditures, and integrating P&T committee decisions into daily pharmacy practice. The implementation of this DUR program has enabled the P&T committee to conduct ongoing, systematic, criteria-based drug-use evaluations.
We have reported a case of lymph node botryomycosis caused by Serratia marcescens, which has not been listed previously as an etiologic agent.
Periprosthetic infections due to Mycobacterium fortuitum and Mycobacterium chelonei occurred in 17 women over a 3.5-year period after implantation of prostheses for breast augmentation. The median incubation period for 16 of the women was 28 days (range, one week to over two years) after surgery; etiologic diagnosis was usually delayed for weeks to months. Odorless and serosanguineous or purulent material was found when the implants were removed, and acid-fast bacilli were often present when smears were examined. Wound infections were chronic and refractory to therapy with various antimicrobial agents. Persistent or recurrent mycobacterial infections complicated attempts to implant new prostheses. Whereas M. fortuitum isolates were susceptible to amikacin, multiple strains of M. fortuitum were distinguished by conventional antituberculous and broth microdilution susceptibility tests. Several clusters of infections were temporally and geographically related; however, sporadic cases were also reported, and no evidence of a contaminated common product or other single source of infection was found.
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The relation of infection with Neisseria gonorrhoeae to the blood groups A, B, AB, and O was examined in 584 women attending a prenatal clinic. The occurrence of gonorrhea was significantly higher in black patients with blood group B than in those with blood groups A, AB, or O.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.