Treatment of end-stage cardiac failure with growth hormone.
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Cachexia↗
Biomedical subjects
R I Larbalestier
Publications and source records attributed to R I Larbalestier.
Tracheal mucormycosis.
Pulmonary mucormycosis is a recognized entity occurring in diabetics and immunocompromised patients. It has a poor prognosis unless early diagnosis is made and appropriate surgical therapy instituted along with appropriate antifungal therapy. We describe here one of few cases of tracheal involvement by mucormycosis. Extensive destruction of the trachea and bibasal pneumonia led to the patient's death.
Aged↗
Optimal approach to the mitral valve: dissection of the interatrial groove.
Surgical exposure of the mitral valve has challenged surgeons for more than 30 years. Many ingenious, but often complex approaches have been devised during this time. Using the dissection of the interatrial groove to bring the left atrial incision more anterior and medial, we have achieved excellent exposure in more than 300 mitral valve procedures. This simple technique does not lengthen the procedure and is not associated with an increased risk of either early or late morbidity.
Boston↗
Acute bacterial endocarditis. Optimizing surgical results.
BACKGROUND: Acute bacterial endocarditis continues to be a condition with high morbidity. Although the majority of patients are treated by high-dose antibiotics, a high-risk patient group requires surgical intervention, which is the subject of this article. METHODS AND RESULTS: From 1972 to 1991, 3,820 patients underwent heart valve replacement at the Brigham and Women's Hospital, Boston. Of this group, 158 patients underwent surgery for acute bacterial endocarditis: 109 had native valve endocarditis (NVE), and 49 had prosthetic valve endocarditis (PVE). There were 108 men and 50 women with a mean age of 49 years (range, 16-79 years); 64% were New York Heart Association functional class IV before surgery, and 12% of the group had a history of intravenous drug abuse. In both NVE and PVE groups, Streptococcus was the predominant infecting agent. Uncontrolled sepsis, progressive congestive failure, peripheral emboli, and echocardiographically demonstrated vegetations were the most common indications for surgery. Eighty-five percent of patients had a single-valve procedure, 15% had a multivalve procedure, and 34 patients had other associated major cardiac procedures. The operative mortality was 6% in NVE and 22% in PVE. Long-term survival at 10 years was 66% for NVE and 29% for PVE. Freedom from recurrent endocarditis at 10 years was 85% for NVE and 82% for PVE. The main factors associated with decreased survival overall were PVE and nonstreptococcal infection. CONCLUSIONS: The morbidity and mortality after surgical treatment of acute endocarditis depend on the site, the severity, and the subject infected. Early aggressive surgical intervention is indicated to optimize surgical results, especially in patients with nonstreptococcal infection or PVE.
Aortic Valve↗