Disappointment, not burnout.
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Burnout, Professional↗
Biomedical subjects
Robert Lichtenberg
Publications and source records attributed to Robert Lichtenberg.
Noninfectious constrictive pericarditis in a heart transplant recipient.
Acute rejection, infection, and allograft coronary artery disease have been recognized as the major causes of postoperative morbidity and mortality in cardiac transplant patients. More recently, pericardial and mediastinal complications have been recognized as a more common complication than previously believed. We describe a case of a heart transplant recipient admitted for apparent congestive heart failure exacerbation who was unresponsive to standard medical management of congestive heart failure and rejection. After further invasive evaluation, it was discovered the patient's condition was attributable to posttransplantation constrictive pericarditis. It is appropriate to consider this diagnosis in any postcardiac surgery (especially heart transplant recipients) in patients presenting with congestive heart failure exacerbations refractory to usual medical management.
Cardiac Catheterization↗
Ejection fraction: subjective visual echocardiographic estimation versus radionuclide angiography.
OBJECTIVES: The aim of this study was to validate the correlation of left ventricular ejection fraction (LVEF) between two-dimensional (2D) echocardiography with harmonic imaging modality and radionuclide angiography (RNA) in a large number of patients. BACKGROUND: Subjective visual estimation of LVEF is the most prevalent method in evaluating left ventricular systolic function. Previous published reports demonstrated that visual estimation from 2D was superior to other mathematical calculations, however the studies contained less than 50 patients. METHODS: Retrospective review of 377 consecutive medical records containing LVEF from both 2D echocardiography and RNA obtained from the same patient within 15 days from January 1998 to September 1999. RESULTS: Correlation coefficient value (r) between 2D echocardiography subjective visual estimation and RNA was 0.84. The r value was further increased to 0.87 when heart transplant recipients excluded. The agreement of LVEF between 2D echocardiography and RNA are higher in normal or severely depressed LV. CONCLUSION: Excellent correlation of LVEF exists between 2D echocardiography subjective visual estimation and RNA, especially in normal or severely depressed LV.
Echocardiography↗
A new angle on the Angle of Louis.
Previous literature has stated that the center of the right atrium lies approximately 5 cm below the sternal angle regardless of body position. Our objective was to measure the distance from the Angle of Louis to various locations in the right atrium and determine whether these distances vary with patients' body habitus. The authors conducted a cross-sectional study with 52 consecutive patients who underwent computed tomography. The Angle of Louis was measured to various right atrial anatomic locations and was correlated with patients' body habitus characteristics. There was a positive correlation between patients' weight or body mass index and the distance of the Angle of Louis to right atrial locations. Therefore, using the traditional 5 cm in an obese patient can and usually will result in an underestimation of right atrial pressure. The authors suggest that in patients with body mass index > 35 kg/m2 (body surface area > 2.5 m2), a jugular venous column height at the clavicle is likely to indicate significantly elevated jugular venous pressure and should be considered abnormal. Therefore, further clinical assessment and subsequent therapeutic decisions of these morbidly obese patients with abnormal jugular venous pressures should be made accordingly.
Adult↗