The definition of the heterogeneous group of coagulase-negative staphylococci (CoNS) is still based on diagnostic procedures that fulfill the clinical need to differentiate between Staphylococcus aureus and those staphylococci classified historically as being less or nonpathogenic. Due to patient- and procedure-related changes, CoNS now represent one of the major nosocomial pathogens, with S. epidermidis and S. haemolyticus being the most significant species. They account substantially for foreign body-related infections and infections in preterm newborns. While S. saprophyticus has been associated with acute urethritis, S. lugdunensis has a unique status, in some aspects resembling S. aureus in causing infectious endocarditis. In addition to CoNS found as food-associated saprophytes, many other CoNS species colonize the skin and mucous membranes of humans and animals and are less frequently involved in clinically manifested infections. This blurred gradation in terms of pathogenicity is reflected by species- and strain-specific virulence factors and the development of different host-defending strategies. Clearly, CoNS possess fewer virulence properties than S. aureus, with a respectively different disease spectrum. In this regard, host susceptibility is much more important. Therapeutically, CoNS are challenging due to the large proportion of methicillin-resistant strains and increasing numbers of isolates with less susceptibility to glycopeptides.

Coagulase-Negative Staphylococci

https://www.mc.vanderbilt.edu/root/sbworddocs/res_edu_thoracic/congenital10_25.pdf

Patent foramen ovale: current pathology, pathophysiology, and clinical status.

Echocardiographic assessment of commissural calcium: a simple predictor of outcome after percutaneous mitral balloon valvotomy.

To the Editor:\n\nPlatypnea-orthodeoxia is a relatively uncommon but striking clinical syndrome characterized by dyspnea and deoxygenation accompanying a change to a sitting or standing from a recumbent position. Since Burchell et al1 described this rare syndrome over half a century ago, no more than 50 cases have been reported in the literature.2\n\nTwo conditions must coexist to cause platypnea-orthodeoxia: an anatomical component in the form of an interatrial communication and a functional component that produces a deformity in the atrial septum and results in a redirection of shunt flow with the …

Mechanisms of Platypnea-Orthodeoxia: What Causes Water to Flow Uphill? Response

Recently, debate has erupted about the clinical significance of cardiovascular shunts. Several major health problems such as stroke and migraine have been associated with patent foramen ovale (PFO) with right-to-left shunt (RLS). The nature of the relationship between these syndromes and PFO is not clearly understood. Technical advances have led to more therapeutic options including device closure of PFO, hence prevention of such a PFO-related stroke has become feasible. Therefore, optimal diagnosis of PFO has become of greater clinical importance. Contrast echocardiography with non-transpulmonary contrast agents has been the cornerstone in diagnosis of PFO with RLS for over four decades. Despite being a relatively invasive procedure, transesophageal echocardiography (TEE) is considered the gold standard for detection of RLS. Several other echocardiographic techniques such as transthoracic echocardiography (TTE) with second harmonic imaging and transcranial Doppler ultrasonography (TCD) have shown increased sensitivity and specificity compared to TEE for the detection of PFO with RLS. Moreover, improvement of skills and techniques used for detection of these shunts has led to greater detection of small and large sized RLS in the echocardiographic laboratory. This review gives and overview of the echocardiographic techniques, contrast agents and manoeuvres used for detection of the major cardiovascular shunts and their clinical relevance to major health problems.

/pdf/the-use-of-contrast-echocardiography-for-the-detection-of-47qarvn6xc.pdf

The use of contrast echocardiography for the detection of cardiac shunts

Mitral balloon valvulotomy (MBV) has proved to be an effective method in the treatment of patients with mitral stenosis. Although several factors determining an optimal immediate result have been described, there is little information regarding long-term follow-up, as well as factors influencing late success after MBV. This study analyzes 350 patients (mean age 46 +/- 12 years) treated by MBV who were clinically followed up between 6 months and 6 years. At least 1 echo-Doppler follow-up study was obtained in 298 patients 28 +/- 14 months after MBV; hemodynamic reevaluations were performed in 66 patients after 23 +/- months. Late success was considered if the patient was in functional class I to II and free of major events (death, restenosis and valve surgery). Restenosis was defined as a 50% loss of initial gain with regard to valve area by echocardiography, which was confirmed hemodynamically. After a mean follow-up of 38 +/- 15 months, 296 patients (84%) remained in functional class I to II, without surgery or the need for an increase in medical treatment. The 5-year Kaplan-Meier survival rate was 94 +/- 1%, whereas restenosis, valve surgery and major event-free probability were 90 +/- 3%, 91 +/- 2% and 85 +/- 2%, respectively. Multivariate study (Cox regression model) identified the presence of sinus rhythm (p < 0.001) and the absence of calcium at fluoroscopy (p < 0.003) as the only independent factors of late success.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors determining late success after mitral balloon valvulotomy

A 67-year-old woman admitted to the hospital with syncope was found to have platypnea-orthodeoxia caused by a dilated aortic root. A transesophageal echocardiogram was taken in the supine and sitting positions (Figure). The images taken in the supine position showed the foramen ovale was …

Platypnea-Orthodeoxia due to Aortic Elongation

Immediate and follow-up results of transluminal balloon dilation for discrete subaortic stenosis

Background. Percutaneous occlusion of secundum type atrial septal defect with an Amplatzer device is an effective treatment alternative. However, there is little information about the use of this treatment for large defects. Patients and method. We retrospectively analyzed the initial and follow-up findings in 31 patients aged 41 ± 18 years who had large atrial septal defects (≥ 30 mm diameter). Mean defect diameter evaluated by the balloon occlusion method was 33.4 ± 3.4 mm (range, 30-40 mm). In all patients we attempted the implantation of an Amplatzer septal occluder. Results. The implant was successful in 23 patients (74%); 3 of whom had a double orifice. The size of the device was 34 ± 3 mm diameter (range, 30-38 mm). Combined associated procedures were balloon pulmonary valvuloplasty in 3 patients and coronary stent implantation in 1. In 4 out of 8 patients where we failed, the implant was attempted but the device was unstable so we decided to retrieve it; in the remaining 4 patients, balloon measurement alone contraindicated the procedure. All patients did well, but one had cardiac tamponade during the procedure that was resolved in the catheterization laboratory. After 15 ± 12 months of follow-up all 31 patients were alive and those who had functional limitation before treatment remained stable, with significant clinical improvement. Conclusions. Percutaneous device occlusion of large atrial septal defects is feasible and effective in most patients.

José Ramón Ortega

Papers

Mechanisms of Platypnea-Orthodeoxia: What Causes Water to Flow Uphill? Response

Factors determining late success after mitral balloon valvulotomy

Platypnea-Orthodeoxia due to Aortic Elongation

Immediate and follow-up results of transluminal balloon dilation for discrete subaortic stenosis

Cierre percutáneo de comunicaciones interauriculares grandes