Steven A. Goldstein, MD, Co-Chair, Arturo Evangelista, MD, FESC, Co-Chair, Suhny Abbara, MD, Andrew Arai, MD, Federico M. Asch, MD, FASE, Luigi P. Badano, MD, PhD, FESC, Michael A. Bolen, MD, Heidi M. Connolly, MD, Hug Cu ellar-Cal abria, MD, Martin Czerny, MD, Richard B. Devereux, MD, Raimund A. Erbel, MD, FASE, FESC, Rossella Fattori, MD, Eric M. Isselbacher, MD, Joseph M. Lindsay, MD, Marti McCulloch, MBA, RDCS, FASE, Hector I. Michelena, MD, FASE, Christoph A. Nienaber, MD, FESC, Jae K. Oh, MD, FASE, Mauro Pepi, MD, FESC, Allen J. Taylor, MD, Jonathan W. Weinsaft, MD, Jose Luis Zamorano, MD, FESC, FASE, Contributing Editors: Harry Dietz, MD, Kim Eagle, MD, John Elefteriades, MD, Guillaume Jondeau, MD, PhD, FESC, Herv e Rousseau, MD, PhD, and Marc Schepens, MD, Washington, District of Columbia; Barcelona and Madrid, Spain; Dallas and Houston, Texas; Bethesda and Baltimore, Maryland; Padua, Pesaro, and Milan, Italy; Cleveland, Ohio; Rochester, Minnesota; Zurich, Switzerland; New York, New York; Essen and Rostock, Germany; Boston, Massachusetts; Ann Arbor, Michigan; New Haven, Connecticut; Paris and Toulouse, France; and Brugge, Belgium

https://www.anmco.it/uploads/u_cms/media/2015/3/ba5b5c8a69e9f498ed500621c8ac3d39.pdf

Multimodality imaging of diseases of the thoracic aorta in adults: From the American society of echocardiography and the european association of cardiovascular imaging: Endorsed by the society of cardiovascular computed tomography and society for cardiovascular magnetic resonance

More than a century ago, Osler took numerous syndrome descriptions of cardiac valvular infection that were incomplete and confusing and categorized them into the cardiovascular infections known as infective endocarditis. Because he was both a clinician and a pathologist, he was able to provide a meaningful outline of this complex disease. Technical advances have allowed us to better subcategorize infective endocarditis on the basis of microbiological etiology. More recently, the syndromes of infective endocarditis and endarteritis have been expanded to include infections involving a variety of cardiovascular prostheses and devices that are used to replace or assist damaged or dysfunctional tissues (Table 1). Taken together, infections of these novel intracardiac, arterial, and venous devices are frequently seen in medical centers throughout the developed world. In response, the American Heart Association’s Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease wrote this review to assist and educate clinicians who care for an increasing number of patients with nonvalvular cardiovascular device–related infections. Because timely guidelines1,2 exist that address the prevention and management of intravascular catheter–related infections, these device-related infections are not discussed in the present Statement. 

View this table:

TABLE 1. Nonvalvular Cardiovascular Device–Related Infections 



This review is divided into two broad sections. The first section examines general principles for the evaluation and management of infection that apply to all nonvalvular cardiovascular devices. Despite the marked variability in composition, structure, function, and frequency of infection among the various types of nonvalvular cardiovascular devices reviewed in this article, there are several areas of commonality for infection of these devices. These include clinical manifestations, microbiology, pathogenesis, diagnosis, treatment, and prevention. The second section addresses each device and describes unique clinical features of infection. Each device is placed into one of 3 categories—intracardiac, arterial, or venous—for discussion.

### Clinical Manifestations

The specific signs and symptoms associated with an infection of a …

http://www.endocardites-aquitaine.fr/fileadmin/documents/documents/2003BADDOUR.pdf

Nonvalvular Cardiovascular Device–Related Infections

The origin of the present comment lies in a failed attempt to obtain, through e-mailed requests, data reported in 141 empirical articles recently published by the American Psychological Association (APA). Our original aim was to reanalyze these data sets to assess the robustness of the research findings to outliers. We never got that far. In June 2005, we contacted the corresponding author of every article that appeared in the last two 2004 issues of four major APA journals. Because their articles had been published in APA journals, we were certain that all of the authors had signed the APA Certification of Compliance With APA Ethical Principles, which includes the principle on sharing data for reanalysis. Unfortunately, 6 months later, after writing more than 400 e-mails--and sending some corresponding authors detailed descriptions of our study aims, approvals of our ethical committee, signed assurances not to share data with others, and even our full resumes-we ended up with a meager 38 positive reactions and the actual data sets from 64 studies (25.7% of the total number of 249 data sets). This means that 73% of the authors did not share their data.

The poor availability of psychological research data for reanalysis

### Background

The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax.

### Frequency

The frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin.1–9 For intracavitary grafts, the infection rate is ≈1% to 5%.1–6 Graft infection is most common after emergency procedures and after reoperation.1–4,10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction.11, …

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement from the American Heart Association

Hypothesis We hypothesized that increased enrollment of female medical students and different priorities of the current generation of students would be important influences on the declining interest in surgical careers. Design Students scored statements on surgical careers on 5-point Likert scales regarding agreement and whether these statements encouraged them to pursue a career in surgery. Data were analyzed using the Mann-Whitney U test. Qualitative comments were iteratively coded using a constant comparative method. Setting Nine US medical schools. Participants A Web-based survey on the Association for Surgical Education server was e-mailed to medical students. A total of 1300 of the 1365 respondents stated their sex. Main Outcome Measures The survey asked questions pertaining to surgical life, surgical residency, surgeons as influence, equity, family, and other influences. Results A total of 680 (52%) of the 1300 respondents were male. Men and women disagreed about whether surgeons lead well-balanced lives (68% and 77%, respectively) and saw this as a deterrent. A total of 35% of women (3% men; P P =.01 for men, P Conclusions The decision to have a family was a more significant influence for women than men, but family and lifestyle priorities were also important to male students, supporting our hypothesis that generation and gender are both important influences on career choices.

/pdf/influences-on-medical-student-career-choice-gender-or-c5isda2it8.pdf

Influences on medical student career choice: gender or generation?

Prosthetic graft infections are an uncommon complication of aortic bypass. These infections may have serious sequelae such as limb loss and can be lethal. They are hard to eradicate and, under certain circumstances, difficult to diagnose. Usually, computed tomography (CT) is the most efficacious imaging method for diagnosis of graft infections due to its quick availability. The sensitivity of magnetic resonance imaging in detection of perigraft infection has not been thoroughly investigated but is probably similar to that of CT. After the early postoperative period, persistent or expanding perigraft soft tissue, fluid, and gas are the CT findings of graft infection. Aortoenteric fistula should be considered a subset of aortic graft infection; however, perigraft air is more likely to be seen with an aortoenteric fistula. Other conditions associated with graft infection include pseudoaneurysm, hydronephrosis, and osteomyelitis. Adjunctive studies such as sinography, ultrasonography, gallium scanning, and labeled white blood cell scanning can be quite useful in diagnosis, determination of the extent of disease, and selection of the treatment modality. White blood cell scanning is an important complementary test to CT in ambiguous cases, such as in the early postoperative period, and may be more sensitive in detection of early graft infection.

Aortic prosthetic graft infections: radiologic manifestations and implications for management.

Background: Although women make up nearly half of medical school classes in the United States, just over 20% of residents in surgery are women (excluding obstetrics/gynecology). The objective of this study was to identify whether the proportion of women surgeons on the faculty who have frequent encounters with medical students during their surgery rotation influences the student’s perceptions about women surgeons or their career choice.

Methods: Seven US medical schools with proportions of women surgeons on the fulltime faculty varying from 10% to 40% were selected to participate in this survey. Women medical students graduating in the spring of 2000 were asked to complete an anonymous 29 question survey designed to assess their perceptions of women surgeons’ career satisfaction. Demographic information about the students such as career choice, age, and marital status was also collected. The differences in responses between those schools with 40% women faculty and those with less than 15% were analyzed.

Results: The overall response rate was 74% (305 of 413). Forty-five percent of students had daily or weekly contact with a woman surgery attending. There were no differences in perceptions of women surgeons’ career satisfaction for those students at schools with 40% women surgeons versus those with less than 15%. However, 21 of 24 (88%) students choosing surgery as a career were from the three schools with a greater number of women surgical role models (P <0.0001). Students who chose a career in surgery perceived the women faculty’s career satisfaction to be higher than did those students not choosing a surgical career (P <0.01).

Conclusions: Women medical students perception of women surgeons’ career satisfaction did not appear to be affected by the proportion of women surgeons on the faculty at their medical school. However, their choice of surgery as a career was strongly associated with a higher proportion of women on the surgical faculty.

Perceptions of women medical students and their influence on career choice.

Background: Although women make up nearly half of medical school classes in the United States, just over 20% of residents in surgery are women (excluding obstetrics/gynecology). The objective of this study was to identify whether the proportion of women surgeons on the faculty who have frequent encounters with medical students during their surgery rotation influences the student’s perceptions about women surgeons or their career choice. Methods: Seven US medical schools with proportions of women surgeons on the fulltime faculty varying from 10% to 40% were selected to participate in this survey. Women medical students graduating in the spring of 2000 were asked to complete an anonymous 29 question survey designed to assess their perceptions of women surgeons’ career satisfaction. Demographic information about the students such as career choice, age, and marital status was also collected. The differences in responses between those schools with 40% women faculty and those with less than 15% were analyzed. Results: The overall response rate was 74% (305 of 413). Forty-five percent of students had daily or weekly contact with a woman surgery attending. There were no differences in perceptions of women surgeons’ career satisfaction for those students at schools with 40% women surgeons versus those with less than 15%. However, 21 of 24 (88%) students choosing surgery as a career were from the three schools with a greater number of women surgical role models (P 0.0001). Students who chose a career in surgery perceived the women faculty’s career satisfaction to be higher than did those students not choosing a surgical career ( P 0.01). Conclusions: Women medical students perception of women surgeons’ career satisfaction did not appear to be affected by the proportion of women surgeons on the faculty at their medical school. However, their choice of surgery as a career was strongly associated with a higher proportion of women on the surgical faculty. © 2002 Excerpta Medica, Inc. All rights reserved.

Thomas Lynch

Papers

Aortic prosthetic graft infections: radiologic manifestations and implications for management.

Perceptions of women medical students and their influence on career choice.

Association for surgical education Perceptions of women medical students and their influence on career choice