Background: Coagulase negative Staphylococci (CoNS) positive blood cultures represent a complex and common challenge in clinical medicine. CoNS are common in skin flora and are often mistaken as contamination. Convers...Background: Coagulase negative Staphylococci (CoNS) positive blood cultures represent a complex and common challenge in clinical medicine. CoNS are common in skin flora and are often mistaken as contamination. Conversely, CoNS can also be implicated in severe and life-threatening bacteremia requiring prompt treatment. A gray area in terms of treatment approach exists for health care providers. The primary aim of this study was to examine predictive factors in patients who have positive CoNS blood cultures that met the CDC case definition of a laboratory confirmed bloodstream infection (LCBI-II) that were subsequently found to have clinically significant true bacteremia. Methods: A retrospective cohort of 288 patients that had at least two separate blood cultures positive for a coagulase negative Staphylococci between November 1st, 2017, and November 1st, 2018, were examined to determine if there were any patient specific factors that would indicate a true bacteremia with CoNS. Results: Retrospective regression analysis demonstrated that those subjected to antibiotics for two days or more (OR = 3.01), those subjected to antibiotics for seven days or more (OR = 2.86), and patients with central access (OR = 4.06) were more likely to have a true infection. Although not statistically significant, an association was also found in immunosuppressed patients (OR = 1.65), and in patients with implanted hardware (OR = 1.16). Conclusion: Patients receiving antibiotics for greater than two days and patients with a central line were more likely to have a true bloodstream infection with coagulase negative Staphylococci.展开更多
This article begins with three problems of ＂dual loyalties＂ in medicine, the supposed fact that military physicians are, as medical officers, sometimes required to do what violates ordinary medical ethics--for examp...This article begins with three problems of ＂dual loyalties＂ in medicine, the supposed fact that military physicians are, as medical officers, sometimes required to do what violates ordinary medical ethics--for example, ignore medical need in order to treat their own wounded before civilians or wounded enemy, help make chemical or biological weapons more deadly, or assist at a rough interrogation. These problems are analyzed as special cases of a problem that could arise in any profession, a problem easily resolved using a theory of professional ethics （more or less） absent from medical ethics until now though common outside. Employing a physician--rather than an ordinary officer, some other kind of healer, or scientist--is to enter a sort of ＂Ulysses contract＂ requiring the physician＇s professional standards to preempt obligations otherwise applying to an employee. In this way, the article also illustrates the benefits that might accrue to medical ethics from drawing （more than is now common） on other fields of practical ethics.展开更多
Sotatol is a nonselective β sympathetic antagonist with additional class Ⅲantiarrhythmic drug activity.In this study,we reported intravenous sotalol inthe suppression of inducible sustained ventricular techycardia g...Sotatol is a nonselective β sympathetic antagonist with additional class Ⅲantiarrhythmic drug activity.In this study,we reported intravenous sotalol inthe suppression of inducible sustained ventricular techycardia guided byelectrophysiologic study and its alectrophysiologic effects.Patients withdocumented sustained ventricular tachycardia or had been resuscitated fromhaemodynamically unstable VT or VF were considered eligible forelectrophysiologic study.Only 21 patients who had sustained ventriculartachycardia induced by programmed ventricular stimulation receivedintravenous sotalol 1.5mg/kg within 15-20 mins after termination oftachycardia.16 patients has coronary artery disease and 5 had dilatedcardiomyopathy.The mean induced VT cycle length was 276±54ms.Repeatprogrammed ventricular stimulation was then performed.Of 21 patients,9(43%)had their sustained ventricular arrhythmia non-inducible and 11 hadtheir VT still inducible.Among the 11 patients who were inducible VT,5was difficult for induction and mean VT cycle length was prolongedsignificantly by sotalol compared with baseline.Sotalol prolonged markedlyright ventricular effective refractory periods(RVERP),sinus cycle length,QT interval,atrial ventricular nodal and intraventricular conduction time.There were no significant differences of the electrophysiologic parametersbetween the group of patients in whom the arrhythmia were suppressed andthe group of patients in whom the arrhythmias were not suppressed.Conclusion Sotalol is an effective drug for the suppression of ventriculartachycardia as judged by programmed electrical stimulation.It prolongedsignificantly RVERP and inhibited cardiac conductive system.展开更多
Objectives To assess the preliminary clinical results of implantation of dual chamber pacemaker defibrillator and to evaluate the safety and effectiveness of placement of endocardial leads in the axillary vein. Meth...Objectives To assess the preliminary clinical results of implantation of dual chamber pacemaker defibrillator and to evaluate the safety and effectiveness of placement of endocardial leads in the axillary vein. Methods Seven patients with ventricular tachycardia and/or ventricular fibrillation (VT/VF), associated with bradyarrhythmia received implantation of a dual chamber pacemaker defibrillator, including 5 patients with coronary artery disease and 2 patients with dilated cardiomyopathy.The atrial and ventricular leads were introduced via the axillary vein under venographic guidance. Results Dual chamber pacemaker defibrillators were successfully implanted in the left chest subcutaneous pocket in 5 patients and the left pectoral muscular pocket in 2 patients. All the VT/VF occurring either inducibly during the procedure or spontanuously during follow-up were detected promptly and treated successfully. Both the pacing and sensing functions were satisfactory. The endocardial leads required were successfully introduced via the axillary vein without major complications.Conclusion Dual chamber pacemaker defibrillators can provide reliable therapy for VT/VF and the dual chamber pacing function. Placement of endocardial leads via the axillary vein under venographic guidance is safe and effective.展开更多
文摘Background: Coagulase negative Staphylococci (CoNS) positive blood cultures represent a complex and common challenge in clinical medicine. CoNS are common in skin flora and are often mistaken as contamination. Conversely, CoNS can also be implicated in severe and life-threatening bacteremia requiring prompt treatment. A gray area in terms of treatment approach exists for health care providers. The primary aim of this study was to examine predictive factors in patients who have positive CoNS blood cultures that met the CDC case definition of a laboratory confirmed bloodstream infection (LCBI-II) that were subsequently found to have clinically significant true bacteremia. Methods: A retrospective cohort of 288 patients that had at least two separate blood cultures positive for a coagulase negative Staphylococci between November 1st, 2017, and November 1st, 2018, were examined to determine if there were any patient specific factors that would indicate a true bacteremia with CoNS. Results: Retrospective regression analysis demonstrated that those subjected to antibiotics for two days or more (OR = 3.01), those subjected to antibiotics for seven days or more (OR = 2.86), and patients with central access (OR = 4.06) were more likely to have a true infection. Although not statistically significant, an association was also found in immunosuppressed patients (OR = 1.65), and in patients with implanted hardware (OR = 1.16). Conclusion: Patients receiving antibiotics for greater than two days and patients with a central line were more likely to have a true bloodstream infection with coagulase negative Staphylococci.
文摘This article begins with three problems of ＂dual loyalties＂ in medicine, the supposed fact that military physicians are, as medical officers, sometimes required to do what violates ordinary medical ethics--for example, ignore medical need in order to treat their own wounded before civilians or wounded enemy, help make chemical or biological weapons more deadly, or assist at a rough interrogation. These problems are analyzed as special cases of a problem that could arise in any profession, a problem easily resolved using a theory of professional ethics （more or less） absent from medical ethics until now though common outside. Employing a physician--rather than an ordinary officer, some other kind of healer, or scientist--is to enter a sort of ＂Ulysses contract＂ requiring the physician＇s professional standards to preempt obligations otherwise applying to an employee. In this way, the article also illustrates the benefits that might accrue to medical ethics from drawing （more than is now common） on other fields of practical ethics.
文摘Sotatol is a nonselective β sympathetic antagonist with additional class Ⅲantiarrhythmic drug activity.In this study,we reported intravenous sotalol inthe suppression of inducible sustained ventricular techycardia guided byelectrophysiologic study and its alectrophysiologic effects.Patients withdocumented sustained ventricular tachycardia or had been resuscitated fromhaemodynamically unstable VT or VF were considered eligible forelectrophysiologic study.Only 21 patients who had sustained ventriculartachycardia induced by programmed ventricular stimulation receivedintravenous sotalol 1.5mg/kg within 15-20 mins after termination oftachycardia.16 patients has coronary artery disease and 5 had dilatedcardiomyopathy.The mean induced VT cycle length was 276±54ms.Repeatprogrammed ventricular stimulation was then performed.Of 21 patients,9(43%)had their sustained ventricular arrhythmia non-inducible and 11 hadtheir VT still inducible.Among the 11 patients who were inducible VT,5was difficult for induction and mean VT cycle length was prolongedsignificantly by sotalol compared with baseline.Sotalol prolonged markedlyright ventricular effective refractory periods(RVERP),sinus cycle length,QT interval,atrial ventricular nodal and intraventricular conduction time.There were no significant differences of the electrophysiologic parametersbetween the group of patients in whom the arrhythmia were suppressed andthe group of patients in whom the arrhythmias were not suppressed.Conclusion Sotalol is an effective drug for the suppression of ventriculartachycardia as judged by programmed electrical stimulation.It prolongedsignificantly RVERP and inhibited cardiac conductive system.
文摘Objectives To assess the preliminary clinical results of implantation of dual chamber pacemaker defibrillator and to evaluate the safety and effectiveness of placement of endocardial leads in the axillary vein. Methods Seven patients with ventricular tachycardia and/or ventricular fibrillation (VT/VF), associated with bradyarrhythmia received implantation of a dual chamber pacemaker defibrillator, including 5 patients with coronary artery disease and 2 patients with dilated cardiomyopathy.The atrial and ventricular leads were introduced via the axillary vein under venographic guidance. Results Dual chamber pacemaker defibrillators were successfully implanted in the left chest subcutaneous pocket in 5 patients and the left pectoral muscular pocket in 2 patients. All the VT/VF occurring either inducibly during the procedure or spontanuously during follow-up were detected promptly and treated successfully. Both the pacing and sensing functions were satisfactory. The endocardial leads required were successfully introduced via the axillary vein without major complications.Conclusion Dual chamber pacemaker defibrillators can provide reliable therapy for VT/VF and the dual chamber pacing function. Placement of endocardial leads via the axillary vein under venographic guidance is safe and effective.
