Impact of echocardiography on the management of patients with mitral valve prolapse

OBJECTIVE: To determine whether echocardiography affects the decisions to use beta blockers or to recommend bacterial endocarditis prophylaxis in patients suspected of having mitral valve prolapse (MVP). DESIGN: Retrospective review of echocardiograms and clinical records. SETTING: Military tertiary care hospital. PATIENTS: 127 patients with clinically suspected MVP (105) or incidentally discovered MVP (22). MAIN RESULTS: Beta blockers were used more often in patients with suspected MVP and positive echocardiograms (45%) than in patients with normal echocardiograms (13%, p less than 0.001). Bacterial endocarditis prophylaxis was recommended more often in patients with suspected MVP and positive echocardiograms (65%) than in patients with normal echocardiograms (11%, p less than 0.001). Presence or absence of a murmur did not influence the decision to recommend bacterial endocarditis prophylaxis. Patients in whom MVP was incidentally discovered were unlikely to receive either beta blockers or the recommendation for bacterial endocarditis prophylaxis. CONCLUSIONS: The results of echocardiography affect the decisions to use beta blockers or to recommend bacterial endocarditis prophylaxis in patients with suspected MVP.     

Isolated polyarteritis nodosa affecting the cecum

Summary We report the case of a 52-year-old white male who developed low back pain and 35-pound weight loss and whose barium enema revealed a constricting lesion of the cecum. After resection, polyarteritis was found to be the cause of the lesion. There was no other histological evidence for arteritis in this patient.The opinions expressed herein are those of the authors and not necessarily those of the Department of Defense, U.S. Air Force, or the Uniformed Services University of the Health Sciences.Figures are published with permission from the Armed Forces Institute of Pathology.     

Comparison of cleansing methods in preparation for colonic surgery

Golytely, an oral gut lavage solution, was compared with a standard bowel cleansing preparation in patients undergoing elective colonic surgery. Sixty patients were randomly assigned to either a one-day preparation with Golytely and bisacodyl or a standard method using a three-day clear liquid diet, cathartics, and enemas. Colon cleansing was better with Golytely (100 percent optimal cleansing vs. 64 percent, P less than 0.05). Patients receiving Golytely had less weight loss and found this preparation more tolerable. Quantitative stool cultures before and after preparation and intraoperatively were not significantly different between the two preparations. In this surgical bowel preparation study, Golytely and Bisacodyl were found to be safe, rapid, and effective. The preparation was well tolerated by patients and has become our preferred method of colonic cleansing.     

Surgical management of bleeding stomal varices

A retrospective chart review of nine patients with stomal varices and portal hypertension who required surgical management of bleeding varices from 1978 to 1986 was performed. The patient's mean age at stoma formation was 46 years (range, 36 to 70 years). Three were female, six were male, and all were Caucasian. Three patients had colostomies and six had ileostomies. Indications for creation of the ostomies included inflammatory bowel disease in six patients and carcinoma in three patients. The time from creation of the stoma to the first bleed was 11 to 196 months (mean, 82 months). The average time between this bleed and surgical treatment was six months. The operative procedures performed included nine mucocutaneous disconnections (MCD) in seven patients (one for recurrent bleeding) and two stoma relocations (one for recurrence). MCD is simple, quick, and associated with a lower morbidity and intraoperative blood loss than stomal relocation. Post-operative follow-up has ranged from 4 months to 4.6 years (mean, 2.5 years). During this period there were two episodes of recurrent varices that required surgery. In the select group of patients that cannot be managed conservatively, MCD is favored and relocation considered only if MCD is technically impossible. Read at the meeting of the American Society of Colon and Rectal Surgeons, Washington, D.C., April 5 to 10, 1987. The opinions expressed are those of the authors and do not reflect the opinions of the United States Air Force or the Department of Defense.     

Crohn''s Disease of the Appendix Presenting as Lower Intestinal Hemorrhage and Cecal Mass

A rare case of Crohn's disease confined to the appendix and presenting with bright rectal bleeding is documented.     

Mycobacterium marinum arthritis

Mycobacterium marinum is an atypical acid-fast organism that is rarelyassociated with septic arthritis. Most often this is seen in patients with monarticular synovitis of the hands or wrists, especially in association with a history of periarticular trauma or exposure to marine environments. From tissue obtained by aspiration or synovectomy, Mycobacterium marinum can be identified by Ziehl-Nielson stain and has optimal growth in Lowenstein-Jenson medium. Therapy should consist of at least two anti mycobacterial agents for a minimum 6 months. Surgical debridement also may be beneficial. The clinician must have a high index of suspicion that exposure to Mycobacterium marinum has occurred so appropriate stains and cultures can be obtained and antimycobacterial therapy initiated.