losartan-potassium and Endocarditis--Bacterial

Blood-sparing surgical technique and perioperative medical management allows complex surgery in Jehovah's Witnesses. The authors review four cases of urgent cardiothoracic surgery performed on Jehovah's Witnesses. No lasting sequelae associated with either bleeding or end-organ ischemia were noted. Cardiopulmonary bypass management, meticulous hemostatic operative technique, and pharmacologic support of hemostasis and erythropoiesis permit this complex surgery.

Topics: Adult; Aged; Anti-Bacterial Agents; Aortic Aneurysm; Aortic Dissection; Aprotinin; Blood Transfusion, Autologous; Blood Vessel Prosthesis Implantation; Cardiac Surgical Procedures; Cardiac Tamponade; Combined Modality Therapy; Comorbidity; Endocarditis, Bacterial; Erythropoietin; Female; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Hematocrit; Hemodilution; Humans; Iron; Jehovah's Witnesses; Male; Patient Acceptance of Health Care; Preoperative Care; Streptococcal Infections; Treatment Refusal; Viridans Streptococci

Topics: Adult; Aged; Anemia; Blood Transfusion; Bone Marrow Transplantation; Cardiac Surgical Procedures; Endocarditis, Bacterial; Erythropoietin; Extracorporeal Circulation; Heart Valve Diseases; Humans; Middle Aged; Postoperative Complications

The authors present results of using recombinant human erythropoietin in patients operated on the heart under conditions of extracorporeal blood circulation. It was found that the intravenous infusions of erythropoietin at the postoperative period accelerated the restitution of circulating erythron indices. The volume of transfusion of the donor erythrocyte-containing media to the patient is given erythropoietin was reliably less than that in the control group. The results obtained allow using erythropoietin to be recommended as an effective method of prophylactics and treatment of anemia in cardiosurgical patients.

Topics: Adult; Anemia; Cardiac Surgical Procedures; Endocarditis, Bacterial; Erythropoietin; Extracorporeal Circulation; Female; Heart Defects, Congenital; Humans; Hypothermia, Induced; Male; Postoperative Care; Postoperative Complications; Recombinant Proteins; Rheumatic Heart Disease

In 2007, several international studies brought useful information for the daily work of internists in hospital settings. This summary is of course subjective but reflects the interests and questions of the chief residents of the Department of internal medicine who wrote this article like an original trip in medical literature. This trip will allow you to review some aspects of important fields such as heart failure, diabetes, endocarditis, COPD, and quality of care. Besides the growing diversity of the fields covered by internal medicine, these various topics underline also the uncertainty internists have to face in a practice directed towards evidence.

Topics: Accidental Falls; Aged; Albuterol; Anemia; Anticoagulants; Antidiuretic Hormone Receptor Antagonists; Atrial Fibrillation; Attitude of Health Personnel; Benzazepines; Bronchitis, Chronic; Bronchodilator Agents; Cardiac Pacing, Artificial; Diabetes Mellitus; Endocarditis, Bacterial; Erythropoietin; Heart Failure; Heparin; Humans; Internal Medicine; Interprofessional Relations; Medical Staff, Hospital; Myocardial Infarction; Recombinant Proteins; Risk Management; Rosiglitazone; Salmeterol Xinafoate; Thiazolidinediones; Thromboembolism; Tolvaptan; Vasodilator Agents; Ventricular Dysfunction, Left; Workload

Jehovah's Witness who require operation represent a challenge to the physician because of the patients' refusal to accept blood transfusion. We report an 8-year-old male of Jehovah's Witness who underwent a surgical treatment of infective endocarditis. He was transferred to our hospital because of high fever and heart murmur. Echocardiogram revealed a developing vegetation of aortic cusps and an aneurysmal change of the non-coronary sinus Valsalva. On admission he was complicated by anemia, purulent meningitis and suppurative arthritis of left knee. There were no signs of cardiac failure. Erythropoietin (6000 U thrice weekly) and iron (60 mg daily) were given for 11 weeks prior to surgery, raising the hemoglobin level from 9.2 g/dl to 18.4 g/dl. Aortic valve replacement and plasty of the sinus Valsalva were then performed. Intraoperatively hemoglobin concentration dropped to 10.3 g/dl and it raised to 15 g/dl postoperatively. We also used Cell-Saver to reduce blood loss. The patient made an uncomplicated recovery. Erythropoietin therapy contributed substantially to the successful outcome of this case.

Topics: Aortic Aneurysm; Aortic Valve Insufficiency; Cardiac Surgical Procedures; Child; Christianity; Endocarditis, Bacterial; Erythropoietin; Heart Valve Prosthesis Implantation; Humans; Male; Sinus of Valsalva