[HSF] Tricuspid vegetation
Tea Acuff
tacuff at swbell.net
Mon Dec 21 17:12:14 EST 2009
What is melidosis? An alcohol resistant. fungus? A black pigmented bacterium? Oedema of the vocal cords?
Tea
Sent from my iPhone
On Dec 21, 2009, at 2:32 PM, Bidstrup Ben <benjamin.bidstrup at bigpond.com> wrote:
Who are you calling sensitive?
BTW, look at when they were using it? Oz is one country where meliodosis causes major issues. An unusual organism.
On 22/12/2009, at 12:31 AM, Tea Acuff wrote:
Well, I don't really believe much anything from much anywhere, but is it good fun to poke at you sensitive blokes down under.
Tea
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On Dec 20, 2009, at 11:38 PM, Bidstrup Ben <benjamin.bidstrup at bigpond.com> wrote:
What is wrong with Darwin? It has some of the best barramundi fishing in the world. Ask David Stump.
On 21/12/2009, at 3:09 PM, Tea Acuff wrote:
Would you believe anything from Darwin?
Tea
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On Dec 20, 2009, at 11:58 AM, Prasanna Simha M <prasannasimha at gmail.com> wrote:
May have a role in septic shock though its use in ARDS +Pneumonia has been
equivocal.
An audit of the use of granulocyte colony-stimulating factor in septic shock
D. P. Stephens , D. A. Fisher and B. J. Currie
Royal Darwin Hospital, Tiwi, Northern Territory, Australia
Correspondence to Dianne P. Stephens, Director of Intensive Care, Royal
Darwin Hospital, Rocklands Drive,Tiwi, Northern Territory 0810, Australia.
Email: dianne.stephens at nt.gov.au
Copyright 2002 Royal Australasian College of Physicians
KEYWORDS
Burkholderia pseudomallei * granulocytecolony-stimulating factor *
melioidosis * mortality * septic shock
ABSTRACT
Abstract
Background: Granulocyte colony-stimulating factor (G-CSF) stimulates the
production of neutrophils and modulates the function and activity of
developing and mature neutrophils. In septic shock, the immune system can be
considered one of the failing organ systems.G-CSF improves immune function
and may be a useful adjunctive therapy in patients with septic shock.
Aim: To evaluate the introduction of G-CSF as an adjunct to our standard
treatment for community-acquired septic shock.
Methods: We performed a prospective data collection and analysis to
determine whether the addition of G-CSF to our standard treatment for
community-acquired septic shock was associated with improved hospital
outcome, compared with an historical cohort ofsimilar patients. We included
all patients admitted to the Intensive Care Unit (ICU) with
community-acquired septic shock between December 1998 and March 2000.
Patients received 300 µg G-CSF intravenously daily for 10 days in addition
to ourstandard treatment for community-acquired septic shock. G-CSF was
discontinued early if the patient was discharged from ICU before10 days or
if the absolute neutrophil count exceeded 75 × 106/mL.
Results: A total of 36 patients with community-acquired septic shock, an
average Apache 2 score of 26.7, and a predictedmortality of 0.79, were
treated with G-CSF from December 1998 to March 2000. Hospital mortality was
31% compared with an historical cohort of 11 similar patients with a
hospital mortality of 73% (P = 0.018). In the subgroup of patients with
melioidosis septic shock, the hospital survival improved from 5% to
100% (P < 0.0001).No
significant adverse events occurred as a result of the administration of
G-CSF.
Conclusion: G-CSF is a safe adjunctive therapy in community-acquired septic
shock and may be associated with improved outcome. The use of G-CSF in
septic shock should undergo further investigation to define subgroups of
patients who may benefit from G-CSF. The use of G-CSF in patients with
septic shock due to Burkholderia pseudomallei is recommended. (Intern Med J
2002; 32: 143-148)
On Sun, Dec 20, 2009 at 11:08 PM, Prasanna Simha M
<prasannasimha at gmail.com>wrote:
Actually Ani , there is some evidence of its use in fungal endocarditis
where it has been of some use as an adjunct to therapy.
There is also evidence that in addition to just increasing there numbers
they also increase phagocytic capacity .
Patient is now resistanct to Vancoycin and the only drug which he is
sensitive is Linezolide to which he was clinically nonresponsive.
I have done surgical excision . You made the statement
"I think one needs a surgical or other solution (as you performed) - no
amount of white cells likely to change that"
can you tell me what you had in mind wrt to "Other solution".
I have done as radical an excision as I thought possible In fact annular
excision went to the AV junction. Luckily I did not have to CABG the RCA.
Prasanna
On Sun, Dec 20, 2009 at 10:53 PM, Ani Anyanwu <anianyanwu at hotmail.com>wrote:
In view of
multidrug resistance I gave him a shot of filgrastim (Granulocyte colony
stimulating factor) which has increased his counts now. I think Marc
Levinson has experience of using this.
I am unconvinced thus far as to using granulocyte stimulation as solution
to surgical infection. After Dr Levinson mentioned it I asked him for some
data or rationale to justify the practice and got no response. I also did
extensive literature search and spoke to a few specialists and also found no
support for the practice. Personally my bet is this is one of many
witchcrafts we practice as surgeons - we all have our beliefs and do strange
things that no one else does which we swear by - that will come to pass and
never get into mainstream practice. Who knows though maybe data will emerge
and it will be shown to be effective.
When you say multiresistant what do you mean? Is it pan resistant to
everything or is it actuallly sensitive to linezolid and vancomycin? If it
is sensitive to those drugs and you are getting no response, .
Ani
Date: Sun, 20 Dec 2009 22:17:51 +0530
From: prasannasimha at gmail.com
To: OpenHeart-L at lists.hsforum.com
CC:
Subject: [HSF] Tricuspid vegetation
30 year old man (HIV negative and not a drug addict or any other
addictions
for that matter) has had large tricuspid vegetations (Multidrug
resistant
MRSA on culture , )not responding to antibioitics and spiking despite
argement but no evidene of pyelonephritis and urine culture negative. No
obvious source identifiable.on Linezolide + Vancomycin + Rifampicin +
Cotrimoxazole (as per antibiogram).CT showed normal spleen and USG +Ct
showed mild right renal enl Emergency tricuspid valve excision done.
Vegetation was on Anterior leaflet and posterior leaflet and there was a
"sodden" septal leaflet requiring excision of the whole valve and also
required excision of 1/3rd of the annulus due to annular extension.I
repalced the tricuspid with an autopericardial valve with no prosthetic
ring
to decrease foreighn material load. I had placed him on prophylactic
vasopressin during CPB and as expected he became mildly vasoplegic but
managed with thepremptive vasopressin. He is off Vasopressin and In view
of
multidrug resistance I gave him a shot of filgrastim (Granulocyte colony
stimulating factor) which has increased his counts now. I think Marc
Levinson has experience of using this. I would like to know from members
who
have used this how long it needs to be used. I am thinking of using
pegelated filgrastim (pegfilgastrim) as it would be cheaper and acts
longer
if needed.
So far cultures have shown MRSA in all leaflets and vegetation
(including
the excised septal leaflet) and I am waiting for histopath. No evidence
of
fungus (If it was positive there is some literature that Filgrastim
helps
as a part of therapy).Any suggestions or advice
Prasanna
--
Prasanna Simha M
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