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Louis encephalitis virus Reservoir Bird Mammal Vector Mosquito (Culex pipiens impotence workup super cialis 80mg free shipping, Cx impotence vs erectile dysfunction super cialis 80 mg with visa. Typical Adult Therapy Supportive Typical Pediatric Therapy As for adult Headache erectile dysfunction diabetes qof order super cialis online from canada, meningitis erectile dysfunction protocol by jason purchase 80mg super cialis with amex, encephalitis, sore throat, myalgia, vomiting and photophobia; most cases Clinical Hints encountered during late summer; infection resolves in 5 to 10 days; case-fatality rate 8% (over 25% above age 65). Staphylococcus aureus exotoxins Reservoir Human (nares, hands) Occasionally cattle (udder) Vector None Vehicle Food (creams, gravies, sauces) Incubation Period 2h 4h (range 30 min 9h) Diagnostic Tests Identification of bacterium in food. Staphylococcus aureus phage group 2 A facultative gram-positive coccus Reservoir Human Vector None Vehicle Direct contact; infected secretions Incubation Period 1d 4d Typical clinical features; Recovery of S. Probably hours to few days Diagnostic Tests Culture of blood, tissue, body fluids Systemic antibiotic. Usually susceptible in vitro to Penicillin, Amoxicillin, Chloramphenicol and Typical Adult Therapy Gentamicin Typical Pediatric Therapy Systemic antibiotic Severe multisystem disease, hemorrhagic diatheses, deafness or meningitis appearing hours to a few Clinical Hints days after contact with pigs or pig products. Phasmidea: Strongyloides stercoralis (Strongyloides fulleborni is occasionally Agent implicated in systemic disease) Reservoir Human? Dog Monkey (for Strongyloides fulleborni) Vector None Vehicle Skin contact Soil Feces Autoinfection Sexual contact (rare) Incubation Period 14d 30d Diagnostic Tests Identification of larvae (or ova, for Strongyloides fulleborni) in stool or duodenal aspirate Ivermectin 200 micrograms/kg/d p. Anguilluliasis, Anguillulosis, Cochin China gastroenteritis, Diploscapter, Halicephalobus, Halicephalobus, Larva currens, Leptodera intestinals, Leptodera stercoralis, Micronema, Pseudo rhabdis stercoralis, Rhabditis stercoralis, Rhabdonema intestinale, Rhabdonema stercoralis, Synonyms Strongyloides fulleborni, Strongyloides stercoralis, Strongyloidose, Threadworm, Turbatrix. Generalized strongyloidiasis: 5 to 22% of patients develop a generalized or localized urticarial rash beginning in the anal region and extending to the buttocks, abdomen, and thighs. Strongyloidiasis Infectious Diseases of Haiti 2010 edition this disease is endemic or potentially endemic to all countries. Typical Adult Therapy Antimicrobial agent(s) directed at known or likely pathogen Typical Pediatric Therapy As for adult Fever, severe headache, vomiting, and signs of meningeal irritation and increased cerebrospinal fluid Clinical Hints pressure; may follow head trauma, meningitis, otitis or sinusitis; case-fatality rate 15% (alert) to 60% (comatose). Synonyms Clinical 1 Most patients present with headache, meningismus, decreased mental status and hemiparesis. Most commonly Staphylococcus aureus Reservoir Human Vector None Vehicle Endogenous Incubation Period Unknown Clinical features (local swelling and purulent discharge from salivary ducts). Typical Adult Therapy Surgical drainage and aggressive parenteral antistaphylococcal therapy Typical Pediatric Therapy As for adult Consider when confronted by unexplained fever in the setting of malnutrition, dehydration and Clinical Hints obtundation; local swelling and discharge of pus from salivary duct are diagnostic. Other Typical Adult Therapy stages: Repeat dosage at one and two weeks Alternatives: Tetracycline, Ceftriaxone Primary, secondary or early (< 1 year) latent: Benzathine Penicillin G : Weight <14 kg: 600,000u Typical Pediatric Therapy i. Other stages: Repeat dosage at one and two weeks Firm, painless chancre (primary syphilis); later fever, papulosquamous rash and multisystem Clinical Hints infection (secondary syphilis); late lesions of brain, aorta, bone or other organs (tertiary syphilis). Canton rash, Chinese ulcer, Christian disease, French disease, German sickness, Harde sjanker, Lues, Neopolitan itch, Polish sickness, Sifilide, Sifilis, Spanish pockes, Syfilis, Treponema pallidum. Congenital syphilis: An infant with a positive serology, whether or not the mother had a positive serology during pregnancy. The prevalence rate among pregnant women in developing countries varies between 3% and 19%. Maternal syphilis is associated with congenital syphilis (one third of births from such pregnancies), and with spontaneous abortion and stillbirth. Syphilis is a chronic disease with a waxing and waning course; and is reported from all countries. Primary syphilis is characterized by a painless chancre at the site of inoculation. Syphilis Infectious Diseases of Haiti 2010 edition 15 as posterior placoid chorioretinitis 143 cases of syphilitic uveitis were reported in the English Language literature during 16 1984 to 2008. Congenital infection is reminiscent of secondary syphilis, and may be associated with deformation of teeth, bones and other structures. Syphilis in Haiti Seroprevalence surveys: 3% to 6% of low risk urban dwellers (Port-au-Prince) in 1990; 6% to 8% in 1991. Bandwurmer [Taenia], Drepanidotaenia, Gordiid worm, Hair snake, Mesocestoides, Raillietina, Taenia longihamatus, Taenia saginata, Taenia solium, Taenia taeniaformis, Taeniarhynchiasis, Tapeworm Synonyms (pork or beef), Tenia. Clostridium tetani An anaerobic gram-positive bacillus Reservoir Animal feces Soil Vector None Vehicle Injury Incubation Period 6d 8d (range 1d 90d) Isolation of C. Metronidazole (2 g daily) or Penicillin G (24 million u daily) or Typical Adult Therapy Doxycycline (200 mg daily). Metronidazole (30 mg/kg daily); or Penicillin G (300,000 Typical Pediatric Therapy units/kilo daily). Therefore, recurrent tetanus is possible, unless the patient is given a series of toxoid following recovery. Generalized tetanus, the most common form, begins with trismus ("lockjaw") and risus sardonicus (increased tone in the orbicularis oris). Localized tetanus presents as rigidity of the muscles associated with the site of inoculation. Cephalic tetanus is a form of localized disease affecting the cranial nerve musculature. Facial nerve weakness, is often apparent, and extraocular muscle involvement is occasionally noted. Neonatal tetanus follows infection of the umbilical stump, most commonly as a result of a failure of aseptic technique following delivery of non-immune mothers. Musca and Fannia species) Vehicle None Incubation Period not known Diagnostic Tests Identification of parasite. Typical Adult Therapy Extraction of parasite Typical Pediatric Therapy As for adult Clinical Hints Conjunctivitis and lacrimation associated with the sensation of an ocular foreign body. Conjunctival spirurosis, Oriental eye worm, Rictularia, Thelazia californiensis, Thelazia callipaeda. Staphylococcus aureus, Streptococcus pyogenes, et al (toxins) Facultative gram Agent positive cocci Reservoir Human Vector None Vehicle Tampon (occasionally bandage, etc) which induces toxinosis Incubation Period Unknown Diagnostic Tests Isolation of toxigenic Staphylococcus aureus. Typical Adult Therapy the role of topical (eg, vaginal) and systemic antistaphylococcal antibiotics is unclear Typical Pediatric Therapy the role of topical (eg, vaginal) and systemic antistaphylococcal antibiotics is unclear Fever (>38. A confirmed case requires all six clinical findings (unless the patient dies before desquamation can occur). Phasmidea: Toxocara cati and canis Reservoir Cat Dog Mouse Vector None Vehicle Soil ingestion Incubation Period 1w 2y Diagnostic Tests Identification of larvae in tissue. Typical Pediatric Therapy As for adult Cough, myalgia, seizures, urticaria, hepatomegaly, pulmonary infiltrates or retrobulbar lesion; Clinical Hints marked eosinophilia often present; symptoms resolve after several weeks, but eosinophilia may persist for years. Overt disease is characterized by fever, cough, wheezing, eosinophilia, myalgia, tender hepatomegaly and abdominal pain. Sporozoa, Coccidea, Eimeriida: Toxoplasma gondii Reservoir Rodent Pig Cattle Sheep Chicken Bird Cat Marsupial (kangaroo) Vector None Vehicle Transplacental Meat ingestion Soil ingestion Water or milk (rare) Fly Incubation Period 1w 3w (range 5d 21d) Serology. Pyrimethamine 25 mg/d + Sulfonamides 100 mg/kg (max 6g)/d X 4w give with folinic acid. Spiramycin (in pregnancy) 4g/d X 4w Pyrimethamine 2 mg/kg/d X 3d, then 1 mg/kg/d + Sulfonamides 100 mg/kg/d X 4w give with Typical Pediatric Therapy folinic acid. Congenital toxoplasmosis: 3 4 the rate and severity of congenital toxoplasmosis are largely related to gestational age at the time of infection. Ocular toxoplasmosis: Ocular toxoplasmosis occurs from reactivation of cysts in the retina. Toxoplasmosis Infectious Diseases of Haiti 2010 edition nonfocal forms of encephalitis. Chlamydia trachomatis, type A Reservoir Human Vector Fly Vehicle Infected secretions Fly Fomite Incubation Period 5d 12d Diagnostic Tests Culture or direct immunofluorescence of secretions. Also administer Typical Adult Therapy topical Tetracycline Typical Pediatric Therapy Erythromycin 10 mg/kg p. Also administer topical Tetracycline Keratoconjunctivitis with palpebral scarring and pannus formation; 0. Trachoma may be differentiated from inclusion conjunctivitis by the presence of corneal scarring and a preference of the latter for the upper tarsal conjunctivae this disease is endemic or potentially endemic to all countries. Signs and symptoms: 1-3 During the first week of illness, the patient may diarrhea, abdominal pain and vomiting. Systemic symptoms usually peak 2 to 3 weeks after infection and then slowly subside; however, weakness may persist for weeks. Flagellate: Trichomonas vaginalis Reservoir Human Vector None Vehicle Sexual contact Incubation Period 4d 28d Microscopy of vaginal discharge.

The likelihood of misclassification has increased in recent years erectile dysfunction commercials buy discount super cialis 80 mg on-line, as physicians? auscultatory skills have become less proficient erectile dysfunction treatment muse order super cialis 80mg line. However impotence at 50 order super cialis no prescription, there are some cases in which the finding may help to confirm the diagnosis erectile dysfunction yahoo answers 80mg super cialis visa, and to reinforce in the minds of cases and their families the importance of adherence to a secondary prophylactic regimen (Table 27). Two reviewers independently assessed the trial quality and extracted the data of six included studies (1,707 patients). Two-weekly or three-weekly injections appeared to be more effective than four-weekly injections. However, the evidence was based on poor-quality trials and the use of outdated formulations of oral penicillin. The dose of Benzathine penicillin given will be based on the weight of the child, see below. Advice on the use of analgesia can be given to families if the injection site is causing pain later that day and/or the next day. Preparation of Benzathine penicillin & Lignocaine 2% To prepare the injection immediately prior to administration. Draw the correct dose (as charted) of Penicillin from the premixed syringe into a 3ml syringe. Give advice (to caregiver or adolescent) on the use of paracetamol at home if the child or young person is experiencing pain later that day or the following day. Registers are primarily for the efficient nurse coordinated delivery of free secondary prophylaxis using delegated authority by a registered medical practitioner to facilitate the process. In addition a minimum data set of epidemiological data enables measurement of the outcome of secondary and primary prevention programmes. Detailed clinical data is best sourced from electronic patient records now widely available in New Zealand. These attempts should include the use of multiple modalities for contact including telephone calls, visits, texting and the use of the local knowledge of community health workers Discuss with primary care nurse and refer to community health worker, public health nurse or other community staff as fitting in the area for follow up. Note this opportunity to involve staff from Maori and Pacific primary health providers, if appropriate Community health worker (or other community staff responsible) follows up patient (and family) to determine reason for non-adherence. Where necessary and appropriate, provides ongoing support, education and arrangers appointments for review at outpatient clinic as fitting in the area for follow up. Note this opportunity to involve staff from Maori and Pacific If adherence is no longer a If non-adherence continues, letter of problem, continue routine planning to discharge is copied to the secondary prophylaxis patient, patient file and all involved in the patient?s care (e. Gram positive cocci producing beta Penicillin (oral): Oral penicillin is known by its ingredient name; phenoxymethylpenicillin, but is more commonly called Penicillin V. Pharyngitis: Acute pharyngitis is an inflammatory syndrome of the pharynx caused by a variety of micro organisms. Most cases are of viral aetiology and occur as part of common colds and influenzal syndromes. The most important cause of bacterial pharyngitis is that due to group A beta haemolytic streptococci (Streptococcus pyogenes). World Health Organisation 97 We need your help to keep Kiwi hearts beating When you support the Heart Foundation you make a difference to the lives of thousands of New Zealanders. For every one of these people, many more are afected husbands, daughters, brothers, friends, me, you. Help us fight the disease that cuts short too many lives and too many stories before they?re told. Your donations are crucial to our ongoing work funding vital research, helping people make healthy living choices, and running community programmes that encourage Kiwi heart health. It explains which cancer tests and treatments are recommended by experts in esophageal cancer. The information in this patient book is based on the guidelines written for doctors. Patients, family and friends can better understand Esophageal Cancer this disease thanks to these comprehensive guidelines and resources to help move forward Awareness Association with treatment. These Guidelines illuminate complex issues as they help answer the important questions that can direct patients on a path to appropriate, life-saving care. People with esophageal cancer and those who this book includes treatment options for most support them?caregivers, family, and friends?may people. Your doctors may suggest other options based on your Starting with Part 1 may be helpful. Read Part 2 to learn about ask your treatment team about anything you don?t how esophageal cancer is staged. Feel free to ask your treatment team to explain a word or phrase that you don?t understand. This chapter goes over the basics of cancer and how it afects the the wall of the esophagus has four layers. The esophagus Squamous cell carcinoma is usually found in the esophagus is part of your digestive system. See Adenocarcinoma is usually found at the bottom Figure 1 for a picture of the esophagus in the body. Cancer starts on the inside and grows through the four layers of the esophagus wall. The three most important diferences between cancer cells and normal cells are: Normal cells grow and then divide to make new cells when needed. Cancer cells make new cells that aren?t needed and don?t die quickly when old or damaged. Cancer cells ignore the stop? signals too close to other and invade nearby from nearby cells and invade nearby tissues. Wife of cancer survivor Cancer cells form a tumor over time because they don?t die like normal cells. The stage of Esophageal tumors frst grow through the four layers a cancer is a snapshot of how far it has of the esophagus wall, and then into the rest of the grown. To describe how far through the esophagus decide which tests and treatments will wall the tumor has grown, a number from 1 to 4 (and help you most. Here are the tumor stages for esophageal cancer: this means that there are abnormal cells on the inside of the esophagus. The tumor hasn?t grown very far about your cancer in order to give it a stage: through the esophagus wall. They work as flters to help fght infection and to remove harmful things from Esophageal tumors frst grow through the 4 layers the body. It is important to know if cancer has of the esophagus wall, and then into the rest of the spread to any lymph nodes. To describe how far through the esophagus number from 0 to 3 to describe whether the wall the tumor has grown, a number from 1 to 4 cancer has reached any lymph nodes. If your doctors don?t know if any lymph nodes have cancer, an X is used instead of a number. T2 M = Metastasis T3 Cancer can spread to areas of the body far from where it started. To describe whether the cancer has T4b spread far (metastasized), either a 0 or a 1 is used. If your doctors don?t know if the cancer has spread, an X is used instead of 0 or 1. We just learned about these four key pieces of information your doctors need to know about your M0 means that the cancer hasn?t spread from cancer: your esophagus. To fgure out the grade, a sample of your tumor these four things are then combined to give the will be studied in a laboratory by a pathologist. When staging pathologist will compare the cancer cells to normal squamous cell carcinoma, the location of the tumor cells. The more diferent they look, the faster the in the esophagus (top, middle, or bottom) is also cancer is expected to spread. It is important to know that two people with G2 means that the cancer cells are somewhat esophageal cancer may be the same stage, even diferent than healthy cells. In other words, there is more than one defnition of G3 means that the cancer cells barely look like a stage. So, diferent combinations of physical characteristics can be the same stage of cancer. In general, people with earlier cancer stages have better outcomes, but not always. The frst rating is done before treatment and is called the clinical (or baseline) stage. If you have surgery, the second rating is done after surgery, and is called the pathologic stage.

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Often laying the patient on his right side for a significant amount of time will help reflux erectile dysfunction recreational drugs buy super cialis 80 mg line. Images are generally not necessary except for a supine post evacuation film at the end of the examination erectile dysfunction gene therapy order super cialis cheap. Remember that contact time by the contrast agent (in the right colon and in the ileum) erectile dysfunction kuala lumpur discount super cialis american express, when the patient has returned to their room erectile dysfunction caused by heart medication super cialis 80mg on line, will often produce the desired results. In particularly recalcitrant clinical situations, you may add Mucomyst 90cc (6 gms) to the contrast enema. Rectum first filled with 3 syringes of 60% barium followed by 3 syringes of barium paste (E-Z-Paste, or equipment) C. Direct patient to defecate on command and film at 2/sec until patient feels empty. Prior to evacuation, the patient should be asked to squeeze (Kegal maneuver), which should accentuate the pubo-rectal sling, decrease the anorectal angle, elevate the pelvic floor, and tighten the anal canal. An enterocele is a loop of small bowel or sigmoid colon that is enclosed in the anterior wall of the rectal prolapse. This is characterized by paradoxical hypertonic muscle contractions and represents a lack of coordination of the pelvic floor musculature. Bartram, Mahieu: Radiology of the pelvic floor in Henry & Swash Coloproctology and the pelvic floor. Defecography Worksheet Anal/rectal angle (normal 90? at rest, 135? during straining) Puborectalis function (normal, decreased, dyskinetic) Anal canal measurement (less than 1. Fistulography Catheter injections, tube injections, wound injections and sinus tract injections all fall into this category. They are usually requested on postoperative patients with numerous complications including wound dehiscence, postoperative abscess, anastomotic breakdown and leak, ulceration or perforation. Prior to fistula injection the radiologist should review the surgical note and chart and discuss the procedure with the patient. Any drainage from tubes or bags should be checked for type of drainage (serous, urine, blood, bile, feces, etc. Such basic observations can be quite useful in planning and interpreting a fistula injection. The toughest decision is often which tube to inject first in a patient with multiple wounds or catheters. Cross-table lateral views and obliques can be helpful to further determine the location in three dimensions of drainage catheters or foreign bodies. Usually most bandages and padding must be removed so that the radiologist is aware of the location and function of all catheters and tubing in place, as well as the location and reason for all surgical wounds and ostomies. If a wound injection is being performed, usually gently inserting a small catheter into the wound as far as it will go easily is helpful to prevent leakage of contrast material out through the wound onto the skin. Frequent checking under the fluoroscopic carriage is necessary to see leakage from a wound or to spot sites of communication to other skin openings. Contrast injection should be performed under fluoroscopic observation at all times. The injection should be discontinued if resistance is encountered or if the patient complains of pain thought to be due to the injection. Water-soluble contrast may cause a transient burning sensation, especially in recent wounds or abraded, inflamed tissues. Many fistulous tracts are poorly communicating, being obstructed by debris or edema. Passive filling is often the rule and, therefore, rotation of the patient through as much of a 360? Often it is not possible to roll the patient prone due to the presence of wounds or tubing. Films After preliminary films are obtained and satisfactorily reviewed, spot films should be obtained during fluoroscopy. Spot films must have a sufficient field of view to recognize relevant anatomy and location (e. Subsequently, it may be impossible to determine where a fistula tract started without early films. Whereas previously most examinations were for diagnostic purposes, most today are done for intervention. Nonetheless it is important for the radiologist to understand how the examination is performed and optimized. You may practice in a center where the approach is different from that currently done at Stanford. Common indications are for identification and removal of common duct stones, as well as diagnosis, dilation and stenting of biliary strictures (malignant, inflammation, and post-surgical). Post-operative Cholangiography this procedure usually follows surgical intervention of the biliary tree (e. If the catheter has a Luer Lock end, that is used for connection to the injection tubing, which is a 30-50 cm in length of clear tubing. A 50 mL syringe is filled with Conray 43 and the connecting tubing is filled with 46 contrast medium (cm). Following connection to the biliary catheter, suction is applied to withdraw bile into the connecting tubing and to rid the tubing of air bubbles. To visualize the intrahepatic ducts optimally, the patient may be placed into a 10? Most patients will have started on tetracyclines as the American College of Obstetricians and Gynecologists recommends empiric antibiotic treatment for women with a history of pelvic infection or when hydrosalpinx is diagnosed at the time of the study. Known contrast allergy, pregnancy, and active pelvic infection are absolute contraindications to the procedure. Support the patient?s hips on a stack of towels to aid visualization of the cervix. Drape lower body as possible, female chaperone Clean vulva and cervix well with Betadine multiple times 6. Have a preliminary impression from the fluoroscopy so that you can get all the proper images. At the end of the procedure, deflate balloon, inject additional contrast medium (if necessary) to visualize the uterine isthmus. After procedure, explain what to expect, sticky contrast material, slight bleeding, be aware of possible infection etc. Contrast media reactions during voiding cystourethrography or retrograde pyelography. Also be aware that during urodynamic evaluation, patients may have a vasovagal response and even syncope. Catheterize and drain the bladder using aseptic technique and materials in the Foley Catheterization kit. For adults instill 300 to 400 mL of contrast material; false-negative examinations can occur with inadequate distention of the bladder. Some patients, especially those with neurogenic or post-operative bladders, may tolerate less volume. It is best to personally speak with a referring urologist as to whether the Foley catheter should remain in place or be removed. Autonomic dysreflexia In patients with spinal cord injuries, bladder filling during cystography may be associated with vasovagal or even more severe neurologic and systemic reactions. Prior to undertaking such procedures, the radiologist should consult with the referring physician and read the relevant section of Uptodate on prophylaxis and treatment of autonomic dysreflexia. In spinal cord injury patients with lesions above the splanchnic sympathetic outflow tract (T5-T6), bladder filling during cystourethrography or urodynamics may trigger a life-threatening imbalance in reflexive sympathetic discharge. Signs of autonomic dysreflexia include piloerection, skin pallor, sudden and severe hypertension with compensatory bradycardia, and profuse sweating and flushing above the level of the injury. The bladder should be drained and if the blood pressure is significantly elevated a short-acting antihypertensive medication (nifedipine or a nitrate) may be given. These medications may also be given prophylactically to patients prior to cystography. Urethrography is performed by the retrograde injection of Cystografin into the urethra. The examination may also be ordered in surgical patients who have undergone a urethroplasty for treatment of stricture. Place the tip of a pediatric catheter at the fossa navicularis (about 2 cm from the urethral meatus). The resident will also access the Radiology Department Med Wiki and review the Resident Educational Resources.

The dilation has been attributed to accompanying pulmonary wall pathology in bicuspid aortic valve morphology and other congenital the optimization of hemodynamic performance of valvular anomalies erectile dysfunction protocol amino acids buy 80mg super cialis free shipping. The most frequent cause of high postoperative gradients is autograft root replacement but unrelated to bicuspid aortic when the effective prosthetic valve area is less than that of the valve disease (260) impotence pregnancy cheap super cialis 80mg otc. This is commonly known as patient no correlation between bicuspid aortic valves erectile dysfunction 5gs buy super cialis 80 mg cheap, degenerative prosthesis mismatch erectile dysfunction rings order super cialis now, even in the presence of a normally func changes of the pulmonary artery and autograft root aneurysm. The autograft is contraindicated if the aor When selecting a prosthesis for a given patient, surgeons tic annulus is greater than 30 mm. The stentless design may increase long term freedom from structural valve degener Special surgical considerations ation and potentially improve survival (261). There is reserved for the young person, it should not be used in the evidence of significant residual gradients with valve sizes 19 young patient with rheumatic heart disease when there is and 21 with the majority of stented bioprostheses and mechan mitral involvement. The sewing cuff configurations of small aortic the young patient with bicuspid aortic morphology and annu mechanical prostheses and external mounted pericardial bio loaortic ectasia. Aortic root replacement may not be recom prostheses have been designed to address these issues. The mended because the autograft may not tolerate systemic stentless bioprostheses also address this issue (262-272). Adopted and modified from American College of Cardiology and American Heart Association Guidelines (29). If an aortic root replacement or repair is fied arch, as well as a calcified intervalvular fibrous body. Aortic annuloplasty of the large annulus with the with a reconstructive procedure if the root is dilated to 40 mm to remodelling procedure may have the same durability as the 45 mm. Supracoronary replacement of the aorta is needed if the reimplantation, modelling aortic reconstruction and coronary root is normal. The small aortic root can be managed by either stentless the patient with mild or moderate aortic stenosis undergo bioprosthesis, supra-annular noncoronary sinus implantation ing coronary artery bypass requires exploration of the valve. If (advantage: one size) of stented bioprosthesis, or patch the leaflets are calcified and fibrotic, they can be replaced with enlargement of the noncoronary sinus and anterior leaflet of a stented or stentless bioprosthesis because the aortic root is the mitral valve (advantage: possibly two sizes). Rate of New observations on the etiology of aortic valve disease: progression of severity of valvular aortic stenosis. Usefulness of Progression of aortic stenosis in adults: New appraisal using Doppler dobutamine echocardiography in distinguishing severe from echocardiography. Am J Cardiol asymptomatic valvular aortic stenosis: Clinical, echocardiographic, 1995;75:191-4. The natural history echocardiography in patients with aortic stenosis and left ventricular and rate of progression of aortic stenosis. Three-year outcome after Rate of change in aortic valve area during a cardiac cycle can predict balloon aortic valvuloplasty: Insights into prognosis of valvular aortic the rate of hemodynamic progression of aortic stenosis. Related predictors of findings to clinical outcome and agreement with hemodynamic outcome in severe, asymptomatic aortic stenosis. The role of intraoperative history of adults with asymptomatic, hemodynamically significant echocardiography in valve surgery. Ross operation for severity, disease progression, and the role of echocardiography in bicuspid aortic valve disease in adults: Is it a valid surgical option? J Heart formula and continuity equation valve areas on transvalvular volume Valve Dis 1993;2:114-8. Echocardiographic Progression of aortic stenosis in adults: New appraisal using Doppler volume flow and stenosis severity measures with changing flow rate echocardiography. Echocardiographic prediction of clinical outcome in medically J Am Coll Cardiol 1989;13:545-50. Guidelines for reporting morbidity and mortality after Task Force on Practice Guidelines (Committee on Management of cardiac valvular operations, Ad Hoc Liaison Committee for Patients with Valvular Heart Disease). Sex differences in left ventricular geometry in aortic National Cardiac Surgery Database. Surgery for aortic stenosis in valve disease at time of surgery for other cardiovascular disease? Timing of valve replacement in aortic stenosis: valve replacement in patients with severe aortic stenosis and a low Moving closer to perfection. Ventricular function in aortic stenosis: How low can potential of early operation. Aortic stenosis: Clinical evaluation and optimal timing of preoperative left ventricular ejection fraction and valve lesion in surgery. Management of survival after valve replacement for aortic stenosis: Reasons for asymptomatic mild aortic stenosis during coronary artery operations. Hemodynamic determinants of prognosis of aortic valve bypass grafting is not a risk factor for aortic valve replacement. Gender differences in left Management of patients with mild aortic stenosis undergoing ventricular functional response to aortic valve replacement. Preoperative history of rheumatic aortic regurgitation: Criteria predictive of death, identification of patients likely to have left ventricular dysfunction congestive heart failure, and angina in young patients. Aortic stenosis with severe left ventricular dysfunction and assessment of the natural history of asymptomatic patients with low transvalvular pressure gradients: Risk stratification by low-dose chronic aortic regurgitation and normal left ventricular systolic dobutamine echocardiography. Aortic regurgitation: A lesion with similarities to elderly patients: Influence of concomitant coronary grafting on late both aortic stenosis and mitral regurgitation. Reversal of left ventricular aortic valve replacement after prior coronary artery bypass grafting. Prognosis of patients and late survival after valve replacement for aortic stenosis. J Thorac with heart failure and unoperated severe aortic valvular regurgitation Cardiovasc Surg 1990;100:327-37. Progression of myocardial replacement and coronary bypass grafting for patients with aortic dysfunction in asymptomatic patients with severe aortic stenosis and coronary artery disease: Early and late results. Role of age and concomitant coronary of native valvular regurgitation with two-dimensional and Doppler artery disease. How to manage patients with mortality due to coronary artery disease after valve surgery. J Heart trends in valvular regurgitation and effect of internal mammary Valve Dis 1996;5:421-9. Survival and functional revascularization: Late clinical results and survival of surgically results after valve replacement for aortic regurgitation from 1976 to treated aortic valve patients with and without coronary artery 1983: Impact of preoperative left ventricular function. Prog valvular aortic stenosis in adults: Literature review and clinical Cardiovasc Dis 2001;43:457-75. Early and late mortality for valve replacement among asymptomatic or minimally of patients undergoing aortic valve replacement after previous symptomatic patients with chronic aortic regurgitation and normal coronary artery bypass graft surgery. Management of mild aortic stenosis during patients with aortic regurgitation and left ventricular dysfunction: coronary artery bypass graft surgery. Managing asymptomatic 28E Can J Cardiol Vol 20 Suppl E October 2004 Surgical management of valvular heart disease patients with chronic aortic regurgitation. Chronic aortic regurgitation: medial changes associated with bicuspid aortic valve: Myth or the effect of aortic valve replacement on left ventricular volume, reality? Chronic aortic abnormalities of the ascending aorta and pulmonary trunk in patient regurgitation: Prognostic value of left ventricular end-systolic with bicuspid aortic valve disease: Clinical relevance to the Ross dimension and end-diastolic radius/thickness ratio. Ann Thorac Surg ventricular systolic function on long-term survival in mitral and 2001;72:1502-8. Improved late Marfan syndrome: Long-term survival and complications after aortic survival in patients with chronic aortic regurgitation by earlier aneurysm repair. Ann Thorac Surg left function and reversal of ventricular dilatation after valve 2002;73:438-43. Management of the patient with aortic root disease and aortic Circulation 1980;61:484-92. Evaluation Operative management of Marfan syndrome: the Johns Hopkins of the results of aortic valve replacement in symptomatic patients. Circulation surgery in patients with marfan syndrome: Long-term survival, 1996;94:2472-8. Circulation treatment of Marfan patients with aneurysms and dissection of the 1980;61:493-5. Therapeutic management of insufficiency: Factors associated with progression to aortic valve patients with Marfan syndrome: Focus on cardiovascular replacement. Thoracic aortic aneurysm:natural history replacement versus aortic valve replacement: A case-match study.