John M. Evans

Comparison Among Acquired Immune Deficiency Syndrome Patients With and Without Clinical Evidence of Cardiac Disease

Abstract The expression of cardiac abnormalities in acquired immune deficiency syndrome (AIDS) has been interpreted in various ways, with some 1–11 reporting that heart disease in patients with AIDS is clinically silent, while others12-l7 have noted the opposite. We suspected that this apparent conflict in findings might be due in part to the difficulty in recognizing cardiac signs and symptoms in patients with AIDS. Recognition would be important if cardiac symptoms, in this population, are even a rough gauge of the severity of the cardiac abnormalities. This study characterizes the clinical features and effect on prognosis of cardiac abnormalities in AIDS.

The blood ammonia in congestive heart failure

Abstract 1. 1. Arterial and venous blood ammonia levels were measured in nine control patients and in nine patients with congestive heart failure. 2. 2. The average arterial and venous ammonia levels of the control patients were 0.79 and 0.83 gamma/c.c., respectively. The average arterial and venous blood ammonia levels of patients with congestive heart failure were 1.33 and 1.06 gamma/c.c., respectively. 3. 3. Patients without liver dysfunction or congestive heart failure show normal blood ammonia values with a negligible arteriovenous difference while patients with congestive heart failure show an elevated blood ammonia with an uptake of ammonia by the tissues. 4. 4. The cerebral manifestations of lassitude, lethargy, and coma seen in congestive heart failure may be due in part to ammonia intoxication, etiologically similar to the cerebral symptoms of hepatic insufficiency. 5. 5. It is suggested that ammonium chloride be used with caution in patients with cardiac failure presenting cerebral manifestations or severe liver dysfunction.

Recurrent Subcutaneous Infection Due to Scopulariopsis brevicaulis in a Liver Transplant Recipient

We describe a case of recurrent Scopulariopsis brevicaulis subcutaneous infection, which occurred 6 years after the patient underwent liver transplantation. Combined surgery and long-term oral therapy with terbinafine resulted in a favorable outcome, although this is not the rule in the previously reported S. brevicaulis infections in immunocompromised patients.

Second-degree heart block and Wenckebach phenomenon associated with anxiety

Abstract The transitory occurrence of first- and second-degree heart block with Wenckebach periods has been described in a 27-year-old Negro man without evidence of organic disease. Emotional factors, possibly mediated through the vagus nerve, are believed to have induced the arrhythmia. The literature on this subject has been reviewed.

Hepatitis E virus infection in HIV-infected patients with elevated serum transaminases levels.

Increases in aminotransferases levels are frequently encountered in HIV-positive patients and often remain unexplained. The role in this setting and natural history of hepatitis E in HIV-infected patients are unknown. The aim of the study was to assess HEV infection in HIV-infected patients attending a Parisian hospital, with a current or previous cryptogenic hepatitis.191 plasma samples collected from 108 HIV-infected patients with elevated aminotransferases levels were retrospectively tested for the presence of hepatitis E virus (HEV) infection markers: anti-HEV IgM antibodies, anti-HEV IgG antibodies, anti-HEV IgG avidity index and plasma HEV RNA.One acute infection, documented by positive tests for anti-HEV IgM antibody, low anti-HEV IgG avidity index and plasma HEV RNA (genotype 3e), and three past infections were diagnosed, without any observed case of persistent infection. The acute hepatitis was benign and resolved spontaneously within two weeks. This infection was probably contracted locally. Acute HEV hepatitis can occur in HIV-infected patients but rarely explains cryptogenic hepatitis, at least in an urban HIV population, regardless geographic origin and CD4 counts.

Serum glutamic-oxalacetic transaminase in coronary artery disease; a review of 201 cases.

The results of serial glutamic-oxalacetic transaminase (GOT) assays in 201 cases in which coronary artery disease was suspected are correlated with the clinical, laboratory, and electrocardiographic changes. In 95 per cent of the cases diagnosed as myocardial infarction on the basis of clinical and electrocardiographic evidence there was an elevation of serum GOT. On the other hand, in 12 per cent of the cases in which clinical and electrocardiographic findings were negative or equivocal with regard to myocardial infarction, there was an elevated serum GOT. In 18 cases that were autopsied the correlation between acute myocardial necrosis and serum GOT elevation was 100 per cent.

Comparative Evaluation of Adherence to Antiretroviral Therapy in Sub-Saharan African Native HIV-Infected Patients in France and Africa

Patients with human immunodeficiency virus (HIV) infection who were native to sub-Saharan Africa but lived in France were less adherent to antiretroviral therapy during a visit back to Africa, compared with their level of adherence in France. This was mainly related to self-perceived insufficient support from family members and/or fear of the consequences of disclosure of their HIV infection status to their family.

Ebstein's anomaly of the tricuspid valve: Angiocardiographic diagnosis

Abstract Angiocardiograms are described which are believed to be characteristic of Ebsteins anomaly of the tricuspid valve, and the other clinical features in one case are presented. The division of the right ventricle into a proximal atrialized portion and a distal functioning portion is demonstrable by angiocardiography in this case.

Aortic stenosis: A study with particular reference to an indirect carotid pulse recording in diagnosis

Abstract The clinical findings in 70 individuals with aortic stenosis are reported. Confirmation of the diagnosis was available in 28. Special emphasis was placed on the indirect recording of the carotid pulse as a diagnostic aid. By means of a “tuned” system, the characteristic contour of aortic stenosis, consisting of a plateaued curve with systolic vibrations, was obtained in 68 of the 70 patients (97 per cent). It is felt that the method described offers a simple and practical diagnostic aid.

BRUCELLOSIS AND HEART DISEASE. III. CHRONIC VALVULAR HEART DISEASE FOLLOWING NONFATAL BRUCELLOSIS

Excerpt In an earlier study1in this series it was noted that endocarditis is the most frequent cause of death in fatal brucellosis. Do valvular lesions also occur in nonfatal brucellosis? We have s...