Hospital Medicine Alert – July 1, 2006

July 1, 2006

• Carotid Artery Stenting and Endarterectomy Compared

  In this retrospective case-control study, carotid stenting with cerebral protection and carotid endarterectomy were not significantly different in early morbidity and mortality.

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• Which Non-Invasive Test is Best for Diagnosing Clinically Significant Carotid Artery Stenosis?

  All of the currently available non-invasive techniques for carotid artery imaging give accurate results when there is a high-grade stenosis (70-99%), but contrast-enhanced MRA is slightly more sensitive.

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• Endocarditis after Acute Q Fever

  Acute Q fever may progress to endocarditis in patients with clinically silent valvulopathy. Those at risk require either extended antibiotic prophylaxis or close serological follow-up. All patients with acute Q fever should undergo transthoracic echocardiography, or in some instances transesophageal echocardiography, to exclude occult valvular abnormalities.

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• Amebic Encephalitis — More Common Than You Might Think

  Antibody testing successfully identified 7 patients whose encephalitis was due to the free-living amoeba, Balamuthia mandrillaris, a pathogen that should be suspected in individuals with soil contact, high CSF protein, and mass-like or ring-enhancing brain lesions.

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• News About Clopidogrel

  Overall, clopidogrel plus aspirin was not significantly more effective than aspirin alone in reducing the rate of myocardial infarction, stroke, or death from cardiovascular disease.

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