For seventy-five years, the Williams Machine Tool Company had provided quality products to its clients, becoming the third largest U.S.-based machine tool company by 1980. The company was highly profitable and had an extremely low employee turnover rate. Pay and benefits were excellent. Between 1970 and 1980, the company's profits soared to record levels. The company's success was due to one product line of standard manufacturing machine tools. Williams spent most of its time and effort looking for ways to improve its bread-andbutter product line rather than to develop new products. The product line was so successful that companies were willing to modify their production lines around these machine tools rather than asking Williams for major modifications to the machine tools. By 1980, Williams Company was extremely complacent, expecting this phenomenal success with one product line to continue for twenty to twenty-five more years. The recession of 1979-1983 forced management to realign their thinking. Cutbacks in production had decreased the demand for the standard machine tools. More and more customers were asking for either major modifications to the standard machine tools or a completely new product design

71 Can we use warfarin during pregnancy or during menstruation in a patient with a prosthetic valve? Is anticoagulation necessary in a patient with a corrected ventricular septal defect (VSD) or corrected coarctation of aorta?

72 I want to ask about Duke criteria in diagnosing infective endocarditis.

73 Is Staphylococcus aureus the most frequent causative agent of acute bacterial endocarditis? And is this typical of acute bacterial endocarditis?

74 Please explain the mechanism of the mycotic aneurysm in infective endocarditis.

75 Why are the right valves more commonly affected in infective endocarditis when the microbes enter through the IV route, for example with IV drug users?

76 You have said that in IV drug users the microbes go directly to the right ventricle, thus causing endocarditis in the right heart. But in dental procedures the microbes also go through the veins to the right heart first, so why are the left heart valves more commonly affected?

77 What causes splenomegaly in infective endocarditis?

78 We know that Janeway lesions appear with infective endocarditis, but is there any other disease that can cause it?

79 Patent ductus arteriosus (PDA) is also called duct-dependent circulation. What is the meaning of this phrase and do 8any other conditions present with a similar condition? What is the implication of this condition to the human body?

80 What is the recommended treatment for a child with both congenital and valvular heart disease?