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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Analysis of 182 patients with chronic disseminated intravascular coagulopathy and malignancy shows common features. Migratory thrombophlebitis occurred in 96 patients while at least a single episode of thrombophlebitis was noted in 113. Seventy-five of the patients bled and 45 had arterial emboli in various organs. Twelve patients had the triad of thrombophlebitis, hemorrhage, and arterial emboli, often sequentially. Hematologic data showed derangements associated with intravascular coagulation, the most prominent of which were hypofibrinogenemia and thrombocytopenia. Other abnormalities included prolonged prothrombin time, increased fibrinogen-fibrin degradation products, decreased levels of factors V and VIII, cryofibrinogenemia, and microangiopathic hemolytic anemia. Forty-one patients had lesions of non-bacterial thrombotic endocarditis at autopsy; 31 of these had arterial emboli during life. None of the lesions were infected. Mitral and aortic valves were most frequently involved. No single mechanism that causes the disseminated intravascular coagulopathy has been identified. However, cell products--secretions and enzymes--and the cells themselves have been proposed as the procoagulant(s) responsible for the syndrome. In addition to treatment of the underlying neoplasm, symptomatic disseminated intravascular coagulopathy should be controlled. Heparin is the drug of choice for treatment of this problem, very little benefit having been observed with warfarin therapy. Long-term use of anticoagulants is potentially feasible for control of chronic disseminated intravascular coagulopathy, but without effective control of the underlying tumor ultimately will be unsuccessful.
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PMID:Trousseau's syndrome and other manifestations of chronic disseminated coagulopathy in patients with neoplasms: clinical, pathophysiologic, and therapeutic features. 83 36

Verrucous endocarditis in the newborn is not only a rare but also a problematic disease as concerns its etiology and pathogenesis. In the older literature septic infections of mother and child were said to be the causative factors. Recent experiences with the pathophysiology and pathomorphology of shock have also shown new aspects of the origin of this kind of endocarditis. Two cases from our own experience are compared with 7 cases from the literature. In the maternal history of gestation there was no infectious disease which could explain the endocarditis of the newborn. A short time after delivery the children showed a respiratory distress syndrome and died between 1.5 hours and 3 days after birth. At autopsy verrucous vegetations up to 8 X 5 X 4 mm in diameter were found on the tricuspid valve in 8 cases, once on the mitral valve and twice on both mitral and tricuspid valve. Malformations of the hearts were not noted. Histologically the fresh vegetations consist of clotted platelets and a fibrin network. At the base of the verruca the valvular leaflets show an edema, occasional fibroblastic changes and tiny lympho-histiocytic infiltrates in the subendothelial layer. Extracardial findings are hyaline membranes of the lungs and microthrombi in small vessels of lung, heart, liver and kidney due to shock and consumption-coagulopathy. According to Mittermayer et al. (1971a, b) who studied endocarditis verrucosa simplex in adults and animal-experiments endocarditis verrucosa simplex of the newborn is probably caused by intrauterine or perinatal shock.
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PMID:[Pathogenesis of endocarditis verrucosa simplex in the newborn (author's transl)]. 92 7

Sixty-five cases of nonbacterial thrombotic endocarditis (NBTE) were discovered at autopsy during a 10 year period--an incidence of 1.6 per cent in the adult autopsy population. In 51 cases, one or more malignant neoplasms were associated; adenocarcinoma represented the most frequent histologic type of related neoplasm. Coagulation abnormalities suggestive of disseminated intravascular coagulation (DIC) were present in 18.5 per cent of the cases. It is possible that both the valvular and peripheral intravascular thromboses in at least some cases of NBTE represent the abnormal coagulation of DIC. Arterial thrombosis with infarction occurred in many peripheral organs. Splenic and renal were most frequent, but cerebral and cardiac consequences were the most significant.
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PMID:Non-bacterial thrombotic endocarditis: clinicopathologic correlations. 99 78

Potential morbidity remains substantial in aortic root replacement. The tissues are often fragile, contributing to the risk of haemorrhage and postoperative complications. In the past surgery has been directed towards minimising haemorrhage by wraparound techniques and the right atrial fistula method of Cabrol. However, recent use of aortic homografts, collagen-impregnated grafts and tissue glues have reduced bleeding and simplified operative technique. Profound hypothermia and total circulatory arrest allows aneurysm resection to extend into the aortic arch. Between 1986 and 1991 25 aortic root replacements were carried out at the Oxford Heart Centre in 21- to 76-year-olds, 13 for aorto-annular ectasia (4 due to Marfan's syndrome), 7 for aortic dissection (2 Marfan's syndrome) and 2 for complications of previous aortic valve replacement. Three patients had homograft root replacement for aortic root endocarditis. We implanted 14 Medtronic composite grafts, 1 St Jude conduit and 7 collagen-coated Dacron grafts (Hemashield, Meadox) into which a Starr-Edwards valve was sewn, as well as 3 homografts. One patient with a massive chronic dissection following previous aortic valve replacement required an interposition graft to the coronary ostia. In the others, the coronary ostia were mobilised from the native aorta and directly implanted into the conduit. In dissections a ring of pericardium or GoreTex was used to buttress the coronary anastomoses. Six patients also required coronary artery grafting. Native aorta was excised and not wrapped around the conduit. Coagulation defects were corrected aggressively with platelets, fresh frozen plasma and cryoprecipitate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Aortic root replacement: modifications of technique with improvements in technology. 138 78

Histopathological study was made of 12 Merino sheep - five splenectomized and seven intact - experimentally infected with Babesia ovis. Non-purulent encephalitis; initially exudative and subsequently interstitial pneumonia; pericarditis, myocarditis and haemorrhagic endocarditis; centrilobular necrotic hepatitis; hyperplasia of the lymphoreticular system; necrosis and vascular changes in adrenal glands were observed. The kidney was the most severely affected organ, exhibiting acute tubular necrosis typical of kidney shock syndrome. The lesions observed were suggestive of hypovolemic shock culminating in haemorrhagic diathesis owing to consumptive coagulopathy. Additionally, the massive release of catabolites from lysis and necrosis apparently produced endotoxic shock.
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PMID:Histopathological changes in sheep experimentally infected with Babesia ovis. 202 25

From January/1983 to March/1988, 28 patients were submitted to valve replacements for prosthetic valve endocarditis in 1,512 valve replacements. Seventeen patients were male, their mean age was 36.7 +/- 12.9 years old, and eight cases were operated under emergency condition. The blood cultures were positive in 14 (50%), the agent most commonly found being Streptococcus viridans in 5 cases. Hospital mortality was 28.5%. The causes of death were septicemia in 4 cases, low output syndrome in 2 cases, cerebrovascular accident in 1 case, and coagulopathy in 1 case. Mortality was higher with statistical significance in the cases whose blood cultures were negative, the cases in which the time from valve replacement to the onset of endocarditis was less than one year, and the cases under emergency condition.
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PMID:[Prosthetic valve endocarditis]. 223 91

We report a case of brucella endocarditis on a native aortic valve causing severe aortic regurgitation, uncontrolled heart failure and disseminated intravascular coagulopathy. The diagnosis was proven by positive serology, isolation of Brucella melitensis from preoperative blood cultures and excised valve. The patient was successfully treated with valve replacement and specific antibiotic therapy.
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PMID:Brucella endocarditis. Report of one case and review of the literature. 268 Dec 18

This is a case report of a 61-year-old man, suffering from infective endocarditis of mitral valve in association with DIC and intracerebral hemorrhage. He was treated symptomatically and conservatively for 80 days after the onset of the DIC. His multiple cerebral hematomas gradually disappeared 2 months after conservative management. Then the diseased mitral valve was replaced with a Duromedics valve. He is doing well at present. In a review of the literature it appears that there is some room for surgical intervention in endocarditis despite the complication of coagulopathy. We feel that one of the most serious complications of infective endocarditis is DIC. Operative management of endocarditis with this complication is recommended to be followed by medical management.
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PMID:[Successful surgical treatment of infective endocarditis complicated with DIC and intracerebral hemorrhage]. 279 82

Skin lesions, an important clue to the cause of septicemia, result from five main processes: (1) disseminated intravascular coagulation and coagulopathy; (2) direct vascular invasion and occlusion by bacteria or fungi; (3) immune vasculitis and immune complex formation; (4) emboli from endocarditis; and (5) vascular effects of toxins. Disseminated intravascular coagulation probably plays only a minor role in pathogenesis. Vascular invasion by bacteria may result in a severe inflammatory reaction, as in meningococcemia, or in a minimal reaction, as in ecthyma gangrenosum. Gram-stained smears of scrapings from the base of skin lesions--a frequently neglected procedure--is an important diagnostic adjunct. Skin biopsies are particularly important in the diagnosis of Rocky Mountain spotted fever and infections caused by Candida.
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PMID:Skin clues in the diagnosis of life-threatening infections. 351 82

The clinical spectrum of neonatal endocarditis, including bacterial and nonbacterial types, is examined in five case reports that were drawn from nursery experiences over a recent 2-year period. In contrast to previous reports of 100% mortality from neonatal endocarditis, one patient survived. Changing heart murmur and hematuria were most frequently associated with bacterial and nonbacterial endocarditis in four of the five cases. Pulmonary hypertension, thrombocytopenia, and coagulopathy were also associated with nonbacterial endocarditis. Echocardiograms were performed on four of the patients; only one was suggestive of endocarditis. Staphylococcus aureus was isolated from both cases of bacterial endocarditis, including the single survivor. Thus, it is suggested that the initial antibiotic coverage of any neonate with the clinical syndrome of sepsis, hematuria, and a heart murmur include antistaphylococcal coverage for the possibility of bacterial endocarditis.
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PMID:Endocarditis in high-risk neonates. 682 46


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