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

The effects of polychlorinated biphenyls were studied in eight germfree pigs. Beginning at fourteen days of age, two pigs each were fed daily 12.5, 25, 50 and 100 mg/kg body weight of polychlorinated biphenyls as Aroclor 1254. Three germfree pigs were negative controls. Clinically the treated pigs had inappetance, a hemorrhagic diarrhea, erythema of the nose and the anus, retarded growth, distended abdomen and at the higher dose levels, incoordination and coma followed by death. Deaths occurred in 11 to 35 days after exposure. At necropsy, the piglets exhibited grossly enlarged mottled liver, erosions of the gastric mucosa, hemorrhages through the mesentery and the intestinal wall, a fibrinous pericarditis, a hypoplastic thymus and congested swollen thyroid glands. The histopathological lesions included hepatic centrolobular necrosis, interstitial myocarditis, endocarditis, myopathy of the muscles, gastric erosions and colitis. All of the organs examined for polychlorinated biphenyls had elevated residue levels which were particularly high in the fat, liver, psoas muscle, brain and kidney and were higher than has been reported in conventional pigs fed approximately equal concentrations of polychlorinated biphenyls. The severity of clinical signs, pathological changes and tissue concentrations were directly related to the dose administered and were more pronounced in the germfree pigs than has been described in conventional pigs.
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PMID:Experimental polychlorinated biphenyl toxicosis in germfree pigs. 9 24

Thirty out of 287 patients (10.4%) admitted to hospital for infective endocarditis between December 1970 and January 1990 had neurological complications. Twenty-three patients had native valve infectious endocarditis and 7 had prosthetic valve endocarditis. The clinical features were characterized by the frequency of aortic valve involvement (23 out of 30) and other complications, especially cardiac failure (16 cases) and peripheral vascular manifestations (7 cases). The commonest organism was the staphylococcus (53% of identified organisms) but the number of negative blood cultures was high (50% of cases). The neurological complication was often the presenting symptom of the endocarditis (19 cases) but it occurred after bacteriological cure in 4 cases. The complications observed were cerebral ischemia (16 cases), cerebral haemorrhage (11 cases), coma (2 cases), and one peripheral neuropathy causing a Claude Bernard Horner syndrome. These complications presented with hemiplegia in 17 cases, a meningeal syndrome in 8 cases, a convulsion in 1 case, a Von Wallenberg syndrome in 1 case, and a Claude Bernard Horner syndrome in 1 case. Twelve patients had a transient or permanent neurological coma. Cerebral CT scan showed ischemic lesions in 7 cases and haemorrhagic lesions in 10 cases. Carotid angiography demonstrated mycotic aneurysms in 6 patients. Twelve patients died: the cause of death was neurological coma (7 cases), low cardiac output (4 cases) and haemorrhagic shock (1 case). Four patients underwent neurosurgery: 3 for clipping a mycotic aneurysm and 1 for drainage of an intracerebral haematoma. Poor prognostic factors were: coma, cardiac failure, cardiac valve prosthesis and, above all, the extent and multiplicity of the neurological lesions. The authors propose the following measures to improve the prognosis: early surgery in cases of large and/or mobile vegetations especially when the infecting organism is a staphylococcus and when a systemic embolism has occurred; routine CT scanning and/or digitised cerebral angiography in all patients with infective endocarditis to detect surgically accessible mycotic aneurysms.
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PMID:[Neurologic manifestations of infectious endocarditis]. 201 89

A 72-year-old woman had been given cimetidine 400mg/day for her gastritis since June 17, 1987. On August 8, she developed oral bleeding. Peripheral blood showed pancytopenia (WBC 1,900/microliters, RBC 208 x 10(4)/microliters, Plt 0.8 x 10(4)/microliters) and bone marrow studies revealed markedly depressed hematopoiesis. Bolus methylprednisolone and high dose gamma globulin were administered, but not effective. On December 11, 1987, she lapsed into coma and died three days later. Autopsy disclosed nonbacterial thrombotic endocarditis and cerebral infarction.
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PMID:[Cimetidine-induced aplastic anemia complicated with nonbacterial thrombotic endocarditis and cerebral infarction]. 207 35

The causes, clinical indications and diagnosis and differential diagnosis of cardiac disorders which may lead to cerebral symptoms are illustrated on the basis of a review of the present day level of scientific research. Principally involved are cerebral ischaemias arising from cerebral embolisms or from reduction of cardiac output in cardiovalvular and myocardial disorders. The incidence of all embolisms of cardiac origin makes up 10% of all ischaemic cerebral infarcts, with auricular fibrillation, irrespective of its origin, mitral stenosis, myocardial infarct, mitral insufficiency and combined mitral valve defects, and, in younger patients, mitral valve prolapse, being, in this order of frequency, of primary clinical significance. The other cardiovalvular and myocardial disorders have, in comparison, a relatively low incidence of cerebral embolisms. Haemodynamically induced cerebral ischaemias frequently occur in the form of complications following acute cardiac arrest, in myocarditis and in case of primary cardiomyopathies resulting from cardiac insufficiency or complicating bradyarrhythmia. They are clinically apparent in the form of syncope, and other impairments of consciousness of various levels of seriousness with and without indications of cerebral origin, extending up to coma. In view of the high incidence of 25% of acute cerebral ischaemias in cases of cardiac disease, not only neurological but also detailed cardiological investigation is vital in all cases for a correct diagnosis and for the selection of a suitable course of treatment. Cerebral complications in bradyarrhythmia and endocarditis are discussed in the context of a review of the relevant literature together with consideration of their epidemiology, aetiology, pathophysiology and clinical profile. Pathological sinus-bradycardia, bradyarrhythmia absoluta, sinu-atrial and atrio-ventricular blockages, carotid-sinus and sick-sinus node syndrome, paroxysmal atrial tachycardia, AV-node tachycardias, and auricular fibrillation and flutter, taken as a whole, lead to cerebral complications affected patients in 5 to 10% of afflictions of the central nervous system occur in 50% of patients suffering from complete AV blockage and, at a not precisely definable frequency, in patients suffering from other bradyarrhythmias. In addition to transitory, uncharacteristic symptoms such as dizziness, vertigo, impairment of vision and balance, presyncope, syncope and Adams-Stokes syndrome dominate the clinical profile. Endocarditis, with an incidence of 0.01 to 0.05% in the overall population, results in central nervous system complications in 12 to 25% of cases on average.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Heart diseases as a cause of cerebral symptoms and syndromes]. 222 59

We evaluated 14 patients with acute cardiogenic embolism who underwent open heart surgery soon after the onset to determine the cerebral and cardiac factors that influence neurologic outcome. The mean interval from onset of cerebral embolism to surgery was 5.3 (range 1-16) days. Five of the 14 patients had vegetations from infective endocarditis (including prosthetic valve endocarditis) as embolic sources, eight had intracardiac thrombi, and one had atrial myxoma. The diagnosed site of infarction before surgery was based on computed tomographic and/or angiographic findings. Of the 14 patients, four had infarcts due to major artery occlusion, seven due to cortical branch occlusion, and two due to perforating artery occlusion; one patient presented with a transient ischemic attack without computed tomographic abnormalities. Ten patients (71%) showed no clinical aggravation after open heart surgery; however, two patients died of massive cerebral hemorrhage, one died of deterioration of brain edema, and another became comatose from midbrain hemorrhage immediately after surgery. The four patients with clinical aggravation comprised three with septic embolism and one with aseptic occlusion of a major artery. From these results, infective endocarditis and a large infarct appear to be possible aggravating factors when patients with recent cerebral embolism undergo open heart surgery.
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PMID:Brain damage after open heart surgery in patients with acute cardioembolic stroke. 279 61

Intracranial mycotic aneurysms (IMA) occur in 1-3% of all infective endocarditis. Although spontaneous resolution was evidenced on serial angiograms in many asymptomatic cases, the prognosis, if they rupture, is reported to be worse and partly contingent on the therapeutic approach. Among 12 patients (six acute and six subacute endocarditis) with ruptured IMA, six were treated surgically and four were treated medically. Two patients died during rupture before any treatment could be started. Six patients had a sudden rupture manifested by coma, less clear consciousness seizures, hemiparesis unilateral mydriasis. CT-Scan showed intracerebral, intraventricular and subarachnoid haemorrhage. Ten angiograms showed 11 IMA. For patients with ruptured IMA, the decision for surgical treatment was made in the presence of deepening coma and extensive mass-lesion on CT-scan (one of six died in the postoperative period). Others received medical treatment (four cases: all survived) and were followed-up with serial angiographies. Of the nine patients who survived, five remained free of any disability 1-4 years later. We suggest that the prognosis of ruptured IMA (25% mortality rate) is not as bad as previously reported if surgery following angiography is performed early in the presence of deepening coma and extensive lesion.
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PMID:Prognosis of ruptured intracranial mycotic aneurysms: a review of 12 cases. 280 80

Patients undergoing open heart surgery who have had recent cardiogenic embolic stroke or have central nervous system dysfunction pose a difficult management problem. There is always the risk that cardiopulmonary bypass and heparinization may exacerbate the neurologic injury. There is no clear data indicating what is a safe interval of time from the onset of neurologic symptoms to the time of surgery. Since 1982 we have operated on 15 patients with recent (2 to 28 days, mean 12.7 +/- 7.9 days) neurologic injury. Indications for surgery included recurrent embolization, sepsis, and hemodynamic deterioration. Three patients were comatose with no focal neurologic signs at the time of surgery, and 12 patients had focal neurologic deficits. All patients had preoperative computed tomographic scans. Embolic cerebral infarctions were documented in 12 patients, one patient had evidence of intracranial hemorrhage, and one patient had a subdural hematoma. Fourteen patients had native or prosthetic valvular endocarditis and one patient had a left atrial myxoma. All patients underwent corrective cardiac surgery. One patient died in the postoperative period from multisystem failure; all other patients have been followed since discharge (6 months to 4 years). All surviving patients demonstrated improvement in their neurologic symptoms and eight patients had complete neurologic recovery. The results of this study indicate that open heart surgery can be safely performed in patients with recent neurologic injury.
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PMID:Results of open heart surgery in patients with recent cardiogenic embolic stroke and central nervous system dysfunction. 366 7

In an effort to ascertain important epidemiologic and prognostic risk factors, we analyzed 33 cases of Staphylococcus aureus meningitis occurring over an 8-year period (1976 to 1984). Staphylococcus aureus caused 6% of all bacterial meningitis at our University Hospital. Fifty percent of cases were pediatric and included 7 newborn infants, of whom 71% were either premature or had low birth weight. Major underlying diseases were: central nervous system (CNS) disorders (55%), endocarditis (21%, predominantly intravenous drug abusers), other sites of infection (27%), and prematurity (24%). Fifty-seven percent of patients were bacteremic and 41% of those had concomitant bacteriuria. Hypoglycorrhachia was present in 27% of cases, positive cerebrospinal fluid (CSF) Gram stain in 20%, disseminated intravascular coagulation (DIC) in 19%, and methicillin-resistant organisms in 18%. Cerebrospinal fluid cultures remained positive for a protracted period (mean, 6.7 days) regardless of the presence or absence of a CNS shunt. Overall mortality was 21%. Favorable outcomes were associated with the eventual presence of sterile CSF (15.4% vs. 100% mortality) and the removal of foreign bodies (10% vs. 67% mortality). Mortality was also associated (p less than 0.5) with the presence of diabetes mellitus, age greater than 60, obtundation or coma on presentation, bacteremia, or DIC. Cure correlated (p less than .05) with CNS shunt-associated infections, age less than 1, normal neurologic examinations on presentation, or the absence of DIC or bacteremia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Staphylococcus aureus meningitis: a broad-based epidemiologic study. 382 85

Among 369 patients with native valve infective endocarditis observed during a 14-year period, 17 were related to S: pneumoniae. Fourteen of them were observed in the last 7 years. At the time of admission 13 exhibited purulent meningitis, 6 of them being comatose. An apparent portal of entry was present in 13 patients including Pneumonia (n = 11) and otitis media (n = 2). Major alcoholism was present in 6 cases. The mean delay between the onset of fever and the discovery of the cardiac murmur was 15 days (range 1 to 60). Twelve patients exhibited congestive heart failure with acute pulmonary oedema in 9. The aortic valve was involved in 12 and the mitral valve in 7 (in 2 patients both mitral and aortic valves were involved). Myocardial and/or annular abscesses were found in 7 patients. Nine patients underwent surgical procedure (3 died) whereas 6 comatose patients were not operated on and died. The overall mortality was 59%. Although antibiotics are effective, the severity of anatomical lesions leads to prompt surgical treatment. The high mortality is mainly due to purulent meningitis.
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PMID:Pneumococcal endocarditis. 651 90

Sixty-five patients with a bleeding disorder and coexistent neurologic abnormalities were examined over a 4-year period to determine: (1) the CNS pathology due to disseminated intravascular coagulation (DIC); (2) the clinical setting in which CNS dysfunction due to DIC occurs; and (3) the neurologic complications of DIC as opposed to those patients dying with concurrent DIC. Criteria for inclusion in the study were the combination of: (1) a neurologic disorder in a patient with clinical evidence of a bleeding disorder; and (2) evidence of DIC by laboratory criteria or the detection of fibrin thrombi in multiple organs at postmortem. Twenty-four of 65 patients met these diagnostic criteria, including 14 men and 10 women, aged 24 to 84 years. Autopsies were obtained in 17 patients. These patients were divided into two groups Group I consisted of 10 patients with evidence of cerebral bleeding or infarction at the onset of DIC. Group II consisted of 14 patients who met the diagnostic criteria for DIC but did not demonstrate postmortem evidence of hemorrhage or infarction in the brain. Patients with malignancy who present with findings suggestive of a large-vessel stroke are likely to have DIC and nonbacterial thrombotic endocarditis. The most common neurologic complications of DIC are large vessel occlusion, obtundation and coma, subarachnoid hemorrhage, and multiple cortical and brainstem hemorrhages and infarction.
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PMID:Neurologic complications of disseminated intravascular coagulation. 720 75


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