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

A total of 99 cases of viridans streptococcal endocarditis encountered during the period of 1973 and 1990 at the Veterans General Hospital-Taipei were reviewed to evaluate its prognostic factors. Applying strict clinical and laboratory criteria, 24 cases were categorized as definite, 44 probable, 23 possible and 8 likely. The symptoms were frequently subtle and atypical but initial laboratory tests gave useful indications: 69.1% with leukocytosis, 78% with anemia, 58.5% with elevation of LDH level, 88.9% with elevation of ESR value and 100% with elevation of CRP level. Furthermore, 32.4% of the cases demonstrated proteinuria and 67.4% microscopic hematuria. Seventy-three of the subjects had a history of underlying heart disease, predominantly rheumatic heart disease. Histological examination and echocardiography revealed that 51 patients suffered from vegetative endocarditis, 7 (13.7%) of whom were found to have anatomically confirmed vegetations without initial echocardiographic evidence, Vascular events were seen in 61 cases (61.6%): peripheral stigmata (32 cases), cerebral vascular accidents (17 cases), pulmonary embolism (10 cases) and others (2 cases). The overall mortality rate was 18.2%. Congestive heart failure with embolization was the most common cause of death in this group. The presence of vegetation was not well correlated with embolic events. There was no statistically significant association between the mortality and the following characteristics: age, sex, underlying heart disease, evidence of echocardiographically detected vegetations, major surgical intervention and recurrent cases except for embolic events (p less than 0.01). In conclusion, viridans streptococcal endocarditis complicated embolic events usually presented with a fulminant course and a grave outcome.
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PMID:Overview of viridans streptococcal endocarditis: clinical analysis of 99 cases. 165 35

Between 1950 and 1985, 240 patients (male/female ratio: 1/3.9, mean age 47.2 +/- 10.4 years [11-71]) with isolated mitral valve stenosis underwent closed mitral valvotomy (CMV). Ten hospital deaths (4.2%) were excluded from further analysis. Follow-up totaled 3,572 patient-years. Pre- and intraoperative predictability of long-term event-free (i.e. no reoperation) survival was examined using the Cox regression analysis. Six preoperative- and one intraoperative variables were found to have independent predictive value: mean pulmonary capillary wedge pressure (25 mmHg), age, congestive heart failure, sex, mean systemic blood pressure (116 mmHg), mitral opening snap, and postoperative regurgitation (judged intraoperatively). The Kaplan-Meier estimate of survival at 1-, 5-, 10-, 15-, 20-, 25-, 30 and 34 years +/- SE were 95 +/- 1%, 85 +/- 2%, 72 +/- 3%, 51 +/- 3%, 32 +/- 4%, 15 +/- 4%, 14 +/- 4%, and 9 +/- 5% respectively. NYHA functional class improved from a mean of 2.8 preoperatively to 1.7 at one year and 1.9 at 5-years. Long-term complications: thromboembolism of 0.67 per 100 patient-years; endocarditis of 0.47 per 100 patient-years. Reoperation was done on 28% with a hospital mortality of 6.3%. The time span from first CMV was mean 14.6 years (0.2-27.8). At reoperation 92% had stenosis, 81% regurgitation, and 8% endocarditis. In conclusion CMV offers good long-term palliation of symptoms from isolated mitral stenosis in patients without signs of irreversible organ damage and with pliable valves. The frequency of endocarditis and thromboembolic complications is low.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Late results following closed mitral valvotomy in isolated mitral valve stenosis: analysis of thirty-five years of follow-up in 240 patients using Cox regression. 171 14

A 47-year-old man was hospitalized in May, 1990, because of breathlessness and continuous fever which appeared about 4 weeks after he had had his periodontic tooth removed in December, 1989. He had been diagnosed as having ventricular septal defect (VSD) at the age of 6 years. When he was hospitalized, he was in a condition of class IV by NYHA classification, with a white blood cell count of 17,300/mm3, an increase in CRP, a red blood cell sedimentation rate of 108 mm/hr, and positive alpha-streptococcus in blood culture. His cardiothoracic ratio was 64% with signs of pulmonary congestion on a chest X-ray film. Echocardiography revealed the presence of VSD and huge vegetations on the tricuspid, mitral and aortic valves. He was considered to have active infective endocarditis (AIE) which had presumably been provoked by VSD and the tooth removal. Penicillin G at a daily dose of 20 million units and gentamicin at a daily dose of 80 mg were intravenously administered to treat the alpha-streptococcus infection for about 4 weeks. Furosemide was used for congestive heart failure. Since, although his cardiac function appeared to have been improved, the signs and symptoms of the infection persisted, triple valve replacement for the tricuspid, mitral and aortic valves and patch closure of the VSD were performed 4 weeks after the hospitalization. The operation revealed inflammatory lesions extending from the endocardium of the right ventricle to the mitral valves through the VSD, and huge vegetations on the tricuspid, mitral and aortic valves. The operation was successful and the inflammatory areas gradually disappeared.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of ventricular septal defect associated with active infective endocarditis which was successfully treated by triple valve replacement and ventricular septal defect patch closure]. 174 71

Prosthetic valve endocarditis (PVE) remains an uncommon but serious complication of cardiac valve replacement. We analysed several risk factors (active or healed, early or late endocarditis, congestive heart failure, arterial emboli etc.) in order to identify the factors which may predict bad outcome. The overall mortality rate was 46.8% (15/32 patients). There was a significantly higher mortality rate in patients with early endocarditis (80%) than in those with late endocarditis (38%) (p less than 0.01). In the group of patients who underwent reoperation, the mortality rate was higher in those with active endocarditis (70%) than in those with healed endocarditis (28.5%) (p less than 0.05). We believe that combined medical and surgical treatment is the best management for bioprosthetic valve endocarditis, with the institution of appropriate preoperative antibiotic therapy, to attempt to achieve sterilization.
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PMID:Bioprosthetic valve endocarditis: factors affecting bad outcome. 175 3

Cardiac diseases of cattle may involve valvular structures, myocardium, pericardium, or blood vessels and are manifested by the clinical signs of cardiac dysrhythmias, cardiac murmurs, generalized edema, muffled heart sounds, jugular venous distention, jugular venous pulsations, pulmonary edema, pleural effusion, or ascites. Digoxin, quinidine, and furosemide can be used effectively to control signs of CHF and cardiac arrhythmias. Combination antimicrobial therapy can be successful for cows with infective endocarditis and thrombophlebitis. Pericardial fluid drainage may temporarily improve cattle with traumatic pericarditis or lymphosarcoma so that short-term goals may be reached.
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PMID:Treatment of cardiovascular disease in cattle. 176 Jul 59

The medical and surgical outcome of 55 patients with prosthetic valve disfunction are reported (39 bioprosthesis and 16 mechanical). Fifty patients were operated and five had medical treatment. The group of patients with mechanical prosthesis had a functional class of 2.4 +/- .74 vs patients with bioprosthesis who had a functional class of 2.8 +/- .71. Forty eight patients (87%) had congestive heart failure, four systemic emboli and three infective endocarditis. Three cases with mechanical prosthesis in tricuspid position were subjected to thrombolysis with streptokinase and experienced clinical and echocardiographical improvement. Time elapsed from original implantation and valve disfunction was 66 +/- 56 months for mechanical prosthesis vs 108 +/- 37 months in bioprosthesis (p less than 0.01), three patients died at surgery and two during the waiting period. All deaths resulted from cardiogenic shock. All of them were previously on functional class IV.
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PMID:[Medico-surgical experience in dysfunction of heart valve prostheses. Report of 55 cases]. 179 7

To evaluate the role of immunoglobulins, complement, circulating immune complexes (CIC), heart antibodies (HAb) and rheumatoid factor (RF) in infective endocarditis, we studied 28 consecutive patients before and after therapy. Statistically significant elevation was seen in IgG (p less than 0.001) and IgA (P less than 0.001) level prior to initiation of therapy as compared to a control group. Following drug treatment a fall was noted in IgA (P less than 0.01) and IgM (p less than 0.01) level as compared to basal values. Low C3 levels were seen in those with renal involvement (p less than 0.05). CIC levels estimated by 4% PEG precipitation assay were found to be elevated in 64% of patients. Patients with shorter duration of illness (less than three months) had higher levels of CIC containing IgG (P less than 0.005), IgA (P less than 0.05) and IgM (P less than 0.05), as compared to those with a longer duration. Initial CIC levels did not predict the clinical course and were found to be of no value in prognosis, although an improvement in congestive heart failure was associated with a rise in C3 (P less than 0.05) and IgM (P less than 0.05) containing CIC and an overall clinical improvement with a rise in IgA (p less than 0.05) containing CIC. There was no statistically significant difference in CIC level, for the entire group studied, before and after therapy. Patients who had rheumatoid factor in their initial serum sample demonstrated a fall in IgG, IgA and IgM containing CIC and a rise in C3 with therapy. The converse was true for those who lacked RF.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Immunologic parameters in infective endocarditis: a prospective study. 180 Mar 4

Nineteen patients with infective endocarditis underwent surgery. Congenital heart disease was found in 6 patients, valve disease in 13. Seven patients had history of rheumatism. Congestive heart failure was noted in 17 patients, arterial embolism in 3, and pulmonary infarction in 1. Blood culture was positive in 36.8%, while vegetations were detected echocardiographically in 58.8% of the patients. Selective surgery was performed in 17 patients and emergency operation in the rest two. There was no operative death. Follow-up for 3-109 months after operation showed no evidence of recurrent endocarditis. We suggest that early surgical treatment is mandatory for intractable infective endocarditis if excellent result is expected.
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PMID:[Surgical treatment of infective endocarditis]. 181 20

Two-dimensional echocardiograms of 58 patients with infective endocarditis were examined to determine if presence and/or size of vegetations on echocardiogram were predictive of morbidity and mortality. Group 1 (38 patients) with one or more vegetations, had a significantly higher rate of complications (emboli, congestive heart failure, need for surgery and death) than group 2 (20 patients) without vegetations (p less than 0.001). Analysis of morphologic characteristics of the vegetations in group 1 was of no predictive value for complications in individual patients. In contrast, patients whose echocardiograms demonstrated vegetations on aortic valve had a significantly higher incidence of heart failure, embolisation, surgery and death than those with vegetations on mitral valve. Thus, the detection of vegetations on initial echocardiogram clearly identifies a subgroup at risk for complications, more so if vegetations are present on the aortic valve, but the vegetations size does not predict an adverse clinical outcome.
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PMID:Clinical relevance of vegetations in infective endocarditis. 182 Oct

Thirty-two patients with native valve infective endocarditis who presented over a 10-year period at our hospital were analyzed retrospectively. The presenting symptom was a persistent fever in 22 patients. In 30 patients, the New York Heart Association functional class was less than II before the development of endocarditis. Blood cultures were positive on all occasions in 24 out of 29 culture-positive patients. All of the viridans streptococci, accounting for 79% of the isolated pathogens, were highly susceptible to ampicillin. Treatment consisted of a 6 week course of antibiotics, usually ampicillin, at a dose of 12 grams/day. In 9 cases, we had to change or stop the antibiotics because of severe side effects. The longer the period before making a diagnosis, the more severe were the symptoms of congestive heart failure and the more frequent was the incidence of cerebral hemorrhage. To initiate treatment as early as possible, in order to minimize valve destruction and to reduce the risk of cerebral hemorrhage, serial blood cultures are recommended in patients with valvular heart disease or congenital heart disease and a persistent fever, with minimal cardiac symptoms.
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PMID:Native valve infective endocarditis in adults--analysis of 32 consecutive cases over a ten-year period from 1980 to 1989. 182 92


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