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

The major medical complications of needle addiction are reviewed. The problem of overdose, and diseases of the skin, lung and kidney are discussed in detail. The importance and prevalence of infections are emphasized, with special reference to infective endocarditis and viral hepatitis. The work is introduced with a historical review.
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PMID:The medical complications of narcotic addiction. I. 32 20

The authors underline the recent increase in the incidence of infective endocarditis (IE) involving the right side of the heart, because of instrumental procedures and, above all drug-addiction. They describe the epidemiology, congenital and acquired predisposing heart diseases, the most common portals of entry of the infective agents, etiology, pathogenesis, pathology, cardiac and extracardiac clinical manifestations and complications, clinical and instrumental diagnosis, medical and surgical therapy, prognosis and prevention of disease.
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PMID:[Infective endocarditis]. 146 91

The doctor-patient interaction in the methadone maintenance treatment clinic is qualitatively different from general medical settings. The patient presents with a specific request for treatment of opioid dependence, most often having already selected the methadone treatment modality, and the initial contact is centered around obtaining methadone. Addiction and needle use increase susceptibility to life-threatening illnesses, such as syphilis, endocarditis, tuberculosis, and AIDS. The physician is working with counselors, nurses, therapists and 12-Step programs, incorporating the best of the medical, psychodynamic, behavioral, and recovery models into treatment. Federal and state governments also control and regulate methadone treatment. Given this complex picture, the basic techniques of methadone maintenance treatment are reviewed, including the intake examination, the annual examination, dose adjustment, withdrawal from methadone maintenance, management of pregnant patients, dual diagnosis patients, and severely ill or medically disabled patients.
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PMID:Methadone maintenance treatment: a primer for physicians. 176 90

We report the cases of three adults with a history of intravenous drug abuse who developed endocarditis caused by Corynebacterium xerosis, Neisseria subflava, and Neisseria flavescens, respectively. No cases of endocarditis caused by C. xerosis or N. flavescens and only one case caused by N. subflava have previously been reported in association with narcotic addiction. The prominent clinical features in all patients included poor response to antibiotic therapy, persistent fever, and major embolic events. Stigmata of infection with human immunodeficiency virus, as manifested by oral candidiasis, cervical lymphadenopathy, and serologic evidence, were present in two of the three patients. At our institution, where Staphylococcus aureus remains the most frequent etiologic agent of narcotic-associated endocarditis, the occurrence of these three cases in a 9-month period is striking. We speculate that infection with human immunodeficiency virus may play a role in the pathogenesis of endocarditis caused by these unusual organisms.
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PMID:Unusual pathogens in narcotic-associated endocarditis. 235 5

One hundred sixty-eight opiate addicts, whose hearts were submitted for necropsy study, were examined with prime focus on modes of death and types of cardiac abnormalities. Twenty various modes of death were identified: active infective endocarditis or its consequences in 67 (40%), drug overdose in 39 (24%), coronary artery disease in 14 (8%), pulmonary granulomatosis in 7 (4%) and 15 various diseases (7 cardiac and 8 noncardiac) in the remaining 41 (24%) patients. Of the 168 hearts examined, only 7 (4%) were normal. Although infective endocarditis (active, healed or both) was most common (80 [48%] patients), there was a broad range of other cardiac abnormalities present: cardiomegaly in 114 (68%) (including 22 patients without another cardiac abnormality), coronary artery disease in 35 (21%), acquired valvular heart disease in 16 (10%), myocardial heart disease in 14 (8%) and a congenital cardiac anomaly in 19 (11%). Of the 35 hearts with various coronary artery diseases, 28 had significant (greater than 75%) narrowing of the cross-sectional area of 1 or more of the 4 major (left main, left anterior descending, left circumflex and right) epicardial coronary arteries by atherosclerotic plaque. Of 112 coronary arteries in these 28 hearts, 52 (46%) were significantly narrowed (a mean of 1.9 of the 4 major coronary arteries/patient). In 27 of these 28 cases, each 5-mm segment of the 4 major coronary arteries was examined histologically. Of the 1,435 five-mm segments examined, 189 (13%) were narrowed 76 to 100% in cross-sectional area by plaque; 347 (24%), 51 to 75%; 336 (23%), 26 to 50%; and 563 segments (39%) were narrowed 0 to 25% in cross-sectional area by plaque. The percents of 5-mm segments narrowed 76 to 100% in cross-sectional area were greater in those patients with (128 of 793 [16%]) than without (61 of 642 [9%]) clinical evidence of myocardial ischemia (p = 0.001). In this study a very high frequency of cardiac abnormalities (161 [96%]) was found at necropsy and most deaths (97 [58%]) were related to cardiac disease. Although death was most often due to diseases whose association to opiate addiction is well recognized (such as infective endocarditis, drug overdose and pulmonary granulomatosis from the venous injection of talc), several other modes of death were present. Most prominent among these was coronary artery disease (14 patients [8%]).
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PMID:Modes of death and types of cardiac diseases in opiate addicts: analysis of 168 necropsy cases. 280 61

The case of a 20-year-old male patient, with a history of addiction to parenteral heroin and recurrent prosthetic valve endocarditis, is presented. In this case the final procedure consisted of a complete translocation of the aortic root and coronary bypass grafting with a composite graft made from a microporous polyurethane (Mitrathane) cardiac patch, a prosthetic valve and two Mitrathane vascular grafts for the coronaries. This is a complex operation, only indicated in cases of extensive destruction of the aortic root due to recurrent endocarditis. To our knowledge, it is the first case of this type performed using Mitrathane.
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PMID:Complete translocation of the aortic root and coronary bypass grafting with a microporous polyurethane (Mitrathane) composite valved graft in the treatment of recurrent prosthetic valve endocarditis. 349 69

The changing microbiology of bacteremia among narcotic addicts in Detroit raised concerns about current presumptive antimicrobial therapy. In a one-year study of incidence, microbiology, sites, and risk factors, 180 bacteremic addicts (15% of addict-related admissions) were followed prospectively. Cases of bacteremia were caused by methicillin-sensitive Staphylococcus aureus (33%), methicillin-resistant S. aureus (MRSA, 24%), streptococci (20%), mixed organisms (11%), Pseudomonas aeruginosa (9%), and miscellaneous other single organisms (3%). Endocarditis (41%) and abscess or cellulitis (34%) were usually found. Multivariate analysis of host factors and addiction habits yielded results predictive of bacterial species but not of infection sites. Previous hospitalization, long-term addiction, and nonprescribed antibiotic use were associated with MRSA acquisition (odds ratio, 8.6:1). All addicts with polymicrobial or P. aeruginosa bacteremia abused pentazocine and tripelennamine (P = .05). Many of the addicts with streptococcal bacteremia were women who did not abuse antibiotics (odds ratio, 20.7:1). Physicians inappropriately prescribed empiric antibiotics for 67 of 72 addicts with MRSA, P. aeruginosa, or polymicrobial infection. The results of regression analysis suggest that, guided by the patient's history, the physician can prescribe appropriate empiric antimicrobial therapy for bacteremia in the febrile addict in Detroit.
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PMID:Bacteremia in narcotic addicts at the Detroit Medical Center. I. Microbiology, epidemiology, risk factors, and empiric therapy. 363 87

Multivariate statistical methods, multiple regression (RA) and automatic interaction detector analysis (AID) were used to study the possibility of an early prediction of staphylococcal etiology in 249 of 851 patients with verified septicemia or endocarditis. The variables included pertinent symptoms and signs and laboratory data available soon after admission. 10 of the 70 variables initially studied showed simple, or in various combinations, a statistically significant partial correlation to staphylococcal etiology in the AID. The highest predictive value with a high probability for staphylococcal etiology was recorded for combinations of the variables: i.v. narcotic addiction and septic pulmonary embolism; non-addiction, wound infection, and hospitalization within 4 weeks; non-addiction, absence of skin infection, presence of foreign body, and age less than 60 yr. Staphylococcal etiology was contradicted by the absence of i.v. narcotic addiction, skin infection, foreign body, septic skin manifestation, surgical procedure within 4 weeks, joint symptom and a C-reactive protein less than or equal to 10 mm. Thus, a prediction of etiology may be valuable in choosing therapy before definite confirmation by positive blood cultures or when blood cultures remain sterile.
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PMID:Prediction of staphylococcal etiology among patients with septicemia with or without endocarditis by multivariate statistical methods. 399 4

A case of pseudomonas endocarditis of biliary origin with impairment of the mitral and tricuspid heart valves is reported. Former history of the patient did not reveal narcotic addiction or previous open-heart surgery. Osteomyelitis is an uncommon complication of pseudomonas endocarditis. Echocardiography was a useful diagnostic method in the present case, showing the vegetation on the tricuspid valve. The poor prognosis of cases with left valvular heart disease which are resistant to medical treatment is emphasized. Differential count of the colonies did not localize the affected heart valve in this case.
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PMID:[Endocarditis due to Pseudomonas aeruginosa (author's transl)]. 677 91

The clinical records of 66 patients with bacterial endocarditis hospitalized in three community hospitals in Saginaw, Michigan, from 1964 through 1979 were reviewed. Data from these nonreferral hospitals demonstrate that infective endocarditis often does not present to the primary care physician with classical physical findings. The etiological organisms were noted to change from being primarily alpha-hemolytic streptococci during the early part of the study to staphylococci and Streptococcus faecalis during later years. Narcotic addiction was a factor of increasing importance in the development of endocarditis and in the changing microbiology of this clinical syndrome.
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PMID:Bacterial endocarditis in the community hospital. 679 42


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