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

The clinical findings relating to 11 patients in Hong Kong (HK) and to 43 patients described elsewhere, all with Streptococcus zooepidemicus septicaemia, are reviewed. There was a particular association with cardiovascular disease (27%) with seven cases of endocarditis, three of abdominal aortic aneurysm and two of deep venous thrombosis. Associations not previously reported included two cases of pharyngitis and two patients with persistent post-operative fever. The overall mortality was 22%. Both human and porcine strains of S. zooepidemicus from HK did not hydrolyse aesculin in contrast to the aesculin-positive biotypes reported previously. HK strains also had very mucoid colonies and capsules of hyaluronic acid were seen in electron micrographs. Samples of chromosomal DNA, extracted by means of HindIII restriction endonuclease, of strains from human beings and pigs were identical. The MIC of penicillin for all strains was less than or equal to 0.03 mg/l but the MBC for all was greater than 32 mg/l. Penicillin alone is generally sufficient for cure but combination with an aminoglycoside may be indicated in seriously ill patients. In our locality, pigs were incriminated as a possible source of human infection whereas consumption of contaminated dairy products is important elsewhere.
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PMID:Streptococcus zooepidemicus (Lancefield group C) septicaemia in Hong Kong. 227 71

Family physicians are often requested to provide preoperative evaluation of elderly patients. Age independently increases the risk of morbidity and mortality in the perioperative period. In addition, the altered physiology of the older patient, in combination with the increased number of disease processes, increases the potential for complications. A comprehensive preoperative assessment includes an evaluation of the patient's present physiological functioning and attempts to detect the presence and status of any disease processes. Evaluation includes a thorough history, physical examination, and laboratory testing. Special considerations in preoperative assessment of the elderly patient include the assessment of nutrition, functional capabilities, and evaluation of the cognitive and emotional status of the patient. Special concerns include prophylaxis for deep vein thrombosis and pulmonary embolus, and antibiotic prophylaxis for endocarditis and for patients with joint prostheses.
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PMID:Preoperative evaluation of the elderly surgical patient. 305 58

Medical and surgical admissions of drug addicts to Stobhill Hospital, Glasgow in the period 1980-1984 were reviewed. Admission numbers, which totalled 123, rose markedly over the period of the study, particularly in the final year. The mean age of addicts was 21 years. Ninety-two per cent abused heroin but many abused combinations of drugs. Inadvertent narcotic overdosage was the commonest diagnosis amongst medical admissions followed by deep venous thrombosis. A small number of cases of staphylococcal endocarditis presented particular problems in diagnosis and management. The commonest reason for surgical admission was abscess formation. Whilst 85% of addicts showed markers of past infection with hepatitis B, chronic carriage of surface antigen occurred in only 10%. Few addicts had withdrawal symptoms although the practice of narcotic and/or tranquilliser prescribing varied. Many admissions were of short duration with 36% ending in patients taking their own discharge. Only 16% of addicts were notified to the Home Office.
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PMID:Admissions of drug addicts to a general hospital: a retrospective study in the northern district of Glasgow. 360 85

The incidence of endocarditis due to Cardiobacterium hominis is probably underestimated because clinical presentations vary greatly and culture of this Gram negative germ is difficult. A 48-year-old man with a past history of post-streptococcic aortic regurgitation was hospitalized twice within 1 week for fever (38 degrees C) and junctional tachycardia which responded to amiodarone. Subsequently, infero-apical necrosis was documented. Based on the result of the laboratory tests, coronary embolism was suspected although 12 blood cultures were negative. The patient recovered well with a standard antibiotic treatment. Fifteen days later, the blood cultures revealed Cardiobacterium hominis. Antibiotic therapy was adapted and aortic valve replacement was programmed. Two months later the patient died from uncontrollable left heart failure. A 63-year-old man who had had mitral valve replacement 10 years earlier for Streptococcus mitis endocarditis was hospitalized for fever (38 degrees C) and a painful left calf. Phlebocavography eliminated deep vein thrombosis and a complete cardiac work-up was inconclusive. Endocarditis was suspected although blood cultures were negative. The patient was given oral penicillin and discharged after one week. Three months later, the patient was again febrile (38 degrees C) and suffered a cerebral vascular event. Fourteen days after blood sampling, cultures revealed Cardiobacterium hominis. The patient's haemodynamic status worsened and valve replacement with atrioplasty was performed. Outcome after 4 years follow-up has been favourable. Endocarditis due to Cardiobacterium hominis, a saprophitic germ of the upper airway and the female genital tract, has been reported in 64 cases in the literature. The clinical picture is often limited to fever and a heart murmur and laboratory tests show an accelerated erythrocyte sedimentation rate and hyperleukocytosis. Inflammatory type anaemia is often found due to the latency of the endocarditis. Complications are frequent and can be fatal due to massive pulmonary emboli, cerebral vascular events or irreversible heart failure. C. hominis is sensitive to amoxycillin and netilmicin. Surgical treatment of the valvulopathy is indicated.
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PMID:[Endocarditis caused by Cardiobacterium hominis]. 820 92

The Ross operation has been performed for more than 25 years and its popularity has increased dramatically in recent years. We developed an interest in this procedure through a combination of a basic dissatisfaction with a device that requires life-long anticoagulation and the belief that a vital, autologous tissue valve with normal valve morphology and hemodynamics would prove to be superior to the mechanical valve, and that these advantages would outweigh the potential drawbacks related to the operation's technical difficulty and the risk of autograft or homograft dysfunction. From December 1992 to November 1994 40 Ross operations as total root replacements in a diverse group of patients between 5 and 72 years of age (median 32) were performed at Rigshospitalet. Seventeen (43%) of the patients had undergone at least one previous open heart operation. Eleven patients (28%) required surgery because of ongoing or previous endocarditis, and of these, nine had aortic annular destruction and cavity/pseudoaneurysm formation and five had prosthetic valve endocarditis. Three patients (8%) were operated because of mechanical valve dysfunction. One patient was treated for an ascending aortic aneurysm and aortic insufficiency. The remaining 25 patients were operated because of congenital or acquired aortic insufficiency, stenosis, or both. Ten patients (25%) underwent concomitant procedures. No mortality or serious complications occurred. Morbidity was limited to one case each of total atrioventricular (A-V) block, sternal pseudarthrosis, minor stroke, and deep vein thrombosis. Thirty-five patients had no or trivial, two patients mild, and three patients moderate autograft valve insufficiency during a median follow-up of 8 months (range 0-23 months). Two patients had pulmonary stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The Ross operation: results of early experience including treatment for endocarditis. 851 18

Group B streptococcus (Streptococcus agalactiae) is a common etiology of bacteremia among adults. Pyomyoma is a rare infectious complication of uterine leiomyomas. We report the case of a diabetic postmenopausal woman with a giant pyomyoma simulating an ovarian cancer. It was associated with S. agalactiae endocarditis and deep venous thrombosis of the right external iliac and femoral veins. Treated initially with intravenous penicillin, amikacin, and anticoagulation, the patient later had abdominal hysterectomy with an uneventful recovery. We also review the cases of pyomyoma reported since 1945. Of 14 cases described (including ours), mortality was 21%. Endocarditis was never reported in association with pyomyoma. The presence of bacteremia and a leiomyoma should raise suspicion for this disease.
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PMID:Streptococcus agalactiae endocarditis and giant pyomyoma simulating ovarian cancer. 1137 3

Thromboembolic events are a major cause of morbidity in cancer patients and may be harbingers of occult malignancy. Trousseau's syndrome (TS) is probably the best known thromboembolic syndrome in the cancer patient, encompassing a variety of paraneoplastic thromboembolic disorders. These include spontaneous recurrent or migratory venous thromboses and arterial emboli caused by nonbacterial thrombotic endocarditis in a patient with malignancy. Although linked to almost all cancers, venous thromboembolism (VTE) is a terminal event in many cancers occurring in women, such as breast, uterine, and lung cancers (Monreal et al. Thrombosis and Haemostasis 1997;78:1316). Appropriate recognition of the syndrome is paramount because TS often requires careful medical surveillance and management. Significant complications of thromboembolic events in the cancer patient include limb ischemia and deep venous thrombosis/pulmonary embolism, which can cause devastating and permanent consequences. The rehabilitation management of these complications is reviewed, with an emphasis on diagnostic and therapeutic approaches in this patient population.
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PMID:Thromboembolic events in the cancer patient. 1450 61

A cerebrovascular thromboembolic event may precede the identification of cancer, and be the first clinical evidence of an underlying malignancy. The malignancy can cause either nonbacterial thrombotic endocarditis or hypercoagulable state, both of which may have clinical manifestions such as thrombotic or embolic occlusion of multiple major cerebral vessels. We present three cases with unusual cerebrovascular events. The first case is a 62-year-old woman who was admitted due to acute left limbs weakness and consciousness disturbance. Brain computed tomographic (CT) scan showed right middle cerebral artery (MCA) and posterior cerebral artery (PCA) infarctions with uncal herniation. The second case is a 44-year-old woman who was hospitalized due to acute bilateral limb weakness and consciousness disturbance. Bilateral MCA, left PCA, anterior cerebral artery (ACA) infarctions and deep vein thrombosis in the left leg were diagnosed. The third case is a 63-year-old man who developed sudden onset of right hemiplegia and consciousness disturbance. Brain CT scan showed bilateral MCA and left ACA infarction. The results of a series of examinations including biochemistry, lipid profile, carotid duplex, and transthoracic and transesophageal echocardiography were unremarkable. All patients had positive disseminated intravascular coagulation (DIC) tests with elevated D-dimers and fibrinogen degradation products (FDP). Further systemic evaluation for malignancy revealed ovarian cancer in the first patient, endometrial carcinoma in the second patient, and adenocarcinoma of lung in the third patient. They all died of the underlying malignancy. Because the hemostatic system can be altered by malignancy, intravascular coagulation abnormalities of these malignancy-related strokes may be disclosed by laboratory assays of hemostasis.
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PMID:Cerebrovascular complications in patients with malignancy: report of three cases and review of the literature. 1531

A 56-year-old man with heparin-induced thrombocytopenia with thrombosis syndrome (HITTS) received anticoagulation with recombinant hirudin (lepirudin) for emergency coronary artery bypass graft (CABG) surgery and aortic valve replacement. The patient experienced life-threatening refractory bleeding that was successfully treated with recombinant factor VIIa. He had a history of infective endocarditis that resulted in severe aortic insufficiency, three-vessel coronary artery disease, and acute renal failure requiring hemodialysis. The patient was transferred from another hospital for the emergency surgery, but before his transfer, he developed HITTS secondary to therapeutic heparin for a deep vein thrombosis of the lower extremity. The presence of HITTS, the urgent nature of the case, and the availability of the direct thrombin inhibitor led the surgical team to select lepirudin for anticoagulation to facilitate cardiopulmonary bypass. After separation from cardiopulmonary bypass, the patient was in a coagulopathic state due to the inability to reverse the lepirudin and the slowed elimination of the drug secondary to inadequate renal function. As a result, the patient experienced excessive generalized oozing that was unresponsive to traditional therapies and blood product transfusions. Recombinant factor VIIa 35 microg/kg was given as rescue therapy. The bleeding slowed, which allowed placement of chest tubes and closing of the sternum. The patient was transferred to the intensive care unit in stable condition with no evidence of thrombosis in the freshly placed bypass grafts or on the bioprosthetic valve. Recombinant factor VIIa appears to be a suitable option as salvage therapy in patients with refractory bleeding secondary to anticoagulation with a direct thrombin inhibitor during cardiac surgery.
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PMID:Recombinant factor VIIa for refractory bleeding after cardiac surgery secondary to anticoagulation with the direct thrombin inhibitor lepirudin. 1655 18

A case of intravenous precipitation of erythromycin is reported along with the patient history, pathologic findings, and a description of the analytical methods and results. The patient was a 75-year-old woman with a history of myocardial infarction, deep venous thrombosis, and diabetes mellitus who underwent aortic valve replacement. She developed endocarditis and recurrent episodes of urosepsis, with multiple organ failure including severe gastric retention, for which she was treated with erythromycin intravenously. She died because of refractory septic shock. Autopsy revealed aortic valve endocarditis, thrombi in the right femoral vein, arterial (nonfungal) thromboemboli in the celiac trunk, and coarse material in the right femoral vein where the tip of the central venous catheter had been located. Microscopical examination of the coarse material showed that it was birefringent crystalline material. Part of the postmortem material was analyzed in the laboratory of the department of clinical pharmacy and revealed the presence of erythromycin. Erythromycin was detected using Fourier transform infrared spectroscopy. An additional specific color test and thin-layer chromatography confirmed this finding. On the basis of the postmortem findings, patient history, and analytical-toxicologic results, we conclude that erythromycin precipitation can occur in vivo after intravenous administration in patients with impaired blood flow.
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PMID:Erythromycin precipitation in vena femoralis: investigation of crystals found in postmortem material of an intensive care unit patient. 1822 76


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