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

A successful repair of infective endocarditis of the tricuspid valve in a drug abuser is reported. A 25-year-old woman with a history of drug addiction was referred to our hospital complaining of high fever despite antibiotic therapy. Blood cultures showed staphylococcal septicemia, and echocardiography revealed large vegetations attached to the tricuspid annulus and massive regurgitation of the tricuspid valve. Blood studies showed renal failure and hematological abnormalities due to septicemia and right ventricular failure. Excision of the vegetation and the posterior leaflet was performed along with annuloplasty (Kay's procedure). The patient's postoperative course was uneventful and subsequent echocardiographic examination disclosed no evidence of recurrence, and insignificant tricuspid valvular regurgitation. Local excision of vegetation and leaflet repair by annuloplasty may be performed in cases with well-circumscribed vegetation and minor leaflet damage.
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PMID:[A case of infective endocarditis of the tricuspid valve repaired by vegetectomy and annuloplasty]. 163 50

Curettage of skin lesions was not followed by bacteraemia in 22 patients. The risk of bacterial endocarditis after curettage and other minor skin surgery is small but should not be overlooked in those with a prosthetic heart valve, a history of other cardiac surgery, a previous episode of infective endocarditis, drug addiction, diabetes, alcoholism, immunosuppression, or renal failure--especially where the skin lesion might be infected.
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PMID:Minor skin surgery. Are prophylactic antibiotics ever needed for curettage? 135

Aside from disease induced by the direct pharmacological effect of heroin or cocaine, the occurrence of several medical complications not directly related to the drug itself is becoming an increasingly serious problem. In addition to the well-known occurrence of infective diseases, including AIDS, related to the i.v. use of heroin, heroin addicts also seem significantly more at risk for chronic nephropathy. Amyloidotic nephropathy is especially frequent in addicts who use heroin by subcutaneous route (skin popping); it seems to be mediated by an immunologic mechanism. Amyloidotic nephropathy is the main cause of renal failure among drug addicted subjects. Cardiovascular and cerebrovascular diseases are the most frequent medical complications observed in cocaine users. However, the occurrence of infective disease, such as endocarditis or hepatitis related to the parenteral use of the drug, is becoming frequent in these patients. Pulmonary disease is also common due to the route of administration of crack. These medical complications of drug addiction belong to the specific field of internal medicine and should be promptly recognized and treated by the physician.
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PMID:[Medical complications connected with the use of drugs]. 177 47

Infective endocarditis remains even today a potential lethal disease. The most frequent bacterial agents are viridans streptococci, staphylococci and enterococci. Left-sided endocarditis predominates except for patients with drug addiction. Modern recommendations of treatment are based on in vitro studies, experimental data from the animal model and clinical studies. Antimicrobial therapy should be parenteral and bactericidal in character. Detailed recommendations for treatment are given. Progressive heart failure, persistent bacteremia and repeated embolism are the most important reasons for surgical intervention. Modern prevention is performed as single or short-term prophylaxis for about sixteen hours. Simple practicability as well as handing out of guidelines to the patient will contribute to improved acceptance.
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PMID:[Therapy and prophylaxis of infectious endocarditis]. 185 6

Since September 1970, we have operated on 55 patients with intractable right-sided endocarditis. All patients were addicted to heroin. Fifty-three underwent tricuspid valvulectomy without replacement and in addition two had pulmonic valve excision. Twenty-four patients (49%) returned to their drug addiction. Six patients (11%) required prosthetic heart valve insertion 2 days to 13 years later for medically refractory right-sided heart failure, and four of these died. Overall, 16 patients (29%) died, six (11%) within 45 days after the tricuspid valvulectomy. One (2%) of these deaths was related to the operation and five were due to uncontrollable infection. Ten (18%) deaths occurred 9 months to 13 years after the tricuspid valvulectomy. Nine were due to drug addiction and one to progressive right ventricular failure 2 months after prosthetic heart valve insertion and 10 years after the initial valve removal. Of the 39 patients who are alive, 37 (67%) have not required prosthetic heart valve insertion. From our observations we reached the following conclusions: (1) Drug addiction is a recurrent and lethal disease. Among these patients, tricuspid valvulectomy without replacement is the operation of choice for the management of intractable right-sided endocarditis; (2) after tricuspid valvulectomy without replacement, only six of 55 patients (11%) had required prosthetic heart valve insertion to control medically refractory right-sided heart failure; (3) in a small percentage of patients the absence of the tricuspid valve may lead to severe and permanent impairment of right ventricular function.
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PMID:Tricuspid valvulectomy without replacement. Twenty years' experience. 196 Sep 98

We present 1 case of right sided endocarditis caused by Fusobacterium nucleatum in a patient with intravenous drug addiction and human immunodeficiency. The clinical features were fever, anemia, and pulmonary embolism. The echocardiogram showed a giant vegetation originated from the right atrial wall prolapsing in diastole into the right ventricle which disappeared after the patient presented pulmonary embolism. The clinical course was uncontrolled with empiric antimicrobial therapy but it was good with metronidazol. The cases previously described in the literature caused by gram-negative anaerobic bacteria are discussed and compared with the present case.
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PMID:[Right-sided endocarditis due to Fusobacterium nucleatum]. 204 51

This report describes the case of a 24-year-old female heroin addict with large tricuspid valve vegetation, recurrent septic pulmonary emboli, and renal failure, due to immune-complex nephritis. The clinical course was initially complicated by acute hepatitis A. Because of recurrent emboli and persistent fever despite adequate antibiotic therapy she underwent excision of the vegetation ("vegetectomy") and tricuspid valvuloplasty. She was well at follow-up 12 months later with trivial tricuspid regurgitation shown by doppler-echocardiography. Kidney and liver function were normal. Right-heart endocarditis in drug addiction and therapeutic approaches are discussed. In selected cases "vegetectomy" and valvuloplasty offer a promising therapeutic alternative.
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PMID:Tricuspid valve endocarditis in the drug addict: a reconstructive approach ("vegetectomy"). 226 37

Patients with staphylococcus endocarditis hospitalized at the Cantonal Hospital Lucerne from 1971 to 1988 are reviewed. A total of 50 patients fulfilled the diagnostic criteria (in 60% of the cases the diagnosis was definite, in 26% probable, and in 14% possible). These 50 patients with staphylococcus infection account for 29% of all patients with infective endocarditis seen during this time interval. Staphylococcus endocarditis affected the mitral valve in 48%, the aortic valve in 36% and--unexpectedly often--the tricuspid valve in 30%. In 54% previously normal valves were infected. Diminished host defence (predominantly intravenous drug addiction and diabetes) was a predisposing feature in 52% of the patients. The average duration of symptoms before diagnosis was 11 days, and in patients with right heart endocarditis it was 21 days. In 20% the condition was not diagnosed before autopsy. The clinical picture was relatively nonspecific: 50% of patients had no diagnostic heart murmur and 10% had no fever. The dominant--often misleading--symptoms were due to embolic complications. Two thirds of the cases with right heart endocarditis had pulmonary emboli. In 38% of the patients endocarditis resulted in heart failure. Overall mortality was 51% and correlated with age and the presence of heart failure, uncontrolled infection or cerebral embolism. In contrast to the high mortality in patients with mitral valve infection (61%), only one of the 11 patients with isolated right heart endocarditis died.
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PMID:[Clinical aspects of staphylococcal endocarditis]. 229 7

In a retrospective survey of patients hospitalized in the Department of Medicine of the University Hospital, Basel, Switzerland, from 1980 to 1986, we found 269 patients with history of past or current drug abuse. The charts of these patients were analyzed for infectious complications according to defined criteria. Heroin was the principal drug consumed by 95%. In 127 patients (47%) at least one infectious complication was diagnosed. In 125 (31%) of 404 admissions, the infectious problem was the main reason for hospitalization. Among the 269 patients, 217 infective episodes occurred. Pulmonary infections were the most frequently occurring (52 episodes). There were 44 cases of viral hepatitis, 30 of human immunodeficiency virus infection, and 25 of minor genital infections. Bone and joint infections and sepsis/endocarditis were diagnosed in seven cases each. The overall mortality was 4.1%; however, only three of the 11 deaths were attributed to infections. Intravenous drug addiction is complicated by a high morbidity because of infections that were seldom lethal during the observed period.
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PMID:Infectious complications in drug addicts: seven-year review of 269 hospitalized narcotics abusers in Switzerland. 274 5

Among the surgical complications of intravenous drug addiction, pyogenic splenic abscess is considered to be a rare entity. A review of the literature reveals only 24 cases of splenic abscess secondary to this particular etiology. The authors report five patients with intravenous drug addiction who underwent splenectomy for pyogenic splenic abscess within 1 year. Fever and abdominal pain were the only constant physical signs. Three patients had associated infective endocarditis, and the other two patients sustained blunt trauma to the left side of the trunk weeks earlier. Computed tomography (CT) and ultrasound were diagnostic in all five patients preoperatively, and they were complementary when combined. Four of the five patients had Staphylococcus aureus septicemia at the time of splenectomy. Three patients recovered from their operations, and the other two, both with endocarditis, died postoperatively from causes unrelated to splenic abscess and splenectomy. A high index of suspicion is warranted in this susceptible group of patients with vague abdominal signs and persistent sepsis to rule out splenic suppuration. The noninvasive imaging methods, CT scan and ultrasound, facilitate early diagnosis in these patients.
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PMID:Pyogenic splenic abscess in intravenous drug addiction. 357 50


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