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

Mycotic aneurysms of the celiac artery are extremely rare, and in our review of the literature we found that in only one case was it due to infective endocarditis. In our case a 19-year-old female patient with culture-negative infective endocarditis presented with pain in the epigastric area. A celiac artery aneurysm was diagnosed by ultrasonography and confirmed on CT scan and angiography, which also demonstrated an associated aneurysm of the superior mesenteric artery. Since excellent collateral circulation was present, simple ligation of the two aneurysms was performed. The patient presented no major complications in the postoperative course.
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PMID:Mycotic aneurysm of the celiac trunk and superior mesenteric artery in a case of infective endocarditis. 205 40

Nine cases of infective endocarditis (IE) on native valves, complicated by arterial embolism of the limbs (AEL), were collected between June 1974 and October 1988 (prevalence 4.3 percent). Among the 11 AEL recorded, 9 involved the lower limbs and 2 the upper limbs. The diagnosis, suspected in patients with acute ischaemia (n = 6), transient (n = 1) or pseudophlebitic (n = 1) pain, or discovered by systematic pulse examination (n = 3), was confirmed by Doppler ultrasound (n = 3), angiography (n = 2) or oscillometry (n = 4). AEL occurred 2.8 weeks on average after the onset of treatment; it appeared 6 months after the end of treatment in 1 case and preceded the diagnosis of IE by 1 to 6 weeks in 3 cases. The causative organisms isolated in 7 cases were: non-haemolytic streptococci (n = 4), Staphylococcus aureus (n = 1), Haemophilus parainfluenzae (n = 1) and enterococcus (n = 1). Vegetations were found in 6 of the 7 patients explored by echocardiography. Two cases of embolism of the femoral artery required embolectomy. Effective heparin anticoagulation was obtained in only one patient. Six patients underwent valve replacement in the acute phase of endocarditis. After a mean follow-up period of 32 months (range 3 to 120 months), only one patient has symptoms (claudication of the left upper limb); 5 patients are asymptomatic with a reduced (n = 5) or abolished (n = 2) pulse. Three embolisms have left no sequelae. Altogether, AEL are not uncommon in infective endocarditis. They rarely influence the functional prognosis and are detected by systematic palpation of the pulses. Anticoagulation in effective doses is discussed. Attempts at removing the obstruction should be made only in cases with poorly tolerated proximal embolism. In patients with multiple or recurrent embolic accidents, valve replacement may be considered.
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PMID:[Arterial embolism of the limbs in infectious endocarditis of the heart valves]. 214 82

A 74-year-old man who had a weight loss of 7 kg in three months, with fever up to 38 degrees C and anaemia (Hb 9.4 g/dl) began to have pain and blue discoloration of fingers II-V of the right hand. Echocardiography demonstrated vegetation on the aortic valve cusps and blood culture grew Aspergillus fumigatus, indicating Aspergillus endocarditis. There were no predisposing factors. Valve replacement was contraindicated because of the age of the patient, the presence of peripheral arterial disease, and previous myocardial infarction. Treatment was started with amphotericin B i.v. (dosage increasing to 50 mg daily) and 1.5 g daily of flucytosine by mouth, to a total of 1.1 g amphotericin B and 41.5 g flucytosine in five weeks. During this time there was a gradual decrease in symptoms and the valve vegetations. Nine months later there has been no recurrence.
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PMID:[Successful drug therapy in Aspergillus endocarditis]. 224 66

The purpose of this study was to determine the incidence of death as the initial manifestation of cholelithiasis. Records of patients who died or underwent cholecystectomy for gallstone-related disease at Duke University Medical Center between 1976 and 1985 were reviewed. Thirty patients died, six of whom (20%) had previous episodes of biliary pain and stone documentation. Twenty-four (80%) were asymptomatic (three with previous incidental diagnosis of cholelithiasis). Reason for admission included acute cholecystitis (nine), pancreatitis (eight), biliary pain (six), cholangitis (four), jaundice (one), and endocarditis (one). Three patients died of gallstone complications without surgical intervention; one patient had renal failure and two had septicemia. Other causes of death were: sepsis (seven patients), cardiac failure (six), pulmonary complications (four), renal failure (three), cerebrovascular accident (three), liver failure (two), pancreatitis (one), and gastrointestinal bleeding (one). During this period, 1731 cholecystectomies were performed without mortality. In this group, the patients were younger (50 +/- 8 years vs. 64 +/- 13 years, p less than 0.001), and had a lower incidence of cirrhosis (p less than 0.001) and diabetes (p less than 0.002). The sex ratio was inverted (p less than 0.001). This study demonstrates that death from gallstones is uncommon (three cases per year), as is death from their initial clinical manifestation (1.2%). The risk of death is two- and ninefold higher in patients with acute cholecystitis or acute pancreatitis. Age, cirrhosis, and diabetes are important determinants of outcome.
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PMID:Deaths from gallstones. Incidence and associated clinical factors. 291 58

Teicoplanin 400 mg, given as an intravenous bolus dose after induction of general anaesthesia, was highly effective in reducing the prevalence of streptococcal bacteraemia following dental extraction. Pulse rate and blood pressure monitoring did not show any adverse cardiovascular reactions after this dose which was extremely well tolerated. Blood samples were collected from adult patients for culture and antibiotic assay about two minutes after the dental procedure. Viridans streptococci were isolated from one of 40 patients receiving teicoplanin (2.5%) compared with 13 of 40 (32.5%) control patients. Another group of patients investigated received amoxycillin 1.0 g, intramuscularly shortly before anaesthesia, and viridans streptococci were isolated from 10 of 40 (25%) patients in this group. The mean serum teicoplanin and amoxycillin concentrations at the time of extraction were 37 and 10 mg/l respectively. Although amoxycillin was administered with lignocaine patients occasionally complained of pain following intramuscular injection. The results of this study suggest that the 400 mg intravenous bolus dose of teicoplanin is more suitable than 1.0 g intramuscular amoxycillin for the parenteral prophylaxis of streptococcal endocarditis in patients with cardiac lesions who require a dental procedure. Also as the teicoplanin dose is easy to administer and free of cardiovascular reactions or 'red man' syndrome it is probably more suitable than vancomycin for providing prophylaxis in patients allergic to penicillin.
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PMID:Comparison of intravenous teicoplanin with intramuscular amoxycillin for the prophylaxis of streptococcal bacteraemia in dental patients. 295 48

The chemistry, mechanism of action, antimicrobial spectrum, pharmacokinetics, adverse effects, and clinical uses of teicoplanin are reviewed. Teicoplanin, a novel glycopeptide that is similar to vancomycin, was isolated in the mid-1970s. A fermentation product of Actinoplanes teicomyceticus, teicoplanin is a structurally complex compound made up of six fatty-acid components attached to a common aglycone. Teicoplanin's mechanism of action, like that of vancomycin, is inhibition of cell-wall biosynthesis. In vitro activity is comparable to that of vancomycin and includes staphylococci, streptococci, corynebacterium, listeria, and anaerobic cocci. Resistance to teicoplanin has been reported with coagulase-negative staphylococci. Teicoplanin is 50 to 100 times more lipophilic than vancomycin. Teicoplanin is poorly absorbed after oral administration but is 90% bioavailable when administered intramuscularly. The drug distributes widely into body tissue and is eliminated primarily renally. Optimal dosing regimens and therapeutic serum drug concentrations have not been well established. Reported adverse effects have included irreversible ototoxicity, allergic reactions with maculopapular rash and eosinophilia, pain at intramuscular injection site, and elevation of aminotransferases. Initial clinical trials have yielded conflicting results in gram-positive bacteremia, endocarditis, osteomyelitis, and soft-tissue infections. Teicoplanin has shown promise in surgical and dental prophylaxis. Comparative trials with vancomycin and other antimicrobial agents must be completed before teicoplanin's role as a therapeutic agent in the treatment of systemic gram-positive infections is defined.
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PMID:Teicoplanin: an investigational glycopeptide antibiotic. 297 8

Dental caries and periodontal disease are the most common afflictions of the tooth. These infectious diseases cause considerable pain and discomfort and ultimately loss of the tooth. Apart from local effects, these infections may extend beyond natural barriers and result in complications that can vary in severity from the excruciating pain of acute pulpitis to life-threatening infections of the deep fascial spaces of the head and neck. In this article, the clinical and pathologic features of dental caries, pulpitis, periapical abscess, pericoronitis, and periodontal infections are discussed as well as prevention and treatment of infections involving the tooth, with emphasis on endocarditis prophylaxis.
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PMID:The tender tooth. Dentoalveolar, pericoronal, and periodontal infections. 307 6

Three exceptional cases of chronic aortic dissection revealed by a pericardial effusion are reported. The patients were two men and a woman admitted for thoracic pain or fever. Initial diagnoses were myocardial infarction, infective endocarditis and tuberculous pericarditis. The effusions were drained on two occasions. Because the pericardial fluid was a mixture of serum and blood, computerized tomography of the thorax and abdomen was performed. All three cases were then diagnosed as aortic dissection (type II in two cases and type III in one case, with retrograde extension to the ascending aorta). The authors underline the utility of drainage and the need for systematic CT scans in patients with sero-haematic pericardial effusion of uncertain origin.
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PMID:[Chronic aortic dissection disclosed by pericardial effusion. Apropos of 3 cases]. 314 60

A previously healthy 17 year old boy had Staphylococcus aureus endocarditis presenting as acute scrotal pain. There was no trauma or evidence of scrotal or epididymal infection. The pain subsided after therapy for endocarditis was started.
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PMID:Staphylococcus aureus endocarditis presenting as acute scrotal pain. 365 70

The characteristics features of right-sided endocarditis are summarized in this case report of a 30-year-old female admitted with a history of high grade, continuous, fever, breathlessness, and dry cough over a 10-day period. The patient had had an incomplete abortion 15 days earlier for which dilatation and curettage was performed. On examination, the patient was toxic, febrile with a pulse of 118/minute and respiration 36/minute. Her blood pressure was 110/70 mm Hg. There was soft, tender hepatomegaly and soft splenomegely. There also were scattered coarse crepitations over both lungs. The vaginal examination revealed posterior fornicial bogginess and tenderness. Urine and cervical pus swab showed growth of klebsiella. The blood culture was negative. A plan chest X-ray revealed multiple, small, basal, pulmonary infiltrates. Posterior colopuncture revealed a small quantity of clear, yellowish fluid. Abdominopelvic ultrasonography revealed an ill-defined haziness in the parauterine region. The patient was treated with ampicillin, gentamycin, and metronidazole, but she continued to deteriorate. An urgent exploratory laparotomy was performed. The patient died on the 2nd postoperative day. The autopsy findings revealed that the heart was normal in size and shape. The tricuspid valve showed a large vegetation projecting into the ventricle. Microscopic examination revealed polymorphonuclear infiltration with clumps of gram-negative bacillifocal areas of myocarditis also were seen. In lungs the right lower lobe showed a small, hemorrhagic infarct. Both the liver and spleen were congested. Kidneys showed multiple petechiae on the external surface and on the cut section. Endocarditis during pregnancy may be because of perinatal infections, urinary tract infection, or septic thrombophlebitis of pelvi veins. Septic abortion of pelvic infection secondary to IUD also can provide portal of entry for bacteria. The common organisms are streptococcus, staphylococci, and occasionally bacteroides and gram negative bacilli. Clinical suspicion of right-sided endocarditis is justified in any patient with prolonged fever, cough, pleuritic pain, tachycardia, and multiple pulmonary infiltrates. Heart murmurs are usually absent and if present are soft and may be heard at atypical sites.
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PMID:Tricuspid valve endocarditis following septic abortion. 371 Oct 12


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