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

The occurrence of bacteremia was investigated in 39 patients undergoing tooth extraction (Group 1), surgical removal of impacted third molars (Group 2), or removal of osteosynthesis plates (Group 3). None of the 39 patients had bacteremia before anesthesia or after nasal intubation for general anesthesia. In two of 23 patients bacteria could be isolated after local anesthesia. Microorganisms were isolated in 14 of 19 patients (74%) with tooth extraction. In nine, a mixture of facultative anaerobic ("aerobic") and strict anaerobic bacteria were identified; in five, anaerobes were isolated exclusively. Two to 130 bacteria were cultured per 10 ml venous blood. Endocarditis causing alpha-hemolytic streptococci were found in seven cases (50%). At least one of the predominating anaerobes (Bacteroides, Fusobacteria, or Peptostreptococci) were found in all positive cases. Bacteremia was found in 40% of the Group 2 patients. There was no bacteremia in the Group 3 patients. The pathogenic relevance of anaerobic bacteremia is discussed and as a consequence it is suggested that the risk of developing organ abscesses as well as the problem of endocarditis following dental bacteremia has to be taken into consideration. On the basis of sensitivity testing, erythromycin does not appear to be the drug of choice in penicillin-allergic patients.
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PMID:Anaerobic bacteremia following tooth extraction and removal of osteosynthesis plates. 347 94

A Working Party of the British Society for Antimicrobial Chemotherapy has recommended an oral regimen for adult patients at risk from infective endocarditis who require dental treatment under a general anaesthesia. The Working Party recommends oral amoxycillin 3 g 4 hours prior to general anaesthesia. This study shows that doses of amoxycillin previously recommended for the prophylaxis of infective endocarditis in children having treatment under local anaesthesia also result in adequate serum concentrations at the time of operation (14.34 mg/l +/- (1 S.D.) 8.64).
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PMID:Serum concentrations of amoxycillin in children following an oral loading dose prior to general anaesthesia: relevance for the prophylaxis of infective endocarditis. 361 Sep 6

From 1962 to 1984, 2460 prosthetic valve implantations in the heart were performed at the Department of Surgery of the University of Heidelberg. In addition to 2291 primary surgical interventions, 169 re-interventions were carried out. 153 emergency operations were necessary. The frequency rate of operations increased continuously; 52% of the operations were performed at the aortic valve and 37% at the mitral valve. In 9% of the cases, two valves had to be replaced, and in 2% even three valve prostheses were implanted. The indications for re-intervention included prosthetic thromboses, paravalvular leakages and prosthetic valve endocarditis. The situations requiring emergency intervention differed from case to case. Early mortality, which had been initially high, could be considerably reduced due to increased experience in surgical technique, anaesthesia, intensive care and improved myocardial protection. The extent and quality of medical postoperative care will determine the success of medical rehabilitation and hence the future professional activity of the patient.
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PMID:[Results of prosthetic heart valve replacement. Primary, secondary and emergency operations]. 389 Dec 88

Prophylactic use of antibiotics in open-heart surgery for insertion of prosthetic valves is common, because of the serious consequences of postoperative staphylococcal infections, most notably prosthetic valve endocarditis. To ensure effective antibiotic cover during surgery, the penetration of cloxacillin and benzylpenicillin into the heart muscle and valves was studied intraoperatively. Both antibiotics were given intravenously (respective initial doses 2 g and 6 g) at induction of anesthesia to ten patients undergoing replacement of aortic or mitral valve, and the same doses were repeated after 4 hours. Serial serum samples and tissue samples from the right atrial auricle and the excised heart valve were analyzed for antibiotic concentrations. The mean serum concentrations of cloxacillin were 204 +/- 93 mg/l 10 min after the initial dose and less than or equal to 26 mg/l 30 min before the second dose. The corresponding values for benzylpenicillin were 323 +/- 145 and 43 +/- 24 mg/l. The cloxacillin concentrations in the auricle just before the start of extracorporeal circulation ranged from 4.5 to 80 mg/kg and (later) in the excised heart valves they were 8.5 to 45 mg/kg. The benzylpenicillin range was 16 to 153 mg/kg in auricle and 13 to 87 mg/kg in valve tissue. The authors conclude that the employed doses of the penicillins are adequate cover against the staphylococci which may be implicated in postoperative infections.
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PMID:Penetration of penicillins into cardiac valves and auricles of patients undergoing open-heart surgery. 401 41

Serum concentrations of amoxycillin were significantly higher with probenecid than without probenecid for up to 18 h after administration of a single 3 g oral dose of amoxycillin. At 12 to 16 h after this dose the mean serum amoxycillin concentrations exceeded the expected minimum bactericidal concentrations of amoxycillin for viridans streptococci when probenecid was given together with amoxycillin. The concurrent oral administration of probenecid with amoxycillin is discussed for the prophylaxis of endocarditis in susceptible patients who require dental procedures under general anaesthesia.
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PMID:The effect of probenecid on serum amoxycillin concentrations up to 18 hours after a single 3 g oral dose of amoxycillin: possible implications for preventing endocarditis. 646 84

A randomized, prospective study of the efficacy of cefamandole naftate versus a combination of ampicillin and cloxacillin was undertaken in 109 adult patients operated on in Leeds during 1979. Sixty patients underwent valve replacement, and 49 had either aortocoronary bypass grafts or other forms of open-heart operation. Teh two groups matched well in age, sex, and type of operation. One gram of either antibiotic was given intravenously during the induction of anesthesia and every 6 hours thereafter for 48 hours. Two additional grams of antibiotic were placed in the prime of the heart lung machine. The overall rate of infection was 7.5% for the entire series, with 1.7% for the group given cefamandole and 13.7% for the group given ampicillin plus cloxacillin (p less than 0.05). The only patient with infection in the former group (1.7%) had sternal wound involvement. Major sternal wound infection occurred in 3 (5.9%) patients in the latter group. All wound infections were caused by Staphylococcus aureus. In 2 of these patients (ampicillin plus cloxacillin group) the infection proceeded to endocarditis. Urinary and respiratory tract infections occurred in 1.9% and 5.9%, respectively, of patients given ampicillin plus cloxacillin. The duration of hospital stay was shorter in the cefamandole group. The results of this study demonstrated that cefamandole confers effective prophylaxis in cardiac operations.
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PMID:Comparative study of cefamandole versus ampicillin plus cloxacillin: prophylactic antibiotics in cardiac surgery. 680 85

Mitral valve prolapse (MVP), reported as occurring in up to 17% of healthy individuals, is considered to be the commonest cardiac valvular abnormality. Although the anaesthetic course may be uneventful, complications may arise for the first time in the peri-operative period and include life threatening dysrhythmias, mitral regurgitation and infective endocarditis. Anaesthetic management of three of the seven patients with MVP treated at our institution over a 12-month period is discussed and the literature reviewed.
Anaesthesia 1983 Jun
PMID:Anaesthetic considerations in patients with mitral valve prolapse. 686 15

Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) experience transient haemostatic defects as a result of adverse changes to their blood components, blood cells and specific coagulation proteins. Aprotinin is a naturally occurring serine protease inhibitor isolated from bovine lung tissue which inhibits kallikrein and plasmin. A high dose aprotinin regimen (aprotinin 280mg loading dose over 20 to 30 minutes after anaesthesia induction followed by 70 mg/h for the duration of the operation and 280mg added to the priming fluid of the CPB circuit) has been used during CPB in order to reduce perioperative bleeding. Recent clinical trials confirm the efficacy of high dose aprotinin in reducing blood loss and transfusion requirements associated with primary cardiac procedures such as coronary artery bypass graft (CABG) or heart valve replacement surgery. High dose aprotinin is also effective in procedures known to possess a high risk for excessive blood loss, such as repeat CABG or heart valve replacement surgery, cardiac surgery in patients with infective endocarditis, or in patients receiving aspirin (acetylsalicylic acid) before surgery. Studies indicate that low dose aprotinin (280mg added to CPB pump prime fluid) is effective in reducing blood loss and transfusion requirements in patients undergoing primary CABG surgery. Additionally, low dose aprotinin regimens (both 280mg added to CPB pump prime fluid and 50% of the high dose regimen) have shown some benefit in repeat CABG surgery; however, more studies are needed to confirm these results. Data from clinical trials indicate that aprotinin is well tolerated. The types and incidences of adverse events reported with aprotinin therapy are generally consistent with those associated with major cardiac surgery, and are not significantly different from those observed in control groups. A trend towards lower graft patency rates, detected by ultrafast computerised tomography (CT), has been observed in aprotinin recipients in 2 US trials. These differences did not reach statistical significance and should be interpreted with caution since the ability of ultrafast CT to determine graft patency has not been validated. Mildly elevated plasma creatinine levels are more commonly observed in aprotinin-treated patients; these changes are transient in the majority of patients. Both high dose and low dose aprotinin regimens (280mg added to CPB pump prime fluid or 50% of the high dose regimen) have reduced blood loss and transfusion requirements in patients undergoing primary and repeat cardiac surgery. The role of aprotinin in paediatric cardiac surgery needs further clarification, while well-designed studies comparing aprotinin with other agents which inhibit fibrinolysis are also awaited with interest.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Aprotinin. A review of its pharmacology and therapeutic efficacy in reducing blood loss associated with cardiac surgery. 754 41

For over 20 years, different methods of interventional catheterisation have partially replaced surgical closure of patent ductus arteriosus (PDA). The authors report the results of a new operative technique, video-thoracoscopy, derived from endoscopic surgery. Under general anaesthesia and after tracheal intubation, two trocarts of 5 mm diameter are introduced into the thorax for the passage of the instruments required for dissection and closure of the PDA. Two hooks are also introduced to retract the lung and dissect the ductal region. Two 9 mm titanium clips are positioned under videoscopic control. Forty-five children underwent this procedure between February 1992 and July 1994. The average age at the time of operation was 13.8 months (range: 3 to 32 months) with an average weight of 14.5 kg (range: 2 to 48 kg) including 10 (22%) with a body weight of less than 6 kg. The surgical indications were haemodynamic in 27% of cases (large shunts with pulmonary hypertension) and prophylactic against endocarditis in 73% of cases. There were no operative fatalities. The immediate complications included: chylothorax (1 case) and left recurrent nerve paralysis (2 cases). A residual shunt was observed in 3 of the 45 cases (6%). In one of these cases, a supplementary clip was effective in suppressing the residual shunt. In the other 2 cases, the residual shunt was respected after a second failure of clipping the duct in one of the cases. The final closure rate was 95.6%. Closure of PDA by video-thoracoscopy is a rapid and safe technique.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Closure of patent ductus arteriosus by video-thoracoscopy in 45 children]. 764 81

Over the last 10 years, the French Federation of Cardiology has circulated recommendations regarding the use of chemoprophylaxis in patients at risk for infective endocarditis. A national survey conducted in 1991, however, showed that the vast majority of both general practitioners and dentists were unaware of these recommendations. Therefore, a Consensus Conference was convened in 1992, with the object of defining and circulating new guidelines which were to be as practical as possible, for the prophylaxis of infective endocarditis. The Consensus Conference first defined which categories of subjects were at risk for infective endocarditis and which types of procedures were potential causes of endocarditis. The second task of the Conference was to determine recommendations for chemoprophylaxis before procedures at risk. For ambulatory dental procedures, a single oral dose of 3 g of amoxicillin administered in the hour preceding the procedure was recommended. Additional recommendations were made for subjects with an allergy to penicillin, for procedures requiring general anaesthesia or for urologic or digestive tract procedures. These recommendations were printed on credit-card format cards and distributed to all practising cardiologists, who were encouraged to give each of their patients at risk a personal card bearing his/her name and the type of heart condition at risk. It is hoped that these measures to both simplify the prophylactic antibiotic regimen and circulate the recommendations from the Consensus Conference may reduce the incidence of this still severe disease.
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PMID:The prophylaxis of infective endocarditis: current practices in France. French Federation of Cardiology. 767 15


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