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Query: UMLS:C0014118 (endocarditis)
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This study was designed to evaluate the early phase events occurring in a stented pulmonary homograft valve implanted in the tricuspid position. A human pulmonary homograft was sterilized in antibiotic solution for 48 hours and cryopreserved in liquid nitrogen (-176 degrees C). Following thawing and trimming, the pulmonary valve was mounted on a Dacron cloth-covered Delrin stent and implanted into the tricuspid position in 3-month-old sheep, for a mean of 95 +/- 5 days. Seven animals were studied. Morphological assessment indicated good structural tissue preservation despite a decrease in viable fibroblasts noted in the distal part of the leaflets. The collagen fibers remained unchanged, and no tissue calcification was found. Viability of the mounted homograft was evaluated using an in vitro tissue culture method, and the viable cells underwent chromosomal analysis to identify whether they originated from the donor or host. Cells with 56 chromosomes, a number intrinsic to sheep cells, were cultured from the donor recipient junctional area. Hemodynamic and angiographic data, which were collected at the time of both implantation and explantation, revealed no functional deterioration of the implanted valve over 3 months. At the time of explantation, six of the seven valves were competent and no cusp retraction or thickening was noted. The seventh valve had deteriorated due to endocarditis. We conclude that stented cryopreserved pulmonary homografts may be useful as bioprostheses in the tricuspid position.
J Card Surg 1991 Dec
PMID:The cryopreserved stented pulmonary homograft valve in the tricuspid position. 160 72

The purpose of the present study was to determine whether increased levels of platelet-activating factor (PAF) type activity can be detected in plasma from patients with septicemia and other diseases. A level of PAF below 0.5 ng/mL of plasma was considered normal. We found that plasma from a patient with adverse anaphylactoidic reaction to intravenous analgetics contained 2.1 ng PAF/mL. In seven patients with septicemia, including urosepsis, endocarditis and peritonitis, and with positive blood culture, increased plasma PAF levels (1-20 ng PAF/mL) were observed. Other patients with clinical indications of septicemia had negative blood cultures and/or increased levels of C-reactive protein (CRP). Yet, in the plasma from these patients, no increased PAF levels were detected under the assay conditions used. Two patients with allergic asthma, requiring treatment with steroids, had no measurable plasma PAF. In the plasma from a patient with idiopathic thrombocytopenic purpura (ITP) only an "endogenous" inhibitor of PAF induced platelet aggregation was initially observed. In spite of this, the patient responded to treatment with the PAF antagonist WEB 2086 with a dramatic increase in platelet count (Lohmann et al., Lancet ii, 1147, 1988). Thereafter, also increased PAF levels (3.3 ng PAF/mL) were detected in plasma, although some "endogenous" inhibitor of PAF was still present. In conclusion, increased PAF levels in plasma from patients support a role of PAF in certain human disease states, such as in anaphylactoid reaction, sepsis and septic shock. The type, relevance and specificity of endogenous inhibitors of PAF deserve further study.
Lipids 1991 Dec
PMID:Platelet-activating factor type activity in plasma from patients with septicemia and other diseases. 181 37

Prosthetic valve endocarditis (PVE) has existed for about 30 years. Its incidence and mortality have decreased compared to the '60s, but they are still remarkable. The distinction between early and late forms of PVE is still justified, only if considered critically. At present the incidence of early PVE is 1% or less. It is caused mainly by staphylococci, Gram-negative bacilli, and fungi, which infect the prosthesis during or immediately after surgery; it carries a mortality of 30-60%. The incidence of late PVE is approximately 1% per year; pathogenesis and clinical features are similar to infective endocarditis (IE) on native valves. Streptococci are the most frequent causative organisms and current mortality is 25-35%. The diagnosis of PVE can be difficult; a strong clinical suspicion, blood cultures, and echocardiography are the most valuable tools. The antibiotic treatment follows the general indications for IE, but in PVE the associations of 2 or more antibiotics are the rule and need to be used according to established protocols. The occurrence of prosthetic dysfunction, para-annular abscesses, and embolism is frequent in PVE and makes prognosis worse. In all cases of complicated PVE or in those due to resistant organisms, an early reintervention must be associated to medical therapy. The surgical treatment of PVE often implies difficult and complex procedures, but early and long-term results are better than those obtained with medical treatment alone. Pharmacological prevention of embolism remains an unsolved problem. The prophylaxis of early PVE has made remarkable progress in the last 20 years and present results appear hard to improve. The prophylaxis of late PVE requires a more widespread awareness of this problem even outside the setting of cardiology and cardiac surgery.
Cardiologia 1991 Dec
PMID:[Infective endocarditis in valve prostheses]. 184 61

All available prostheses, either mechanical or biological, may undergo structural alterations which are cause of reoperation or death. Some of these complications are common to all valves, whereas some are specific for certain models. Modern mechanical prostheses usually are resistant to structural deterioration, but still thrombogenic thus requiring long-term anticoagulation therapy to avoid thrombotic and thromboembolic episodes, which implies the risk of anticoagulation related hemorrhages. Bioprostheses, on the other hand, present a lower thrombogenicity, however they undergo by definition structural degeneration, especially dystrophic calcification, which is usually cause of reoperation within 8-10 years from implantation. Other prosthetic complications, such as infective endocarditis and fibrous tissue overgrowth, are common to both types of prostheses.
Cardiologia 1991 Dec
PMID:[Structural changes in valve prostheses]. 184 11

A mail survey of this type has several inherent drawbacks. First, answers to some of the questions, particularly those pertaining to complication rates, rely on the memory of participants. Second, the wording of certain questions may have imparted different meanings. Third, the format of the questionnaire may have confused some. Fourth, one cannot expect that all questionnaires will be answered fully. Fifth, as indicated by several respondents, several important topics (eg, topical anesthetic agents and mode of their delivery, prophylaxis against infective endocarditis, tracheobronchial stent placement, endobronchial intraluminal radiotherapy) were not included. Many respondents suggested inclusion of these and other questions in future surveys. Nevertheless, in the absence of any survey looking into a large number of bronchoscopy-related practices, mail surveys have the advantage of reflecting nationwide practice rather than results from selected centers, and this report provides some insight into bronchoscopy practices in North America. While the results indicate the present trends in bronchoscopy practices in North America, they do not establish or recommend any standards in bronchoscopy.
Chest 1991 Dec
PMID:Bronchoscopy in North America: the ACCP survey. 813 1

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.
J Thorac Cardiovasc Surg 1991 Dec
PMID:Tricuspid valvulectomy without replacement. Twenty years' experience. 196 Sep 98

The in vivo efficacy of daptomycin, a new cell wall-active anti-gram-positive-bacterial agent, was compared to those of cloxacillin and vancomycin in a rat model of Staphylococcus aureus endocarditis. Both methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) strains were used. When therapy was initiated early (8 h) after infection, at the time when valvular bacterial counts were relatively low (approximately 10(6) CFU/g of vegetation), 3 days of therapy was found to be effective against the MSSA strains whatever the antibiotic regimen. In contrast, when the onset of therapy was delayed up to 15 h after infection, so that higher bacterial counts could develop on the valves (approximately 10(9) CFU/g of vegetation), a longer period of treatment (6 days) was required to cure infection. Under these conditions after 3 days of therapy, daptomycin was more effective than cloxacillin and vancomycin against the MSSA strains. Similarly, daptomycin showed a greater activity than vancomycin against the MRSA strain after 3 days of treatment, but after 6 days both antibiotics were equally effective. Decreasing doses of daptomycin showed decreasing activity: 10 mg/kg of body weight every 12 h (q12h) was better than 5 mg/kg q12h, whereas 5 mg/kg q24h (providing drug levels in blood detectable only during the first 12 h) failed to cure infection. In vitro, daptomycin was highly bactericidal at high concentrations (25 and 60 micrograms/ml, corresponding to peak levels in serum after doses of 5 and 10 mg/kg, respectively) and bacteriostatic at lower concentrations (0.5 to 2.5 micrograms/ml, corresponding to trough levels in serum). In conclusion, against low-bacterial-count S. aureus endocarditis, daptomycin showed an efficacy similar to those of vancomycin and cloxacillin. Against high-bacterial-count S. aureus endocarditis, daptomycin showed a higher bactericidal activity than cloxacillin (against the MSSA strains) and vancomycin (against both the MSSA and MRSA strains).
Antimicrob Agents Chemother 1990 Dec
PMID:Comparative efficacy of daptomycin, vancomycin, and cloxacillin for the treatment of Staphylococcus aureus endocarditis in rats and role of test conditions in this determination. 196 5

Acute disseminated staphylococcal disease may develop in previously healthy children below the age of 15 years. It progresses rapidly and may cause death in a significant number. The diagnostic criteria are infection in 2 or more anatomical sites and isolation of a coagulase-positive Staphylococcus aureus from the blood or from a site of infection. We present an 11.5-year-old boy with disseminated staphylococcal disease with evidence of cellulitis, osteomyelitis and endocarditis. He developed intracranial hemorrhage as a complication and survived, but with mild residual hemiparesis. Nervous system involvement, such as meningitis and brain abscess, have been described in this particularly severe disease. This is the only known report of intracranial hemorrhage as a complication of the disease.
Harefuah 1990 Dec 16
PMID:[Intracranial hemorrhage complicating acute disseminated staphylococcal disease in a child]. 207 64

Since it is very rare that cardiac tamponade due to myocardial rupture caused by infective endocarditis, occurs we are reporting this case. A 62 year old man, who had underlying diseases of pneumoconiosis and hypertensive heart disease, visited Chikuho Rosai Hospital complaining of chest oppression and general fatigue on Feb. 7, 1987. He was diagnosed as having ischemic heart disease by electrocardiogram. Two days later, he suddenly had chills and a fever, and the laboratory data showed leukocytosis and a positive C-reactive protein (CRP). The echo cardiogram showed mitral regurgitation (MR) and aortic regurgitation (AR), but neither vegetation nor pericardial effusion was observed. On Feb. 16, he was admitted with shock, and he died the next day. The blood cultures grew gram-positive cocci, respectively. From the clinical symptoms, chest roentgenogram and electrocardiogram, we suspected a cardiac tamponade. On autopsy findings, though coronary arteries were intact, the aortic valves had severe valvular adhesions, calcifications and hypertrophies. The rupture hole was observed in the left ventricles, which was just under the aortic valve through the pericardiac space. It seemed that he died of a cardiac tamponade due to the outflow of blood from this hole. On histopathologic findings of the cardiac wall, gram-positive cocci and many of neutrophils were observed.
Kansenshogaku Zasshi 1990 Dec
PMID:[An autopsied case of infective endocarditis with cardiac tamponade due to myocardial rupture]. 207 73

We report a case of a 32-yr-old woman on chronic intermittent haemodialysis, who developed endocarditis due to a Corynebacterium group JK, involving both the native aortic and mitral valves. Despite a four-week treatment with vancomycin, an aortic root abscess developed. The diagnosis was confirmed on autopsy.
Neth J Med 1990 Dec
PMID:Native valve endocarditis due to Corynebacterium group JK. 207 17


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