ABSTRACT
Central Nervous System [CNS] infections especially meningitis is a medical emergency that once suspected should be proved through Lumbar Puncture [LP] and cerebrospinal Fluid [CSF] analysis. On the other hand due to life - threatening complications such as brain herniation in the people older than 60, the procedure safety is debated. This study was done in order to determine the necessity of the Lumbar Puncture [LP] in the patients older than 60 years old who are suspected to meningitis. This descriptive study was done in Infectious Clinic of Imam Reza Hospital, Mashad, Iran from fall 2003 to fall 2005. 90 patients who were suspected to meningitis and undergone brain CT scanning and LP were studied. The results of patient's history, physical examination, demographic information, CT scanning and LP all collected in a questionnaire and analyzed by spss and statistics examinations. Among 90 patients suspected of meningitis who underwent Brain CT-scan and LP, 81 suffered from loss of consciousness, 2 were chronic course and 7 without clinical LP contraindication other than age. 75 had normal CT-scan and 15 had abnormal CT-scan, among which was no space occupying lesion with mass effect or midline shift. Final diagnosis was acute bacterial meningitis in 14 cases and aseptic meningitis in 7 cases and other causes of meningitis in 7 cases, Encephalitis in 1, and 61 cases other CNS infection. Despite other clinical contraindications for LP in most of the patients, in 75 cases. [83%] brain CT-scan was normal and in only 15 cases [17%] there was abnormal CT-scan among which none was a contraindication for LP [i.e space occupying lesion with mass effect or midline shift]. Therefore the role of "age over sixty" as an absolute indication for Brain CT-scan, regarding the existing medical facilities and conditions in our country, did not seem acceptable
ABSTRACT
We presented two non-addicted patients with Tricuspid valve endocarditis. The first patient was a 38-year-old diabetic female with; fever chills, anemia, and microscopic hematuria and pyuria that occurred during several weeks. The plain radiography of chest was normal and high resolution computed tomography [HRCT] of chest, was done because of predominant pulmonary symptoms and signs that revealed consolidation and cystic formation in the left parynchyma. Based on these findings in HRCT we decided to start anti-tuberculosis treatment, but no significant response was seen. Tran's Thoracic Echocardiography [TTE] was done and revealed large vegetation of Tricuspid valve. The second patient was a 45 -year-old man who admitted with acute fever and left lower lobe infiltrate and systolic murmur. TTE was normal but Trans Esophageal Echocardiography showed large vegetation on the Tricuspid valve. Staphylococcus aurous grew in 2/3 blood cultures. We suggest that right-sided endocarditis must be considered in any patient with fever and recurrent pulmonary symptoms and signs, with or without abnormal chest X- ray, heart murmur or intravenous drug addiction