Brucella Endocarditis of Pseudoaneurysm of an Aortic Composite Graft

The occurrence of Brucella endocarditis following Bentall operation is a rare and life threatening condition, particularly when it is complicated by development of a pseudoaneurysm. Here we present a 40-year-old veterinarian with bicuspid aortic valve, who developed type A aortic root dissection and required Bentall operation. His past medical history was positive for an episode of treated brucellosis. Four months after the operation, he developed signs, symptoms and serological findings of brucellosis for the second time and was treated with antibiotics. Then after he was well untill about 14 days prior to his recent admission, when he again developed hip pain, fever, shortness of breath, profound fatigue and weakness. His transthoracic echocardiography was suggestive of endocarditis. A transesophageal echocardiogram revealed detachment of valve-conduit from the annulus and the mitral-aortic intervalvular fibrosa and the presence of a large aortic pseudoaneurysm with multiple vegetations attached to its Dacron walls. A huge pseudoaneurysm was detected at surgery and the whole valve-conduit was replaced with a 25 mm homograft. Blood and vegetation cultures turned to be positive for Brucella melitensis. Early echocardiographic diagnosis and prompt surgical intervention were helpful for survival of our patient who had aortic pseudoaneurysm complicated by Brucella endocarditis.

Effects of pentoxifylline on oxygenation and exercise tolerance in patients with severe chronic obstructive pulmonary disease

Background: It was hypothesized that the use of Pentoxifylline would increase arterial O2 saturation and increase exercise tolerance in patients with Chronic Obstructive Pulmonary Disease [COPD]

Methods: We tested this hypothesis in 23 patients with COPD and pulmonary hypertension. Patients were randomized to receive Pentoxifylline or placebo, each for a 12-week period, in a prospective, double-blind study to assess the effects of Pentoxifylline on oxygen saturation and exercise tolerance via pulse oximetry and the 6-Minute Walk Test [6MWT]

Results: At the end of the 12 weeks, the six-minute walk distance rose from 351.9 +/- 65 meters to 393 +/- 67 meters in the Pentoxifylline group [10 patients] and increased from 328 +/- 79 meters to 353 +/- 66 meters in the placebo group [10 patients] [P=0.142]. Resting oxygen saturation by pulse oximetry changed from 87 +/- 4% to 85 +/- 14% in the Pentoxifylline group and from 88 +/- 3% to 88 +/- 2% in the placebo group [P=0.676]. There were no significant changes in dyspnea severity index and heart rate before and after the 6MWT

Conclusion: Pentoxifylline does not seem to improve exercise capacity and dyspnea in patients with severe and very severe COPD Trial Registration Number: IRCT201202018889N1