ABSTRACT
We report a case of methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infectious endocarditis (IE) which was successfully treated with linezolid (LZD). The patient was a 44-year old woman. She was referred to our hospital because of fever of unknown origin. MRSA was detected from blood cultures and echocardiography revealed vegetation on the right coronary cusp of the aortic valve. She was diagnosed with MRSA endocarditis according to the Duke criteria, and was immediately give vancomycin (VCM) and isepamicin. Sixteen days after administration of VCM, she had a progressively increasing skin rash. It was considered a side effect of antibiotics and VCM was replaced with teicoplanin (TEIC). Eventually, LZD was given to her at 22 days after hospitalization because TEIC was not effective. LZD alleviated the fever and diminished the signs of vasculitis due to endocarditis within a week. LZD was continued for 4 weeks with cardiac failure medically controlled, and she underwent aortic valve replacement using a mechanical prosthetic valve. LZD was injected just before the operation and continued for 15 days postoperatively, followed by oral administration of levofloxacin. She was discharged 35 POD and no recurrence of the infection had been observed at 1 year after the surgery. LZD could be an alternative therapy for MRSA endocarditis, but further examinations are warranted to determine the most appropriate regimen.
ABSTRACT
A 42-year-old woman with antiphospholipid syndrome (APLS) secondary to systemic lupus erythematosus (SLE) complicated with thrombocytopenic purpura was successfully treated by mitral valve replacement with a mechanical prosthesis and tricuspid valve annuloplasty for mitral valve stenosis and regurgitation due to Libman-Sacks endocarditis. Intraoperative hemorrhagic oozing due to thrombocytopenia was effectively managed with platelet transfusion. Negative microbial culture and pathological examination of the resected mitral valve demonstrated an atypical sterile verrucose lesion, the findings of which were typically characteristic of Libman-Sacks endocarditis in SLE. She was successfully discharged 31 days after the operation without any hemorrhagic or thromboembolic events. However, 100 days after surgery, she suffered from fatal cerebral infarction caused by poor Coumadin compliance. Regarding the prosthetic valve selection, it is reasonable to select the mechanical valve because 1) anticoagulation therapy is necessary for APLS, 2) the risk of the dialysis induction due to the lupus-induced renal failure leading to a high calcium turnover, which results in accelerated bioprosthetic valve calcification. In case of SLE with APLS, in which anticoagulation and antiplatelet therapy is required to prevent the thromboembolic event and thrombocytopenic purpura, after valve replacement, strict management of anticoagulation plays an essential role to prevent thromboembolic complication.
ABSTRACT
<p><b>OBJECTIVES</b>To verify whether the concentrations of arsenic (As) and its compounds in the air (referred to here as arsenic concentrations) affect the standardized mortality ratio (SMR) associated with lung cancer.</p><p><b>METHODS</b>Using monitoring survey data on arsenic concentrations published by the Ministry of the Environment, we classified the municipalities for which arsenic concentrations were measured (measured municipalities) into ten groups according to the average arsenic concentration. We then determined the SMR of lung cancer, stomach cancer, pneumonia, cerebrovascular disease and cardiac disease for each group using socio-demographic data, such as the national census and demographic trends. The relationships between these factors were compared and investigated by statistical means.</p><p><b>RESULTS</b>No effect of arsenic concentrations on stomach cancer, cerebrovascular disease or cardiac disease was observed, and while significant differences in pneumonia were observed among several of the male subjects, there were no significant effects of arsenic concentration. However, lung cancer and arsenic concentration showed a significantly positive correlation for both males and females (males: Spearman r = 0.709, P < 0.05; females: Spearman r = 0.758, P < 0.05). The probability of type alpha error was less than 5% in areas with more than 1.77 ng As/m(3) (71st percentile) and less than 1% in areas with more than 2.70 ng As/m(3) (91st percentile). These results confirm that the SMR of lung cancer tends to be higher than the national average in areas of higher arsenic concentrations.</p><p><b>CONCLUSIONS</b>The SMR of lung cancer is significantly higher in areas with arsenic concentrations of 1.77 ng/m(3) or more.</p>
ABSTRACT
A 52-year-old man had a history that included aortic valve replacement due to infectious endocarditis in 1987. Chest X-ray showed slight enlargement of the superior mediastinum in 1998, but the enlargement was very mild and there had not been any significant change since 1998. However, chest X-ray demonstrated an extremely protruding mass on the right side of the superior mediastinum in May 2004 and a pseudoaneurysm located in the ascending aorta was demonstrated by computed tomography. We considered this aneurysm had been caused by ascending aortic cannulation for blood return from cardiopulmonary bypass (CPB) during the previous surgery. On re-operation, CPB was established by femoro-femoral bypass and median sternotomy was performed. The pseudoaneurysm measured 60mm in diameter and there was a felt-pledget on top of the aneurysm. Under deep hypothermic cardiac arrest, we incised the aneurysm and closed the orifice of the pseudoaneurysm using a patch (Hemashield Woven Fabrics). On pathological examination, the wall of the pseudoaneurysm showed a structural loss of the blood vessel and the felt-pledget had been exposed to the inferior of the aneurysm breaking through the wall. We considered this a non-mycotic pseudoaneurysm because of this patient's clinical course, surgical and pathological findings. We encountered a pseudoaneurysm in the ascending aorta that was detected and treated surgically about 20 years after aortic valve replacement.
ABSTRACT
A 61-year-old woman had extracardiac unruptured aneurysms of the right and noncoronary sinuses of Valsalva, detected incidentally on electrocardiogram taken for a physical checkup. Two-dimensional echocardiography revealed that the sizes of the aneurysm of the right and noncoronary sinuses were 41×40 and 38×28mm respectively, but the shape of left coronary sinus was almost normal. The aortic valve leaflet was normal and the diameter of the aortic annulus and sinotubular junction was 23 and 27mm respectively. The Doppler color-flow echocardiogram showed moderate aortic regurgitation which resulted in prolapse of the right aortic cusp due to deformity of the annulus. We performed modified aortic root remodeling using a tailored Dacron graft to preserve the native aortic valve. Right and noncoronary sinuses of Valsalva were all excised with a small button of the aortic wall around the ostia of the right coronary artery. The left coronary sinus was left as it was. Then each commissure received sub-commissural annuloplasty and was pulled up. The defect of Valsalva was reconstructed with a 26mm Dacron tube graft, the proximal end of which was tailored to a scallop shape and that correspond to left coronary sinus was excised. The right coronary artery was reimplanted utilizing the Carrel patch method. Although we needed additional CABG to the right coronary artery and IABP support due to vasospasm of the right coronary artery, the postoperative course was uneventful. Echocardiography of the aortic valve before discharge showed a normal function without regurgitation.
ABSTRACT
We report an 81-year-old woman with giant left atrial myxoma who had been admitted with congestive heart failure. Diagnosis was established by echocardiography and a moderate degree of tricuspid valve regurgitation was also found. The tumor was extensively attached to the atrial septum, and was excised completely including endocardium. She had concomitant tricuspid annuloplasty. Atrial fibrillation occurred on postoperative day 10, but conversion to a sinus rhythm was seen on postoperative day 19. She was discharged in good condition on postoperative day 36. Even in a patient over 80 years old with congestive heart failure, aggressive surgical treatment of left atrial myxoma should be performed.