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Objective: To explore the clinical characteristics of patients with Brucella endocarditis. Methods: The clinical data of 9 patients with Brucella endocarditis admitted to Beijing Ditan Hospital from October 2008 to August 2018 were retrospectively analyzed. Through the electronic medical record system of the hospital. Through assessing the electronic medical record system of the hospital, demographic data, main symptoms, vital signs, blood culture, Rose Bengal Plate Agglutination Test, echocardiography, electrocardiogram, chest imaging and other clinical data of included patients were inquired and recorded. Patients were followed up by telephone for medication, operation and outcome. Results: The 9 patients were all Han nationality, aged from 25 to 66 years, 7 out of 9 patients were male, and they came from Hebei, Shandong, Shanxi, Inner Mongolia and Beijing. Of the 9 patients, 5 were farmers, 2 were self-employed, 1 was a technician, and 1 was unemployed. Of the 9 cases, 8 had a history of close contact with cattle and sheep, and 5 had a history of eating beef and mutton. Rose-Bengal Plate Agglutination Test and blood culture were positive in all 9 patients. Aortic valve was involved in 7 out of 9 patients, mitral and tricuspid valve was involved in 1 patient, respectively, and aortic dissection occurred in 1 patient. Condition of 1 patient rapidly deteriorated after admission and finally died during hospitalization despite antibiotic therapy, the remaining patients received long-term antibiotic treatment. A total of 7 patients who underwent valve replacement were followed up. One patient died of cerebral hemorrhage 6 months after operation, and the remaining 6 patients recovered well after valve replacement. Heart failure occurred in all 9 patients, and pericardial effusion occurred in 8 patients. Electrocardiogram showed low voltage of the QRS complex in the limb in 3 cases and poor R-wave progression in V(1)-V(3) lead in 2 cases, and sinus tachycardia in 2 cases. One patient developed non-specific ST-T abnormalities. All patients had fever, 7 patients complained of weakness, and 6 patients complained of palpitations. Among the 9 patients, 7 cases had anemia, 7 patients had pneumonia, 6 had bilateral pleural effusion, 4 had thrombocytopenia. Creatinine was above normal in 4 patients, urine protein was positive in 3 patients, Delta Bilirubin was higher in 3 cases. Conclusions: Patients with Brucella endocarditis often suffer from heart failure and have severe complications. Adequate antibiotic therapy in combination with valve replacement is effective for the treatment of patients with Brucella endocarditis.
Subject(s)
Adult , Aged , Animals , Cattle , Humans , Male , Middle Aged , Brucella , Brucellosis , China , Endocarditis, Bacterial , Heart Valve Prosthesis , Retrospective Studies , Sheep , Treatment OutcomeABSTRACT
@#AIM: To report <i>in vivo</i> confocal microscopic(IVCM)in corneal edema.<p>METHODS: Twenty-one patients with clinically diagnosed corneal edema were involved. All cases, in addition to control group of five normal eyes, were examined with IVCM. <p>RESULTS: IVCM findings in corneal edema showed that epithelial bullae appeared as dark, round areas with well-defined margins in all of the patients; Subepithelial fibroblasts and scarring; Other IVCM features included absent(57%)or reduced(43%)subbasal nerves in central corneal; Apart from the associated scar tissue, BZ presented a branching pattern of fine, darklines in all of the patients. Furthermore, fine or coarse granularity with avariable degree of reflectivity were noted in the anterior stroma in 13 of the 21 cases(62%); The number of keratocytes in the stroma of corneas was less than that in the normal corneas measured by using confocal microscopy in all of the patients; Endothelial changes with total obscuration of endothelial cell borders were seen in all of the patients. IVCM findings in the control group showed normal patterns.<p>CONCLUSION: This is the study in which IVCM features of corneal edema have been found in detail. Subepithelial fibroblasts, reduced subbasal corneal nerves and stromal keratocyte were well documented in this study. With increasing popularity of endothelial keratoplasty this work supports the role of IVCM in quantitative evaluation of corneal edema in preoperative stages, as well as after surgery.
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@#AIM: To analyze microstructural changes, after epithelium-off corneal collagen cross-linking for progressive keratoconus by using <i>in vivo</i> confocal microscopy(IVCM).<p>METHODS: Totally 15 eyes in 15 patients with progressive keratoconus were treated by the photochemical epithelium-off cross-linking method. Patients were examined pre- and postoperatively by confocal <i>in vivo</i> laser scanning microscopy.<p>RESULTS: The sub-basal nerve significantly decreased or disappeared and the anterior corneal stroma had a honeycombed appearance but without the typical hy-perreflective keratocyte nuclei after early stage of treatment. At 3mo postoperatively, the corneal stroma had a small amount of the typical hy-perreflective keratocyte nuclei. After 12mo,the corneal stroma almost recovered to the preoperative level, but the sub-basal nerve were still sparse and didn't reach the preoperative level. The endothelial cells showed no significant reduction during the follow-up.<p>CONCLUSION: This IVCM study revealed loss of the sub-basal nerve plexus and loss of anterior stromal keratocytes in the early postoperative period, with regeneration of keratocyte repopulation by 12mo postoperatively, but the sub-basal nerve plexus didn't reach the preoperative level.