A Case of Septic Pulmonary Embolism Associated with MRSA Infective Endocarditis / 결핵및호흡기질환

Septic pulmonary embolism is the process in which an infected thrombus becomes detached from its site of origin and lodges in a pulmonary artery, and is usually associated with infective endocarditis, especially right-sided, or infection-associated with indwelling catheters, peripheral septic thrombophlebitis, and periodontal diseases, etc. Here, we report a case of septic pulmonary embolism associated with tricuspid valve infective endocarditis. A 23-year-old female was admitted to our hospital, due to fever, sore throat, and myalgia. In her past medical history, she had undergone a surgical operation for closure of a ventricular septal defect, but was informed that the operation resulted in an incomplete closure. The initial chest radiograph demonstrated multiple rounded, parenchymal nodules in various sizes; several nodules had central lucency suggesting cavitations. Echocardiography demonstrated a large vegetation attached to the septal tricuspid valve leaflet, extending from right ventricular inflow tract to outflow tract. Computed tomography of thorax revealed bilateral peripheral nodules and wedge-shaped consolidation at various sizes, mostly accompanied by cavitations.

Relationship between Plasma Taurine Concentrations and Left Ventricular Dysfunction in Hemodialysis Patients / 대한신장학회잡지

In maintenance dialysis patients, death is most often due to cardiac disease. The common causes of death in nondiabetic dialysis patients are congestive heart failure. Relation between taurine and cardiac contractility had been reported in animal studies. Uremic patients have taurine deficiency and this may induce impairment in cardiac contractility. We performed this study to evaluate the relationship between plasma taurine concentration and left ventricular(LV) function by echocardiography in clinically stable 23 hemodialysis(HD) patients. HD patients had significantly lower plasma taurine concentrations(29.1+/-9.4 micromol/L) compared to control(57.6+/-17.5 micromol/L). There were significant correlations between plasma taurine concentrations and fractional shortening(FS)(r=0.422, P<0.05), and taurine and LV end-diastolic diameter(LVEDD)(r=-0.531, P<0.01). By partial correlation analysis of controlling hematocrit, this correlations were maintained between taurine and LVEDD(r=-0.46, P<0.05) and there was a tendency of correlation between taurine and FS(r=0.37, P=0.09). There was a significant correlation between plasma taurine concentrations and normalized protein catabolic rate(NPCR)(r=0.42, P<0.05), insulin-like growth factor 1(IGF-I)(r=0.43, P<0.05) and prealbumin(r=0.54, P<0.05). Group I in whom plasma taurine concentrations were below median value had significantly lower FS(29.7+/-8.2 vs. 38.5+/-8.0%, P<0.05) and higher LVEDD(57.7+/-4.7 vs. 53.1+/-3.0mm, P<0.05) and LV mass index(299.2+/-73.1 vs. 192.4+/-49.7g/m2, P<0.05) than group II in whom plasma taurine concentrations were above median value. On linear multiple regression analysis, plasma taurine concentrations and diastolic blood pressure were independently correlated with FS. In conclusion, taurine deficiency may be one of the factors affecting LV dysfunction in maintenance HD patients.