[High-degree atrioventricular (AV) block]. / Borreliakardit ­ ovanlig orsak till atrioventrikulärt block.

In elderly patients high-degree atrioventricular (AV) block is often due to irreversible degeneration of the cardiac conduction system. Reversible causes must however be excluded prior to pacemaker implantation. In younger patients reversible causes are more likely, as well as more unusual etiologies. Lyme carditis is a rare, but reversible cause of AV block. It is a manifestation of Lyme borreliosis - an infectious disease caused by the bacteria Borrelia burgdorferi. Lyme carditis should particularly be considered in young and middle-aged patients with a high-degree AV block. When pretest probability is intermediate to high, a positive serological test makes the diagnosis of Lyme carditis highly likely. In these cases antibiotic treatment may revert the conduction disturbance, thus preventing unnecessary implantation of a permanent pacemaker.

Fatal infective endocarditis caused by Aerococcus sanguinicola: a case report and literature review.

Aerococcus sanguinicola is a bacterium that can cause urinary tract infections and on rare occasions infective endocarditis (IE). The prognosis of IE caused by aerococci is generally favourable despite that the patients are typically old and have multiple comorbidities. Here we report a case of A. sanguinicola native valve aortic IE in a 68-year-old man with an underlying urinary tract condition. The infection led to severe aortic valve insufficiency and rapid death before the patient could be subjected to surgery. This demonstrates that IE caused by A. sanguinicola can be severe and cause valve destruction. In addition to the case report, we provide a review of the current literature on A. sanguinicola IE.

Solitary liver lesions of indeterminate malignancy--outcome following surgical resection.

BACKGROUND: Well-differentiated hepatocellular carcinoma (HCC) may resemble benign liver lesions on initial diagnostic work-up. The validity of surgical resection for preoperatively unclear liver lesions was investigated in this study. PATIENTS AND METHODS: We conducted a retrospective analysis of 483 patients subjected to liver resection over a 15-year period. RESULTS: Forty-five patients (9%) were considered to have presented with indeterminate solitary lesions. There were 18 cases of HCC (40%) and 27 cases (60%) of benign lesions, most commonly focal nodular hyperplasia (n=18). Patients with HCC had a higher median age as compared to patients with benign pathology (67 vs. 55 years; p=0.002) and the median tumor size was larger (85 vs. 30 mm; p=0.007). Major complications (Clavien grade III or higher) occurred in three cases (7%) and there was no in-hospital mortality. CONCLUSION: The results favor an aggressive approach, i.e. surgical intervention, to patients presenting with indeterminate solitary liver tumors due to the high likelihood of an underlying HCC.