ABSTRACT
Clinical signs of heart valve malfunction are often not specific so that recognition frequently depends on nonclinical methods. The chest radiographs of 34 patients with 41 prosthetic valve malfunctions (PVM) were compared before and after valve failure. The most frequent sign of PVM is postcapillary hypertension (90%). A marked increase in heart size occurs with regurgitation but not with obstruction. A change in attitude of a valve of more than 6 degrees. in the aortic and 12 degrees in the mitral position is virtually diagnostic of dehiscence. This was seen in 52% of patients with paravalvular regurgitation and in 29% of all patients with PVM. When dehiscence is suspected on clinical or radiologic grounds the valve should be examined fluoroscopically. Changes in the azygos vein and the vascular pedicle of the heart and the development of pleural effusions are less useful signs of PVM. Although the chest radiograph is often not diagnostic of PVM, it may point to the need for definitive investigation.
Subject(s)
Heart Valve Prosthesis , Radiography, Thoracic , Adult , Aortic Valve , Female , Humans , Male , Mitral Valve , Prosthesis Failure , Tricuspid ValveABSTRACT
The clinical and microbiological features of 31 cases of mycetoma seen in 8 years at a Riyadh hospital are described. Eighteen were due to Streptomyces somaliensis, 10 to Madurella mycetomatis and one each to Actinomadura madurae, Nocardia asteroides, and an unidentified species of Cladosporium. No immune defects were detected in the patients. Eleven had osteolytic lesions and 17 required surgery. Only seven patients were cured. Streptomyces infections were seen from all parts of Saudi Arabia outside the Rub Al Khali, but Madurella occurred mostly in highland regions where rainfall is higher.
Subject(s)
Mycetoma , Actinomycetaceae/isolation & purification , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Extremities/pathology , Female , Follow-Up Studies , Geography , Humans , Male , Middle Aged , Mitosporic Fungi/isolation & purification , Mycetoma/immunology , Mycetoma/microbiology , Mycetoma/pathology , Mycetoma/therapy , Nocardia asteroides/isolation & purification , Saudi Arabia , Streptomyces/isolation & purification , Time FactorsABSTRACT
A retrospective analysis was made of the radiologic features of 30 cases of mycetoma. Conventional radiographs, computerized tomography (CT), and isotope bone scans were assessed. Soft-tissue swelling was the only abnormality in 27%. Periosteal reaction was present in 67%, sclerosis in 53%, endosteal reaction in 50%, and cortical erosions in 43%. Cavities which were found in 33% are important as predictors of the causative micro-organism. Conventional radiographs are essential to the management of mycetoma as bone involvement makes non-surgical cure unlikely. The role of CT in diagnosis and management appears to be minor, except when the thigh is involved. Isotope bone scanning appears to have no value in either diagnosis or management.
