ABSTRACT
OBJECTIVES: To assess the value of each of the Duke criteria for the diagnosis of infective endocarditis (IE). METHODS: Detailed review was done of charts of all cases discharged with the diagnosis of IE, and classification as 'definite', 'possible' and 'rejected' cases was made according to the Duke criteria. The diagnostic impact of each criterion was assessed by reclassifying each 'definite' case after subtraction of each individual criterion and by reclassifying each 'possible' and 'rejected' case after addition of each individual criterion. RESULTS: From 1983 to 1993, 179 cases were identified in the databases of two hospitals. When the Duke criteria were applied, 124 (6967%) were classed as 'definite', 43 (2466%) as 'possible' and 12 (763%) as 'rejected' cases. Of the 67 pathologically proven cases, 52 (78610%) were 'definite' cases when the criteria were applied before pathology. If the major microbiological criterion is subtracted, 53% (69%) of the 'definite' cases become 'possible' or 'rejected'. When the echocardiographic criterion is subtracted, 34% (68%) of the 'definite' cases become possible or rejected. Among minor criteria, fever and predisposition, contributing to the classification of respectively 31% (68%) and 27% (68%) of the 'definite' cases, were the most powerful. On the other hand, the minor microbiological criterion and immunologic phenomena were responsible for the classification of only 2% (62%) and 6% (64%) respectively, of the 'definite' cases. CONCLUSIONS: Depending on the criterion examined, 47-98% of the 'definite' cases of IE would remain 'definite' if this particular criterion were absent. The major microbiological criterion had the highest relative importance. In this retrospective study, in which only 32 (18%) patients had a transesophageal echocardiogram, the echocardiogram contributed to 15% (66%) of the 'definite' cases according to the major criterion and to 19% (66%) according to the minor criterion. This study illustrates that the degree of certainty of the diagnosis of IE often depends on the presence/absence of only one criterion.
ABSTRACT
We report a patient who presented with a delayed spontaneous right ventricular rupture at the anterior atrioventricular groove after open heart operation. Successful surgical repair consisted of reestablishing anterior atrioventricular groove continuity by pericardial patch placement on the arrested heart. We discuss the risk factors that could initiate the primary tear and contribute to the extension of this type of right ventricular rupture.
Subject(s)
Heart Rupture/surgery , Aged , Atrioventricular Node , Cardiac Surgical Procedures/adverse effects , Heart Rupture/etiology , Heart Rupture/physiopathology , Hemodynamics , Humans , Male , Risk Factors , Treatment OutcomeABSTRACT
The discovery of high hemoglobin and hematocrit values in a patient necessitates the determination of the red blood cell mass in order to confirm the absolute character of the polycythemia. If a true polycythemia is confirmed, its etiology must then be established. The diagnostic approach of polycythemia is presented in this paper. It is illustrated by a case presentation in which a polycythemia secondary to a renal carcinoma is discussed. Erythrocytosis is a classical, albeit rare manifestation of this type of tumor, and has the advantage of allowing early detection. Thus, it permits a prompt treatment plan, thereby improving the prognosis of such a neoplasia. The usefulness of a serum level of erythropoietin (EPO) is subsequently discussed. The diagnostic value of EPO remains controversial because of the overlapping values recorded amongst healthy patients, patients with polycythemia vera and others with secondary polycythemia. Finally, we discuss the presence of substances in paraneoplastic polycythemias whose biological activity is close to that of EPO. However, this molecules of a different structure would not be detected by the radioimmunoassay used to measure erythropoietin level.
