Myocardial protection using single dose del Nido Cardioplegia with and without topical cooling.

INTRODUCTION: Del Nido cardioplegia (DN) is gaining acceptance in adult cardiac surgery but there is paucity of experimental data regarding its efficacy. We set out to assess the safety and efficacy of single-dose DN with and without topical cooling (TC) versus multi-dose blood cardioplegia (BC). METHODS: Thirty-two healthy adult sheep had pressure-volume (PV) catheters placed in the left (LV) and right (RV) ventricle. Animals were assigned to receive cold (4°C) antegrade solution for a 60-min arrest using: (1) multi-dose (every 20 min) BC with TC (n = 11), (2) single-dose DN with TC (DN-C, n = 10), or (3) single-dose DN without TC (DN-H, n = 11). LV and RV PV-derived indexes, epicardial echocardiographic strains, and blood samples were acquired before CPB and at 1, 2, and 3 h of reperfusion. Dobutamine bolus (2.5 µg) was given after 3 h to test for myocardial reserve. RESULTS: Time to rhythm restoration was shortest (54 ± 29 s, 118 ± 167 s, and 172 ± 170 s for DN-H, DN-C, and BC, respectively; p = 0.024) and number of shocks lowest (1.7 ± 1.8, 3.6 ± 2.8, and 5.6 ± 4.6 for DN-H, DN-C, and BC, respectively; p = 0.020) in DN-H group. Hemodynamic, load-independent myocardial function, echocardiographic, and metabolic data revealed only slight differences between groups. Troponin I levels did not differ between groups. With dobutamine, preload-recruitable stroke work of both LV (136 ± 50%, 131 ± 31%, 142 ± 58% for BC, DN-C and DN-H, respectively; p = 0.993) and RV (161 ± 67%, 185 ± 45%, 166 ± 75% for BC, DN-C and DN-H respectively; p = 0.580) increased similarly. CONCLUSIONS: Single-dose DN cardioplegia with or without topical cooling offered comparable biventricular myocardial protection to multi-dose BC for a 60-min arrest in sheep.

Safety and Immunogenicity of a Recombinant Protein RBD Fusion Heterodimer Vaccine against SARS-CoV-2: preliminary results of a phase 1-2a dose-escalating, randomized, double-blind clinical trial.

BackgroundWe report safety, tolerability, and immunogenicity of a recombinant protein RBD-fusion heterodimeric vaccine against SARS-CoV-2 (PHH-1V). MethodsA dose-escalation, phase 1-2a, randomized clinical trial was performed in Catalonia, Spain. Each cohort had one safety sentinel that received PHH-1V vaccine of the corresponding dose, and remaining participants were randomly assigned to receive PHH-1V formulations [10{micro}g (n=5), 20{micro}g (n=10), 40{micro}g (n=10)] or control BNT162b2 (n=5). Two intramuscular doses (0-21 days) were administered. Primary endpoint was solicited events 7 days after each vaccination and secondary-exploratory endpoints were humoral and cellular immunogenicity. Findings30 young healthy adults were enrolled, thirteen were female. Vaccines were safe, well tolerated. The most common solicited events for all groups were tenderness and pain at the site of injection. The proportion of subjects with at least one reported local and/or systemic solicited adverse events (AE) after first or second vaccine dose were lowest in PHH-1V (n=21, 84%) than control group (n=5, 100%). AE were mild to moderate, and no severe AE nor AE of special interest were reported. All participants had a >4-fold change at day 35 in total binding antibodies from baseline. Variants of concern (VOC) alpha, beta, delta and gamma were evaluated using a SARS-CoV-2 pseudovirus-based neutralization assay. All groups had a significant geometric mean fold rise (p<.0001) at day 35 against all studied VOC. Similar results were obtained when a full replicative virus neutralization assay was carried out. InterpretationPHH-1V was safe, well tolerated, and induced robust humoral responses. These data support further exploration of PHH-1V in larger studies. FundingHIPRA ClinicalTrials.gov IdentifierNCT05007509 Research in contextO_ST_ABSEvidence before this studyC_ST_ABSWe searched PubMed up until August 1, 2021, with the terms "SARS-CoV-2", "COVID-19" and "vaccine". We initially identified 12,952 results but when added the terms "clinical trial" and "variants" this number decreased to 50. Of these references twelve were clinical trials, and although several vaccines were under development, and the ones that were already approved for administration in the general population described the neutralization effect to the different circulating variants of concern, we could not find any reference to a vaccine developed using variants of concern instead of ancestral Wuhan strain. Added value of this studyTo the best of our knowledge, our study is the first clinical trial to assess the effect as a primary series of a recombinant protein receptor-binding domain fusion heterodimer PHH-1V vaccine against SARS-CoV-2 not including the ancestral strain in its composition. This vaccine contains RBD from B{middle dot}1{middle dot}351 (beta) and B{middle dot}1{middle dot}1{middle dot}7 (alpha) variants and is co-formulated with an oil-in-water adjuvant emulsion. In this first-in-human randomized clinical trial, two doses of the SARS-CoV-2 PHH-1V vaccine in a range of 10 to 40 {micro}g/dose were safe and well-tolerated and induced robust humoral immune responses to different circulating variants of concern, including alpha (B1{middle dot}1{middle dot}7), beta (B{middle dot}1{middle dot}351), delta (B{middle dot}1{middle dot}617{middle dot}2) and gamma (P{middle dot}1). Additionally, the PHH-1V 40{micro}g dose vaccine elicited moderated cellular immune responses, particularly to variants of concern alpha and delta. Implications of all the available evidenceThese findings indicate that the recombinant protein receptor-binding domain fusion heterodimer vaccine PHH-1V is safe and immunogenic. Phase 2b and Phase 3 clinical trials are ongoing to further investigate its safety and protective efficacy as heterologous booster.

Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry / 대한뇌졸중학회지

Background@#and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score 3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups’ criteria). @*Results@# Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). @*Conclusions@# Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.

Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry / 대한뇌졸중학회지

Background@#and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score 3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups’ criteria). @*Results@# Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). @*Conclusions@# Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.

Serum lipid profile changes and their clinical diagnostic significance in COVID-19 Mexican Patients

BackgroundCOVID-19 has been recognized as an emerging and rapidly evolving health condition. For this reason, efforts to determine changes in laboratory parameters of COVID-19 patients as biomarkers are urgent. Lipids are essential components of the human body, and their modulation has been observed implicated in some viral infections. MethodsTo evaluate the clinical diagnosis utility of the lipid profile changes in Mexican COVID-19 patients, the lipid profile of one hundred two COVID-19 positive patients from three hospitals in Culiacan, Sinaloa in northwest Mexico, was analyzed. ROC curves and binary logistic regression analysis were used as a predictive model to determine their clinical diagnostic utility. ResultsSignificant changes in the serum lipid profile of patients with COVID-19, such as low levels of cholesterol, LDL, and HDL, while high triglycerides and VLDL were observed. The same abnormalities in the lipid profile among non-critical and critical COVID-19 patients were detected. The predictive model analysis suggests that cholesterol and LDL have AUC values of 0.710 and 0.769, respectively, for COVID-19 (p= 0.0002 and p= <0.0001), and LDL low levels might be a risk factor for critical COVID-19 (OR= 2.07, 95% IC: 1.18 to 3.63; p= 0.01). ConclusionOur findings suggest that low cholesterol and LDL levels could be considered an acceptable predictor for COVID-19, and low levels of LDL might be a risk factor for critical COVID-19 patients.

Bicipital tuberosity bone characteristics in surgical reattachment of the distal biceps: anatomical and radiological study.

PURPOSE: The aim of this study was to measure the cortical thickness and bone density of the different parts of the bicipital tuberosity, to evaluate the importance of these variables on resistance to pulling out of distal biceps tendon reinsertion implants. METHODS: Sixteen cadaveric arms were used for this study. A multiple detector computed tomography was performed in each proximal radius. Bone thickness and density of anterior, posterior cortex and anterior trabecular bone were measured in proximal, medial and distal parts of the bicipital tuberosity. Statistical and concordance analyses of results were performed. RESULTS: In our specimens, the medial and distal parts of the anterior cortex and the anterior trabecular bone were thicker, mean 11.3 mm SD 2.72 and 11.17 mm SD 3.05, with a significant difference when compared to the proximal part; mean 10.3 mm SD 2.35, of radial tuberosity. The three posterior segments where all thicker compared to the anterior cortex (proximal 3.15 SD 1.31; medial 3.33 SD 1.5; distal 3.34 SD 1.43 mm), but without statistical differences between them. The measured bone density was equivalent in the three portions of the anterior cortex and trabecular bone [proximal 1924.63 SD 547.22; medial 1848.19 SD 538.59; distal 2100.47 SD 396.32 Hounsfield units (HU)]. The posterior cortex was denser compared to the anterior cortex and the anterior trabecular bone in all the segments (proximal 1962.63 SD 223.57; medial 1907.16 SD 232.08; distal 1987.06 SD 189.12 HU), but without statistical differences between the three parts. CONCLUSIONS: Based on the results of this anatomic study which have demonstrated that anterior cortex and anterior trabecular bone of the medial and distal regions of the bicipital tuberosity are thicker than proximal part, we postulate that these segments could give better pulling out resistance to monocortical implants. Our findings suggest that the strongest parts of the bicipital tuberosity are the proximal and medial parts of the posterior cortex. We can afford them drilling across the radius using a bicortical implant in the proximal and medial section of the radial tuberosity. Furthermore, we suggest that an increased margin of safety could be achieved to prevent injury to the posterior interosseous nerve, drilling the cortical hole in the proximal part of the radial tuberosity without losing resistance properties.

Expression of developing neural transcription factors in diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH).

DIPNECH is characterized by neuroendocrine cell hyperplasia, tumorlets, and eventually carcinoid tumors. Although it is regarded by some authors as a preneoplastic condition, this issue is controversial. New pathologic criteria have recently been proposed for the diagnosis of DIPNECH, and a subgroup of carcinoid tumors expressing developing neural transcription factors (DNTFs), with clinicopathologic features similar to those of DIPNECH, has been recognized. This paper reports on the clinical and pathological findings in three cases of DIPNECH and investigates the expression of three DNTFs (TTF1, ASCL1, and POU3F2). All patients were female, with a mean age of 63 years, and all lesions were located in the periphery of the lung. In two cases, typical carcinoids were associated with a spindle-cell component. All neuroendocrine proliferations were DNTF positive. The morphologic (spindle-cell component), phenotypic (DNTF expression), and clinicopathologic (peripheral tumors, female predominance) similarities suggest that DIPNECH may be a preneoplastic lesion for peripheral carcinoids.

Superficial Acral Fibromyxoma involving the nail's apparatus. Case report and literature review.

Superficial Acral Fibromyxoma is a rare tumor of soft tissues. It is a relatively new entity described in 2001 by Fetsch et al. It probably represents a fibrohistiocytic tumor with less than 170 described cases. We bring a new case of SAF on the 5th toe of the right foot, in a 43-year-old woman. After surgical excision with safety margins which included the nail apparatus, it has not recurred (22 months of follow up). We carried out a review of the location of all SAF published up to the present day.

Superficial Acral Fibromyxoma involving the nail's apparatus. Case report and literature review

Superficial Acral Fibromyxoma is a rare tumor of soft tissues. It is a relatively new entity described in 2001 by Fetsch et al. It probably represents a fibrohistiocytic tumor with less than 170 described cases. We bring a new case of SAF on the 5th toe of the right foot, in a 43-year-old woman. After surgical excision with safety margins which included the nail apparatus, it has not recurred (22 months of follow up). We carried out a review of the location of all SAF published up to the present day.

Clinical and Molecular Study of the Extracellular Matrix Protein 1 Gene in a Spanish Family with Lipoid Proteinosis

BACKGROUND: Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by a hoarse voice, variable scarring, and infiltration of the skin and mucosa. This disease is associated with mutations of the gene encoding extracellular matrix protein 1 (ECM1). CASE REPORT: This was a clinical and molecular study of a new case of LP with a severe phenotype. A 35-year-old female born to nonconsanguineous parents developed dermatological and extracutaneous symptoms in her 9th month of life. The neurological abnormalities of the disease began to appear at the age of 19 years. Computed tomography revealed cranial calcifications. CONCLUSIONS: The diagnosis of LP was confirmed by histopathological findings and direct sequencing of ECM1. A new homozygous nonsense mutation was identified in exon 7 of ECM1, c.1076G>A (p.Trp359*). This mutation was not detected in 106 chromosomes of healthy individuals with a similar demographic origin. Microsatellite markers around ECM1 were used to construct the haplotype in both the parents and the patient. Reports on genotype-phenotype correlations in LP point to a milder phenotype in carriers of missense mutations in the Ecm1a isoform, whereas mutations in the Ecm1b isoform are thought to be associated with more severe phenotypes. The present findings in a Spanish patient carrying a truncating mutation in exon 7 revealed complete dermatological and neurological manifestations.

Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis.

UNLABELLED: Our aim was to assess the predictive value of liver stiffness (LS), measured by transient elastography (TE), for clinical outcome in human immunodeficiency virus / hepatitis C virus (HIV/HCV)-coinfected patients with compensated liver cirrhosis. This was a prospective cohort study of 239 consecutive HIV/HCV-coinfected patients with a new diagnosis of cirrhosis, done by TE, and no previous decompensation of liver disease. The time from diagnosis to the first liver decompensation and death from liver disease, as well as the predictors of these outcomes, were evaluated. After a median (Q1-Q3) follow-up of 20 (9-34) months, 31 (13%, 95% confidence interval [CI]: 9%-17%) patients developed a decompensation. The incidence of decompensation was 6.7 cases per 100 person-years (95% CI, 4.7-9-6). Fourteen (8%) out of 181 patients with a baseline LS < 40 kPa developed a decompensation versus 17 (29%) out of 58 with LS ≥ 40 kPa (P = 0.001). Factors independently associated with decompensation were Child-Turcotte-Pugh (CTP) class B versus A (hazard ratio [HR] 7.7; 95% CI 3.3-18.5; P < 0.0001), log-plasma HCV RNA load (HR 2.1; 95% CI 1.2-3.6; P = 0.01), hepatitis B virus coinfection (HR, 10.3; 95% CI, 2.1-50.4; P = 0.004) and baseline LS (HR 1.03; 95% CI 1.01-1.05; P = 0.02). Fifteen (6%, 95% CI: 3.5%-9.9%) patients died, 10 of them due to liver disease, and one underwent liver transplantation. CTP class B (HR 16.5; 95% CI 3.4-68.2; P < 0.0001) and previous exposure to HCV therapy (HR 7.4; 95% CI 1.7-32.4, P = 0.007) were independently associated with liver-related death; baseline LS (HR 1.03; 95% CI 0.98-1.07; P = 0.08) was of borderline significance. CONCLUSION: LS predicts the development of hepatic decompensations and liver-related mortality in HIV/HCV-coinfection with compensated cirrhosis and provides additional prognostic information to that provided by the CTP score.

[Report of the editors, 2010]. / Informe de los Editores, 2010.

The Editors of the Rev Clin Esp inform herein on their editorial activity in the last year (November 2009 to October 2010) according to three different sections: (a) Objectives and achievements during 2010, (b) editorial activity, and (c) objectives for 2011. During 2010, we have updated the editorial algorithm (manuscript time lag). We have developed the "E-case reports" section and we have linked the abstracts of the Annual Congress of the Spanish Society of Internal Medicine (SEMI) to a journal supplement (electronically available). Since 2010, the subscribers have been able to receive all of the contents of the Rev Clin Esp on-line and to perform self-evaluations in order to obtain 1.7 credits per each journal issue (continuing education). In 2010 we handled 402 manuscripts (7.2% more than in 2009), 35% of which were accepted for publication. We asked 186 reviewers for their expert opinion, 75% of whom sent their reports in less than two weeks. The mean time needed to reach an editorial decision concerning original manuscripts ("accepted / rejected") was 44.5 days and for papers not sent to external reviewers 19.5 days. Collaboration with the work groups produced good results (2.4 published manuscripts per issue), but this could be improved if all the groups collaborated in all the journal sections. Our objectives for 2011 are to complete the renewal of the Rev Clin Esp scientific committee, in accordance with the SEMI Council, and to continue to proceed with the actions initiated to increase the journal impact factor. Rev Clim Esp is an open forum for all internal medicine specialists. Responsibility falls on all of us to collaborate in order to make our journal a little better day by day.

Endothelial function in HIV-infected patients with low or mild cardiovascular risk.

BACKGROUND: Highly active antiretroviral therapy for HIV-infected patients is associated with metabolic side effects, which could cause an increased cardiovascular risk in these patients. Non-invasive study of endothelial function by brachial artery ultrasound can detect subclinical atherosclerosis. Several studies have assessed endothelial function in HIV-infected patients with associated cardiovascular risk factors. OBJECTIVES: The aim of this study is to determine endothelial function in HIV-infected patients under antiretroviral therapy with low or mild coronary risk and lipid levels within the normal range. METHODS: Transversal study including 28 HIV-infected adults (15 receiving antiretroviral therapy and 13 naive) with low or mild cardiovascular risk and 12 healthy controls. Subjects with diabetes mellitus, hypertension, cardiovascular disease, obesity, high cholesterol or high triglyceride levels were excluded. Endothelial function was determined with flow-mediated dilation (FMD) of the brachial artery by ultrasound study. RESULTS: Treated HIV-infected patients had significantly lower FMD (5.93 +/- 3.56) than healthy controls (10.64 +/- 3.08, P = 0.008). Naive patients had an intermediate FMD, but this was not statistically significant. CONCLUSIONS: HIV-infected patients receiving antiretroviral therapy who have low or mild cardiovascular risk and lipid levels within the normal range have endothelial dysfunction compared with healthy controls.

Primary malignant melanoma of the vagina. Poor response to radical surgery and adjuvant therapy.

Primary malignant melanoma of the vagina is an extremely rare condition usually found in postmenopausal women. It has a poor prognosis associated with a high rate of recurrences and rare long-term survivorship. We describe a case and review the literature emphasizing the importance of prognostic factors and elective treatment.

Multicentric reticulohistiocytosis. The long course of a rare disease.

Multicentric reticulohistiocytosis is a rare systemic disease. The patients usually develop an erosive polyarthritis in a few years. The most effective treatment is still unclear due to the few reports published of this disease. We report a case of multicentric reticulohistiocytosis with clinical, histopathologic and immunohistochemical study. The patient was treated with cyclophosphamide and nonsteroidal antiinflammatory drugs with an infrequent long-term survival.

Consideraçöes sobre os distúrbio neurológicos da endocardite infecciosa: apresentaçäo e discussäo acerca de 10 pacientes / Considerations on neurologic disturbances in infectious endocarditis: presentation and discussion of ten patients

Säo apresentados os protocolos de 10 enfermos com endocardite infecciosa (e.i), alguns deles com confirmaçäo clínico-patológica que tornam claras e fidedignas as informaçöes clínicas da história e do exame físico, à luz das respectivas correlaçöes. Ficam demonstradas, nos 10 casos desta doença aqui apresentados, a gravidade da e.i. e a sua complexidade em muitas ocasiöes. As lesöes neurológicas säo achados frequentes nesta patologia (30 a 50 por cento), podendo abrir a cena clínica dos enfermos, aparecer na evoluçäo e/ou mesmo nos períodos de tratamento, de convalescença ou, ainda, tardiamente, meses ou anos após a cura clínica. Quando presentes, os distúrbios neurológicos, dependendo da fase de surgimento e da sua natureza podem complicar ou facilitar o diagnóstico da e.i., mas em todas as circunstâncias o prognóstico é sempre mais sério em sua presença, constituindo-se näo raramente na causa mortis. Qualquer queixa ou achado de alteraçäo neurológica na e.i. obriga-nos à ampla investigaçäo que, no mínimo, deve incluir a realidade de tomografias computadorizadas cerebrais e o estudo angiográfico cerebral completo, à procura de lesöes potencialmente fatais, como aneurisma/s micótico/s cerebral/ais e abscesso/s cerebral/ais, ou ainda na busca de lesöes outras, isoladas ou associadas, como nos pacientes apresentados no presente estudo

Endocardite infecciosa: uma surpreendente e traiçoeira patologia: a propósito de dois casos com lesöes neurológicas / Infectious endocarditis: an amazing and treacherous pathology: about two cases with neurologic lesions

Este é um relato acerca de dois pacientes com endocardite bacteriana (S. alpha hemolyticus e S. aureus) que, numa mesma tarde, procuraram o ambulatório de reumatologia do HSE-MS-RJ com queixas de febre, manifestaçöes reumatológicas e fenômenos tromboembólicos cutâneos expressando-se por lesöes de vasculites embólicas e por tromboembolismo para artérias poplíteas. Havia, em ambos, suspeita clínica da formaçäo de aneurisma micóticos. A primeira paciente, jovem, com endocardite por S. alpha hemolyticus, sem lesöes neurológicas mas com indicaçäo absoluta de estudo angiográfico cerebral completo, näo chegou a fezê-lo, morrendo em consequência da ruptura de aneurisma micótico cerebral até entäo silencioso. O segundo, paciente idoso de 64 anos, alcoólatra crônico em falência multiorgânica, tendo endocardite por S. aureus e meningite somadas ainda a várias complicaçöes vasculares embólicas, sobreviveu, seja por näo ter feito aneurisma/s micótico/s complicado/s, ou por näo haver ocorrido maiores complicaçöes ou, ainda, por ter a cura do/s mesmo/s sido obtida com o uso dos antimicrobianos, resultado este amplamente conhecido

Endocardite infecciosa e manifestações neurológicas: apresentação e discussão de casos / Infectious endocarditis and neurologicals troubles presentation and case discussed

São apresentados e discutidos três casos de endocardites bacterianas agudas, que apresentaram quadro clínico com manifestações neurológicas graves. A presença de distúrbios neurológicos nestes enfermos não somente dificulta com freqüência o diagnóstico da verdadeira origem dos fenômenos observados, como ensombrece o prognóstico da endocardite infecciosa. Tais pacientes, no programa da investigação, têm que ser submetidos a uma série de exames dispendiosos e de realização mandatória, na busca de complicações potencialmente fatais, as quais, não raramente, necessitam de procedimentos neurocirúrgicos ou de monitoração, vigilância e terapêutica prolongadas