[A case report of infective endocarditis with acute pulmonary edema and renal dysfunction treated by emergent mitral valve replacement and postoperative extracorporeal ultrafiltration].

A 40-year-old woman with staphylococcus aureus endocarditis of the mitral valve associated with acute pulmonary edema and renal dysfunction is presented. The patient was admitted to Hiroshima University Hospital with infective endocarditis. On the 14th day after admission, she suffered from severe cardiac failure and oligouria, then she was transferred ICU. Chest X-ray film showed pulmonary congestion and echocardiogram revealed 4th grade of mitral valve regurgitation. Emergent mitral valve replacement was performed and rupture of anterior mitral chorda was found as the cause of acute pulmonary edema. Postoperative care was difficult because of advanced renal failure and cardiac failure not responded to diuretics. Extracorporeal ultrafiltration method was effectively used on the 1st and the 2nd postoperative days and 3000 ml of water was filtered without hemodynamic change. Symptoms of renal and cardiac failure recovered promptly after ultrafiltration. Emergent operative and postoperative use of ultrafiltration method is effective in some cases of infective endocarditis complicated with cardiac and renal failure.

Splenic vein thrombosis as a consequence of chronic pancreatitis: a study of three cases.

Splenic vein obstruction was found in three patients with chronic pancreatitis. All had suffered epigastric pain, but no specific findings which suggested obstruction of the splenic vein were evident on physical or laboratory examinations. Enlarged pancreatic contour with calculi and pseudocyst formation were observed by CAT scan in all three cases. Gastric varices were found in two patients who had episodes of gastric bleeding. The splenic vein was shown to be occluded in two patients in the venous phase of celiac angiography and was entirely nonvisualized by percutaneous portography in the third case. The first patient underwent elective surgery, while the second patient had emergency surgery due to intraabdominal abscess formation with gastric bleeding. The surgical procedure in both patients was splenectomy coupled with distal pancreatectomy. Thrombus formation was confirmed by venous dissection at surgery.