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2.
Intern Med ; 57(3): 301-310, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29225254

RESUMO

Objective The purpose of this study was to present the recent clinical profiles and the real-world management of infective endocarditis (IE). Methods All medical records of patients with IE were reviewed retrospectively for their clinical data, including clinical presentation, laboratory results, blood cultures, echocardiographic findings, treatments and complications. Using the clinical data collected, we calculated the EuroSCORE II, the European risk score for adult cardiac surgery, the Charlson Comorbidity Index as a surrogate of comordibity, and the Katz Index as a surrogate of frailty. Results Thirty-eight patients were identified as having IE (24 men, age: 71.8±13.1 years). Congestive heart failure occurred in 16 patients (42%), stroke in 14 (50%), and systemic embolism in 5 (13%). The EuroSCORE II and Charlson Comorbidity Index were high (7.7±5.8% and 5.5±2.8%, respectively). The Katz Index was fair (5.5±1.4) before the onset but deteriorated to 2.8±2.7 at the time of establishing the diagnosis of IE (p<0.001). Early surgery was performed in 22 cases (61%). In-hospital death occurred in 10 cases (26%). A EuroSCORE II ≥9%, Staphylococcus aureus etiology, and a Charlson Comorbidity Index were suggested as determinants of in-hospital death (hazard ratios: 173.60, 9.31, 1.57, respectively). In contrast, early surgery was suggested as a determinant of the survival (hazard ratio: 0.04). The Charlson Comorbidity Index was also suggested as a determinant for selecting conservative management (odds ratio: 1.40). Conclusion Comorbidity may influence the treatment selection and outcome of elderly patients with IE.


Assuntos
Endocardite/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Endocardite/complicações , Endocardite/diagnóstico , Endocardite/terapia , Feminino , Mortalidade Hospitalar , Hospitais Comunitários , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
3.
J Ultrasound Med ; 36(3): 659-664, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28127793

RESUMO

Primary mural endocarditis is an extremely rare infection in which nonvalvular endocardial involvement is seen without any cardiac structural abnormalities such as ventricular septal defects. The rapid and precise diagnosis of this disease remains challenging. We present 2 cases (67- and 47-year-old male patients) of pathologically confirmed primary mural endocarditis that could have been detected by initial transthoracic echocardiography in the emergency department. Transthoracic echocardiography and transesophageal echocardiography play critical roles in the early recognition and confirmation of primary mural endocarditis.


Assuntos
Ecocardiografia Transesofagiana , Endocardite/diagnóstico , Endocardite/terapia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapia , Idoso , Diagnóstico Diferencial , Endocardite/diagnóstico por imagem , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade
5.
Intern Med ; 55(11): 1463-5, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27250053

RESUMO

A 25-year-old previously healthy man was hospitalized for syncope. While standing, he suddenly lost consciousness, followed by a generalized tonic clonic seizure. An electrocardiogram demonstrated asystole. No cardiac abnormalities were detected on the echocardiogram, cardiac magnetic resonance imaging (MRI), positron emission tomography, or a coronary angiogram. An electrophysiological study showed normal sinus node and atrioventricular node function. An electroencephalogram revealed small spike waves in the fronto-temporal region. Brain MRI demonstrated a left-sided amygdala enlargement. To the best of our knowledge, this is the first case of temporal lobe epilepsy with an amygdala enlargement that induced cardiac asystole.


Assuntos
Tonsila do Cerebelo/fisiopatologia , Epilepsia do Lobo Temporal/complicações , Parada Cardíaca/etiologia , Adulto , Tonsila do Cerebelo/diagnóstico por imagem , Eletrocardiografia , Eletroencefalografia , Epilepsia do Lobo Temporal/diagnóstico por imagem , Parada Cardíaca/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia por Emissão de Pósitrons , Lobo Temporal
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