Combined aortic and mitral valve repair in active infective endocarditis

We describe a case of successful combined repair of the aortic and mitral valves for an indication of active infective endocarditis involving both valves. Mitral valve repair was achieved by vegetation debridement, fixation of the anterior mitral commissure, resection and suturing of the posterior mitral leaflet, and posterior annuloplasty with autologous pericardium. Aortic valve repair was achieved by vegetectomy and commissural plication. Postoperative clinical course was without signs of recurrent infection, and echocardiogram demonstrated mitral valve competence with trivial aortic regurgitation. We concluded that simultaneous valve repair is a viable option in the context of active endocarditis.     

Aortic valve endocarditis in an acutely rejecting orthotopic heart transplant recipient

Infective endocarditis is an infrequent but serious complication in heart transplant recipients. We report successful treatment for this serious complication.     

135例急性感染性疾病所致肝功能损害临床分析

目的　分析临床急性感染性疾病所致肝功能损害的特点及其恢复时间。方法　对 135例急性感染性疾病患者入院肝功能指标进行分析 ,观察治疗第 2周及第 4周时患者异常肝功能指标恢复情况。结果　除 6例死亡外 ,其余患者异常肝功能指标升高多在正常值上限 3倍以内 ,治疗第 4周异常肝功能指标治愈率分别为 AL T92 .4%、AST91.6 %、GGT75 .6 %、AL P91.3%、 SB10 0 %、 SB’ 10 0 %和 TBA 85 .7% ,HBs Ag ( )携带者与 HBs Ag (- )者治疗第 4周上述指标治愈率无显著差异。第 4周时 GGT仍升高者恢复缓慢或不易恢复正常。结论　急性感染性疾病致肝功能损害多呈轻度及一过性升高 ;HBs Ag ( )携带者肝脏应急储备及修复功能较正常人无明显下降 ;GGT恢复缓慢或不易恢复正常者可能留有持久性的肝内毛细胆管损伤     

氧氟沙星加双黄连注射液静脉滴注致肝损害1例

氧氟沙星 (ｏｆｌｏｘａｃｉｎ)和双黄连 (Ｓｈｕａｎｇｈｕａｎｇｌｉ ａｎ)已成为临床常用的抗菌药 ,但其不良反应亦不可忽视。我们曾遇见 1例用该 2药治疗上呼吸道感染引起严重肝功能损害 ,报道如下。病人男性 ,2 1ａ。主要因咽痛、咯痰、发热 2ｄ入院。病人于入院前 2ｄ出现咽痛、咯黄痰、胸痛、发热 (Ｔ38.9℃ )。诊断为上呼吸道感染。在当地卫生所给予氧氟沙星注射液(四川科伦大药厂生产 ,规格 :1 0 0ｍＬ :0 .2ｇ批号 0 1 30 1 2 )0 .2ｇ(1 0 0ｍＬ) +双黄连注射液 (齐齐哈尔第二制药厂生产 ,规格 :每支 2 0ｍＬ批号 30 0 1 32 ) 2 0…     

感染性心内膜炎老年患者的临床特征及病原学分析

目的分析感染性心内膜炎（IE）老年患者的病原学和临床特征,为该病的预防和治疗提供科学依据。方法选取2015 年3 月-2016 年2 月上海市第八人民医院收治的IE老年患者96 例,对其采动脉血,进行细菌培养,使用Phoenix-100全自动细菌鉴定/药敏系统进行病原学鉴定。结果96 例IE患者中,病变位置在左心者76 例（79.17%）;病变位置在右心者7 例（7.29%）;病变位置在左右心者7 例（7.29%）;病变位置不明确者6 例（6.25%）;在上述96 例患者中,检出病原菌45 株,以酿脓链球菌为主,有25 株占55.6%;伴有心脏基础疾病者46 例（47.92%）。在多因素分析中,血红蛋白<90g/L和医院感染是IE老年患者的主要不安全性因素,而对其采取手术治疗是安全性因素。结论酿脓链球菌是IE 老年患者的主要病菌,应预防控制其危险因素,手术治疗是保护性因素。     

Contemporary management and outcomes of infective tunnelled haemodialysis catheter-related right atrial thrombi: a case series and literature review

INTRODUCTIONInfective haemodialysis catheter-related right atrial thrombus (CRAT) is a complication of tunnelled catheter use. Management recommendations are based mainly on published case series prior to 2011. We report our institution’s recent experience in managing infective haemodialysis CRAT and correlate treatment with outcomes.METHODSWe conducted a retrospective analysis of haemodialysis CRAT cases diagnosed on transthoracic echocardiography between 1 January 2011 and 31 December 2017. Clinical outcomes, including mortality at 180 days post diagnosis and thrombus resolution, were traced from electronic medical records.RESULTSThere were 14 cases identified. The median age was 59 (range 47–88) years and 11 (78.6%) were male. Sepsis was the most common reason for hospitalisation (71.4%). Blood cultures identified Staphylococcus aureus in seven cases, of which two were methicillin-resistant. Three had coagulase-negative Staphylococcus. All cases received antibiotics with infectious disease physician input. Seven were treated with catheter removal alone, of which three died within 180 days. Both cases treated with catheter removal plus anticoagulation survived at 180 days. Of the two cases who had anticoagulation without catheter removal, one died within 180 days and the other did not have thrombus resolution. Three underwent surgical thrombus removal, of which two died postoperatively and the last required repeated operations and prolonged hospitalisation. Mortality at 180 days post diagnosis was 42.9%.CONCLUSIONCatheter removal and anticoagulation are modestly effective. Surgery is associated with poor outcomes. Despite contemporary management, infective haemodialysis CRAT still results in high mortality. Prospective studies are needed to identify the optimal management.     

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1990年12月至2006年12月，我院共收冶759例急性肠梗阻，其中21例（占2．77％）死亡。本文对其死亡原因及其防治措施加以探讨。     

Clinical considerations regarding infective Libman-Sacks endocarditis

A case of aortic infective endocarditis due to Hemophilus paraphrophilus in a patient with previous Libman-Sacks endocarditis is presented. Suggestions regarding antibiotic prophylaxis are made concerning patients with systemic lupus erythematosus.