Bacterial endocarditis. Survey of patients treated between 1963 and 1975.

Hospital records of forty-nine patients with a diagnosis of bacterial endocarditis at the University of Kentucky Medical Center Hospital from 1963 to 1975 were reviewed. Data collected and statistically analyzed resulted in the following conclusions: 1. Bacterial endocarditis affected males three to four times as often as females. 2. Morbidity was significant, with an average hospital stay of 4 weeks. 3. The mortality rate among the entire group of patients was 42.8 per cent. A significantly higher rate of 66.7 per cent was noted in patients with prosthetic heart valves. 4. The most prevalent predisposing factor was rheumatic heart disease. 5. There were five cases (10.2 per cent) in which dental procedures were the probable precipitating cause, once again pointing out the importance of detecting susceptible patients and proceeding with dental therapy only after adequate prophylactic measures. 6. The most frequently isolated microorganism was Staphylococcus aureus. 7. Chloramphenicol was the most effective in vitro antiboitic tested, with erythromycin a close second. Although it might appear that penicillin was not as effective, the concentration in actual usage may differ significantly from that in the tested discs. Penicillin, therefore, still remains the foundation for treatment in susceptible cases.     

Condylar resorption following temporomandibular joint arthroscopy in a patient with essential thrombocythemia.

Condylar resorption of the temporomandibular joint (TMJ) is a poorly understood phenomenon that is the subject of much controversy. The following case report depicts a unique case of condylar resorption (CR) in a 49-year-old female patient with essential thrombocythemia who underwent arthrocentesis of the TMJ. The exact cause of the CR is unclear but it is speculated that it was likely due to hemorrhagic and thrombotic complications during surgery secondary to an elevated platelet count.     

Mucopolysaccharidoses: Ultrastructure of leukocyte inclusions

Ultrastructural study of leukocytes from 7 patients with mucopolysaccharidosis (MPS) I, II, or III demonstrated a variety of membrane-bound inclusions in 34 to 68% of lymphocytes and larger mononuclear cells. The most common inclusions were membrane-bound vacuoles containing faintly osmiophilic material, but a variety of clear vacuoles, dense granular inclusions, and myelin figures were also seen. Fingerprint profiles were present in small percentages in MPS II and III, indicating that they are not as specific as previously considered. Granulocytes, lymphocytes, and larger mononuclear cells from a patient with MPS VII showed many small and larger membrane-bound vacuolated inclusions, some of which contained large dense granules. The presence of alterations in a readily accessible tissue such as blood indicates that ultrastructural study of leukocytes may be a useful adjunct in guiding further biochemical studies in MPS, es pecially in early or obscure cases.     

Management of the dental patient with congestive heart failure

This article presents the basic pathophysiology, clinical findings, medical management, and dental management for patients with congestive heart failure. The emphasis is on the role of the dentist in detecting these patients based on history and clinical findings, referring the patient for medical diagnosis and management, and working closely with the physician to develop a dental management plan that will be effective and safe for the patient.     

Clinical and biochemical variation and family studies in the multiple acyl-CoA dehydrogenation disorders

We report clinical and biochemical studies in patients with multiple acyl-CoA dehydrogenation disorders (MAD) and their parents. A severely affected (MAD:S) patient presented with neonatal acidosis leading to death and excreted a wide range of straight- and branched-chain acyl CoA derivatives. Two patients with mild variants of the same disorder (MAD:M) presented with neurologic abnormalities, acidotic coma, and/or poor growth; they primarily excreted ethylmalonate and variable amounts of adipate. Fibroblasts from the MAD:S patient demonstrated severely defective radiolabeled substrate oxidation, while the MAD:M cells had milder oxidative defects. Fibroblasts from two other MAD:M and six other MAD:S patients demonstrated analogous defects in substrate oxidation. As a group, MAD:S cells deficient in electron transfer flavoprotein:ubiquinone oxidoreductase had significantly lower residual oxidative activities than did MAD:S cells deficient in electron transfer flavoprotein. Fibroblasts from the parents of four MAD:S patients oxidized radiolabeled substrates significantly less effectively than did normal infant controls but were indistinguishable from normal adult cells. We found relatively higher residual oxidative activities in maternal than in paternal cells. Amniocytes from a fetus at risk for MAD:S catabolized labeled substrates normally; the infant has been clinically and biochemically normal up to 30 months of age.     

Disseminated intravascular coagulation and fibrinolysis as a cause of postextraction hemorrhage. Report of a case.

Presented is a case in which severe, prolonged hemorrhage, subsequent to simple dental extractions in an 85-year-old Negro man, was due to disseminated intravascular coagulation, with secondary fibrinolysis resulting from metastatic adenocarcinoma of the prostate gland. The difficulty and delay in diagnosis, selection of proper therapeutic regimen, and complications encountered during treatment are discussed.