ABSTRACT
BACKGROUND: Fistula to the pericardial cavity is a very rare complication of perivalvular abscess during infective endocarditis, with Staphylococcus aureus being the most commonly associated microorganism. METHODS: We report a fatal septic shock due to a mitral endocarditis revealed by a myocardial abscess fistulised toward the pericardial cavity. RESULTS: A 66-year-old female without previous valvular disease was admitted to intensive care for severe sepsis. A few hours after admission, an unexpected cardiac arrest occurred. Chest computed tomographic-scan and transoesophageal echocardiography revealed a pericardial effusion due to a perivalvular mitral abscess fistulised toward the pericardial cavity. Despite prompt management including surgical debridement and appropriate antibiotics, death occurred 36hours after intensive care admission. All blood cultures as well as native mitral valve and pericardial fluid grew methicillin-sensitive Staphylococcus aureus. CONCLUSIONS: Intensivists should consider this rare complication in patients with staphylococcal infective endocarditis and perivalvular abscess.
Subject(s)
Abscess/diagnosis , Endocarditis, Bacterial/diagnosis , Mitral Valve/diagnostic imaging , Pericardial Effusion/etiology , Staphylococcal Infections/diagnosis , Staphylococcus aureus/isolation & purification , Abscess/complications , Abscess/microbiology , Aged , Echocardiography , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/microbiology , Female , Humans , Mitral Valve/microbiology , Pericardial Effusion/diagnosis , Pericardial Effusion/microbiology , Pericardium , Staphylococcal Infections/complications , Staphylococcal Infections/microbiology , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) is often used for the treatment of low-back pain (LBP). However, its effectiveness is controversial. OBJECTIVE: To determine the efficacy of TENS in the treatment LBP when associated to a therapeutic education program (TEP). DESIGN: Open randomized monocentric study. SETTING: University hospital between 2010 and 2014. PATIENTS: A total of 97 patients suffering from LBP. INTERVENTIONS: Routine care (TENS group) or routine care plus a therapeutic education program (TENS-TEP group) based on consultation support by a pain resource nurse. MAIN OUTCOME MEASURES: EIFEL and Dallas Pain Questionnaire scores. RESULTS: Twenty-two patients (44%) were still assessable at the end-of-study visit, whereas 33 (70%) were assessable at the same time point in the TENS-TEP group (Pâ=â.013). The EIFEL score and the Dallas score had a similar evolution over time between groups (Pâ=â.18 and Pâ=â.50 respectively). Similarly, there were no significant differences between the groups with respect to resting pain scores (Pâ=â.94 for back pain and Pâ=â.16 for leg pain) and movement pain scores (Pâ=â.52 for back pain and Pâ=â.56 for leg pain). At Month 6, there was no significant difference between the groups (Pâ=â.85) with regard to analgesics and social impact. Two patients presented a serious adverse event during the study (one in each group) but non-attributable to the treatment studied. CONCLUSION: This study does not support the use of TENS in the treatment of patients with chronic LBP even though patients benefited from a therapeutic education program by a pain resource nurse. However, the higher number of premature withdrawals in the TENS group may be due to early withdrawal of patients who did not experience improvement of their symptoms.