William Osler and his Gulstonian Lectures on malignant endocarditis.

Current perceptions of the association between William Osler and bacterial endocarditis are, for many of us, encompassed by the eponym, "Osler's nodes." Osler himself credited others with priority in description of those nodes, and the eponym is justified only because it signals the overlordship of the disease that the great clinician maintained for 3 decades (1885 through 1915). In the Gulstonian Lectures on malignant endocarditis, Osler provided, as Cushing said, "the first comprehensive account in English of the disease and did much to bring the subject to the attention of clinicians." In the present account, I have sought to assess the degree to which Osler's contributions to knowledge and understanding of bacterial endocarditis were extended or limited by forces of time and circumstance that, for the most part, extended beyond boundaries that any effort on his part could have altered.

Evolution of aortic valve replacement for native aortic valve endocarditis.

In 1964 and 1965, two groups of surgeons, Dr Thomas Yeh and colleagues from Medical College of Georgia and Dr Andrew Wallace and colleagues from Duke University, published reports of aortic valve exploration, debridement, and replacement for endocarditis. Their initial thoughtful and meticulous procedures initiated valve surgery as a treatment of native aortic valve endocarditis.

New developments in the treatment of infective endocarditis infective cardiovasculitis.

The natural history of infective endocarditis has undergone remarkable changes over the past 100 years as regards both the demographic characteristics of the disease and changes in the incidence of the so-called diagnostic signs. Alongside these changes and the development of new and better diagnostic tools and criteria, we are also facing new problems with the precise definition of cardiovascular infections and calculation of the incidence of the disease. Nosocomial endocarditis presents an emerging problem of diagnosis and treatment after heart valve surgery, with pace-maker catheters, defibrillators and a very large variety of foreign materials used in connection with heart valve surgery. New technological progress including new types of prosthetic valves and use of homografts or the Ross operation will give a greater possibility of choosing the best solution in a particular case. Antimicrobial chemotherapy is mainly based on our understanding of the pathophysiology of the disease and efficacy of the antibiotics achieved in an experimental animal model of endocarditis. Important recommendations of single or combined drug therapy or the dosing regimens of antibiotics are still an expression of expert opinion not always supported by experimental or clinical proof. A typical example is the recommendation of two divided doses of gentamicin for treatment of streptococcal endocarditis. Nevertheless, it is the author's opinion that the development of uncomplicated, easy to handle diagnostic and treatment regimens are justified in order to achieve better compliance with these recommendations.

Historical aspects of infective endocarditis.

Infective endocarditis was a fatal disease three generations ago. Temporal evolution of knowledge made possible important advances in diagnostic techniques, especially in echocardiography, the possibility of cardiac surgery during the active infectious process and new guidelines for antibiotic prophylaxis before interventional procedures. Nowadays, infective endocarditis is curable. In this review, we describe historical aspects of endocarditis, from Osler's observations in the 19th century to the change from a "clinically possible" to a "clinically defined" disease.