[Results of observation of infective endocarditis patients during 1965-2005].

AIM: To clarify the trends in infective endocarditis by our experience for 40 years. MATERIAL AND METHODS: During the last 40 years (1965-2005) we observed 620 patients with infective endocarditis (IE). There were 615 patients with subacute IE (99.2%) and only 5 patients with acute IE (0.8%). There were 402 males (66.8%) and 218 females (35.2%). The age was 16-84 years (mean age 53 +/- 17). We studied the finding of hemoculture, echocardiography, immunological investigations, the levels of C-reactive protein. RESULTS: Streptococcal endocarditis runs a standard course, but more often we encountered staphylococcal, enterococcal endocarditis with a severe course. Predisposing cardiac disorders in 264 IE patients were rheumatic heart disease, congenital heart disease, mitral prolapse, involutive valve disease, hypertrophic cardiomyopathy, prosthetic valve. CONCLUSION: Conventional and unconventional IE cases, recurrent IE, current criteria of IE are described.

[Some problems of the current therapy of infective endocarditis]. / Nekotorye voprosy sovremennoi terapii infektsionnogo éndokardita.

AIM: To analyse clinical characteristics of endocarditis for the last 10 years, treatment difficulties and how to overcome them. MATERIAL AND METHODS: 135 patients with infectious endocarditis (IE) were examined according to the routine scheme using modern methods of diagnosis and therapy control: transthoracic and transesophageal echo-CG, test for antibiotics sensitivity of the microflora, etc. Immediate results were assessed in all the patients, some of them were followed up for maximum 5 years. RESULTS: Last decade was marked for growing difficulties in the treatment of IE related to its polyetiology. It can be caused by such therapy-resistant microbes as Staphylococcus aureus, Pseudomonas aeruginosa, anaerobic infection, nosocomial infection, injections of narcotic drugs, etc. CONCLUSION: Current course of IE dictates the necessity of fighting resistant microflora especially in case of nosocomial disease. Recurrences become more frequent. Indications to surgery did not change for the last decade. The best treatment results are achieved after antibacterial treatment of the valve.

[Hospital infectious endocarditis and endocarditis in drug addicts]. / Bol'nichnyi infektsionnyi éndokardit i éndokardit narkomanov.

AIM: To specify etiology and clinical course of nosocomial infectious endocarditis (IE) and IE of drug addicts (AIE). MATERIALS AND METHODS: 8 cases of AIE and 27 IE cases after various invasive interventions (nosocomial endocarditis). RESULTS: Among causing agents of IE and AIE were Staphylococcus aureus, Proteus, Escherichia coli, Pseudomonas aeruginosa, anaerobic microflora, pathogenic fungi. AIE is characterized by affection of the tricuspid valve, pulmonary artery thromboembolism. Among nosocomial endocarditides are frequent IE of the replaced valve, caused by infection of venous catheters, dental manipulations, chronic hemodialysis. IE and AIE are most frequently treated with the following antibiotics: ampicilin, gentamycin, augmentin, unasin, cephalosporins, rifadin, ciprofloxin, tienam. CONCLUSION: Nosocomial IE and AIE have drawn much attention in the last decade because of development of new complex invasive treatments and expansion of narcomania.

[The diagnostic difficulties in a current course of infectious endocarditis]. / O trudnostiakh diagnostiki infektsionnogo éndokardita sovremmenogo techeniia.

The paper reports 152 cases of infectious endocarditis observed in two Moscow hospitals. Accurate diagnosis of the disease is complicated by frequent nosocomial endocarditis, endocarditis occurrence in aged patients the diagnosis in whom requires differentiation with tumors, lymphogranulomatosis, blood diseases, etc. To make the diagnosis easier, transesophageal echocardiography and comparison of clinical and echo-CG findings were practiced.

[Infectious endocarditis in middle-aged and elderly patients]. / Infektsionnyi éndokardit u bol'nykh pozhilogo i starcheskogo vozrasta.

The analysis is presented of clinical picture, running, therapy and prognosis of infectious endocarditis in 67 patients over 60. They appeared to develop progressive cardiac failure, frequent thromboembolism of the cerebral vessels. The disease is often associated with other age-related disorders, proved difficult for differential diagnosis. Elderly patients show resistance to antibacterial therapy more frequently and have worse prognosis for endocarditis outcome.

[Infectious endocarditis: its resistance to therapy, causative factors and means of combating it]. / Infektsionnyi éndokardit--rezistentnost' k terapii, obuslovlivaiushchie ee faktory i puti preodoleniia.

Based on the data obtained during observation over 270 patients with infectious endocarditis the authors discuss factors that cause antibacterial therapy resistance encountered particularly often over the recent decade. Among the factors, the authors mark polyetiology of the disease over the recent years, "new" patterns of endocarditis in terms of the pathogenesis, predominance of primary endocarditis with highly virulent microorganisms, late disease diagnosis, inadequate antibacterial treatment, and so forth. Approaches to overcoming treatment resistance are also considered.

[Diagnosis of infectious endocarditis and the assessment of the effectiveness of its treatment]. / Diagnostika infektsionmogo éndokardita i otsenka éffektivnosti ego lecheniia.

The results of investigation and treatment of 58 patients with infectious endocarditis are presented. Changed clinical pattern of the disease, its increasing incidence among older people and the emergence of its "immunologic" variety with signs of myocarditis, vasculitis and, less commonly, glomerulonephritis have been noted over recent years. The disease has become polyetiologic. Methods of treatment for infectious endocarditis are discussed with reference to the etiology and clinical pattern of the disease. Indications for surgical treatment are outlined.

[Infectious endocarditis: problems of diagnosis and nomenclature]. / Infektsionnyi éndokardit--voprosy diagnostiki i nomenklatury zabolevaniia.

Altogether 240 patients with infectious endocarditis (IE) were examined. The problems of IE diagnosis, particularly the reasons for late and initially erroneous disease diagnosis are discussed on the basis of the authors' own and reported data. The differential-diagnostic table containing the criteria of differential diagnosis of IE, rheumatic fever, systemic lupus erythematosus, lymphogranulomatosis is presented.

[Clinico-morphologic analysis of septic (infectious) endocarditis]. / Kliniko-morfologicheskii analiz septicheskogo (infektsionnogo) éndokardita.

Pathomorphosis of the disease has been studied on the basis of clinical and autopsy observations in the last three decades. The importance of staphylococcus, enterococcus, and gram-negative bacteria has been shown to increase among the causative agents of septic endocarditis; frequently the infectious agents have been observed to alternate in the course of the disease. Many manifestations of endocarditis were established to be associated with the circulating immune complexes containing bacterial antigens. In the last decade, primary septic endocarditis comprised about half of the observations. The proportion of isolated endocarditis and destructive changes of aortal valves increased. Myocarditis has become more frequent and in more than half of the cases it is associated with glomerulonephritis. In contrast, peripheral manifestations of endocarditis have considerably lost their diagnostic value. Among thromboembolic complications, venous thromboembolus of the pulmonary artery, and pulmonary infarction became more prevalent.