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PubMed · 8545921

[Pneumococcal tricuspid valve endocarditis].

S Rasmussen·U Talleruphuus·J H Wandall
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Abstract

Endocarditis caused by pneumococci is a rare disease and cases that only affect the tricuspid valve represent less than 1% of all cases of endocarditis. A case presenting with a primary pneumonia and septicaemia is described. Due to persistent fever and the occurrence of a cardiac murmur echocardiography was done and demonstrated vegetations on the tricuspid valve. The course was complicated with septic pulmonary emboli before the patient recovered. Endocarditis with pneumococci may occur as a complication to a primary pneumonia and underestimation of the frequency with which it occurs is a possibility. Attention should be paid to patients with a primary pneumonia who do not respond to the initial treatment and to those who after an initial response show recurrent fever.

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Diagnosis, DifferentialEndocarditis, BacterialHumansMaleMiddle AgedPneumococcal InfectionsPneumonia, PneumococcalSepsisTricuspid ValveUltrasonographyCase ReportsJournal Article

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BibTeXRIS

S Rasmussen, U Talleruphuus, J H Wandall. 1995-12-11. [Pneumococcal tricuspid valve endocarditis].. https://pubmed.ncbi.nlm.nih.gov/8545921/

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Diagnosis and treatment of sleep apnea within the community. The Walla Walla Project.

BACKGROUND: Patients with sleep disorders are common in primary care, yet most physicians lack training in the diagnosis and treatment of such patients. OBJECTIVES: To enhance recognition of sleep disorders by community physicians and transfer the diagnostic testing and care of such patients from tertiary care centers to the local community. To present our polysomnogram experience relevant to sleep apnea. METHODS: Sleep disorders specialists provided a community with education, diagnostic equipment, and ongoing support as sleep disorders expertise was established locally. Outcomes for a 2-year period were assessed by chart review, patient questionnaire, tabulation of polysomnographic data, and comparison with published reports from specialized centers. RESULTS: Referral for sleep testing increased by almost 8-fold in patients at the Walla Walla Clinic in Walla Walla, Wash, from 0.27% (2 of 752 cases reviewed) to 2.1% (294 of 14330 internal medicine patients). Data were collected from all community physicians for a 2-year period on 360 new patients who underwent polysomnogram testing. This resulted in the diagnosis of sleep-related breathing disorders in 81% and periodic leg movements of sleep in 18%. Nasal continuous positive airway pressure treatment was given to 228 patients (average baseline apnea index of 19.1), representing a higher volume of patients than at many traditional sleep centers, yet compliance with continuous positive airway pressure was comparable. CONCLUSIONS: Sleep apnea is significantly underrecognized by primary care physicians. As a result of the intervention, local sleep expertise was established and large numbers of patients were discovered and treated in the community. Thus, a significant public health problem is identified and a solution established.

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