[HSF] Endocarditis with splenic infarct

Fri Jun 1 12:15:40 EDT 2007

Tea that is a perceptive question. Interestingly enough, despite the prevalence of racism in South African society at the time, a genetic cause for the difference was never suggested, and all the blame was put on a diet high in saturated fats. This tied in with the cholesterol levels in the patients. Ironically about a decade later a high incidence of familial hypercholesterolemia was discovered in people of white Afrikaner descent. It was also apparent by then that there were other factors in play in people of Indian descent, (which ,of course, has been seen in many transplanted Indian populations around the world). This did not detract from the dominant influence of diet. Today with the adoption of Western diets people of indigenous African descent now have plenty of coronary disease.
Bob

-----Original Message-----
From: Tea Acuff <tacuff at swbell.net>
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 31 May 2007 5:03 pm
Subject: Re: [HSF] Endocarditis with splenic infarct

So was his conclusion that it was diet, it was genetic, or both.
ea

---- Original Message ----
rom: "rwmfglycar at aol.com" <rwmfglycar at aol.com>
o: OpenHeart-L at lists.hsforum.com
ent: Thursday, May 31, 2007 10:51:27 AM
ubject: Re: [HSF] Endocarditis with splenic infarct

ohn Brock at the University of Cape Town. Together with others the major 
esearch work he did was to define the relationship between the dramatically 
ifferent incidences of coronary artery disease of European descended, native 
frican and mixed race people and the dfferent diets they ate.
ob

----Original Message-----
rom: Michael Firstenberg <msfirst at gmail.com>
o: OpenHeart-L at lists.hsforum.com
ent: Thu, 31 May 2007 11:30 am
ubject: RE: [HSF] Endocarditis with splenic infarct

Who was 'your' wise professor?
Michael Firstenberg <msfirst at gmail.com>
----Original Message-----
om: rwmfglycar at aol.com
: OpenHeart-L at lists.hsforum.com
nt: 5/31/2007 10:20 AM
bject: Re: [HSF] Endocarditis with splenic infarct
ear Michael,
ou may well be right that, during the tenure of one or other committee of 
nscientous colleagues setting board exams, the edict was promulgated that the 
leen gets attention first in these circumstances. I dare say that another 
mmittee might come up with a different answer. You would be hard put to find 
lid "evidence based" data to justify one opinion or another. There is 
perficial logic in what you thought the "correct  board answer" is or was, but 
at would you do if the patient was in heart failure? 
ise professor of mine some 55 years ago said to me "I am not here to get you 
rough your exams; for that you need low cunning. I am here to teach you how to 
arn and how to think; that will last you the rest of your life".
u may realise from my reply that, as a teacher, I was never satisfied by an 
swer to a question that started with "for the boards the answer is...".
yway, in the circumstances of the case described, doing the heart first worked 
 my hands. It would not be difficult to come up with a scenario that dictated 
ifferent order. One of the problems with exams is that questions and expected 
swers that fit the structure of exams inevitably do not do justice to the 
mplexities of real life
b
----Original Message-----
om: Michael Firstenberg <msfirst at gmail.com>
: OpenHeart-L at lists.hsforum.com
nt: Thu, 31 May 2007 7:07 am
bject: RE: [HSF] Endocarditis with splenic infarct

hought the 'board' answer was take the spleen out first.  One less pussed out 
gan to seed your new valve?
chael Firstenberg <msfirst at gmail.com>
---Original Message-----
m: rwmfglycar at aol.com
 OpenHeart-L at lists.hsforum.com
t: 5/31/2007 3:55 AM
ject: Re: [HSF] Endocarditis with splenic infarct
ar Nand,
at was the size of the vegetation? If more than 1 cm there was an indication 
 surgery before discharge. (I am well aware that ID people ignore the 
d won lessons of the past and that they get away with their negligence 
en).The fact that he had a large enough splenic infarct to be clinically 
dent obviously says something about the size of the vegetation, and suggests 
o that it was growing if despite shedding a substantial embolus it remains 
 same size (antibiotics do not easily sterilise large vegetations). Isn't the 
ient  lucky that it didn't hit the brain?
ractice was to get the heart done first and do the spleen electively in a 
k or so. The worry is that manipulation  of the spleen post op might produce 
teremia and recurrent endocarditis. I never saw this happen under the 
igatory continued antibiotic cover. It is quite possible that the infarct 
l resolve wthout intervention but that needs very careful following.
t customary these days to treat active endocarditis as an outpatient? I have 
ell you that I regard that as irresponsible, feckless, stupid and more, but 
n perhaps I am just a grumpy oldtimer.

---Original Message-----
m: nand kejriwal <nkkejriwal at gmail.com>
 OpenHeart-L at lists.hsforum.com
t: Thu, 31 May 2007 4:30 am
ject: Re: [HSF] Endocarditis with splenic infarct
ear members 
 year man, admitted 2 weeks back with mitral valve endocarditis with 
etation. Blood culture - Enterococcus faecalis. Put on Gentamycin and 
xycillin and discahrged. Readmitted 3 days ago with severe abdominal 
n. 
 acute splenic infarct. No evidence of abscess formation. at this stage. 
peat TOE - vegetation still the same size. 
erred to me today. I am planning to operate tomorrow. 
inion of the forum regarding splenic infarct. My plan is to leave the 
een alone and follow it up in the postop period. What are the chances of 
eding into the infarct during heparinisation? Would anyone recommend 
comitant splenectomy? 
anks 
nd 
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