A 58 year-old man was referred to our hospital with a fever after dental treatment. He had undergone an operation for aortic root replacement 9 months earlier. Streptococcus species were cultured with venous blood culture. An echocardiogram revealed vegetation attached to the prosthetic valve. The prosthetic valve function was good and he did not suffer from heart failure, therefore he was treated with antibiotics. Five days after starting antibiotics, we observed embolization of the brain and the kidney as well as an elevation of his inflammatory reaction. Accordingly, we performed emergency surgery. There was no paravalvular abscess or valve dysfunction, so we simply resected the vegetation and debrided the surrounding tissue. Post-surgical antibiotic therapy was continued for 5 weeks and then he was switched to oral medication. Three years after surgery, he is free from any PVE recurrence.

It is well known that extreme repetitive stress on the apophysis without considering the physical characteristics of children induces a growth disorder of the growing skeleton. However, only a few studies have evaluated the indexes of the muscle-tendon complex as a risk factor of apophysitis. The purpose of this study was to investigate the relationship between the elastic properties of the Achilles tendon, physical characteristics, muscle tightness (MT) and general joint laxity score (GLP), and tenderness from typical apophysitis (calcaneal tubercle, tibial tuberosity and iliac spine) in kindergarten and elementary school students. Body and lower leg size, and MT of the calf muscle increased ; while GLP decreased significantly with age. The Elastic index of the Achilles tendon and its standard deviations were greater among 5^th and 6^th graders than among 3^rd and 4^th graders. Point tenderness was more frequent in older age groups (4^th-6^th graders) than in younger age groups (kindergartren-3^rd graders) and was greatest in 4^th graders. When subjects were categorized into groups with and without point tenderness, no significant differences were found between GLP, muscle tightness of gastrocnemius, quadriceps and iliopsoas. However subjects who showed point tenderness had a higher Elastic index (p=0.07). Considering the pathomechanics of apophysitis, repetitive traction of the apophysis by a stiffer muscle-tendon unit lead to injury of the apophysis and growth plate. Tendon properties appear to be more sensitive to the pathomechanics of apophysitis.

BACKGROUND/AIMS: To determine the nutritional markers important for assessing the degree of pancreatic insufficiency due to chronic pancreatitis in routine clinical practice. METHODS: A total of 137 patients with chronic pancreatitis were followed up for more than 1 year. They were divided into two groups: a pancreatic diabetes mellitus (DM) group, consisting of 47 patients undergoing medical treatment for DM of pancreatic origin, and a nonpancreatic DM group, consisting of 90 other patients (including 86 patients without DM). Serum albumin, prealbumin, total cholesterol, cholinesterase, magnesium, and hemoglobin were compared between the two groups. RESULTS: The total cholesterol was significantly lower in the pancreatic than the nonpancreatic DM group (164 mg/dL vs 183 mg/dL, respectively; p=0.0028). Cholinesterase was significantly lower in the former group (263 U/L vs 291 U/L, respectively; p=0.016). Among the 37 patients with nonalcoholic pancreatitis, there was no difference in the cholinesterase levels between the pancreatic and nonpancreatic (296 U/L vs 304 U/L, respectively; p=0.752) DM groups, although cholesterol levels remained lower in the former (165 mg/dL vs 187 mg/dL, respectively; p=0.052). CONCLUSIONS: Cholinesterase levels are possibly affected by concomitant alcoholic liver injury. The total cholesterol level should be considered when assessing pancreatic insufficiency due to chronic pancreatitis.
Adult ; Aged ; Aged, 80 and over ; Cholesterol/*blood ; Cholinesterases/blood ; Diabetes Mellitus, Type 2/complications ; Exocrine Pancreatic Insufficiency/*blood/etiology ; Female ; Follow-Up Studies ; Humans ; Liver Cirrhosis, Alcoholic/blood ; Male ; Middle Aged ; Nutritional Status ; Pancreas/enzymology ; Pancreatitis, Alcoholic/blood/complications ; Pancreatitis, Chronic/blood/*complications ; Serum Albumin/analysis