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The authors report their experience on etiological and clinical aspects of infective endocarditis (IE). A series of 182 consecutive patients, including 83 cases of medical IE, 73 cases of IE in intravenous drug abusers (DA), 22 cases of IE on late prosthetic valves and 4 cases of IE on early prosthetic valves were evaluated since 1976. Medical IE occurred frequently in the elderly patients and in most of the cases (80%) involved natural valves with underlying abnormalities, either rheumatic (42%) or degenerative (33%) or malphormative (25%). Pre-existing valvular pathology was not needed for IE in DA, occurring in 13%, mainly due to a previous IE. In most of the cases IE in DA was a staphylococcal IE (80%) and a right-sided IE (77%). Streptococci were frequent agent both in medical and late prosthetic valves IE (55%): however, a wide pattern of microorganisms, including "unusual" pathogens like nutritionally variant Streptococci, Haemophylus parainfluenzae, Haemophylus paraphrophylus, Coxiella burnetii and the so-called "non pathogen microorganisms" (e.g. Neisseria sicca) was identified as etiological agent. As regards the clinical approach and diagnosis, the Authors underline some atypical clinical presentations of IE: the pulmonary presentation, occurring in right-sided IE, mainly in DA; the neurological presentation, suggesting staphylococcal etiology and left-sided IE; the vasculitis presentation, miming connective tissue diseases; the cardiac presentation, observed in aortic localization (1 case). One or more severe complications occurred in 65% of the patients, contributing to adverse outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)

Doxorubicin is a common antitumoral agent, widely used to treat patients with a variety of neoplastic diseases: acute and severe dose-related chronic cardiotoxicity is the major limitation to optimal use of anthracycline antibiotics. Cancer patients with clinically important heart disease are thus generally not eligible for anthracycline therapy. This review discusses the clinical aspects and possible underlying pathogenetic mechanisms of cardiac damage. Also described is the diagnostic evaluation necessary for early warning of a cardiac event during anthracycline therapy as well as the means to prevent it. The authors also discuss the anthracycline derivatives, verapamil, and dexrazoxane (ICRF-187), a new cardioprotector agent.

A case of severe neonatal hypophosphatasia is reported; X-ray aspects are described and differential diagnosis with other forms of foetoneonatal dwarfism is discussed.