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Background and Objective: To analyze the risk factors associated with mortality in invasive pneumococcal disease in the university hospital Fundación Jiménez Díaz (Madrid, Spain) during 11 years., Patients and Method: We performed a retrospective study of patients attending the emergency service of the hospital from January 1993 to August 2003. We registered data on mortality, clinical and microbiological evolution and relapses., Results: We studied 263 patients with pneumococcal baceteremia and invasive disease caused by Streptococcus pneumoniae (pneumonia, meningitis, sepsis, bacteremia of unknown origin and oligoarthritis). Mortality was 12.5%. Variables associated with mortality in a logistic regression analysis included absence of leukocytosis (p = 0.04), acidosis (p < 0.01), respiratory signs and symptoms (tachypnea, pleuritic pain) (p = 0.02), and neurologic manifestations (decreased consciousness level; (p < 0.01)., Conclusion: Patients at highest risk of death because of invasive pneumococcal disease are critically ill, with no leukocytosis, with severe respiratory or neurological symptoms and undergoing invasive procedures such as mechanical ventilation and tracheostomy.

A case of aortic valve endocarditis caused by Coxiella burnetii and operated on with success is reported. The patient is doing well at 18 months follow up. Diagnosis of Q-fever endocarditis was made by high antibodies against phase I Coxiella burnetii antigens titration and by demonstration of aortic valvular vegetations by bidimensional echocardiography. Our patient suffered emergency aortic valve substitution due to acute hemodynamic failure and started a long-term treatment with doxycycline and rifampicin. Some interesting aspects about the diagnosis and treatment of this patient are reviewed because long-term follow-up and serological controls are still rare in the literature.

Intraoperative echocardiography with Doppler color flow imaging technique can provide the surgeon with an immediate and direct assessment of cardiac anatomy and function. To determine the utility of this recent technique, we have examined 15 patients pre, per, and postoperatively with Doppler color flow imaging. The intraoperative study was performed before and after cardiopulmonary bypass. A sterile transducer was placed directly on the epicardial surface of the heart, and multiple views were recorded. Intraoperative echocardiography with Doppler color flow imaging technique demonstrated excellent correlation with preoperative and postoperative findings, allowing an immediate evaluation of the surgical results. These preliminary results suggest that intraoperative Doppler color flow imaging technique is a valuable adjunct in heart surgery. It is particularly useful in valve repair, and in surgical repair of congenital heart disease.