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Of 81 cases of infectious endocarditis seen at our institution from 1988 to 1995, 61 had positive culture (75%) and, of these, 10 (16%) were caused by enterococcal strains (9 by Enterococcus faecalis, 1 by Enterococcus faecium). The 10 cases consisted of 5 native valve endocarditis and 5 late prosthetic valve endocarditis. Median age of patients was 50 years (range 21-58); 6, were males. Diagnostic or surgical procedures on the abdomen, genito-urinary tract, or chest preceded the onset of fever in almost all cases. Nine enterococcal strains showed low-level resistance to aminoglycosides and one was highly resistant. Seven patients were treated with ampicillin and gentamicin and 2 with teicoplanin and gentamicin. The patient, whose infection was caused by an high gentamicin-resistant E. faecalis, was treated with the combination of ciprofloxacin and cotrimoxazole chosen on the basis of the in vitro susceptibility tests. Congestive heart failure occurred in 4 patients and major embolic events in 3. All patients were cured; 4, with medical therapy alone and 6, with antimicrobials associated with surgical substitution of the valve. The data indicate that enterococcal endocarditis, when treated with appropriate antimicrobial regimens, associated with surgical treatment when necessary, has a very low mortality rate. The conventional treatment, -lactams plus gentamicin is usually effective. However, for high-level gentamicin-resistant strains alternative treatments must be selected on the basis of the in vitro susceptibility tests.

To evaluate the role played by hepatitis C virus (HCV) in mixed cryoglobulinemia in subjects with chronic hepatitis, we studied 72 consecutive patients: 43 had HCV-related chronic hepatitis, 19 HBV-related chronic hepatitis, and 10 chronic hepatitis of other etiology. We used second generation ELISA and RIBA to test for mixed cryoglobulinemia and anti-HCV antibodies in both serum and cryoprecipitates; HCV RNA were evaluated by "nested" PCR. Serum levels of rheumatoid factor and complement were also determined. The immunoglobulins in the cryoimmunoprecipitate were characterized by immunofixation electrophoresis. Cryoglobulinemia was present in 47% of the patients with chronic hepatitis C but in none of the sera of patients with HBV-related chronic hepatitis nor in those with chronic hepatitis of non-viral etiology. Type II mixed cryoglobulinemia was observed in 45% of the cases, and type III in 55%. HCV RNA and anti-HCV antibodies were present in all the cryoimmunoprecipitates. Ninety-five percent of the cryoglobulinemic patients had serum rheumatoid factor and 80% of them had low serum levels of C4. Our data indicate that mixed cryoglobulinemia is frequently associated with HCV-related chronic hepatitis, and that HCV and anti-HCV antibodies play an essential role in the development of mixed cryoglobulinemia.

We evaluated the effect of Amphotericin B, a polyen antimycotic agent, on the excretory functions of the isolated perfused rat liver. At 5 X 10(-6) and 10(-5) M, Amphotericin caused a rapid dose-dependent cholestasis. This effect was paralleled by an increase in canalicular permeability, as evaluated by sucrose C14 B/P ratio. The data indicate that Amphotericin B is a potent cholestatic agent in vitro and suggest that caution should be exercised in the use of this drug in hepatopatic patients.