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Nocardia asteroides Pericarditis

      In the June 1990 issue of the Proceedings (pages 819 to 824), Poland and colleagues contributed a valuable article on Nocardia pericarditis, including a critical review of the literature. In a discussion of surgical treatment options for purulent pericarditis, they included “creation of a pericardial window.” Such an approach would be contraindicated, if the correct definition of pericardial “window” is applied. Unfortunately, the authors join a wide company of others who have mistakenly used this label.
      A pericardial window is a surgical opening between the left pleura and the pericardium, which is rarely used because of the availability of adequate treatment for malignant pericardial effusions.
      • Spodick DH
      The normal and diseased pericardium: current concepts of pericardial physiology, diagnosis and treatment.
      • Spodick DH
      Pericardial windows are suboptimal.
      I feel certain that the authors would not wish to contaminate the left pleural cavity with infectious pericardial contents.
      It is difficult to understand how the widespread misperception of this term arose. Catheter drainage to the outside, even with a large pericardial hole and a large tube, is not a “window.” In any other cavity or hollow organ, it would simply be called “drainage.” Unfortunately, physicians often adopt fancy verbiage when plain terminology will do.
      • Spodick DH
      Cardiolocution (editorial).
      In this case, it is hardly a terminologie quibble—it is the description of a procedure different from that intended. These remarks are made to clarify an otherwise excellent presentation.

      REFERENCES

        • Spodick DH
        The normal and diseased pericardium: current concepts of pericardial physiology, diagnosis and treatment.
        J Am Coll Cardiol. 1983; 1: 240-251
        • Spodick DH
        Pericardial windows are suboptimal.
        Am J Cardiol. 1983; 51: 607
        • Spodick DH
        Cardiolocution (editorial).
        Am J Cardiol. 1981; 48: 973-974

      Linked Article

      • Nocardia asteroides Pericarditis: The authors reply
        Mayo Clinic ProceedingsVol. 65Issue 9
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          We appreciate the thoughtful letters of Drs. Joshi and Spodick. Dr. Joshi is correct in pointing out two additional cases of Nocardia asteroides pericarditis in patients infected with the human immunodeficiency virus (HIV). The addition of these two cases further strengthens our conclusions regarding management of this disease. Neither patient in that series underwent pericardiectomy, and both subsequently died of complications of Nocardia infection (Holtz HA: Personal communication). Of note, the Centers for Disease Control does not routinely code the diagnosis of nocardiosis in patients with HIV infection, and the HIV Division is unaware of any association between HIV infection and nocardiosis (Selik R: Personal communication).
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