Synbiotic yogurt consumption by healthy adults and the elderly: the fate of bifidobacteria and LGG probiotic strain.

Synbiotic dietary supplements are used to modulate the intestinal microbiota in adults; however, studies regarding elderly people are limited. The aim of this work is to determine the effect of regular consumption of yogurt containing Lactobacillus rhamnosus GG (LGG) and the fructooligosaccharide (FOS) Actilight(®) both in healthy adults and the elderly suffering from constipation. Yogurt was administered daily for 4 weeks; faecal samples were collected before starting, after 4-week administration and a 15-day wash out period, and analyzed for LGG and bifidobacteria counts. Constipation status in the elderly was recorded by a standardized questionnaire. Bifidobacteria did not increase in either groups; at the end of the intervention trial, LGG was detected in significantly different amount in the faeces of the elderly and adults, being higher in adults (95% vs. 30%). An increased evacuation number in the elderly was evidenced, probably due to the presence of FOS in yogurt.

Morphological and phenotypical characterization of Bacillus sporothermodurans.

AIMS: Enumeration of resistant bacteria in ultra-high temperature (UHT) treated milk; morphological characterization and phenotyping of resistant strains by traditional and nontraditional methods and their identification by molecular biology. METHODS AND RESULTS: Modified standard plate count agar (PCA) and modified brain-heart infusion (BHI) agar were used for colony counts. Physiological culture traits were determined as suggested by Bergey's Manual of Systematic Bacteriology or in modified J-broth or in modified BHI agar. Scanning electron microscope (SEM) was used for microscopic examination. Strain identification was carried out by polymerase chain reaction (PCR). A total of 125 (62.81% of 199) samples were positive and the bacterial load was higher than 10(5) CFU ml(-1) in 46 samples (28.80% of 125). The 16S rRNA sequence of bacterial cultures obtained from UHT-treated milk was similar to that of Bacillus sporothermodurans M215 type strain((T)) and different biotypes were found by analysis of colony appearance, cell morphology and physiological traits. CONCLUSIONS: Bacillus sporothermodurans was the predominant sporigenous micro-organisms in UHT milk. SIGNIFICANCE AND IMPACT OF THE STUDY: BHI agar is more suitable than PCA for quality control of milk after UHT treatment. Modified J-broth medium is useful to determine selected physiological traits of B. sporothermodurans. The strains characterized and identified as B. sporothermodurans were significantly different compared with the type strain.

Ventriculotomy repair during revascularization of intracavitary anterior descending coronary arteries.

Optimal revascularization of the rare variant anomolous intracavitary left anterior descending coronary artery requires, by definition, entrance into the right ventricular cavity. We present a simple method to repair the ventriculotomy without risk of obliterating the left anterior descending coronary artery, septal perforators, or diagonal branches.

Effects of surgical manipulation on coronary stents: should surgical strategy be altered?

BACKGROUND: Coronary artery bypass grafting is usually indicated for those patients who undergo open heart surgical procedures who have previously undergone percutaneous transluminal coronary angioplasty regardless of the absence of stenosis. Occasionally, however, if the treated artery has remained patent for many years and there is a shortage of conduit material or the patient is undergoing a complex operation, the branch is left ungrafted. With the gaining popularity of coronary stent placement, patients with these devices are undergoing open heart operations with increasing frequency. METHODS: To determine whether normal surgical manipulation during open heart surgical procedures results in obliteration of the Palmaz-Schatz stents previously deployed in the epicardial arteries, we developed an experimental model using ten isolated adult pig hearts. This allowed us to perform stent deployment and surgical manipulation and to apply direct pressure on the stented areas, with each heart evaluated by angioscopy and angiography and, finally, stent explantation. RESULTS: Retraction of the heart resulted in severe deformity of all left anterior descending artery stents, mild deformity of those in the circumflex artery, and mild or no deformity of those in the right coronary artery. However, direct pressure over the stented epicardial arteries (enough to retract the heart) resulted in complete obliteration of every intracoronary stent. CONCLUSIONS: The findings from this study indicate that once the need for surgical revascularization arises, a previously stented coronary artery should be bypassed even if the angiographic findings are normal, because of the likelihood that manipulation during an open heart operation will result in significant deformity or obliteration of the stent.

Severe deformity of a Palmaz-Schatz stent after normal surgical manipulation.

This report describes a case in which normal surgical manipulation during dissection of the heart while performing a repeat revascularization procedure produced a significant deformity in Palmaz-Schatz stents previously implanted in a saphenous vein graft. The graft had shown satisfactory angiographic appearance immediately before the operation, and consideration was given to leaving it in place. Its replacement, however, prevented a major intraoperative mishap.

Diagnosis of fulminant pulmonary embolism by transthoracic echocardiography.

When pulmonary embolism is severe enough to produce acute cor pulmonale, transthoracic 2-dimensional echocardiography can promptly yield findings highly suggestive of this condition while ruling out competing diagnoses. We present a case diagnosed by transthoracic echocardiography and successfully treated despite a prolonged refractory cardiac arrest.

[Sarcoid-like hepatic granulomas, associated with gastric neoplasia. Description of a case]. / Granulomi epatici sarcoido-simili, associati a neoplasia gastrica. Descrizione di un caso.

Giant cell granulomas in liver biopsies is a relative common finding. Among the many causes of granulomatous lesions of the liver primary biliary cirrhosis and sarcoidosis are the most frequently diagnosed. On the other hand sarcoid-like granulomatous reaction can be encountered associated to malignant tumours. Purpose of the present paper is to describe a case of a sarcoid-like reaction of the liver associated to gastric adenocarcinoma. The patient was a 66 yr old man who underwent gastrectomy for a signet-ring cell adenocarcinoma. Pathological anamnesis was unremarkable. Liver function tests were within normal limits. Chest x ray was normal. A liver biopsy was performed during surgery as the liver presented an irregular surface. On histology giant cell granulomas with sarcoid-like features were seen in the hepatic parenchyma. Same reaction was present in the perigastric lymph nodes. The patient died immediately after surgery due to massive pulmonary embolism. No autopsy was performed. Among the possible diagnoses primary biliary cirrhosis, sarcoidosis and paraneoplastic sarcoid-like granulomatous reaction were considered. Primary biliary cirrhosis and sarcoidosis were excluded on the basis of the past clinical history of the patient, that was unremarkable; furthermore liver function tests performed preoperatively were within normal ranges. Thus paraneoplastic sarcoid-like reaction involving the liver was regarded as the most likely diagnosis.

Postoperative management of cerebral air embolism: gas physiology for surgeons.

Cerebral gaseous microemboli are present in most, if not all, cardiopulmonary bypass-assisted operations. Fortunately, the great majority are subclinical. Clinically significant cases of cerebral air embolism are largely underdiagnosed, undertreated, and underreported. The management of cerebral air embolism has been challenged due to the lack of prospective, randomized studies. Preventive measures that have been implemented throughout the years, resulting from empirically acquired knowledge, have avoided frequent major mishaps. Perfusion accidents, in which massive amounts of gas are pumped into patients, are managed intraoperatively by common-sense heroic measures which, at best, remove 50% of the embolized gas. Postoperative confirmation of a neurologic insult after a cardiopulmonary bypass-assisted operation, in which a cerebral air embolism is likely the source, is one of the most distressing situations a surgical team has to confront, due in part to the lack of pathognomonic diagnostic tools and to the absence of a "scientifically proven" (supported by prospective, randomized studies) therapeutic regimen. In lieu of the latter, we present the physical and physiologic bases that will justify the use of several therapeutic tools when facing a suspected CAE. These tools, when applied rationally, will represent some of the most innocuous modalities in the medical armamentarium.

Successful myocardial revascularization and neurologic recovery in a patient with prolonged refractory cardiac arrest and a chronically occluded left internal carotid artery.

Heretofore, the longest successfully treated cardiac arrest reported in the literature, secondary to myocardial ischemia, was one that required 45 minutes of cardiopulmonary resuscitation before coronary bypass surgery. We present a unique case of successful resuscitation after a cardiac arrest secondary to myocardial ischemia. The arrest lasted 78 minutes (30 minutes of closed cardiac massage and 48 minutes of open cardiac massage). As soon as a perfusionist was available, cardiopulmonary bypass was initiated. After completion of the distal anastomosis and upon removal of the aortic cross clamp, the patient spontaneously recovered sinus rhythm for the 1st time since her cardiac arrest 2 hours and 10 minutes earlier. This 70-year-old woman, with a history of chronic occlusion of the left internal carotid artery, recovered fully, without evidence of neurologic or myocardial insult. We believe that vigorous closed and open cardiac massage, followed by cardiopulmonary bypass and the correction of myocardial ischemia, enabled this patient to survive a prolonged refractory cardiac arrest.

[Post-traumatic intrathoracic gastric volvulus. Presentation of a clinical case]. / Volvolo gastrico intratoracico post-traumatico. Presentazione di un caso clinico.

The paper describes a case of traumatic hernia of the diaphragm, complicated by mixed gastric volvulus, with a rapid onset and severe clinical symptoms. The etiopathogenesis, diagnosis and therapeutic methods inherent in this rare affliction are discussed.

The role of serial echocardiography in the evaluation and differential diagnosis of pericardial disease.

Echocardiography is an established method for the diagnosis of pericardial effusion. Echographic findings in fibroadhesive disease have also been described. The interpretation of a changing serial echogram during the clinical course of pericardial disease has not been established. Sixteen patients with echographic evidence of pericardial effusion were followed with serial echographic studies. In seven, surgical or autopsy correlation was obtained. Because of the serial changes noted we undertook a study in dogs to clarify the problem of variability in intensity of sound reflected from the pericardial space. Three open-chested dogs were studied with rapid sequence surface echograms as blood introduced into the pericardial space was converted from the unclotted to the clotted state. In all three dogs blood clooting increased the intensity or sound reflected from the pericardial space. Our study of two patients with fibroadhesive pericardial disease documents serial changes in echoes from the pericardium and pericardial space accompanying the clinical evolution of the disease process, and suggests a method for avoiding the commonly encountered difficulty in proper identification of the pericardial and epicardial echoes. Our preliminary studies suggest that serial echograms should play an important role in the management of patients with pericardial effusion; further surgical/pathological correlations are required.