Metritis vaccination in Holstein dairy heifers using a herd-specific multivalent vaccine - Effects on uterine health and fertility in first lactation.

In cattle, acute puerperal metritis (APM) compromises animal welfare and has an economic impact to the farmer because of the detrimental effects on reproductive performance, milk production, and survivability. The aim of this randomized clinical study was to investigate the effects of a prepartum immunization using a herd-specific multivalent vaccine on incidence of APM, prevalence of clinical endometritis (CE), and selected measures of reproductive performance in primiparous Holstein cows. Pregnant nulliparous cows (230±4days of gestation) assigned to the vaccinated group (VG; n=142) received subcutaneously 5.0mL of a multivalent herd-specific vaccine containing inactivated whole bacterial cells of Trueperella pyogenes, Escherichia coli, Streptococcus uberis, Bacteroides species, and Peptostreptococcus species obtained from uterine swabs of primiparous cows suffering from APM at the time of enrolment and three weeks later. Heifers allocated to the control group (Co; n=144) remained unvaccinated. Rectal temperature in the first 10days in milk (DIM) did not differ between treatments, and no interaction between treatment and day was observed (interaction treatment*day: p=0.623). Incidence of APM (VG, 46.0%, Co, 48.9%, p=0.588), number of antibiotic doses per cow to treat APM (VG, 0.63±0.81, Co, 0.64±0.75, p=0.496), prevalence of CE at 35 DIM (VG, 24.6%, Co, 19.3%, p=0.350), first service pregnancy per artificial insemination (VG, 40.3%, Co, 45.5%, p=0.541), number of inseminations until 150 DIM (VG, 2.0±1.4, Co, 1.9±1.3, p=0.749), interval from calving to first service (median days, VG, 52, Co, 52, p=0.915), and interval from calving to pregnancy (median days, VG, 90, Co, 83, p=0.419) did not differ between VG and Co. Treatment did not affect activity of aspartate aminotransferase (AST) and creatine kinase (CK) or concentrations of beta-hydroxybutyrate (BHB) and haptoglobin in serum samples collected at 5 DIM. Furthermore, treatment did not influence yields of milk, fat or protein in the first 100 DIM. Moreover, no signs that vaccination provided an attenuation of severity of the APM cases were detected as the course of rectal body temperature and values of AST, CK, BHB, and haptoglobin were not influenced by treatment within the group of cows with diagnosed APM. Use of this herd-specific multivalent vaccine designed to reduce metritis was not efficacious at reducing the risk of uterine disease or influencing production and reproduction in dairy cows.

Persistent atrial fibrillation ablation concomitant to coronary surgery.

OBJECTIVE: This analysis was undertaken to evaluate the results of persistent atrial fibrillation (pAF) ablation procedures concomitant to coronary surgery and to identify the risk factors for pAF recurrence. METHODS: Since 2001, a total of 126 consecutive patients with pAF (duration: 0.5-33 years) underwent ablation concomitant to coronary surgery (isolated or in combination with valve surgery), whereby two encircling isolation lesions around the left and the right pulmonary veins and a connecting lesion between both was created using radiofrequency ablation. Patients were reevaluated at discharge, 3 months and 3 years after surgery. RESULTS: Survivals at the time of reexamination were 96.8, 95.1 and 94.7 %, respectively. Stable sinus rhythm (SR) could be documented in 66.4, 75.1 and 75.9 % of surviving patients. Long-term pAF before surgery and a larger left atrium (LA) were predictive of postoperative pAF return ( P < 0.01). Statistical analysis demonstrated a cut-off point of 5 years for pAF and 50 mm for LA diameter: 89.1 % of patients with pAF duration of < 5 years and 86.2 % of patients with LA size of ≤ 50 mm were in stable SR at late follow-up. Cardiac rhythm at 3 months was predictive for long-term rhythm prognosis ( P < 0.01). Age, gender and concomitant diseases (e.g. arterial hypertension, diabetes, renal insufficiency), and the underlying cause of heart disease did not significantly influence the postoperative cardiac rhythm. CONCLUSIONS: The duration of pAF and the LA size are the most reliable preoperative variables to predict the success rate of ablation in patients undergoing coronary surgery. The probability of re-establishing stable SR is excellent when pAF duration is short and LA size is small.

Early and late results of permanent atrial fibrillation ablation surgery in aortic valve and CABG patients.

OBJECTIVE: The study investigates the early and late results of permanent atrial fibrillation (AF) ablation surgery concomitant to coronary artery bypass grafting (CABG) and/or aortic valve (AV) surgery. METHODS: Between February 2001 and April 2006, a selective group of 80 patients with permanent AF (median: 48 months [Perc25/75 24/110; range: 6 - 360 months]) underwent either bipolar (n = 60) or monopolar (n = 20) radiofrequency (RF) ablation procedures concomitant to CABG and/or AV surgery (CABG: n = 39; AV: n = 30; AV + CABG: n = 11). All patients were restudied to assess survival, conversion rate to stable sinus rhythm (SR) and New York Heart Association (NYHA) class early (3 +/- 1 months) and late after surgery (30 +/- 15 months). Data were analyzed exploratively. RESULTS: Survival at 3 and 30 months was 98 % and 96 %, respectively. Stable SR could be documented in 73 % and 77 % of patients. Long-term AF before surgery and larger LA size were predictive for AF return after surgery ( P = 0.004 and P = 0.032, respectively). Neither age, gender, the application modus of the RF energy nor the underlying cardiac disease influenced the postoperative cardiac rhythm significantly. NYHA class improved significantly after surgery ( P < 0.0005), particularly when stable SR was achieved ( P = 0.049). CONCLUSION: Preoperative permanent AF duration time and larger LA size are useful variables to predict the success rate of concomitant ablation surgery in CABG and/or AV patients. Further it could be demonstrated that established SR remained stable over time.

Early and late results of restrictive mitral valve annuloplasty in 121 patients with cardiomyopathy and chronic mitral regurgitation.

OBJECTIVE: This study investigated the early and late results of restrictive mitral valve (MV) annuloplasty in patients with chronic mitral regurgitation (MR) and advanced ischemic (ICM) or dilated cardiomyopathy (DCM). METHODS: From October 2001 to September 2006, 121 patients (age: 69 +/- 9 years) with a left ventricular ejection fraction (LVEF) of 30 +/- 9 % and chronic MR grade 3 - 4 (ICM: n = 102, DCM: n = 19) underwent restrictive prosthetic ring annuloplasty (downsizing of 2.7 +/- 0.8 ring sizes). Eighty-five ICM-patients had indications for concomitant coronary artery bypass grafting (CABG). All patients were restudied at 7 +/- 1 days, 3 +/- 1 and 30 +/- 12 months after surgery to assess survival, residual MR, New York Heart Association (NYHA) class and left ventricular (LV) function (end-systolic/end-diastolic dimensions/volume indexes and LVEF). Data were analyzed exploratively. RESULTS: 30-day mortality was 3.3 %; survival at follow-up was 95 % and 91 %, respectively. Postoperative recurrence of significant MR (> grade 2) was absent in all patients. NYHA class, LV dimensions/volume indexes and LVEF improved significantly after surgery in both groups ( P < 0.0005). A prediction of continuous postoperative improvement of myocardial function in the sense of reverse remodeling could be demonstrated by univariate logistic regression for ischemic etiology and concomitant CABG ( P = 0.0001). In DCM-patients or ICM-patients without CABG, the postoperative benefit on myocardial function was limited. CONCLUSION: Restrictive mitral valve (MV) annuloplasty corrected chronic MR in cardiomyopathy patients with low mortality and improved contractility. Surgery also prevented recurrence of significant MR, although the phenomenon of postoperative continuous reverse myocardial remodeling could not be verified in cases with a non-ischemic etiology or ICM without concomitant CABG.

Ablation surgery failure after combined permanent atrial fibrillation ablation and mitral valve surgery.

OBJECTIVE: The aim of this study was to evaluate the early and late results of a permanent atrial fibrillation (pAF) ablation concept carried out concomitantly with mitral valve (MV) surgery and to identify risk factors for ablation surgery failure. METHODS: Between February 2001 and April 2006, 109 patients with pAF over a median time of 48 months (Perc25/75; range 6 - 396 months) underwent monopolar endocardial radiofrequency ablation procedures concomitantly with MV surgery. All patients were restudied to assess survival, conversion rate to stable sinus rhythm (SR) and New York Heart Association (NYHA) class early (3 +/- 1 months) and late after surgery (36 +/- 19 months). For data assessment an explorative data analysis including univariate and multivariate binary logistic regression was performed. RESULTS: Early and late survival was 95 % and 91 %, respectively; at follow-up stable SR was documented in 76 % (74 %) of patients. NYHA class improved significantly after surgery ( P = 0.009), particularly when stable SR was achieved ( P = 0.042). Among these MV patients left atrial (LA) enlargement and pAF of long-time duration prior to surgery were detected as risk factors for postoperative recurrence and persistence of atrial fibrillation ( P = 0.026 and P = 0.002); furthermore, advanced age and significant tricuspidal regurgitation at the time of surgery were also relevant. The best prediction (95 % of patients) for SR, as demonstrated in a multivariate model, was based on the factors LA size and pAF duration ( P = 0.052 and 0.005). CONCLUSION: Particularly the preoperative LA size and pAF duration seem to be useful parameters to evaluate the success rate of ablation performed concomitantly with MV surgery. It could be demonstrated that an established SR remains stable over time.

Changes of myocardial function after combined coronary revascularization and mitral valve downsizing in patients with ischemic mitral regurgitation and advanced cardiomyopathy.

OBJECTIVE: At present not much data is available on changes in myocardial function after combined coronary artery bypass grafting (CABG) and downsizing of the mitral valve (MV) by restrictive prosthetic ring annuloplasty in patients with chronic ischemic mitral regurgitation (IMR) and advanced cardiomyopathy. METHODS: 63 patients with coronary artery disease, chronic IMR grade 3 - 4+, ischemic cardiomyopathy and reduced left ventricular (LV) function (LV ejection fraction [LVEF] of 30 +/- 9 %; range 12 - 45 %) underwent combined CABG and MV downsizing. Clinical follow-up and serial echocardiographic studies were performed to assess survival, New York Heart Association (NYHA) class, mitral regurgitation (MR), leaflet coaptation height (LCH), left atrial (LA) and LV end-systolic/end-diastolic dimensions/volumes and volume indices (LVESD, -EDD; LVESV, -EDV; LVESVI, -EDVI), fractional shortening (FS) and LVEF to evaluate the changes in myocardial function after surgery. RESULTS: Early mortality (< 30 days) was 1.6 %, survival at follow-up was 95 % (3 +/- 1 months) and 83 % (2 +/- 1 years), respectively. Functional class improved significantly after surgery; recurrence of relevant MR was absent in all patients. In general, LA/LV dimensions/volumes and volume indices, FS and LVEF improved significantly, even in patients with already severely reduced preoperative LV function (LVEF

Permanent atrial fibrillation ablation surgery in CABG and aortic valve patients is at least as effective as in mitral valve disease.

BACKGROUND: Data on combined permanent atrial fibrillation (pAF) surgery and coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) are scarce, and the mid- and long-term effects on survival and cardiac rhythm are unknown. MATERIAL AND METHODS: In a prospective analysis 125 patients (Group I: CABG and/or AVR, n = 50; Group II: mitral valve [MV] surgery, n = 75) with pAF (> or = 6 months) underwent either concomitant monopolar (Group I: n = 20; Group II: n = 75) or bipolar (Group I: n = 30) radiofrequency (RF) ablation procedures. Group I patients had a significantly smaller left atrial (LA) size than Group II patients (LA-diameter: 47.7 +/- 4.6 vs. 58.2 +/- 6.1 mm; p < 0.01). Regular follow-up was performed from 3 to 36 months after surgery to assess survival, NYHA-class, and conversion rate to stable sinus rhythm (SR). RESULTS: Early mortality (< 30 days) of Group I patients was 0% (Group II: 2.7%), cumulative survival at long-term follow-up was 0.95 vs. 0.82 (p = 0.31) and NYHA-class improved significantly in both groups, particularly in cases with stable SR. At follow-up 80% of Group I patients had SR (Group II: 70%). In Group I patients the bipolar approach was associated with significantly shorter ablation procedure times compared to the monopolar procedure (12.1 +/- 3.4 vs. 18.9 +/- 1.6 min; p < 0.05). CONCLUSIONS: Concomitant pAF ablation surgery in CABG and/or AVR is safe and at least as effective as in MV surgery, presumably because severe LA enlargement is exceptionally rare in this group.

Abdominal complications following cardiac surgery.

Type and frequency of abdominal complications after open heart surgery are described. Out of 3,312 patients, 48 patients (1.4%) developed early postoperative abdominal complications with a mortality rate of 14.5%. Paralytic ileus, erosive gastritis and gastrointestinal hemorrhage were the most frequent complications, whilst intestinal ischemia, acute cholecystitis and acute pancreatitis were less frequently observed. The comparison of the frequency of abdominal complications in cardiac surgery patients with the same complications in other operated patients showed no significant difference (hi-square test), with the exception of COLD which was more frequent in the group with abdominal complications. No association was found between perioperative treatment with aprotinine and the development of abdominal complications.

[Abdominal complications after heart surgery interventions]. / Abdominelle Komplikationen nach kardiochirurgischen Eingriffen.

OBJECTIVE: Risk factors of abdominal complications after cardiac surgery are largely unknown. We undertook this study to determine different types of abdominal complications after cardiac surgery and to identify patients at risk. PATIENTS AND METHODS: 3312 adult patients were operated between Jan. 91 and Oct. 95 (2352 males, 960 females, 62.6 +/- 0.18y). We included all patients who suffered from abdominal complications within 30 days postoperatively. RESULTS: Abdominal complications are rare after cardiac surgery using cardiopulmonary bypass (CPB) (1.4%), but they are associated with high mortality (14.5%) in our department. Abdominal complications like paralytic ileus (43.8%), erosive gastritis (22.9%) and gastrointestinal bleeding (18.8%) are more often, compared with acute cholecystitis (14.5%), acute pancreatitis (8.3%) and intestinal ischemia (19.5%). Patients with intestinal ischemia are at high risk and do have a high mortality (83%). Abdominal complications can be found more often in connection with prolonged myocardial ischemia and valve replacement or combined operations. Prediction of complications on the basis of anamnestic data alone was not possible. CONCLUSION: Abdominal complications after cardiac surgery, especially intestinal ischaemia, are life-threatening. Prediction of abdominal complications is impossible. We have to concentrate on an early diagnosis and therapeutic intervention to lower mortality. A close cooperation between cardiac and general surgeons is mandatory for a successful treatment of life-threatening abdominal complications such as intestinal ischemia.

[Cardiomyopathy after osteosarcoma treatment: a contribution to the cardiotoxicity of adriamycin]. / Kardiomyopathie nach Osteosarkombehandlung: ein Beitrag zur Kardiotoxizität von Adriamycin.

The frequency and severity of clinical and subclinical heart damage were studied in patients who had been treated with adriamycin (ADR) as part of the Cooperative Osteosarcoma Studies (COSS). The study charts of 785 patients from 63 participating institutions were reviewed: The overall incidence of drug-induced congestive heart failure was 2.2% (17 cases, 5 fatal). Late left ventricular function was studied in 29 tumor free survivors 81 +/- 41 month after treatment with 342 +/- 113 mg/m2 ADR. A detailed history and physical exam for signs of overt heart disease were obtained. M-mode echocardiography (ECHO, 29 cases) with evaluation of the fractional shortening rate (FS) and radionuclide ventriculography (RNV, 18 cases) with determination of the systolic ejection fraction at rest (EF) were used to screen for subclinical cardiac disease. Impaired cardiac function leading to pathological values was documented in close to one half of these patients. The frequency and severity of clinical and subclinical heart damage increased with cumulative adriamycin and time since cessation of anthracycline therapy.

Sleep and waking states in infancy: normative studies.

Twelve-hour polygraphic recordings were obtained in 20 normal healthy term infants at 1 week of age, at monthly intervals up to 4 months, and at 6 months of age. Each minute of these recordings was coded into active sleep (AS), quiet sleep (QS), wakefulness (AW), or indeterminate (IN) based on polygraphic and behavioral variables. For each state, a dozen variables were computed with the help of a laboratory computer. Together these variables describe trends in the development of sleep and wakefulness in the laboratory: an increase in QS and a concomitant decrease in AS, an increase in sustained episodes of these states, and continuous sleep onset in AS throughout this time span. Considerable variability appears to characterize immature sleep patterns, but a reduction in variability was noted between 3 and 4 months of age. The number of sustained sleep-state episodes and the percentage of AS and IN proved to be stable characteristics of individual infants. The large variability among and within infants sheds doubt on the usefulness of polygraphic monitoring of sleep states for early detection of abnormalities.

Respiratory behavior in near-miss sudden infant death syndrome.

Seventeen infants with unexplained prolonged apnea that has been designated near-miss sudden infant death syndrome were monitored for sleep and cardiorespiratory variables during a 12-hour, all-night recording session. Infants were matched for gestational age, sex, and age at recording with control infants. Respiratory variables studied included respiratory rate, respiratory variability, apnea duration, apnea density, and periodic breathing. No statistically significant differences were found in sleep state or respiratory variables between near-miss and control infants. Eight infants (47%) had no recurrence of prolonged apnea, whereas three (17.6%) had recurrent apneic episodes for six weeks to eight months following the original episode. No clinical or polygraphic finding predicted which infant would exhibit recurrent apnea. None of the infants was monitored at home. All infants were developing normally when examined at 1 to 2 years of age.