[The surgical angioplasty of the left main coronary ostial stenosis--a low risk operation]. / Plastia de largire a ostiului coronarian stâng--o interventie chirurgicala cu risc scazut.

To evaluate a different technique for the treatment of the left main coronary artery ostial stenosis, the coronary ostial surgical angioplasty. Three patients underwent this operation. After placing the patient on cardiopulmonary bypass and aortic cross clamping, the main pulmonary trunk was retracted laterally. The left main coronary artery was approached anteriorly through a curved aortotomy. Reconstruction was performed using fresh or treated with glutaraldehyde pericardial patch. There were no in-hospital deaths. In one case, the aortic suture had to be reconstructed with a GoreTex patch. We didn't note other complications. The patch plasty of the left main coronary trunk is a safe procedure, with no important complications, despite its technical difficulty.

[Fungal native aortic valve endocarditis. Combined medico-surgical treatment]. / Endocardita fungica de valva aortica nativa. Rezolvare medico-chirurgicala.

The fungal etiology of the native aortic endocarditis is a rare situation. Most often the etiologic factors are medical manoeuvres like cardiovascular surgery (cardiac prosthesis), cardiac defibrillators or stimulators, the prolonged use of the intravenous catheters, antibiotics, immunosuppressors, etc. We are presenting the case of a patient with cardiac stimulator, with rare fungal native aortic endocarditis, complicated with cerebral embolization, in which we have chosen a combined therapy: aortic replacement with biologic prosthesis and pre and post operative anti fungal therapy. We are considering that in this case the combined medico-surgical therapy was the right choice.

[A comparison between systolic pressure variations under mechanical ventilation and classic pressure parameters in predicting fluid responsiveness in patients after coronary surgery]. / Studiu comparativ intre variatiile presiunii arteriale sistolice si parametrii presionali clasici in predictia raspunsului hemodinamic la umplere la pacientii post by-pass aorto-coronarian.

Evaluation of the value of the systolic pressure variations (SPV) under mechanical ventilation and of its components (delta down and delta up) in predicting fluid responsiveness in patients after coronary surgery by comparison with classic parameters. A prospective,randomized study, on 50 patients who underwent CABG surgery, in the early postoperative period (the first two hours). We assessed the following parameters: CO, CI, CVP, PCWP, SAP, DAP, MAP, SVP, delta down and delta up. The including criteria were: sinus rhythm, CI < or = 2,5 l/min/m2, PCP < 18 mmHg. All the patients underwent a fluid challenge (500 ml of colloids in 10 min). Three patients were excluded: 3 for a PCWP > 18 mm Hg, 1 for loosing the sinus rhythm and 1 for an early return in the OR for bleeding. After a new assessment of the same parameters the patients were divided in two groups: group A (28 pts) with a raise of CI > 15%, and group B (22 pts) with a CI variation < 15%. In each group was statistically analyzed the variation of each parameter. Results Both parameters provided by SPV analysis are able to predict the fluid responsiveness with a great accuracy: the positive predictive value of a SPV > 12 mmHg is above 92,85% and of a delta down > 5 mm Hg is above 96,42%; the negative predictive value of a SPV < or = 12 mmHg is above 90,90% and of a delta down = 5 mm Hg is above 95,45%. None of the "classic" pressure parameters (MAP, CVP, PCWP) used in hemodynamic assessment have revealed a statistical significant variation. The SVP method's parameters are superior to classic pressure parameters (MAP, CVP, PCWP) in predicting fluid responsiveness in patients after coronary surgery.

[Pulmonary embolism--complication of proximal deep venous thrombosis in colorectal cancer. Diagnosis and management]. / Tromboembolismul pulmonar--complicatie a tromboflebitei proximale paraneoplazice în cadrul neoplasmului colo-rectal. abordare diagnostica si terapeutica.

We present the case of a 57 years old male, without cardiovascular history, with colorectal cancer and proximal deep venous thrombosis, who develops a massive pulmonary embolism. The surgical treatment consists in embolectomy of right ventricle, pulmonary trunk, left and right pulmonary artery. The specifics of the case is discussed: etiology and prevention of pulmonary embolism (caval filter) and treatment: the contraindications of thrombolytic therapy and the indications and perspectives of surgical treatment.

[The effect of the type of peptone for protein catabolism and realkalinization in Klebsielleae cultures]. / Influenta tipului de peptona pentru catabolismul proteinic si realcalinizarea culturilor la Klebsielleae.

According to the authors of the present paper, the formation of the MR+ and MR- groups is not explained by the variable degree of acidification, but by the various capacity of realkalinization of cultures. pH increases to values tending to 8 due to the formation of amines, ammonia and other basic products. They are the result of oxidative degradation processes, thus explaining the dependence on oxygen and the strictly aerobic character of the reaction. The acid-alkaline variation is influenced by the different content of peptones in monoaminodicarboacylic (meat-contraindicated) and diaminomenocarvoxylic (casein/soya bean-recommended) acids. The alkaline reversion may be determined in liquid media, having included ab initio either bromthymol blue, or bromcresol purple. The changes in pH may be read directly, colorimetrically, after an 18-20-hour incubation. By changing the interpretation (acid from glucose) and the indicator suggested by Clark and Lubs, the name "methyl red" becomes meaningless. At the same time, the introduction of other biochemical parameters (proteinic catabolism, realkalinization, dependence on oxygen) and the modification of the conditions of methods, justify the suggestion that the process of alkaline reversion, noted by the abbreviation "Reval", should be considered as a "per se" reaction and the laboratory determination should be patented as a routine test for the diagnosis of Enterobacteria.

[Aerobic conditions and the dynamics of the methyl red reaction in Klebsielleae]. / Conditionarea aeroba si dinamica reactiei rosului de methyl la Klebsielleae.

The development of the methyl red reaction (MR) in Klebsielleae, analyzed during a 4-day thermostatting, showed important pH-variations. Two steps are distinguished during the reaction dynamics: the former of acidification, common to all Enterobacteriaceae and the latter of alkaline reversion, specific to Enterobacter, Klebsiella, Serratia and other MR germs. The processes determining the alkaline reversion are conditioned by the presence of large amounts of air/oxygen (aerobic processes). In this situation, the lack of oxygen and maintenance of a relative degree of anaerobiosis block realkalinization (media covered with paraffin oil) whereas the large aeration stimulates it (optimum ratio between the large contact surface and a small volume of medium). Alkaline reversion cannot be explained by the more or less intense process of glucose fermentation but by degradations of nitrogenized substances with formation of amines, ammonia, and other basic compounds. That is why the analysis of the reaction mechanism of methyl red has to consider the characteristics of the catabolism of the nitrogenized substances and the intense realkalinization capacity of the culture medium proper to Klebsielleae but poorly expressed and non efficient in Enterobacteriaceae.

[Electron microscopic observations on the existence of "deflagellation tolerance" processes capable of explaining the selective isolation of vibrios in semisolid agar]. / Observatii electronomicroscopice cu privire la existenta unor procese de "deflagelare-toleranta", capabile sa explice izolarea selectiva a vibrionilor în agar semisolid.

The authors identified a group of substances (flagellar depression factors--FDF) which suppress the mobility of enterobacteria (immobilization) but do not influence the Vibrio movements (tolerance). FDF do not affect the vital processes, multiplication and formation of colonies. Electron microscopic interpretation showed that, in the usual media, enterobacteria have characteristic peritrichous cilia, whereas in media with FDF they are denuded of their flagellation formation. As such a process of flagellation depletion seems to be not known, we suggest the term "deflagellation" to name it. In a completely different way, the vibrios keep their single cilium located apically and implicitly their moving ability. These behaviour differences are evident in semisolid agar with FDF. The deflagellated enterobacteria are, therefore, immobilized, and multiply, forming small punctual colonies, of 0.5-1 mm phi, whereas the vibrios tolerating FDF develop and at the same time move in the liquid agar, mass, forming large colonies, of 8-14 mm phi. The electron microscopic observations presented show the existence of a "deflagellation tolerance" process and also explain the specific typology of the colonies of vibrios and enterobacteria formed in liquid agar with FDF.

[Changes in the antibacterial activity of nitrofurantoin preparations induced by peptone and hydrolysates]. / Modificari in activitatea antibacteriana a preparatului nitrofurantoin determinate de peptona si hidrolizate.

The determination of the activity of the product nitrofurantoin (10 and 100 mcg) versus 324 strains of Gram-negative bacteria showed that the diameter of the inhibition zones and the MIC values on a medium with a definite composition (7SG) are considerably larger than on the Mueller-Hinton (MH) medium, in the bacto-tryptose (BT) medium. An increase with 8-12 mm phi or with 2-4 binary dilutions changes the interpretation from resistant, on the MH and BT media into sensitive on the 7SG medium. The low results recorded on the conventional media reveal the existence of an antagonism between peptone and nitrofurantoin, similar to that known for sulfamides. The authors believe that the peptone antagonism has hindered the knowledge of the activity of the nitrofurfural derivatives and the correct assessment of the bacteria sensitivity. They also consider questionable the elimination tendency of the small dosage of microtablets of nitrofurantoin (10 mcg) and sulfamide (30 mcg), since their apparent insufficiency might be due less to the inadequate contraction of substances and more to the inadequate testing media. The results plead for the use of the media with definite chemical composition sulfamide and nitrofuran antagonists free and for reconsideration of several methodologic problems: use of the media with definite chemical composition; introduction of an intermediary dosage of maximum 100 mcg/microtablet; reassessment of the sensitivity categories for sulphafurazole and nitrofurantoin.