Bacillus cereus prosthetic valve endocarditis.

Bacillus cereus is a ubiquitous organism that often contaminates microbiological cultures but rarely causes serious infections. Reports of B. cereus endocarditis are infrequent. Infection in patients with valvular heart disease is associated with significant mortality and morbidity. We describe a case of B. cereus endocarditis involving a mechanical mitral prosthesis that resolved after replacement of the prosthetic valve. We also review the previous cases reported in the literature.

Pulmonary hydatidosis: surgical treatment and follow-up of 240 cases.

OBJECTIVE: We review a series of 240 patients treated surgically for pulmonary hydatid cyst in our center between 1966 and 1988, assessing the results with our surgical technique, which involves a novel needle aspiration device designed by Professor D. Figuera, and postoperative treatment protocol. PATIENTS AND METHODS: The majority (60.4%) of the patients were from areas endemic for hydatid disease. The mean age of the patients at the time of the surgical procedure was 31.5 +/- 7.2 years (range: 4-70 years). A trocar-suction device was used for the needle aspiration of 276 (92%) of the 300 cysts encountered in the 240 patients. The remaining 24 cysts were removed integrally by means of different surgical techniques such as cyst enucleation, lobectomy, segmentectomy and atypical pulmonary resection. The residual cavity was treated by pericystectomy and eversion to the pleural surface in 238 cases (86.2%) and by capitonnage in 38 (13.7%). High vacuum suction (-30 cm H2O) was employed in every case. Depending on when the procedure was performed, the patients were treated with mebendazole or albendazole according to the protocol designed by Bekhti. RESULTS: Clinical assessment of the symptoms and plain chest X-ray led to the correct diagnosis in 228 cases (95%). In six (2.5%), imaging studies such as ultrasonography, computed tomography and nuclear magnetic resonance were required, and in the remaining six cases (2.5%), the diagnosis was established intraoperatively or in the subsequent histopathological study. One hundred and seventy patients (70.8%) presented a solitary lung cyst, while the remaining 70 (29.2%) were found to have multiple cysts in one or more lobes of one or both lungs. In addition, 45 patients (18.7%) presented hepatic cysts and 25 (10.4%) had cysts in other locations. After 18 years of follow-up, the survival rate was 94.6%. Of the surviving patients, 98.3% were free of pulmonary hydatid disease and 95.1% were free of hydatid disease. CONCLUSIONS: The trocar-suction device employed here for needle aspiration of hydatid cysts has demonstrated its efficacy in preventing the rupture of the cyst and its possible dissemination. With its use, the parasite is eradicated and the residual cavity can be excised.

Improved distribution of pulmonary flush solution to the tracheobronchial wall in pulmonary transplantation.

This report describes the experimental results obtained with conventional (pulmonary artery, PA) flushing versus retrograde perfusion (via left atrium, LA) using 99mTc-labeled macroaggregated albumin (MAA-99mTc) to ascertain the distribution throughout the tracheobronchial (TB) tree in 10 Large-White pigs. Lung preservation was achieved with 4 degrees C Euro-Collins solution (60 ml/kg) instilled via PA (n = 5) or LA (n = 5). Simultaneously, MAA-99mTc was given using the same respective route and the isotope uptake quantified at different TB levels after heart-lung block harvest and dissection of all tissue adjacent to TB: proximal and distal trachea and right and left main bronchi. Retrograde distribution resulted in a significantly higher 99mTc count compared to the PA route (p < 0.01).

[Fluorine in parenteral nutrition solutions]. / Flúor en soluciones de nutrición parenteral.

The daily contribution of F in patients subjected to TPN has been determined, based on the F content of 61 commercial solutions used to prepare the different TPN. The determinations have been done by means of a potentiometric method with and F selective electrode and a double union reference electrode. Only those commercial solutions contained in glass ampules showed traces of F, while none was detected in samples contained in plastic or other type of glass containers. In the glass ampules, the F content oscillated between 115 micrograms/l in those of 10% calcium chloride, to 931 micrograms/l in those of potassium chloride. The total contribution of F based on these preparations in TPN, does not reach 100 micrograms/day, which is much below the recommended daily dose for safety and adequacy.

Efficacy of low-dose OKT3 as cytolytic induction therapy in heart transplantation.

BACKGROUND: The need for prophylactic cytolytic treatment in heart transplantation is a controversial issue. Its use, however, might prevent the onset of cellular rejection in the immediate postoperative period, facilitating patient management. It has recently been suggested that the administration of these products at low doses might have the same immunologic impact and would reduce secondary effects and the cost of treatment. METHODS: In a nonrandomized retrospective study, we assessed 45 consecutive patients who underwent orthotopic heart transplantation in 1992 and 1993. Six patients who died before receiving the complete OKT3 dose were excluded. Twenty-three patients were treated with 5mg/day doses of OKT3 for 7 consecutive days. Another 16 patients received 2.5 mg of OKT3 for 7 consecutive days. RESULTS: There were no significant differences between the two groups with respect to CD3 counts on days 2 (0.1% +/- 0.3% versus 0.04% +/- 0.25%; p > 0.05) and 6 (0.2% +/- 0.45% versus 0.1% +/- 0.3%; p > 0.05), number of rejection episodes (1.45% +/- 0.8% per year of follow-up versus 1.7% +/- 1.2%, p = 0.66), number of infectious complications (8 versus 3, p > 0.05), total methylprednisolone dose used to treat rejection crises (3900 +/- 2765 versus 3600 +/- 1963 mg; p = 0.71), adverse effects attributed to OKT3 (two versus none), or length of the postoperative hospital stay (36.8 +/- 19 versus 30.2 +/- 20.9 days). CONCLUSIONS: As cytolytic induction therapy in heart transplantation, a daily regimen of 2.5 mg of OKT3 for 7 days achieves the same clinical and immunologic effect as the conventional 5 mg/day dose. In addition, it results in a considerable reduction in the cost of treatment.

Heart transplantation in a patient with liver hydatidosis.

The human can serve as an accidental intermediate host to Echinococcus granulosus, a parasite that targets dogs as its definitive hosts. We present the case of a 27-year-old man with liver hydatidosis, who underwent heart transplantation because of ischemic cardiomyopathy. The immunosuppressor treatment had no effect on the size of the cysts, which were removed surgically 14 months after heart transplantation; good results persist after 3 years of follow-up.

[Nickel content of parenteral nutrition solutions]. / Contenido de níquel en soluciones de nutrición parenteral.

Determination of the nickel content in 49 commercial solutions used in parenteral nutrition, by means of atomic absorption spectroscopy in a graphite kiln. Important differences were found between the different components (less than 5 to 23.000 ppb). The largest concentrations of Ni were found in sodium chloride, phosphate salts, 10% calcium chloride and 2M potassium chloride, whereas the aminoacid, glucose and lipid solutions contained the smallest concentrations. The amount of Nickel in the preparations varied depending on the supplier and different salts of the compound itself. The Nickel intake in 2 TPN solutions with high and low concentrations of Ni (827 and 270 micrograms respectively) was also analyzed, and this intake was higher than the estimated amount absorbed in the diet. In the case of the TPN with a high Nickel content, this was higher than the level detected as being the cause of sensitivity reactions in patients sensitive to Nickel.

Polar lipids of non-alkaliphilic Halococci.

Until recently, only one species of Halococcus has been recognized, namely, H. morrhuae, but a large number of extremely halophilic non-alkaliphilic cocci have now been isolated from hypersaline habitats in Spain and classified into four phenons (A-D); one of the phenon D strains has been classified as a new species, Halococcus saccharolyticus. Examination of the lipids of H. saccharolyticus and four strains of phenons A-C showed the presence in all of them of C20-C20 and C20-C25 diether molecular species of phosphatidylglycerophosphate (PGP), phosphatidylglycerol (PG) and phosphatidic acid (PA); a monounsaturated isoprenoid C20-C20 (phytanyl-phytenyl) species of PGP; a sulfated diglycosyl diphytanylglycerol (S-DGD) with structure 2,3-diphytanyl-1-(6-HSO3-mannosyl-1-2-glucosyl)-glycerol, which is identical to the S-DGD-1 in Haloferax mediterranei; a phosphoglycolipid (P-TGD) tentatively identified as a phytanyl-phytenyl-(H2PO3-galactosyl-mannosyl-glycosyl)-glyce rol, and two unidentified glycolipids present only in traces. No phosphatidylglycerosulfate (PGS) was detected in any of the strains examined. This pattern of lipids appears to be characteristic of the strains of Halococcus from salterns in Spain, but studies of a larger number and variety of Haloccus are necessary to establish this conclusion with certainty.

[Thiamine stability in parenteral nutrition]. / Estabilidad de tiamina en nutrición parenteral.

In the present work we have studied the stability of thiamine by HPLC in parenteral nutritions provided with or without lipids. As source of nitrogen we have used Freamine 8.5%. Thiamine came from the multi-vitamin complex Pancebrin. The results of this study show that this vitamin is not stable for more than 24 h, even if parenteral nutritions are kept at 4 degrees C, except for solutions that do not contain lipids and are kept at 4 degrees C. Light does not influence the degradation rate of thiamine.

Thrombectomy of the Björk-Shiley prosthetic valve revisited: long-term results.

Thrombotic obstruction of the Björk-Shiley prosthetic valve is a catastrophic complication, often leading to a fatal outcome. Worldwide experience with the Björk-Shiley valve supports the need for long-term anticoagulation to prevent entrapment of the disc. Replacement of the malfunctioning device is associated with a high mortality, and therefore a more expeditious method is desirable. It is our experience that simple thrombectomy may suffice in most occasions, even for the mitral position, and especially when done through a bicameral approach in order to visualize both supravalvular and infravalvular regions. The philosophy and results with thrombectomy and disc rotation in 12 cases of thrombotic occlusion of the Björk-Shiley valve are described. It is suggested that this method may be preferable to replacement of the thrombosed prosthetic valve in select patients.

Outlet-strut fracture and disc embolization in 27-mm and smaller Björk-Shiley convexo-concave valves: historical overview and 3 case reports.

Outlet-strut fracture leading to primary failure of Björk-Shiley convexo-concave disc valves has only recently been reported in valves of 27-mm size and smaller. We now report an additional 3 cases of outlet strut failure in smaller convexo-concave valves, in a series of 899 implantations (overall incidence, 0.33%) of convexo-concave valves in various sizes and in 2 variant opening angles (60 degrees and 70 degrees ), during a 6-year period. All failures were confined to lots implanted during 1981 and 1982. We describe these 3 cases within the context of an historical overview of the Björk-Shiley tilting-disc valve, and propose methods of surgical intervention when this life-threatening complication arises.

Neuropathology of heart transplantation: 23 cases.

We reviewed the clinical histories, operative results, and neuropathologic findings of 23 consecutive patients who had heart transplants. Prolonged preoperative hypotension and failure of cerebral autoregulation of blood flow, followed by postoperative elevation of blood pressure beyond the limits of cerebral autoregulation, may account for the high incidence of neurologic complications (70%); 60% were vascular. Immunosuppressive therapy may have been responsible for the high incidence (20%) of opportunistic intracranial infections. Lymphoproliferative disorders occurred in three patients (13%).