[Renaissance of surgery for coronary artery disease]. / Renaissance der Bypasschirurgie.

Coronary bypass surgery is now a standard therapy for the treatment of coronary heart disease. Developed in the 1960s, the coronary artery bypass operation was the most performed operation at all in the 1980s. There was and still is rapidly advancing. The recovery of coronary surgery was held back in the 1970s with the introduction of heart catheterisation. To date, the number of interventional revascularizations has increased, while the number of bypass operations has reached a plateau. 30 resp. 40 years after the introduction of the two techniques it is still controversial which is the method of choice. According to the latest guidelines there is strong evidence that coronary artery surgery for patients with complex coronary artery disease is the gold standard: A Renaissance of bypass surgery.

Sternal plate closure: indications, surgical procedure and follow-up.

OBJECTIVES: Titanium plate osteosynthesis (Synthes) is an alternative option for sternal closure. The indications and time point of application are still debated. This study investigated the application and feasibility of this technique after median sternotomy. METHODS: Forty-one patients (29 M/12F, mean age 63 ± 17 years) received the plate system for complicated sternal conditions. Indications, intraoperative course and postoperative follow-up were assessed. RESULTS: Sternal deformity was present in 5 % (2/41), sternal fractures in 17 % (7/41), bone defect in 12 % (5/41), wire loosening in 39 % (16/41) and pseudoarthrosis in 27 % (11/41). 54 % (22/41) of patients showed concomitant sternal infection. Two intraoperative complications were noted: mammary artery injury (1 patient), pleural injury (1 patient). At discharge the patients reported no pain (90 %, 37/41) or only occasional discomfort (10 %, 4/41). Postoperative complications were subcutaneous hematoma in 12 % (5/41), seroma in 12 % (5/41) and sternal reinfection in 7 % (3/41). 12 % (5/41) showed occasional discomfort and 7 % (3/41) had persistent pain leading to plate removal. CONCLUSION: The Titanium Sternal Fixation System is comfortable and easy to use. It can be used to treat a wide spectrum of indications, especially for pseudoarthrosis, an entity which has not yet received sufficient attention.

"When Aneurysm Ain't Aneurysm": sinus of Valsalva aneurysm mimicked by healed abscess cavity under the aortic valve.

In a 70-year-old patient with severe aortic valve stenosis, preoperative standard imaging (transthoracic echocardiography and angiography) detected an unclear subannular cavity structure. Initially interpreted as an aneurysm of Valsalva, the structure was identified intraoperatively as a huge chronic abscess cavity and exclusion was carried out by pericardial patch plasty. This case draws attention to the importance of a differential diagnosis of an abscess due to infective endocarditis in cases of unclear subannular structures rashly diagnosed as aneurysm of Valsalva.

Production of staphylococcal enterotoxin D in foods by low-enterotoxin-producing staphylococci.

The goal of this investigation was to determine whether staphylococcal strains producing enterotoxins at nanogram levels per milliliter in laboratory medium, not detectable by gel diffusion methods, could produce sufficient enterotoxin in foods to result in food poisoning. Three low-enterotoxin D (SED)-producing strains were selected for this research because this enterotoxin is produced in smaller amounts than the other enterotoxins. The foods used were cream pie and cooked ham, divided into two portions, sterile and non-sterile. Each portion was inoculated with known concentrations of the staphylococcal strains under study and incubated for 48 h at 25, 30, and 37 degrees C. Samples were taken after 24 and 48 h. Enterotoxin was detectable in both sterilized and unsterilized cream and ham after 24 h at 37 degrees C with an inoculum of 10(3)/g. Some strains produced detectable amounts of enterotoxin in the sterilized foods after 24 h at 30 degrees C and some produced detectable amounts of enterotoxin in the sterilized foods after 24 h at 25 degrees C with inocula of 10(4)/g. It can be concluded that staphylococcal strains producing enterotoxin at ng/ml levels in laboratory medium, not detectable by gel diffusion methods, can produce sufficient enterotoxin (ng/g) in foods to cause food poisoning.

Cell-free mercury volatilization activity from three marine caulobacter strains.

Three mercury-resistant marine Caulobacter strains showed an inducible mercury volatilization activity. Cell-free mercury volatilization (mercuric reductase) from these three marine Caulobacter strains was characterized and compared with enzyme activities determined by plasmids of Escherichia coli and Staphylococcus aureus. The temperature sensitivity of the Caulobacter mercuric reductase was greater than that of mercuric reductase from other gram-negative sources. Cell-free enzyme activity required NADH or NADPH, with NADPH functioning much better at lower concentrations than NADH. The Km for the Caulobacter enzyme was 4 microM Hg2+. Ag+ was a competitive inhibitor of Caulobacter mercuric reductase (Ki = 0.2 microM Ag+), as with previously studied enzymes. Arsenite was a noncompetitive inhibitor of the Caulobacter enzyme with a Ki of 75 microM AsO2-.

Estudio epidemiologico e microbiologico de um surto de intoxicacao alimentar. / Epidemiological and microbiological study of an outbreak of food intoxication

O estudo de um surto de toxi-infeccao alimentar que ocoreu simultaneamente em dois restaurantes de uma mesma instituicao, indicou a carne cozida condimentada ou a maionese de batata, ambas preparadas de vespera, como a causa da toxi-infeccao. A mediana do tempo de incubacao correspondeu a doze horas e meia, a duracao dos sintomas foi inferior a vinte e quatro horas em quase todos os casos e a diarreia foi o sintoma predominante. Embora as contagens de Clostridium prefringens nas fezes dos doentes tenha sido elevada, nao se pode deixar admitir tambem Bacillus cereus, como possivel causa do surto

Partial purification of western equine encephalitis virus by fractionation procedures.

Concentracao, purificacao parcial e fracionamento do virus da encefalite equina do oeste (WEE) foram realizados pelos processos de precipitacao com sulfato de amonia e centrifugacao a alta velocidade. As hemaglutininas foram achadas nas fracoes de antigenos soluveis obtidos, pela precipitacao com solucao de sulfato de amonio, nas concentracoes de 30, 40 e 50 porcento.Os antigenos do tipo de fixacao de complemento foram achados, tanto nas fracoes de antigenos soluveis, como nas preparacoes contendo os antigenos precipitados. Pelo menos dois antigenos do tipo precipitinas foram determinados nas fracoes precipitadas pelas solucoes de sulfato de amonia, nas concentracoes de 70 e 80%. As fracoes correspondentes a concentracao de sulfato de amonia nos valores 40 e 50 porcento apresentaram a maior reatividade nas reacoes de fixacao complemento (FC), hemaglutinacao (HA) e imunodifusao (ID)