MitraClip step by step; how to simplify the procedure.

The MitraClip system is a device for percutaneous edge-to-edge reconstruction of the mitral valve in patients with severe mitral regurgitation who are deemed at high risk for surgery. Studies have underlined the therapeutic benefit of the MitraClip system for patients at extreme and high risk for mitral valve surgery, suffering from either degenerative or functional mitral regurgitation. The MitraClip procedure shows low peri-procedural complication rates, and a significant reduction in mitral regurgitation, as well as an improvement in functional capacity and most importantly quality of life. It hereby widens the spectrum of mitral valve repair for the Heart Team. The current review underscores the efficacy of the procedure and describes the technique to simplify the procedure.

Surface and intracardiac ECG for discriminating conduction disorders after CoreValve implantation.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) has been developed to minimize operative morbidity and mortality in high-risk symptomatic patients unfit for open surgery. With the proximity of the aortic valve annulus to the conduction system there is, however, an unknown risk of conduction disturbances necessitating monitoring and often cardiac pacing. MATERIALS AND METHODS: We enrolled 50 consecutive patients from January 2007 to 2008 in our prospective evaluation of conduction disturbances measured by surface and intracardiac ECG recordings. Baseline parameters, procedural characteristics as well as twelve-lead surface ECG and intracardiac conduction times were revealed pre-interventionally, after TAVI and at 7-day follow-up. RESULTS: TAVI was performed successfully in all patients. During 7 days of follow-up the rate for first-degree AV block raised from 14% at baseline to 44% at day 7 (p < 0.001), while rates for type II second- and third-degree were 0 versus 8% (p < 0.001) and 0 versus 12% (p < 0.001), respectively. Similarly, the prevalence of new left bundle branch block (LBBB) rose from 2 to 54% (p < 0.001). Intracardiac measurements revealed a prolongation of both AH and HV interval from 123.7 ± 41.6 to 136.6 ± 40.5 ms (p < 0.001) and from 54.8 ± 11.7 to 71.4 ± 20.0 ms (p < 0.001), respectively. Pacemaker implantation at a mean follow-up of 4.8 ± 1.2 days was subsequently performed in 23 patients (46%) due to complete AV block (12%) and type II second-degree AV block (8%) while another 13 patients (26%) received a pacemaker for the combination of new LBBB with marked HV prolongation. The high rate of first-degree AV block was primarily driven by an increase in HV interval. CONCLUSION: Cardiac conduction disturbances were common in the early experience with CoreValve implantation necessitating close surveillance for at least 1 week.

[Surgically assisted rapid maxillary expansion. Effects on the nasal airways and nasal septum]. / Chirurgisch unterstützte transversale Oberkieferdistraktion. Auswirkungen auf Nasenwege und Nasenseptum.

BACKGROUND: Surgically assisted rapid maxillary expansion (SARME) is a standardized method to treat cross bites in maxillofacial surgery. Changes to the nasal airways are assumed due to the anatomic dependence between the palate and the nasal floor. PATIENTS AND METHODS: In this study 19 patients with a transverse deficit of the upper jaw underwent SARME. CT scans were performed 1 month pre- and 6 months postoperatively. Effects to the lower nasal airways, the nasal septum and the hard palate were subsequently evaluated. RESULTS: The mean distraction width of the upper jaws was 5.84 mm (SD 2.19) postoperatively. In addition to the dentoalveolar gain in width, a significant increase in the nasal floor was observed (p<0.001). The anterior part of the nasal floor was increased by 14.11%. An anterior-caudal tilt of the upper jaw was observed in the anterior part measuring 1.5 mm (SD 1.05). No significant deviation of the nasal septum occurred. CONCLUSION: SARME has a significant effect on ear, nose and throat medicine. Nasal airways enlarge significantly, while no significant deviation of the nasal septum is observed.

Intermediate short-term tourniquet use during the preparation of a free vascularised fibula flap for mandibular reconstruction. A case report.

First described by Taylor et al. in 1975, the fibula flap is well established as a universal method for reconstruction of defects in several medical fields. Mostly a tourniquet is kept on during the whole procedure of harvesting the fibula flap. In some hospitals the operation is performed without tourniquet. The outcome is mostly described as successful, but functional impairment and donor site morbidity should not be neglected and severe complications are not frequently reported. In this article we describe a modification of the standard harvesting techniques to minimise the ischaemia time of the flap as well as the danger of severe blood loss. The tourniquet was only activated during the final disconnection of the fibular artery and was released immediately after the successful harvesting of the fibula flap. This method combines the safety of a tourniquet during the critical disconnection procedure and the advantages of a long perfusion of the donor site and the graft.

Factors affecting the stability of screws in human cortical osteoporotic bone: a cadaver study.

We investigated several factors which affect the stability of cortical screws in osteoporotic bone using 18 femora from cadavers of women aged between 45 and 96 years (mean 76). We performed bone densitometry to measure the bone mineral density of the cortical and cancellous bone of the shaft and head of the femur, respectively. The thickness and overall bone mass of the cortical layer of the shaft of the femur were measured using a microCT scanner. The force required to pull-out a 3.5 mm titanium cortical bone screw was determined after standardised insertion into specimens of the cortex of the femoral shaft. A significant correlation was found between the pull-out strength and the overall bone mass of the cortical layer (r(2) = 0.867, p < 0.01) and also between its thickness (r(2) = 0.826, p < 0.01) and bone mineral density (r(2) = 0.861, p < 0.01). There was no statistically significant correlation between the age of the donor and the pull-out force (p = 0.246), the cortical thickness (p = 0.199), the bone mineral density (p = 0.697) or the level of osteoporosis (p = 0.378). We conclude that the overall bone mass, the thickness and the bone mineral density of the cortical layer, are the main factors which affect the stability of a screw in human female osteoporotic cortical bone.

[Morphologic and lipid chemistry findings in atherosclerotic femoral arteries]. / Morphologische und lipidchemische Befunde an atherosklerotischen Femoralarterien.

During autopsies of 34 individuals, 110 specimens were taken from femoral arteries and examined by microscopy and lipid chemical analyses. Five types of lesions were differentiated: 1. normal intima, 2. diffuse intimal hyperplasia, 3. fatty streaks, 4. fibrous plaques, 5. atheromatous lesions. Since studies on femoral arteries have not been performed so far, our results were compared with known results from aortas and coronary arteries. However, no essential differences were found by comparing morphologic results and lipid compositions. Esterified and free cholesterol increased approximately 30-fold, phospholipids approximately 6.5-fold, with progressing atherosclerosis. The intima of a 40-year-old alcoholic was found to have an extremely low level of cholesterol esters, while the other findings were not changed.

Ornithine-containing lipids in Thiobacillus A2 and Achromobacter sp.

20 bacterial strains (corresponding to 16 species) were screened for ornithine lipids. Only two species (Thiobacillus A2 and Achromobacter sp.) turned out to contain ornithine lipids (2.71 mmol/100 g and 0.38 mmol/100 g bacterial dry weight, respectively). In both ornithine lipids, a 3-hydroxy fatty acid was amide-linked to the alpha-amino group of ornithine, a normal fatty acid was ester-linked to the 3-hydroxy group of the former. The predominant fatty acids were 18:1(11) and 3-hydroxy-20:1(13) in Thiobacillus A2, 16:0 and 3-hydroxy-18:1(11) in Achromobacter sp. All monounsaturated fatty acids (with one exception) belonged to the (n-7) family. 11, 12-Epoxy octadecanoic acid was identified among the ester-linked fatty acids of Thiobacillus A2. Phosphatidylcholine was the principal phospholipid in both bacterial species.

The transfer of bovine J blood group activity to erythrocytes: chemical nature of transferable and of non-transferable J.

The bovine J blood group substance exists as a glycosphingolipid (ceramide decahexoside as well as ceramide dodecahexoside) and as a glycoprotein. The lipidic form occurs in erythrocyte membranes, both forms are found in serum. The lipidic J substances were isolated from erythrocytes and from serum, and identified by thin-layer chromatography with lipidic J substances isolated from spleen. The glycoprotein nature of the non-lipidic J of serum was evident by pronase-catalysed hydrolysis yielding J-active glycopeptides of lower molecular weights. The lipidic J was completely extracted from lyophilized stroma with chloroform/methanol. From lyophilized serum, however, it was completely extracted only in the presence of water, indicating different binding partners in serum and in erythrocyte membranes. The J lipid was incorporated as intact molecule into the erythrocyte membrane by a simple incubation technique. The incorporation was inhibited by various glycerophospholipids (called blockers). The J glycoprotein could not be transferred to the erythrocyte membrane. Three methods are described which are suitable for the preparation of a blocker-free fraction enriched with J lipids from J-positive serum.

Isolation and characterization of glycosphingolipids with J blood group activity from bovine spleen.

Two glycosphingolipids with J blood group activity were found in J-positive bovine spleen. They were tentatively identified as ceramide deca- and dodecahexosides containing galactose, glucose, N-acetylgalactosamine and N-acetylglucosamine in a molar ratio of 5:3:1:1 and 6:3:2:1, respectively. Fucose was not present. Ceramide decahexosides without J activity were also found in J-negative bovine spleen. The principal component fatty acids of the J-active glycosphingolipids were saturated even-numbered long-chain acids with 16 to 24 C atoms. Their principal long-chain bases were sphingosine and dihydrosphingosine with smaller amounts of phytosphingosine. Both J-active glycosphingolipids were readily water-soluble and showed strong activity in the bovine J and in the porcine A blood group system. They exhibited no cross-reactivity in the human A system. However, a J-negative glycosphingolipid fraction - also from J-negative spleen - with shorter carbohydrate chain-length showed strong activity in the human A system.

Ubiquinones (Coenzyme Q) in hydrogen oxidizing bacteria.

The isoprenoid quinone content and composition of several strains of the following hydrogen oxidizing bacteria were studied: Xanthobacter autotrophics, Xanthobacter flavus, Paracoccus denitrificans, Pseudomonas pseudoflava, P. carboxydovorans, P. carboxydo-hydrogena. All strains studied contained ubiquinone (UQ) in concentrations between 0.7 and 2.8 µmol/g bacterial dry weight. No menaquinones were found. UQ of all strains (except one) contained side chain lengths of 10isoprenoid units (UQ-10), two strains contained in addition UQ-8. UQ-9 was found in Pseudomonas carboxydohydrogena only.

A nystatin-resistant mutant of Rhodotorula gracilis. Transport properties and sterol content.

A nystatin-resistant mutant of Rhodotorula gracilis was obtained by treatment of the wild strain cells with N-methyl-N-nitro-N-nitrosoguanidine and selected on agar plates containing 150 micrograms nystatin/ml. Three important transport functions of the plasma membrane of mutant cells: the accumulation of monosaccharides, the generation and maintenance of the pH-gradient and of the membrane potential, as well as the cell respiration were insensitive to at least 10(-5) M nystatin. This concentration of nystatin inhibited completely all these processes in wild strain cells. Analysis of cellular sterols revealed a defect of ergosterol biosynthesis in the mutant, which was localized at the last oxidative step between 5,6-dihydroergosterol and ergosterol.

The inactivation of the bovine J blood group substance by the periodate ion.

1. Treatment of J-positive (Jcs) bovine erythrocytes with periodate (0.25 mmol/l final concentration, 1 hour, room temperature) has no effect on the J activity. Higher periodate concentrations cause spontaneous haemolyses. 2. Treatment of the lipids extracted from (and containing all J activity of) Jcs erythrocytes with periodate leads to a decrease of J activity even with lower periodate concentrations. 3. Treatment of the stroma prepared from Jcs erythrocytes with periodate demonstrated the relative stability of the J antigen up to 0.25 mmol/l periodate. At the same time the sialic acid concentration of stroma is reduced to about 13% of the initial concentration. 4. Desialylation of Jcs erythrocytes or Jcs stroma with sialidase does not affect the J activity thus confirming previous findings. On the other hand, the J activity of desialylated Jcs stroma is much more susceptible to periodate. 5. It is concluded that membrane-bound sialic acid shields the membrane-bound J antigen from being attacked by periodate.

Chemical characterization of porcine blood serum components with A and SLA activity.

The porcine A blood group substance is found in the serum as a lipid and, additionally, in certain animals, as a glycoprotein. Swine lymphocyte antigens (SLA) occur in the serum only as glycoproteins. Heat treatment of the solid residue obtained by lipid extraction yielded a water-soluble fraction with low protein content, high A activity, but no SLA activity. Poly(glycosyl)ceramides with SLA activity do not occur in the serum; poly(glycosyl)ceramides with A activity cannot be excluded. Desialylation of protein fractions has no effect on A and SLA activity. Both A and SLA activities of protein fractions are stable to mild alkaline hydrolysis thus indicating N-glycosidic carbohydrate-peptide linkages.

Quantification of antigens with haemolysing antibodies exemplified by the bovine J blood group system.

1. The J blood group activity of red cells is measured in terms of 50% haemolysis ('direct test'), that of dissolved or suspended samples in terms of 50% haemolysis inhibition ('indirect test') in a standardized bovine J system. 2. The volume of J-containing sample required for a 50% haemolysis inhibition decreases with increasing J activity. 3. The volume of anti-J required for a 50% haemolysis of J-positive erythrocytes also decreases with increasing J activity. 4. The use of antigen units (UAg) was introduced to serve as a measure of J activity of dissolved or suspended samples. 5. Antigen units were also used to characterize J-containing red cells. This was made possible by measuring the relation of the direct test (on red cells). Thus, a relatively simple method of determination of red cell UAg is obtained. 6. It was confirmed by absorption experiments that erythrocytes containing high concentrations of antigen require relatively low amounts of antibody to bring about a 50% haemolysis, but are able to bind a relatively high excess of antibody.

Occurrence of phosphatidylcholine in hydrogen-oxidizing bacteria.

15 strains of hydrogen-oxidizing bacteria were grown heterotrophically, harvested during the stationary phase of growth, and analyzed for their principal phospholipids. All strains - with the exception of Corynebacterium autotrophicum strain SA 32 and Pseudomonas pseudoflava - contained phosphatidylcholine as a major constituent. It is concluded that the presence of phosphatidylcholine is neither characteristic of a peculiar bacterial genus or family, nor is it absolutely correlated to the ability to oxidize hydrogen. The phosphatidylcholines of all strains contain C19 cyclopropane acid which is, in some strains, predominantly located at C-2 position of the glycerol moiety.