Heart transplantation during active infective endocarditis: case report and review of the literature.

Bacterial infections are a contraindication to organ transplantation, but infective endocarditis may require heart transplantation when otherwise untreatable. We describe a heart transplant patient with cardiomyopathy and ongoing defibrillator endocarditis due to Staphylococcus epidermidis. An initial attempt at percutaneous extraction of the 5 implanted leads was unable to eradicate the infection and was complicated by severe decompensation, requiring a new implant for biventricular pacing. Despite continuing bactericidal treatment, the patient showed persistent infection on the implanted leads with further hemodynamic deterioration. The decision was therefore made to list the patient for heart transplantation. The procedure was successful in removing all of the hardware. No recurrence of infection was observed despite persistence of large vegetations on the removed defibrillator leads. The patient had an uneventful postoperative course, remaining free of symptoms with negative blood cultures at 3 months' follow-up. Our experience showed that active infection of defibrillator leads may not represent an absolute contraindication to heart transplantation when all other medical and surgical treatments have been proven to be ineffective.

[Management of infections from cardiac implantable electronic devices: recommendations from a study panel]. / Diagnosi e terapia delle infezioni dei dispositivielettronici cardiaci impiantabili(CIED): raccomandazioni di un gruppo di studio.

Cardiac Implantable Electronic Device (CIED) infections are an emerging clinical issue. There are no national recommendations on the management of these infections, also due to the limited number of dedicated and high quality clinical studies. Therefore, researchers from southern Italian centres have decided to share the clinical experience gathered so far in this field and report practical recommendations for the diagnosis and treatment of adult patients with CIED infection or endocarditis. Here we review the risk factors, diagnostic issues (microbiological and echocardiographic) and aetiology, and describe extensively the best therapeutic approach. We also address the management of complications, follow-up after discharge and the prevention of CIED infections. In this regard, a multidisciplinary approach is fundamental to appropriately manage the initial diagnostic process and the comorbidities, to plan proper antimicrobial treatment and complete percutaneous hardware removal, with the key support of microbiology and echocardiography.

Radiographic assessment of atrial dipole position in single pass lead VDD and DDD pacing. The Multicenter Study Group.

Atrial electrode position was determined by radiographic analysis in 160 patients paced in single-lead VDD for second- or third-degree A-V block, implanted > 1 year with Phymos single pass leads and Phymos 3D pacemakers. The packing lead features an atrial dipole with a 30-mm electrode interspace. In 44% of patients, the upper atrial electrode was positioned within a band of 20 mm centered at the level of the superior vena caval insertion (junctional area) and was in the inferior vena cava or in the atrium in 35% and 21% of cases, respectively. In spite of these different dipole locations, all patients had stable atrium-driven pacing at routine follow-up visits. With the electrode in the junctional area, unipolar stimulation of up to 5 V for 1 ms resulted in stable atrial capture in 63% and 59% of the patients in supine and upright positions, respectively. With the electrode in the atrium, corresponding success rates were 45% and 54%. In the atrium, however, the prevalence of diaphragmatic stimulation was significantly lower than at the junction (10% vs 42% in supine position; 21% vs 47% upright). Though atrial sensing function proved adequate in a wide range of positions, these results suggest that the Phymos lead atrial dipole should be positioned within the atrium, as close as possible to the atrial wall, to maximize the number of VDD patients who might benefit from single-lead DDD pacing.

Selected biological activities of saraines.

1. The Mediterranean sponge Reniera sarai, Pulitzeri-Finali, 1969 (Demospongiae: Haploscleridae: Renieridae) possesses in large amounts a series of unprecedented polycyclic alkaloids, saraines 1-3 and saraines A-C. 2. The structural peculiarities of saraines, their chemical-physical characteristics, along with their relevant abundance in the sponge, prompted a study aimed at investigating their biological properties. 3. Saraines were assayed for their cytotoxic, antibacterial, insecticidal and potential antitumoral activities. These results, along with the growth inhibition of fertilized sea urchin eggs, are reported.

Insect antifeedant activity and hot taste for humans of selected natural and synthetic 1,4-dialdehydes.

The antifeedant activity towards larvae of Leptinotarsa decemlineata and Spodoptera littoralis and the hot taste for the human tongue have been determined for natural and synthetic 1,4-dialdehydes. Among the bicyclic dialdehydes the biological activity has been found to be dependent on the distance between the two aldehyde groups; tricyclic and pentacyclic dialdehydes are inactive in both tests. A short synthetic route to (-)- and (+)-polygodial is reported.

[Temporary artificial pacing after open-heart surgery (author's transl)]. / L'elettrostimolazione cardiaca temporanea nel decorso post-operatorio cardiochirurgico.

A three-year experiences with the treatment by artificial pacing of the cardiac rhythm anomalies after open-heart surgery, at the Institute of Surgery of the Heart and Great Vessels, Ist School of Medicine, University of Naples, are reported. The most frequent arrhythmias occurring during or soon after open-heart surgery and the main aetiologic factors are examined. The surgical techniques for pacing and their indications are considered. Thereafter some particularly interesting cases are reported.