Phylogenetic analysis of a biofilm bacterial population in a water pipeline in the Gulf of Mexico.

The aim of this study was to assess the bacterial diversity associated with a corrosive biofilm in a steel pipeline from the Gulf of Mexico used to inject marine water into the oil reservoir. Several aerobic and heterotrophic bacteria were isolated and identified by 16S rRNA gene sequence analysis. Metagenomic DNA was also extracted to perform a denaturing gradient gel electrophoresis analysis of ribosomal genes and to construct a 16S rRNA gene metagenomic library. Denaturing gradient gel electrophoresis profiles and ribosomal libraries exhibited a limited bacterial diversity. Most of the species detected in the ribosomal library or isolated from the pipeline were assigned to Proteobacteria (Halomonas spp., Idiomarina spp., Marinobacter aquaeolei, Thalassospira sp., Silicibacter sp. and Chromohalobacter sp.) and Bacilli (Bacillus spp. and Exiguobacterium spp.). This is the first report that associates some of these bacteria with a corrosive biofilm. It is relevant that no sulfate-reducing bacteria were isolated or detected by a PCR-based method. The diversity and relative abundance of bacteria from water pipeline biofilms may contribute to an understanding of the complexity and mechanisms of metal corrosion during marine water injection in oil secondary recovery.

[Acute coronary syndromes without ST segment elevation. Why should we take an interventionist approach?]. / Síndromes coronarios agudos sin elevación del segmento ST. Por qué debemos ser intervencionistas?

The incidence of unstable angina and non-Q-wave myocardial infarction has increased dramatically. Risk of death and infarction is greatest in the first 6-8 weeks after admission. Risk stratification should be performed in patients with acute coronary syndromes at the earliest opportunity. The VANQWISH trial and TIMI-III B suggested that most patients do not benefit from routine, early invasive management. In the FRISC II trial, the rates of death/myocardial infarction at 6 months were 9.4% in patients treated with an early invasive strategy vs 12.1% with a more conservative approach. The previously reported superiority of the invasive strategy was also confirmed by the TACTICS-TIMI 18. The trial's primary composite end point at 6 months was significantly reduced in the invasive group: 15.9% vs 19.4% of the conservative group. The early invasive strategy was more beneficial the higher the patient's risk. We do not know whether we have reached the limits in terms of improving outcome with available strategies. What we do know is that all patients discharged following an acute coronary syndromes need to be treated aggressively in order to neutralize vulnerable atherosclerotic plaques and to manage cardiovascular risk factors.

[Use of transjugular intrahepatic portosystemic shunt (TIPS) in an 84 year-old patient during acute variceal bleeding]. / Utilizacion del shunt portosistemico intrahepatico transyugular (TIPS) en un paciente 84 años durante un episodio de hemorragia aguda por varices esofagicas.

The transjugular intrahepatic protosystemic shunt (TIPS) is a nonsurgical method with low mortality which does not interfere with subsequent liver transplantation. We describe the case of an old male patient with chronic hepatopathy who was admitted because of an episode of variceal bleeding. Due to the failure of the medical treatment and sclerotherapy, coronarian stomachic vein was embolized with a coil and a TIPS was performed during the acute episode of variceal bleeding. He evolved favorably and after a year of the procedure remains asymptomatic.

Densitometric quantitative analysis of intracoronary ultrasound images: anatomopathological correlation.

To establish if the videodensitometric analysis (VDA) of the intracoronary ultrasound images (IVUS) can predict the qualitative and quantitative composition of the atherosclerotic coronary plaques, thirty-one patients who had undergone anatomopathological study of directional coronary atherectomy (DCA) samples and pre- and post-intervention IVUS image were analyzed. The video IVUS images were digitized in a 512 x 512 matrix and analyzed for densitometric differences with an Automatic Image Analysis System (AIAS) (Vidas 2000, Zeiss Kontron). The components of the plaque were arbitrarily divided into three densitometric categories using a 256 gray scale: high density (HD) 121-255, medium (MD) 81-120 and low (LD) 30-80. The relative percentage of each component was automatically recorded. The DCA samples were microscopically examined and put into the AIAS. The components were divided into: collagenous tissue (CT); lipid-necrotic debris (LND); proliferative tissue (PT). The area of each component was expressed as a percentage of the total. Linear correlation analysis was applied. Comparison between the IVUS and the histological composition of the plaque showed that: HD corresponded to CT; MD to PT; LD to LND. The correlation between the percentage distribution of the densitometric categories and the anatomopathological components showed a correlation coefficient r = 0.91 between HD and CT; r = 0.87 between MD and PT; r = 0.88 between LD and LND. The VDA of the IVUS can distinguish three basic components of the atherosclerotic plaque: fibrous, lipid-necrotic and proliferative tissue, allowing absolute and relative quantitative analysis. This capability may be of interest for device selection and histopathological correlation.

Percutaneous balloon mitral valvuloplasty: early and late results according to surgical risk and echocardiographic score.

OBJECTIVE AND DESIGN: Early results, complications and follow-up of 70 patients undergoing percutaneous balloon mitral valvuloplasty (BMV) were retrospectively analyzed to establish whether an increased surgical risk or an unfavourable echocardiographic score influenced the results. PATIENTS: The patients were divided into two groups according to the presence (group A, n = 31) or absence (group B, n = 38) of high surgical risk factors. The patients were also divided into two other groups according to the presence (group C, n = 46) or absence (group D, n = 20) of favourable mitral valve anatomy. Group A (high surgical risk) included patients fulfilling at least one of the following criteria: 65 years of age or older; previous surgical commissurotomy; depressed left ventricular function; respiratory or hepatic insufficiency; or previous aortic valve replacement. Mitral valve anatomy was classified as 4 to 16, according to the echocardiographic score established by Abascal et al. Group C patients had echocardiographic score below 8 and group D had echocardiographic scores of 8 or greater. INTERVENTIONS: Mean mitral valve gradient (MVG) and area (MVA) were Doppler-estimated immediately before and 48 h after the BMV. MAIN RESULTS: There were no differences in the early results and complications between groups A and B (MVA 1.8 +/- 0.5 versus 1.9 +/- 0.4 cm2). Final MVA was significantly greater in group C than in group D (MVA 1.9 +/- 0.4 versus 1.6 +/- 0.4 cm2; P = 0.03). There was no difference in the incidence of complications. Over a follow-up period averaging 19.1 months (range 1 to 55), 90.7% of the patients were in New York Heart Association functional class I or II. Four patients had a mitral valve replacement, one had a surgical commissurotomy and one had a second BMV. Two unrelated deaths occurred. There were no differences in the characteristics of the study population and the incidence of events in the follow-up period between groups. CONCLUSIONS: The results and outcome of BMV were unrelated to the general surgical risk, suggesting that this procedure may be used with particular benefit in this group of patients. In contrast, mitral valve anatomy must be considered as an important determinant of the results.