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Background and Aim of the Study: The Ultracor heart valve is a recent entry in the evolution of the tilting disc valve. This report summarizes the experience with the Ultracor valve from three European centers., Methods: Between 1990 and 1996, 446 patients received 499 Ultracor heart valve prostheses in 450 procedures, including 225 (50.0%) aortic, 172 (38.2%) mitral and 49 (10.9%) double valve replacements. An additional four (1.0%) patients had mitral valve replacement (MVR) added to a previous aortic valve replacement (AVR) and were considered double valve replacement (DVR) patients. The total follow up was 751 patient-years (pt-yr) for AVR (mean 3.4), 440 pt-yr for MVR (mean 2.6) and 125 pt-yr for DVR (mean 2.4). Nine patients (one AVR, eight MVR) were lost to follow up, which was 98% complete., Results: The actuarial survival rate, including operative mortality rate, at five years was 90% for AVR, 77% for MVR and 82% for DVR. The linearized complication rates (%/year) for AVR, MVR and DVR were: 2.1, 4.0 and 4.0 for late mortality; 0.1, 3.0 and 0.8 for thromboembolism; 0, 0.2 and 0 for thrombosis; 2.0, 1.6 and 1.6 for anticoagulant-related hemorrhage (ACH); 0.3, 0.5 and 1.6 for prosthetic valve endocarditis (PVE); and 0.5, 0.9 and 3.2 for reoperation, respectively. The actuarial rates of freedom from complications at five years were: thromboembolism, 99% for AVR and 88% for MVR; thrombosis, 100% for AVR and 99% for MVR; ACH, 91% for AVR and 94% for MVR; PVE, 99% for AVR and 97% for MVR; reoperation, 98% for AVR and 98% for MVR. No structural failure was observed., Conclusions: Seven years' experience showed the Ultracor heart valve prosthesis to be comparable with other currently used mechanical heart valves. Continued evaluation of this prosthesis is warranted in order to obtain a more extended clinical follow up.

Motile group N streptococci, classified as Vagococcus fluvialis, have been isolated from cows' udders, human and animal feces, river water, and seawater. They possess an unusual membrane lipid and fatty acid pattern. We isolated and characterized 13 polar lipids, 8 of them also found in other gram-positive bacteria: mono- and dihexosyldiacylglycerol, an acylated and a glycerophosphate-substituted derivative of the latter, cardiolipin, phosphatidylglycerol, D-alanylphosphatidylglycerol, and L-lysylphosphatidylglycerol. Besides them, we characterized two rare compounds, bis(acylglycero)phosphate and alpha-D-glucopyranosylcardiolipin, and two compounds so far not detected in nature, D-alanylbis(acylglycero)phosphate and D-alanylcardiolipin. The concomitant occurrence of four aminoacyl phospholipids in one organism is another unique finding. Substituted cardiolipins represent a novel lipid class: in vagococci, D-alanylcardiolipin is a major membrane lipid component, contributing 11 and 26 mol% of total lipids in the exponential and stationary phases of growth, respectively. The vagococcal lipids contain even-numbered straight-chain saturated and cis-monounsaturated fatty acids, but the cis-monoenic acids belong to the omega-9 series and not the omega-7 series, found in enterococci, lactococci, and streptococci.

Estimation of the inclination of the occlusal plane and its spatial orientation during the insertion of plaster casts in the articulators space, and control during the clinical phase of the prosthetic work, is one of the key problems in dental prosthetics. The aim of this investigation was to compare the relations of the basic roentgencephalometric parameters applied and to determine their reliability. Five angular variables were analysed: OP-MdP, OP-PP, OP-CP, OP-FP and OP-SNP, on a sample of 86 radiographs of subjects with almost normal occlusion by applying basic statistical parameters and the correlation's analysis. The results gave mean values of the investigated variables with estimation of their variability and level of mutual correlation, which can be used when determining individual inclination of the occlusal plane. Parameters FP and SNP showed significant stability and reliability which can be successfully applied in prosthodontics.

A novel gel entrapment method has been developed where macropores are created within alginate beads to provide an environment for high-density growth of mammalian cells. The method takes advantage of an interaction between poly(ethylene glycol) (PEG) and alginate to provide a network of pores within the bead for growth while the surrounding alginate matrix retains the integrity of the bead and minimizes cell leakage. Hybridomas were grown to a density approaching 10(8) cells/mL of beads in this system, while conventional alginate restricted growth to a maximum of 2 x 10(7) cells/mL of beads. In addition, cell leakage was minimal even at high cell densities, which was not the case with the conventional alginate system. Study of the conventional system determined that cell growth was limited by the alginate matrix; increasing the alginate concentrations resulted in lower final cell densities. In contrast, the PEG-alginate system permits growth in pores so the alginate matrix serves only as a structural matrix for cells. The pore size can be varied as a function of PEG concentration (10-20 wt % PEG) to provide radially defined areas for cell growth and radial diffusion pathways for nutrients/products in the adjacent alginate matrix. Because the PEG-alginate entrapment process does not require additional chemical reactions or temperature changes, the system offers a simple alternative to attain high cell densities in an immobilized bead system. As an illustration of the concept, cells entrapped in this system were grown to high density in both batch and perfusion modes for the production of monoclonal antibodies. Using the suspension batch culture as the base case, the specific monoclonal antibody production rate increased 1.6-fold for the slower growing batch-immobilized culture and 3-fold for the immobilized perfusion culture.

In a cross-sectional study we analysed the present situation of mentally disordered offenders treated in forensic hospitals of North Rhine-Westphalia under section 63 StGB-in comparison with the first block sampling in 1984. One of the important findings was that there has been an increase in violence in respect of the index delinquency as well as the criminal record. Those patients who were again committed to a forensic hospital showed more violent criminal offences too. The average duration of hospitalisation has been reduced from 6.1 to 4.8 years.

This follow-up study presents patients who underwent orthodontic space closure in the maxilla after traumatic loss of frontal teeth or aplasia of a lateral incisor. Comparison covers findings obtained from casts and cephalograms in 24 patients with or without compensatory extraction. The findings indicate that acceptable results regarding axial tooth positioning and profile can be obtained without compensatory extraction. Prerequisites are distal occlusion of the first molars by one premolar width and continuous monitoring for regular overbite and uncrowded lower incisors. If orthodontic space closure can be achieved only by compensatory extraction, the indication for this space closure procedure calls for even more critical judgement.

Objective: Percutaneous mitral valvuloplasty has been shown to be an acceptable alternative to surgery as treatment for selected patients with severe mitral stenosis. We examined hemodynamic, echocardiographic, and pathomorphologic findings in a series of 308 patients undergoing balloon valvuloplasty, 41 of whom underwent subsequent surgery, in search of possible predictors of an unsuccessful outcome., Intervention and Results: Patients with severe mitral stenosis underwent Inoue single ballon valvuloplasty over a 48-month period and had follow-up for a mean of 14.5+/-16.8 months (range 1 to 64 months). Of the 308 patients, 267 (Group I) were clinically improved and stable throughout follow-up, while subsequent surgery was required in 41 (Group II) after 38.2+/-143.5 days (range 1 to 1212). Significant differences between the groups were observed for NYHA class (2.7+/-0.6 vs 2.9+/-0.6, p<0.05), mitral valve area (1.0+/-0.3 vs 0.9+/-0.2 cm2, p<0.01) and left atrial endsystolic dimension by echo (51.3+/-8.0 vs 55.4+/-10.2 mm, p<0.01). Two of the 41 Group II patients underwent surgery for left to right shunting, 1 for tamponade and 2 were lost to follow-up. The excised mitral valves of the remaining 36 patients all showed calcification and/or fibrosis: 9 homogenous, 5 non-homogenous; 19 were classified as having a funnel-shaped deformity, and 3 did not fit into a discrete category. Among the funnel-shaped valves, 13 had a tear versus 6 where dilation was primarily accomplished by stretching. Only one of 9 valves with homogenous calcification was torn, whereas a tear was noted in 3 of the 5 with non-homogenous calcification., Conclusion: Funnel-shaped valves and those with non-homogenous distribution of calcification and/or fibrosis appear to be least suitable for balloon valvuloplasty.

From September 1987 to February 1994, we treated 147 patients ranging between 11 and 82 years old with different mechanical circulatory support systems. The applied devices were the Bio-Medicus centrifugal pump in 61 patients, the Abiomed BVS System 5000 in 49 patients, the Thoratec ventricular assist device in 42 patients, and the Novacor left ventricular assist device in 7 patients. On the basis of indication for mechanical circulatory support, the patients were divided into three groups: group 1 consisted of 72 patients with postcardiotomy cardiogenic shock; group 2, 50 patients in whom mechanical support was used as a bridge to cardiac transplantation; and group 3 (miscellaneous), 25 patients in cardiogenic shock resulting from acute myocardial infarction (n = 14), acute fulminant myocarditis (n = 3), primary graft failure (n = 2), right heart failure after heart transplantation (n = 3), and acute rejection (n = 3). Time of support ranged from 1 hour to 97 days (mean duration, 10.8 days). Seventy-five patients (51%) were discharged from the hospital. The best survival rate was achieved in group 2 with 72%, followed by group 1 with 44% and then group 3 with 28%. The most frequent complications in group 1 were bleeding (44%), multiple-organ failure (24%), neurologic disorders (18%), and acute renal failure (15%). In group 2, the major complications were bleeding (34%) and cerebrovascular disorders (22%) and in group 3, multiple-organ failure and sepsis (60%) and bleeding (32%).

Although the psychosexual development of patients with Klinefelter's syndrome is often delayed, the sexual identity is generally male. This paper reports on a 56-year-old patient whose initially good psychosocial integration gave way to a transsexual development with a meanwhile clearcut female sexual identity as the consequence of a personal crisis situation. This case report illustrates the interaction of biological and psychodynamic etiological factors.

The literature regards the surgical-orthodontic treatment of ectopic canine as being the optimal therapy. This treatment, however, often takes a long time and disturbances in the functional occlusion often occur after treatment is ended. For this reason it was decided to evaluate the treatment's success taking into consideration age at time of treatment, angulation, and functional occlusion. The post-treatment examinations of 66 patients up to five years after treatment reveal above all a correlation between treatment success and age at the time treatment begins. In addition patients with class II/2 and tooth aplasia were identified as constituting a risk group. These malocclusions, therefore, are a sign that there is a risk of ectopic canines. The occlusion type in laterotrusion movement provides group guidance. Beginning treatment after age 25 years should be critically evaluated, because the treatment period is prolonged.

We observed in eleven dogs the blood flow in the alveolar bone during the tooth movement with the bone scintigraphy for one year. Additional we used for histological evaluation polychrome sequence marking and for improving of therapy electrostimulation. There is a correlation between tooth movement and blood flow. Four to six weeks after beginning tooth movement and blood circulation are reduced although the applied force was continuous all the time. This is an advice for stress interruption during treatment. Electrostimulation improves the conditions for tissue regeneration because the lifetime of osteoblasts is prolonged.

A skin projection of the orbitale as palpated through soft tissues was designated on the left cheek of 22 subjects. The nasion, orbitale and cephalostat nasion direction medium were plotted on transparent paper after teleroentgenography. Mutually parallel lines were drawn through the points, the line obtained on the construction of the nasion direction medium used as a basic one. Distances between the lines were measured and results statistically processed. Transfer of the model into the articulatory region by means of the orbitale and buccal arch nasion direction appeared not to orientate reliably the model according to reference planes of the head. Our results are consistent with literature data available.

In this study, teleroentgenocephalograms of 34 subjects with at least 20 natural teeth were used. Correlation between the angle formed by linking the PORION-NASION-SPINA NASALIS ANTERIOR (PONANS angle) points and the angle made by Frankfort horizontal and occlusion plane was studied. The coefficient of correlation was 0.1263. It is considered that there is no correlation if the coefficient of correlation is less than 0.5. Thus, there was no correlation in the study sample, which is consistent with the results reported by Karkazis and Polyzois, but in disagreement with those published by Monteith. In our sample, the occlusion plane could not be oriented in the articulatory space or in toothless mouth by means of the method proposed by Monteith.

Benzodiazepine derivates can cause transient global amnesia even when administered in therapeutical doses. As amnesia seems to be more frequent than supposed, it is relevant for traffic medicine. We shall discuss forensic cases in which Midazolam amnesia was suspected with special attention to the interpretation of toxicological data.

A 42-year-old man who 16 years previously had had mediastinal radiotherapy (total focal dosage of 52 Gy) for a malignant lymphoma, developed chest pain on mild exertion. Coronary arteriography during a diagnostic cardiological work-up revealed a 50-70% stenosis of the right coronary artery near its origin and a 90% stenosis in the main left coronary artery. Except for being slightly over-weight (85 kg at a height of 181 cm) there were no risk factors for coronary heart disease and there was no evidence for arterial disease elsewhere. A double aortocoronary vein graft was placed to the right coronary artery and the interventricular branch of the left coronary artery. The postoperative course was unremarkable and the patient has resumed his occupation. This report emphasizes that, in case of atypical chest pain after mediastinal radiotherapy, coronary heart disease as a late complication should be considered.

The application of the rectal temperature time of death nomogram at the scene of death by 11 authors from 6 lego-medical institutes resulted in a standard deviation of the differences between nomographic and real death time of +/- 1.3 h in 46 cases (group I) with met requirements and clearly defined points of contact, nevertheless, including 9 cases with a more progressive cooling (0.5 greater than Q greater than or equal to 0.2). In cases with a real death time of more than 4h (N = 26) the standard deviation was +/- 1.0 hours corresponding to permissible variation of 95% of +/- 2.0 hours. Consequently, the permissible variation of 95% was much smaller than that suggested by the nomogram. The nomographic death time interval did not agree with the real one in 5 cases out of additional 30 cases with recognizably unsure points of contact (group II).

The occurrence of anthelmintic resistance in Trochostrongylus colubriformis and resistance to morantel are reported for the first time in New Zealand. In two controlled anthelmintic trials with experimentally infected sheep, morantel citrate at either 8.8 mg/kg or 10 mg/kg had no effect on worm burden. An efficacy of >99% was demonstrated for mebendazole at 12.5 mg/kg against this strain.

Development, rearrangement and reaction to pressure on post-mortem lividity were investigated by using different shackle-instruments. The behaviour of post-mortem lividity at the shackle-point and its surrounding areas in some cases may allow to draw a conclusion, if shackle occurred during life or after death.

Intraoperative measurements of blood flow were made in 44 patients in whom a total of 112 venous bypass grafts were inserted. Blood flow through the graft was measured by a standard electromagnetic device as well as by a new method, consisting of a roller pump run-off system. At an average of 5 months after operation all patients underwent control coronaro-angiography. Overall patency-rate was 86.6%. Using the standard method mean flow in the patent grafts was 78 ml/min and 39 ml/min in the occluded grafts. Using the new run-off method mean flow in the patent grafts was 142 ml/min and 78 ml/min in the occluded grafts. It is concluded that measuring distal coronary artery run-off capacity provides a reliable index for predicting patency rate. For several reasons roller-pump run-off measurement has advantages over the generally used electromagnetic measurements.