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Objective: A number of factors can lead to a maternal pro-inflammatory response resulting in a spontaneous preterm birth. However, it remains unknown if an upregulation in the maternal immune system early in pregnancy leads to an increase in pro-inflammatory cytokines and ultimately preterm birth. Therefore, we hypothesize an increase in vaginal and systemic pro-inflammatory cytokines early pregnancy is associated with an increased risk of preterm birth., Study Design: Patients initiating prenatal care prior to 14 weeks gestation were recruited for eligibility. A vaginal swab and serum sample was obtained at the first prenatal visit and these were then stored at -80 C. Patients were then followed for their gestational age at delivery. Five patients delivering preterm (cases) were matched with ten patients delivering at term (controls) based on age, BMI, smoking status and ethnicity. The serum and vaginal swabs from the cases and controls were then analyzed for the following cytokines using a multiplex cytokine assay: GM-CSF, IL-1b, IL-6, TNFα, and Rantes., Results: A total of 116 patients were screened for eligibility and 96 of these patients had samples obtained prior to 14 weeks gestation. Of these 96, 5 had a spontaneous preterm birth and these were matched to 10 controls. There was no difference detected in the cytokine concentrations of GM-CSF, IL-1b, IL-6, TNFα, and Rantes in the serum or cervicovaginal fluid between cases and controls., Conclusion: This study demonstrates there is no difference in cytokine concentrations of several pro-inflammatory cytokines in the vagina or in the serum prior to 14 weeks gestation in patients delivering preterm. Therefore, the concentration of the cytokines analyzed in this study from the vagina and serum have little predictive value on the risk of preterm birth. Further research is needed to deepen our understanding of the mechanisms leading to preterm birth.

Transapical aortic valve implantation is indicated in high-risk patients with aortic stenosis and peripheral vascular disease requiring aortic valve replacement. Minimally invasive direct coronary artery bypass grafting is also a valid, minimally invasive option for myocardial revascularization in patients with critical stenosis on the anterior descending coronary artery. Both procedures are performed through a left minithoracotomy, without cardiopulmonary bypass, aortic cross-clamping, and cardioplegic arrest. We describe a successful combined transapical aortic valve implantation and minimally invasive direct coronary bypass in a high-risk patient with left anterior descending coronary artery occlusion and severe aortic valve stenosis., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Transapical transcatheter aortic valve implantation is an emerging technique for high-risk patients with symptomatic aortic valve stenosis, peripheral vascular disease, and severe concomitant comorbidities. However, a previous major surgical intervention involving the left hemithorax and the lung has always been considered a technical surgical challenge or even a potential contraindication for this minimally invasive procedure. With this report, we demonstrate, for the first time, that a previous left pneumonectomy followed by mediastinal radiotherapy does not affect the feasibility of transapical transcatheter aortic valve implantation, and we discuss the preoperative workup and the peculiar intraoperative cardiac imaging and surgical assessment., (© 2010 Wiley Periodicals, Inc.)

Transcatheter stent-valve implantation in stenosed congenital bicuspid aortic valves is under debate. Heavily calcified elliptic bicuspid valves represent a contraindication to catheter-based valve therapies because of a risk of stent-valve displacement, distortion, or malfunctioning after the implantation. In this case report we illustrate our experience with a patient suffering from stenosed congenital bicuspid aortic valve who successfully underwent a transapical 26-mm Edwards Sapien stent-valve (Edwards Lifesciences Inc, Irvine, CA) implantation. Postoperative distortion, malfunctioning, and paravalvular leaks were not detected., (Copyright 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

The transapical transcatheter aortic valve implantation (TA-TAVI) in degenerated aortic bioprosthesis is an emerging therapy for surgically non-amenable patients. However, the presence of different types of aortic bioprostheses (stented and stentless), available in different sizes (19-27 mm), can be at the origin of important mismatches between the malfunctioning, degenerated aortic valves and the inner stent-valves implanted through transapical accesses (23 and 26 mm Edwards Sapien transcatheter stent-valves). We report an emergency TA-TAVI treatment of a severely regurgitant degenerated 23 mm Mitroflow aortic bioprosthesis (Sorin Group, Milano, Italy) implanted seven years earlier in an 80-year-old lady, and we reviewed the current available literature about transapical 'valve-in-valve' procedures to analyze the hemodynamic results and the ideal 'prosthesis-to-prosthesis' match.

Background: Cardiac computed tomographic scans, coronary angiograms, and aortographies are routinely performed in transcatheter heart valve therapies. Consequently, all patients are exposed to multiple contrast injections with a following risk of nephrotoxicity and postoperative renal failure. The transapical aortic valve implantation without angiography can prevent contrast-related complications., Methods: Between November 2008 and November 2009, 30 consecutive high-risk patients (16 female, 53.3%) underwent transapical aortic valve implantation without angiography. The landmarks identification, the stent-valve positioning, and the postoperative control were routinely performed under transesophageal echocardiogram and fluoroscopic visualization without contrast injections., Results: Mean age was 80.1 +/- 8.7 years. Mean valve gradient, aortic orifice area, and ejection fraction were 60.3 +/- 20.9 mm Hg, 0.7 +/- 0.16 cm(2), and 0.526 +/- 0.128, respectively. Risk factors were pulmonary hypertension (60%), peripheral vascular disease (70%), chronic pulmonary disease (50%), previous cardiac surgery (13.3%), and chronic renal insufficiency (40%) (mean blood creatinine and urea levels: 96.8 +/- 54 microg/dL and 8.45 +/- 5.15 mmol/L). Average European System for Cardiac Operative Risk Evaluation was 32.2 +/- 13.3%. Valve deployment in the ideal landing zone was 96.7% successful and valve embolization occurred once. Thirty-day mortality was 10% (3 patients). Causes of death were the following: intraoperative ventricular rupture (conversion to sternotomy), right ventricular failure, and bilateral pneumonia. Stroke occurred in one patient at postoperative day 9. Renal failure (postoperative mean blood creatinine and urea levels: 91.1 +/- 66.8 microg/dL and 7.27 +/- 3.45 mmol/L), myocardial infarction, and atrioventricular block were not detected., Conclusions: Transapical aortic valve implantation without angiography requires a short learning curve and can be performed routinely by experienced teams. Our report confirms that this procedure is feasible and safe, and provides good results with low incidence of postoperative renal disorders., (2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Our experience with the Sapien trans-apical aortic valve (Edwards Lifesciences Inc., Irvine, CA, USA) has been straightforward without per-procedural mortality except in 1/16 consecutive cases who developed non-apical haemorrhage early after valve implantation. We describe the case of an 84-year-old female carrying a very high operative risk (logistic EuroScore of 44%), who underwent a trans-apical stent-valve implantation for severe and symptomatic aortic valve stenosis (23 mm). Due to massive blood loss, an emergency sternotomy and cannulation for cardiopulmonary bypass resuscitation were necessary to treat (without success) an unusual and unexpected subaortic left ventricular free-wall rupture that occurred few minutes after the stent-valve positioning and implantation. To the best of our knowledge, this is the first described case of a left ventricular free-wall rupture occurring after an otherwise non-complicated standard catheter-based aortic valve replacement., (Copyright 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.)

The trans-apical aortic valve implantation (TA-AVI) is an established technique for high-risk patients requiring aortic valve replacement. Traditionally, preoperative (computed tomography (CT) scan, coronary angiogram) and intra-operative imaging (fluoroscopy) for stent-valve positioning and implantation require contrast medium injections. To preserve the renal function in elderly patients suffering from chronic renal insufficiency, a fully echo-guided trans-catheter valve implantation seems to be a reasonable alternative. We report the first successful TA-AVI procedure performed solely under trans-oesophageal echocardiogram control, in the absence of contrast medium injections.

Patients who develop a severe stenosis in biological pulmonary conduits previously implanted for pulmonary outflow trunk reconstructions are treated either by surgical re-replacement, or by transcatheter stent-valve implantation through a femoral vein access. A catheter-based sub-xyphoidian access through the right ventricle for stent-valve positioning in a pulmonary conduit has rarely been proposed. We describe the case of a 20-year-old man who underwent a pulmonary trunk reconstruction for a congenital pulmonary valve dysplasia and a few years later developed a stenosis in the pulmonary conduit. He was successfully treated with a 23 mm Edwards Sapien stent-valve implantation in pulmonary position, through an unusual right ventricular, sub-xyphoidian access and without contrast medium injections and pleura opening.

Leptospira interrogans serovars grippotyphosa and ballum were isolated from kidney and urine of an American Foxhound pup. The pup was from a litter of 12, all of which were unthrifty. Titers for serovar grippotyphosa in pups from the litter ranged from 200 to 6,400 and 23 of 36 adult dogs in the kennel had titers to that serovar. None of the sera was tested for antibodies to serovar ballum. Leptospires were not isolated from or observed in 2 littermates and 1 penmate, but gram-positive organisms morphologically compatible with Encephalitozoon cuniculi were detected in their brains and kidneys.

The isolation of serovar canicola from the Norway rat (Rattus norvegicus), shows that it is a reservoir of canicola and is therefore significant from an epidemiological point of view. The isolation of pyrogenes and grippotyphosa from a water rat, Nectomys squamipes is also described.

A new leptospiral serotype in the serogroup Pyrogenes is described. The strain was isolated from one gray "four-eyed" opossum (Philander opossum). It is proposed that the serotype be designated guaratuba, strain An-7705. The isolations of serotypes ballum from the South American field mouse (Akodon arviculoides), szwajizak and icterohaemorrhagiae from the North American opossum (Didelphis marsupialis), and grippotyphosa from many other wild animal species as well as domesticated animals are also described.

Confirming previous observations on dog populations in other parts of the world, notably Japan, the Philippine Islands, and some countries in South America, we found that a high percentage of dogs in Trinidad are infected with organisms from many serogroups of Leptospira. Serogroups Canicola and Icterohaemorrhagiae were most commonly found. Ten isolates obtained from 50 kidneys from stray dogs (20% infectivity rate) were typed as portland-vere (six) and canicola (two) of the Canicola serogroup, copenhageni of the Icterohaemorrhagiae serogroup (one), and georgia in the Hebdomadis serogroup (one). To the best of our knowledge, this is the first record of a serotype in the Hebdomadis serogroup being isolated from a dog. A cat isolation was identified as canicola. Serological results showed that 55% or more of stray dogs had been exposed as opposed to only 12.5% of the cats examined. Serogroups Canicola, Icterohaemorrhagiae and Hebdomadis are found most frequently in dogs, cats, mongooses, and man in Trinidad.

Two leptospiral serovars belonging to the Hebdomadis Serogroup are described. These strains are represented by two isolations from apparently healthy zebu cattle. It is proposed that the serovars be designated guaicurus strain Bov. G and goiano strain Bov. 131.

All known isolates of Leptospira interrogans obtained in Trinidad, Grenada and St. Vincent up to the end of 1979 are listed. There were 80 from Trinidad, 20 from Grenada and 2 from St. Vincent, representing at least 20 serotypes from 11 or more serogroups. Six of the serotypes were first reported from Trinidad. The leptospires were isolated from man, domestic animals and wildlife species.

A method for improving the original Galton microtechnique for detecting leptospiral antibodies has been developed. Simultaneous titrations were performed on 281 animal and human sera and 17 hyperimmune sera with the microscopic agglutination (MA) test and the improved microtechnique. Reproducibility of the improved microtechnique was determined independently on 65 animal sera by two laboratory sections. The results obtained by comparing positive test data from human and animal sera indicated that agreement between the original MA test and this new method exceeded 94%, whereas the original Galton microtechnique and the original MA test agreed in a maximum of 77% of the tests. This study indicates that the results obtained with the improved microtechnique are much more comparable to results obtained with the original MA test than are those obtained with the original Galton microtechnique.