Toxicity to vapor exposure and topical application of essential oils and monoterpenes on Musca domestica (Diptera: Muscidae).

The medical and veterinary pest Musca domestica L. has developed resistance to most insecticides used against it. For this reason, there is a constant search for new alternative control tools. The aims of this study were (1) to evaluate the toxicological effects caused by the fumigant activity and the topical application of five essential oils and five monoterpenes in M. domestica adult males and (2) to study the variation of the fumigant activity of the essential oils and monoterpenes according to the solvent used (acetone or a silicone base). Houses flies were exposed to vapors delivered by filter paper treated with 200 microl of essential oil or monoterpene (10%) in acetone or a silicone base. The knockdown time 50% (KT50) values obtained for essential oils (expressed in minutes) were 3.3 (eucalyptus); 10.1 (orange); 10.4 (mint); 10.9 (lavender); and 17.7 (geranium). The KT50 values obtained for monoterpenes (expressed in minutes) were 2.3 (eucalyptol); 7.5 (limonene); 7.6 (linalool); 19.0 (menthone); and 22.6 (menthyl acetate). In all cases, a delay in the onset of poisoning symptoms was observed when a silicone base vehicle was used. When topically applied, the lethal dose 50% (LD50) values for essential oils (expressed in micrograms of oil/insect) were 0.07 (geranium); 0.09 (mint); 0.13 (lavender); 0.14 (eucalyptus); and 0.16 (orange). The LD50 values for monoterpenes (expressed in micrograms of monoterpene/insect) were 0.04 (linalool); 0.09 (menthyl acetate); 0.10 (limonene); 0.11 (menthone); and 0.13 (eucalyptol). These results suggest that the studied essential oils and monoterpenes are potential tools for controlling M. domestica.

David operation: single center 10-year experience.

AIM: Aortic valve-sparing operation has been progressively widely performed for the treatment of aortic root aneurysm. Nowadays, this procedure has been proposed even in presence of a bicuspid aortic valve, severe aortic regurgitation or in primary aortic dissection repair. We present our ten-year experience focusing on mid-term echocardiographic follow-up. METHODS: Between June 2002 and February 2012, 139 patients (mean age of 61±12 years) underwent aortic valve-sparing operation with valve reimplantation. Twenty-seven patients (19%) had bicuspid aortic valve; in eighteen cases (13%) cusp motion or anatomical abnormalities concurred in determining aortic regurgitation and needed an adjunct cusp repair. A Gelweave Valsalva™ graft was implanted in all the patients. RESULTS: The mortality pre-discharge was 0.7% (1 patient). The cumulative 1-year, 5-years and 8-years survival rates were 99%, 93% and 87% respectively. Postoperative aortic regurgitation more than mild degree (>2+/4+) was the only significant risk factors for redo aortic valve surgery Freedom from reoperation due to aortic valve regurgitation was 96% at 1 year, 90% at 5 years and 86% at 8 years. When comparing freedom from reoperation in patients with bicuspid vs tricuspid aortic valve, no differences were found (P=0.31) and the rate of aortic valve reoperation was significantly higher (P<0.001) in patients who received leaflet's repair. CONCLUSION: The durability of valve reimplantation was found to be excellent in patients with tricuspid aortic valve and normal or nearly normal cusps. Cusp prolapse and complication after cusp repair turned out to be the main causes for early failure.

Effect of the preservation of annulo-papillary continuity on left ventricular ejection fraction after mitral valve replacement. A clinical randomized study on patients affected by rheumatic valve disease.

This perspective study has been designed to evaluate the modifications induced on left ventricular contractility by the interruption of annulo-papillary continuity during mitral valve replacement in patients with rheumatic valve disease. Patients with associated cardiac diseases were not admitted to the study. Sixty-nine patients entered the trial, each patient was randomly assigned to mitral valve replacement either with preservation of the annulo-papillary continuity (PAPC) or with excision of all the chordae (EC). Patients with mitral stenosis (MS) and combined mitral disease (MS & R) were considered separately. The four groups were similar regarding preoperative characteristics including the radioisotopic left ventricular ejection fraction (LVEF). All the patients had the mitral valve replaced with a bileaflet prosthesis fixed by interrupted mattress sutures in the supra-annular position; the methods of anesthesia, cardiopulmonary bypass and myocardial preservation were similar in all patients. In the patients of the two EC groups a complete excision of the mitral valve was performed. In the patients of the PAPC groups a modified Miki's technique was used to preserve annulo-papillary continuity; in eight cases with heavy calcification of the subvalvular apparatus, after total excision of the mitral valve, PTFE sutures were used to reconnect the annulus to the papillary muscles. After 6 months' follow-up, 2D and Doppler echocardiography was completed in each patient to confirm the absence of any prosthetic leakage and left ventricular outflow tract obstruction. (LVOT).(ABSTRACT TRUNCATED AT 250 WORDS)

Mortality and morbidity from intra-aortic balloon pumps. Risk analysis.

BACKGROUND: The purpose of this study, was to assess the incidence of and predictors for mortality and morbidity in patients who required postoperative intra-aortic balloon pump (IABP) support. METHODS: We have retrospectively estimated 116 patients and data were statistically analyzed, and significant variables were evaluated with multivariate analysis. RESULTS: Mortality rate was 57.8% (67 patients). Nineteen patients (16.3%) had major vascular complications: 12 patients (10.3%) limb ischemia, 1 patient (0.9%) aortic dissection, 6 patients (5.2%) mesenteric infarction. Thirty patients (25.8%) had minor vascular complication: 23 patients (19.8%) bleeding from insertion site, 7 (6%) patients infection of insertion site. Limb ischemia was resolved by IABP removal (10 patients), thrombectomy (2 patients). No patient required limb amputation. Sixty patients (51.7%) had renal insufficiency, of which 40 patients needed dialysis. Fifteen patients (10.3%) had neurological complications, 13 patients (11.2%) thrombocytopenia and 5 patients (4.3%) sepsis. CONCLUSIONS: The incidence of IABP insertion in our institution was 1.5%. Mortality rate is similar to mortality of other studies in which the IABP has been inserted in the postoperative period. We have found that timing of IABP insertion, thrombocytopenia, presence of peripheral vascular disease and the redo intervention are independent predictors of mortality. We also found that female sex, diabetes, history of cigarette smoking and preoperative use of antiplatelet drugs are independent predictors of limb ischemia. The following factors are instead independent predictors of renal insufficiency: postoperative ejection fraction lower than 40% and non use of dobutamine in the postoperative period.

Comparison between single and double internal mammary artery grafts: results over ten years.

BACKGROUND: In view of the superior patency of the internal mammary artery (IMA), grafting of this vessel to the left anterior descending artery is advantageous in terms of survival and quality of life; the benefits of using both the mammary arteries remain unproved. METHODS: Among the patients operated upon during the period 1988-1990, we randomly selected 150 patients in whom one IMA (group 1) was grafted and 150 patients in whom both IMAs (group 2) were grafted. The survival and event free curves of these two groups of patients were designed using the Kaplan-Mayer method; the log-rank test was used to assess the statistical difference between the curves and to determine whether, in the long term, benefits were superior in patients in whom both IMAs were grafted. RESULTS: Patients in group 1 were older (p = 0.002). In this group there were more patients with diabetes (p = 0.004) and with peripheral vascular disease (p = 0.047). There were more female patients in group 2 (p < 0.02) and more coronary vessels were grafted (p = 0.03). Follow-up was complete (100%) and equivalent in duration for both groups (109 +/- 30 months for group 1 and 110 +/- 33 months for group 2, p = NS). The survival rate at 10 years was equal for both groups (82.5 +/- 3.4% for group 2 vs 82.9 +/- 3.2% for group 1, p = NS) and so was the freedom from cardiac death. The provocative test for myocardial ischemia was more frequently positive in group 1 than in group 2 (21 vs 10 cases, p = 0.054). Freedom from new myocardial infarction (p = NS), angina recurrence (p = NS) and reoperation (p = NS) was equally distributed during follow-up. Group 2 patients more frequently necessitated coronary angioplasty but the difference was not significant (p = 0.17). Survival free from angina recurrence, new myocardial infarction, coronary angioplasty and reoperation was more frequent in group 2 (respectively 74.6 +/- 3.8 vs 70.7 +/- 4.1%) but the difference was not statistically significant (p = NS). CONCLUSIONS: After 12 years of follow-up, patients submitted to grafting of a single IMA more frequently presented with inducible myocardial ischemia, but neither survival nor the quality of life were superior in the patients in whom both IMAs were grafted.

[Pacemaker-induced infection: diagnosis by multi-plane transesophageal echocardiography]. / Infezione di elettrocatetere di pacemaker: diagnosi con ecocardiografia transesofagea multiplana.

We report the identification by multiplane transesophageal echocardiography of a vegetation on a permanent pacemaker lead in a patient with persistent bacteriemia. The lesion could not be visualized with transthoracic echocardiography. The diagnosis of vegetation was based on the visualization of a freely highly mobile mass attached to the pacemaker lead, with different echogenicity from the lead. The entire pacing system was surgically removed through a right atrial approach, and inspection confirmed pacemaker lead vegetation. We conclude that transesophageal echocardiography should be considered to investigate suspected pacemaker lead infection in patients with negative transthoracic echocardiography.

Antilisterial activity by enterococci in a model predicting the temperature evolution of Taleggio, an Italian soft cheese.

Enterococcus ssp. produced broad-spectrum bacteriocins, which were active against Listeria innocua and Listeria monocytogenes. Inhibition of L. innocua in milk by different starter cultures was evaluated. Milk was inoculated with a conventional starter (Streptococcus salivarius ssp. thermophilus and Lactobacillus delbrueckii ssp. bulgaricus mixed cultures) as a sole starter or in combination with inhibitory starter cultures (Enterococcus ssp., bacteriocin-producing strains). Tests were performed under a temperature gradient that reproduced the first 55 h of Taleggio cheese manufacturing and in the presence of rennet. Results indicated that satisfactory inhibition of L. innocua was linked to the combined synergistic antimicrobial effect of pH decrease and bacteriocin production. Overall, data suggested that a potential existed for use of the antagonistic activity from enterococci for protection of Taleggio cheese during ripening, when L. monocytogenes may often reach dangerous concentrations.

[Ultrasonic decalcification in aortic stenosis. Clinical and doppler echocardiographic results]. / Decalcificazione ultrasonica della stenosi aortica. Risultati clinici ed eco-doppler.

Ten elderly patients with aortic valve stenosis and with a small calcified annulus (less than 20 mm) were treated by ultrasonic valve debridement (UVD) while 17 other elderly patients underwent aortic valve replacement (AVR) during the same period. The clinical and doppler results were assessed for a mean follow-up period of 20 months. Patients with significant aortic regurgitation or associated valve disease were excluded. The patients were studied by m-mode, two-dimensional and Doppler echocardiography before, immediately after, and at 6 months interval after the procedure. A successful decalcification was achieved in 8 patients. The valve was replaced in 2 patients because of cusp perforation or unsatisfactory intraoperative result. All patients showed significant postoperative increase in the mobility of the valve cusps, decrease in the amount of calcium, decrease of the aortic mean valve gradient (from 62 +/- 25 to 23 +/- 6 mmHg, p less than 0.001) and increase of the aortic valve area (from 0.49 +/- 0.11 to 1.21 +/- 0.3, p less than 0.001). The mean valve gradient was slightly higher after UVD than after AVR and showed a slight trend to further increase during follow-up, although only one patient had evidence of restenosis. A mild aortic valve insufficiency was present postoperatively in 6 patients. Worsening of insufficiency was noted in 2 patients during the follow-up period and one subject was re-operated on. Surgical ultrasonic debridement of the aortic valve may be effective in selected surgical candidates with small calcified valve and annulus, but subsequent occurrence of aortic insufficiency and restenosis may seriously limit its application.

[The use of bilateral mammary artery in myocardial revascularization. The risk factors emergent from a multivariate analysis conducted on 474 patients]. / L'uso della arteria mammaria bilaterale nella rivascolarizzazione miocardica. Fattori di rischio emersi da un'analisi multivariata condotta su 474 pazienti.

BACKGROUND: The internal mammary artery is used as coronary artery graft conduit because of its superior patency. According to some authors, the bilateral IMA can increase perioperative morbidity. The aim of this study was to determine the risk factors increasing perioperative mortality and morbidity in the use of bilateral IMA. METHODS: We analyzed the data of 474 patients operated consecutively with the use of bilateral IMA between January 1987 and December 1995 at the Department of Cardiac Surgery of the Varese Hospital. The univariate analysis was done on 17 ordinal variables using a "Fisher exact test" and on 4 continuous variables by "pooled-variance t-test" to investigate risk factors for mortality, mediastinitis, superficial wound infection and aseptic dehiscence of the sternum; a p-value lower than 0.1 was used as cut-off point to introduce the variables into a stepwise multiple logistic regression analysis. RESULTS: From the univariate analysis are: postoperative low-output syndrome (p = 0.01), LVEF (p = 0.02) and number of grafts (p = 0.04) are correlated to hospital mortality (1.5%); obesity (p < 0.001) and peripheral arteriopathy (p = 0.009) are correlated to postoperative mediastinitis (5%); obesity (p < 0.001), peripheral arteriopathy (p = 0.009), surgeon (p = 0.001), year of operation (p < 0.001), reoperation for bleeding (p = 0.004) and length of extracorporeal circulation (p = 0.02) are correlated to superficial wound infection (7%); obesity (p = 0.002) and COPD (p = 0.05) are correlated to aseptic dehiscence of the sternum (2%). The multivariate analysis identified low LVEF as the only independent risk factor for hospital mortality (p = 0.03), whereas obesity (p = 0.01) and peripheral vasculopathy (p = 0.03) proved to be correlated to postoperative mediastinitis; obesity (p < 0.001), year of the operation (p < 0.001), low LVEF (p = 0.007) and reoperation for bleeding (p = 0.01) were correlated to superficial infection of the wound and obesity turned out to be the only risk factor for aseptic dehiscence for the sternum (p = 0.003). The infection of the wound did not increase mortality, but it did increase the mean postoperative length of hospital stay (6 days for patients free of any complications of the wound versus 29.7 days for patients with complications of the wound). CONCLUSIONS: In patients with bilateral mammary grafts, obesity is the main risk factor for complications of the wound and this event greatly increases the length of the patient's hospital stay. Consequently, we suggest that bilateral mammary artery grafts be used carefully in this subset of patients.

Characterization of a fully active N-terminal 37-kDa polypeptide obtained by limited tryptic cleavage of pig kidney D-amino acid oxidase.

In order to obtain further information on the structure of D-amino acid oxidase (EC 1.4.3.3), limited proteolysis experiments have been carried out on its apo-, holo-, and holoenzyme-benzoate forms. The enzyme is unsensitive to 10% (w/w) chymotrypsin, while incubation with 10% (w/w) trypsin, under nondenaturating conditions, produces inactivation and proteolysis patterns which are different for the three forms of enzyme analyzed. These results confirm the previously reported conformational changes which occur upon binding of coenzyme to the apoprotein, and of benzoate to holoenzyme. The stable 37.0-kDa polypeptide, obtained from the apo- and holoenzyme-benzoate complex upon cleavage of a C-terminal 2.0-kDa fragment, retains full catalytic activity with unaltered kinetic parameters, and the coenzyme binding properties of the native enzyme. These results are in agreement with the tentative localization of the FAD-binding domain in the N-terminal region of the enzyme, and with the hypothesis that the function of the C-terminal region of D-amino acid oxidase could be related to the import of the enzyme into the peroxisomes, as suggested by Gould et al. (Gould, S. J., Keller, G. A., and Subramani, S. (1988) J. Cell. Biol. 107, 897-905).

cDNA cloning, sequence analysis, and chromosomal localization of the gene for human carnitine palmitoyltransferase.

We have cloned and sequenced a cDNA encoding human liver carnitine palmitoyltransferase (CPTase; palmitoyl-CoA:L-carnitine O-palmitoyltransferase, EC 2.3.1.21), an inner mitochondrial membrane enzyme that plays a major role in the fatty acid oxidation pathway. Mixed oligonucleotide primers whose sequences were deduced from one tryptic peptide obtained from purified CPTase were used in a polymerase chain reaction, allowing the amplification of a 0.12-kilobase fragment of human genomic DNA encoding such a peptide. A 60-base-pair (bp) oligonucleotide synthesized on the basis of the sequence from this fragment was used for the screening of a cDNA library from human liver and hybridized to a cDNA insert of 2255 bp. This cDNA contains an open reading frame of 1974 bp that encodes a protein of 658 amino acid residues including 25 residues of an NH2-terminal leader peptide. The assignment of this open reading frame to human liver CPTase is confirmed by matches to seven different amino acid sequences of tryptic peptides derived from pure human CPTase and by the 82.2% homology with the amino acid sequence of rat CPTase. The NH2-terminal region of CPTase contains a leucine-proline motif that is shared by carnitine acetyl- and octanoyltransferases and by choline acetyltransferase. The gene encoding CPTase was assigned to human chromosome 1, region 1q12-1pter, by hybridization of CPTase cDNA with a DNA panel of 19 human-hamster somatic cell hybrids.

[Multiple anastomosis with the internal mammary arteries]. / Anastomosi multiple con le arterie mammarie interne.

Between February 1984 and June 1985 90 consecutive patients underwent a surgical procedure of myocardial revascularization with multiple anastomoses, using one or both internal mammary arteries by single or sequential anastomoses. In 53 cases venous graft were also used. 86 cases had elective surgery and 4 had emergency surgery for unstable angina. Most of the patients had triple vessels disease; left main stenosis was present in 14. Left ventricular ejection fraction was less than 0.35 in 8 cases. A single internal mammary artery was used in 61 patients with sequential anastomoses; in 3 of these a triple sequential anastomoses was performed. In 29 patients both mammaries were used, 6 of these were anastomosed in double sequential way. Right mammary was always sewn on the marginal branch of the circumflex artery through the transverse sinus. The incidence of perioperative myocardial infarction was 2.2%. There was no hospital mortality. Reparative surgery to control immediate postoperative bleeding was required in 5 patients (5.5%). 5 cases presented a wound infection. 32 sequential anastomoses were restudied angiographically: 30 of these were patent and 2 malfunctioning. There were two late deaths: one 5 months postoperative, for gastric hemorrhage and the second one 6 months after surgery for inferior myocardial infarction. Mean follow-up of 10 months was complete in 88 surviving patients of whom 80 (91%) were asymptomatic, and 8 cases had residual angina: 5 only during exercise, 3 at rest. We conclude that the extended use of the internal mammary artery grafting, as single or sequential anastomoses, is technically feasible and provides adequate perfusion to the area of myocardium supplied by such grafts.

[Emergency myocardial revascularization in acute evolving myocardial infarct]. / Rivascolarizzazione miocardica d'emergenza nell'infarto miocardico acuto evolvente.

Immediate coronary artery bypass for acute evolving myocardial infarction could be the elective therapy if provided on useful time, because myocardial salvage can be achieved by early reperfusion. Thirty eight patients had emergency coronary artery by-pass graft for acute evolving myocardial infarction during the early phase: 35 were male, the mean age was 51 years (34 to 74). The mean interval between the onset of symptoms and surgery in this series of patients was two hours and a half. This interval seems to be also the time limit in our experience to get a partial or complete recovery of ischemic area. Four patients died in hospital, but they were in severe cardiogenic shock before emergency surgery. Twenty nine cases were free of symptoms at a mean follow-up of 18 months (6 to 36) and two suffered for residual angina. Three patients died after discharge few months later: two during redo emergency vein grafts operations, one in deep left ventricular failure, while he was waiting for heart transplant. All these patients operated on as emergency developed acute myocardial infarction during their stay in hospital waiting for catheter study, surgical operation or during percutaneous transluminal coronary angioplasty. Saphenous vein grafts, were used in twenty nine patients, left internal mammary artery in nine cases, single in four and associated to saphenous vein in five, with an average number of anastomoses of 2.6 (1 to 6) for patient. ECG was found to be normal in 76% of the patients operated on within two hours and a half from the beginning of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

[The internal mammary artery in myocardial revascularization]. / L'arteria mammaria interna nella rivascolarizzazione miocardica.

Internal mammary artery by-pass graft is a very usefull alternative to venous by-pass graft for myocardial revascularization. From February 1982 up to August 1984, 111 patients with coronarosclerosis have been operated on with left internal mammary artery. Right internal mammary artery has been also used in 2 cases. Left internal mammary artery has been used as a sequential graft 13 times. Vein grafts have been associated in more than 2/3 of the patients who had surgery with internal mammary artery and the mean of anastomoses per patient was 2.9. Five patients had a perioperative myocardial infarction and one an infarction shortly after the operation. Ten patients had immediate reoperation: 5 for postoperative bleeding, 2 for arterial graft anastomosis occlusion, 2 for sudden ST elevation and 1 for acute myocardial infarction. Only one patient died for acute myocardial infarction post-operatively, following coronary artery spasm. Eighty-six patients have been followed-up 3 to 31 months after surgery. Advantages and limits of this surgical technique are discussed.

Haemolysis due to active venous drainage during cardiopulmonary bypass: comparison of two different techniques.

To facilitate mini-access for cardiac surgery, two different methods of active venous drainage are used: vacuum assisted drainage and centrifugal pump aspiration on the venous line. The aim of this study was to compare the haemolysis produced using these two techniques. From June to December 1999, 50 consecutive patients were operated on using a ministernotomy. All of these patients had valvular surgery for either valve repair or valve replacement (9 MVRepair, 11 MVR, 29 AVR, 1 AVR + MVR). They were randomized into two groups: Group A, 25 patients who underwent surgery where vacuum assisted drainage was used, and Group B, 25 patients where kinetic asssisted venous drainage with centrifugal pump venous aspiration was used. Patient characteristics of both groups were similar for age, gender, body weight, body surface area, height, cardiopulmonary bypass (CPB) time, aortic crossclamp time, priming volume, cardioplegia volume, haemoglobin concentration, haematocrit, serum creatinine, bilirubin, lactate dehydrogenase (LDH), serum glutamic oxaloacetic transaminase (sGOT), serum glutamic pyruvic transaminase (sGPT), aptoglobin, reticulocytes, and platelet count. We checked all these laboratory parameters preoperatively, at the end of CPB, and 2 and 24 h after operation. We also checked haemoglobinuria at these same time points. We assessed blood loss at 6, 12, and 24 h after the operation and calculated total postoperative bleeding. There was a tendency towards a greater increase in LDH, sGOT and sGPT in Group A more than in Group B, but these data did not reach statistical significance. Platelet count was always lower in Group A and aptoglobin increased in Group A more than in Group B. More patients in Group A had haemoglobinuria. These findings indicate that haemolysis is increased more in patients treated with vacuum assisted drainage, when compared to the rise in haemolysis in those treated with centrifugal pump venous drainage. Total bleeding is also greater in Group A.