Multilocus sequence typing of Mycoplasma agalactiae.

Mycoplasma agalactiae is the main cause of contagious agalactia, a serious disease of sheep and goats, which has major clinical and economic impacts. We have developed a multilocus sequence typing (MLST) scheme using the sequenced genomes of the M. agalactiae strains PG2 and 5632. An MLST scheme based on the genes gltX, metS, gyrB, tufA and dnaA was designed and in total 3468 bp of sequence were analysed for each strain. MLST offers a highly discriminatory typing method for M. agalactiae and was capable of subdividing 53 strains into 17 distinct sequence types, largely according to geographical origin. MLST detected unexpected diversity in recent isolates from Spain, identifying two novel outliers, and enabled typing of novel Mongolian isolates for the first time. Genetic diversity in the sequenced regions was largely due to mutation, with recombination playing a much smaller role. A web-accessible database has been set up for this MLST scheme for M. agalactiae: http://pubmlst.org/magalactiae/. MLST offers a robust, objective molecular epidemiological tool for M. agalactiae that that enables interlaboratory comparison of data.

Revascularization of residual viable myocardium improves left ventricular dysfunction in patients after myocardial infarction.

The symptoms and prognosis of patients after myocardial infarction are essentially influenced by left ventricular function. About 50% of infarct related segments contain partly viable myocardium. The aim of this study was to test the hypothesis that regional and global left ventricular function can be improved by revascularization of infarct related segments with residual myocardial viability. In 15 of 30 consecutive patients, residual viable myocardium was found in the affected segment within 2.2 +/- 1.6 months after AMI. Myocardial viability was estimated by exercise-redistribution-reinjection thallium scintigraphy (SPECT imaging). Rest and exercise radionuclide ventriculography was performed to measure regional and global left ventricular ejection fraction before and after revascularization of the infarct related artery. 10 +/- 3 months after revascularization we observed a significant increase in the regional left ventricular ejection fraction at rest (from 32 +/- 16% to 41 +/- 19%; p = 0.03), global left ventricular ejection fraction at rest (from 38 +/- 12% to 46 +/- 11%; p = 0.01), regional LV ejection fraction during exercise (from 34 +/- 16% to 46 +/- 20%; p = 0.01), and global left ventricular ejection fraction during exercise (from 38 +/- 14% to 49 +/- 14%; p = 0.02). The results show that after revascularization of infarct related segments with residual myocardial viability, the regional and global left ventricular ejection fraction may be significantly improved, both at rest and during exercise. Thus infarct related segments should be tested for residual viability. In its presence revascularization is recommended, as the left ventricular function may be markedly improved.

[Synchronous occurrence of neoplasias of the thyroid gland and hyperthyroid nodular struma in an endemic area]. / Synchrones Auftreten von Neoplasien der Schilddrüse und hyperthyreoten Knotenstrumen im Endemiegebiet.

The simultaneous occurrence of hyperthyroidism and differentiated carcinoma of the thyroid gland is more frequent than previously assumed. In our endemic goiter region 16.5% of patients with thyroid carcinoma have hyperthyroidism and 1.8% of patients with hyperthyroidism have a thyroid carcinoma. The tumors are predominantly located in autonomous adenomas but are also found in cold nodules. Not only scintigraphically cold nodules but also warm and hot nodules must be suspected of malignancy. Consistent preoperative cytodiagnosis of all goiter nodules, including hot nodules, is therefore recommended. Surgical treatment of toxic multi-nodular goiters should be considered more often.

[The supply of iodine in the province of Vorarlberg]. / Die Jodversorgung im Bundesland Vorarlberg.

For evaluation of iodine supply in Vorarlberg, Austria, iodine urine excretion was measured in 299 patients. The Mean was 74,3 +/- 53,6 micrograms J/g Cr, the Median 61 micrograms J/g Cr. 79% of the patients showed an iodine deficiency I according to WHO classification and 41% an iodine deficiency II. In this patient group were included 44 subjects with no thyroid disease who showed an iodine excretion of 70.8 +/- 56,5 micrograms J/g Cr and a Median of 50,5 micrograms J/g Cr. There was no statistical difference to the values of the patient group. Regional evaluation of iodine supply showed an iodine deficiency I in 78% and an iodine deficiency II in 38% in the industrial region of the Rheintal. In the region Walgau with mixed industrial-rural population an iodine deficiency I was found in 81% and an iodine deficiency II in 45%. In the rural areas of Bregenzerwald and deep valleys an iodine deficiency I could be demonstrated in 81% and 83% respectively and an iodine deficiency II in 47 and 57% respectively. This moderate but statistically not significant differences show the minor influence of alimentation in iodine supply. Assuming a constant table salt consumption the results support the common belief that iodine supply in iodine deficient areas is strongly connected to incorporation of iodinated table salt. Therefore an increase of the iodination of table salt in Austria seems to be necessary to guarantee sufficient iodine supply.