[Septicemia and endocarditis with multiple implants : CIED, TAVI, MK clip and LAA occluders]. / Septikämie und Endokarditis bei multiplen Implantaten : CIED, TAVI, MK Clip und LAA-Okkluder.

Infective endocarditis (IE) as well as septicemia in patients with implanted cardiac devices are severe diseases and diagnosis is often delayed due to a variety of misleading symptoms. Imaging with transesophageal echocardiography (TEE) and also microbiology play a key role in both the diagnosis and management. They are also useful for the prognostic assessment of patients with IE, for follow-up during treatment, during extraction of the implant and after surgery. In addition to antibiotic treatment, removal of the implant is also necessary, at least if vegetation is detected. Not only the removal of the implant but also the underlying cardiac disease, the frequently occurring severe cardiac insufficiency, the advanced age and the not uncommon high degree of fragility of the patients mean that decision making for treatment and management as well as renewed implantation after completion of treatment are a challenge. The optimal treatment is only possible with a close cooperation between various specialist disciplines and should therefore be carried out in experienced centers.

[Leadless endocardial ultrasound based left ventricular stimulation : WISE CRT System: alternative to conventional methods]. / Sondenlose endokardiale linksventrikuläre Stimulation : WiSE™ CRT-System: Alternative zu herkömmlichen Verfahren.

There are still several limitations in delivering cardiac resynchronisation therapy (CRT). After 6 months, 20-40% of patients fail to have clinical benefit due to various reasons. Endocardial stimulation rather than conventional epicardial pacing has been shown to be more physiological, improves electrical stimulation of the left ventricle (LV), has less dispersion of electrical activity and results in better resynchronisation. The WiSE™ CRT System ("Wireless stimulation endocardial system"; EBR Systems, Sunnyvale, CA, USA) provides an option for wireless, LV endocardial pacing triggered by a conventional right ventricular pacing spike from a co-implant. The feasibility of the WiSE™ CRT System has been successfully demonstrated in a population of failed cardiac resynchronisation patients with either failed implantation of a conventional system, nonresponse to conventional therapy or upgrade from pacemaker or defibrillator, where a conventional system was not an option. The WiSE™ CRT System is an innovative technology with promising safety, performance and preliminary efficacy.

Individual- and Neighbourhood-Level Indicators of Subjective Well-Being in a Small and Poor Eastern Cape Township: The Effect of Health, Social Capital, Marital Status, and Income.

Our study used multilevel regression analysis to identify individual- and neighbourhood-level factors that determine individual-level subjective well-being in Rhini, a deprived suburb of Grahamstown in the Eastern Cape province of South Africa. The Townsend index and Gini coefficient were used to investigate whether contextual neighbourhood-level differences in socioeconomic status determined individual-level subjective well-being. Crime experience, health status, social capital, and demographic variables were assessed at the individual level. The indicators of subjective well-being were estimated with a two-level random-intercepts and fixed slopes model. Social capital, health and marital status (all p < .001), followed by income level (p < .01) and the Townsend score (p < .05) were significantly related to individual-level subjective well-being outcomes. Our findings showed that individual-level subjective well-being is influenced by neighbourhood-level socioeconomic status as measured by the Townsend deprivation score. Individuals reported higher levels of subjective well-being in less deprived neighbourhoods. Here we wish to highlight the role of context for subjective well-being, and to suggest that subjective well-being outcomes may also be defined in ecological terms. We hope the findings are useful for implementing programs and interventions designed to achieve greater subjective well-being for people living in deprived areas.

Socioeconomic Status and Self-Reported Tuberculosis: a Multilevel Analysis in a Low-Income Township in the Eastern Cape; South Africa

Few studies have investigated the interplay of multiple factors affecting the prevalence of tuberculosis in developing countries. The compositional and contextual factors that affect health and disease patterns must be fully understood to successfully control tuberculosis. Experience with tuberculosis in South Africa was examined at the household level (overcrowding; a leaky roof; social capital; unemployment; income) and at the neighbourhood level (Gini coefficient of inequality; unemployment rate; headcount poverty rate). A hierarchical random-effects model was used to assess household-level and neighbourhood-level effects on self-reported tuberculosis experience. Every tenth household in each of the 20 Rhini neighbourhoods was selected for inclusion in the sample. Eligible respondents were at least 18 years of age and had been residents of Rhini for at least six months of the previous year. A Kish grid was used to select one respondent from each targeted household; to ensure that all eligible persons in the household stood an equal chance of being included in the survey. We included 1020 households within 20 neighbourhoods of Rhini; a suburb of Grahamstown in the Eastern Cape; South Africa. About one-third of respondents (n=329; 32) reported that there had been a tuberculosis case within the household. Analyses revealed that overcrowding (P?0.05) and roof leakage (P? 0.05) contributed significantly to the probability of a household TB experience; whereas higher social capital (P?0.01) significantly reduced this probability. Overcrowding; roof leakage and the social environment affected tuberculosis prevalence in this economically disadvantaged community. Policy makers should consider the possible benefits of programs that deal with housing and social environments when addressing the spread of tuberculosis in economically poor districts

Improving subjective well-being of the poor in the Eastern Cape.

This study investigated the effects of income, health, social capital, marital status, employment, education and crime experience on subjective well-being within a poor community in the Eastern Cape of South Africa. It appeared that higher income is associated with higher subjective well-being and that social capital serves as an important subjective well-being predictor in all income groups. Efforts must be made to ensure that countries do not develop economically at the expense of other aspects of life important for well-being in the very poor, such as social capital.

[Clinical course of a partially thrombosed, symptomatic aneurysm of the basilar artery tip with partial recanalization subsequent to coiling]. / Verlaufsbeschreibung eines teilthrombosierten symptomatischen Basilariskopfaneurysmas mit teilweiser Rekanalisierung nach Coiling.

A 72-year-old patient was referred to the neuroradiological department for diagnostic angiography. She was suffering from vertigo and double vision. Magnetic resonance imaging performed elsewhere had demonstrated a giant aneurysm of the basilar artery tip 2 cm in diameter. Angiography revealed a large aneurysm with a broad neck that was partially thrombosed, which precluded closure by coiling. Neurosurgical management by clipping also appeared to be unsuitable because of the proximity to the cerebrum. The decision was reached to proceed expectantly by closely monitoring the clinical course. When the aneurysm increased in size in the ensuing weeks, coiling was performed successfully. Angiographic follow-up showed reperfusion of the aneurysm neck and closure was again achieved by repeat coiling. Reperfusion is not a rare complication following coiling and often necessitates renewed intervention.

[Clinic, diagnosis, and therapy of subarachnoidal hemorrhage]. / Klinik, Diagnostik und Therapie der Subarachnoidalblutung.

In most cases a saccular aneurysm is the cause of acute subarachnoidal hemorrhage (SAH). The usual symptoms are severe headache and meningism. Due to the high mortality rate caused by rebleeding an early occlusion of the aneurysm should be strived for. For this early diagnosis an exact identification of the aneurysm and its configuration is essential.

Population responses to acute and chronic cadmium exposure in sexual and asexual estuarine gastropods.

: The acute lethal and chronic sublethal responses of sexual (Hydrobia ventrosa) and asexual (Potamopyrgus antipodarum) gastropod populations to cadmium exposure were examined. Three questions were addressed: (i) are there differences in responses of sexual and asexual populations; (ii) are the response patterns similar in lethal and sublethal exposure conditions; and (iii) how does preexposure to cadmium influence these responses. No differences between the two species in mean acute tolerance (LC50) could be detected, but a significant difference was found between the slopes of the concentration-response curves. The steeper slope for P. antipodarum indicated a more uniform response for the asexual species than for H. ventrosa. In the sublethal experiment there was a significant difference in mean growth rate where, in general, P. antipodarum grew faster than H. ventrosa. P. antipodarum was more affected by cadmium at the low cadmium exposure, whereas growth rates were reduced equally for the two species at the high cadmium concentration. Pre-exposure to cadmium did not increase the tolerance to chronic exposure in either of the species, but P. antipodarum exhibited a tendency toward increased tolerance to acute cadmium stress after pre-exposure.The results show that there are differences between these closely related sexual and asexual species in response to cadmium, and that these differences are more pronounced under chronic sublethal exposure conditions.

Black South African women on excursions: A reflection on the quality of township life for seniors.

Club excursions afford unique learning experiences for senior black women which redefine roles for older township women and reinforce positive intergenerational relationships. Personal accounts of the highlights of excursions out of townships obtained from over 120 female club members in focus group interviews contrast sharply with their daily experience of the depressed quality of life in the townships. Evidence suggests that participation in senior excursions, which are commonly viewed as a luxury in developing contexts, enhances the social prestige of older women in the community. From a human resources development viewpoint, it is argued that excursions which inspire self-confidence and widen horizons may assist the older generation to make a greater contribution to shaping community life in post-apartheid South Africa.

Polygamy, economic security and well-being of retired Zulu migrant workers.

Why does polygamy still persist when changing circumstances challenge the conventional wisdom that polygamy and numerous progeny provide social security in old age? To answer this question an in-depth questionnaire survey of 253 retired Zulu male migrants resident in rural areas examined the relationship between polygamy, economic security, and quality of life after return migration. Results indicate that polygamous marital status contributes only indirectly to feelings of enhanced well-being relative to economic advantage and good health. It is concluded that despite changing economic circumstances a traditionally-oriented polygamous head of a Zulu household may still expect to feel optimistic about his social and spiritual security in old age. Further research is required to explore Zulu women's views regarding the longer-term advantages of polygamy throughout the life course.

[Use of a computer system in perinatal data collection]. / Die Anwendung eines Computersystems zur perinatalen Datenerfassung.

We present a computer system for obstetrical and perinatological data collection. All deliveries of the years 1984, 1985, and 1986 have been collected with this data collection program, so that there is how a data base containing 7,975 data records. A relational data base was chosen for data collection and storage. Either off-line or on-line data collection is possible by medical users via menu monitoring. Various possibilities of use are described.

Removing formaldehyde from embalmed cadavers by percolating the body cavities with dilute ethanol.

Formaldehyde was removed from embalmed animal cadavers by pumping ethanol (20%) through the pleural and peritoneal cavities of 4 goats, 4 cows and 4 horses. The goats were percolated intermittently for 7 days and the large animals continuously for 72 h. Just after opening the body cavities, samples of air close to the organs were collected and analyzed for formaldehyde using a spectrofluorimetric method. The concentration of formaldehyde in the air samples was in goats 0.45 +/- 0.44 microgram/l (mean +/- SD), cows 0.42 +/- 0.29 microgram/l and horses 0.43 +/- 0.25 microgram/l.

Purification and characterization of a plasminogen activator from mouse cells transformed by an oncogenic virus.

On the basis of cellular morphology, a subline of mouse sarcoma virus-infected 3T3 cells was selected which released a 48 000-dalton plasminogen activator at an approx. 40-fold higher rate than those of the parent line, and which continued to do so for several months when the cells were maintained in serum-free culture medium. Culture medium (3.5 l) containing 0.6 mg plasminogen activator per l was used to purify 620 micrograms of the enzyme 130-fold with a yield of 32% by affinity chromatography followed by anion exchange chromatography and gel filtration. Crucial for the yield was the use of a non-ionic detergent and of inhibitors of proteolysis to prevent adsorption and degradation, respectively. The purified enzyme was homogeneous as evaluated by SDS-polyacrylamide gel electrophoresis and had an isoelectric point of pH 9.2. The purified enzyme showed characteristics of a trypsin-like serine protease (labeling with [3H]diisopropylphosphorofluoridate which was prevented by p-nitrophenyl-p'-guanidinobenzoate) and converted the single chain of human plasminogen into two chains of plasmin with electrophoretic mobilities identical to those of the chains formed by non-purified enzyme and by human urokinase. In the absence of inhibitors, solutions of purified enzyme were stable for 24 h at 4 degrees C at pH 3-9.

Inhibition of a plasminogen activator from oncogenic virus-transformed mouse cells by rabbit antibodies against the enzyme.

Antisera were raised in rabbits against an electrophoretically pure 48 000 dalton plasminogen activator from mouse cells transformed by an oncogenic virus. The IgG fraction of the antisera inhibited 48 000 dalton mouse plasminogen activators from a variety of sources (neoplastic and nonneoplastic), a 29 00) dalton plasminogen activator from mouse urine and a 48 000 dalton plasminogen activator from rat urine. No inhibition was observed of a 75 000 dalton plasminogen activator extracted from mouse lung, of mouse plasmin or of plasminogen activators from human urine and from oncogenic-virus transformed chicken cells. The IgG antibodies were stronger and more specific inhibitors of the 48 000 dalton mouse plasminogen activator than any previously tested compounds.