Fungal endocarditis of a bioprosthetic aortic valve. Pharmacological treatment of a Candida parapsilosis endocarditis.

INTRODUCTION: In October 2011, a 72-year-old man was referred from a peripheral hospital with subsequent diagnosis: fungal sepsis with suspicion for endocarditis of a bioprosthetic aortic heart valve. In May 2010, a bioprosthetic aortic valve implantation (Edwards Magna) and CABG (LIMA graft on LAD) were performed. CASE: At the time of admission, the patient was in good general condition; the physical examination was unremarkable. Hemoculture detected Streptococci thermophilus and Candida parapsilosis. Neither an oscillating intracardiac mass on the valve nor an abscess could be detected in several transesophageal echocardiographies (TEEs). The F(18)-FDG PET-CT showed an increased tracer uptake in the area of the prosthetic aortic valve. The findings argued for a fungal endocarditis of the prosthetic aortic valve. Heart surgeons refrained from implantation of a new prosthetic aortic valve because of the unfavorable prognosis. Therefore, high-dose i.v. therapy with liposomale amphotericin B (5 mg/kg BW) and voriconazol (4 mg/kg BW twice a day) was started. A new F(18)-FDG PET-CT after 2 weeks showed no tracer uptake in the area of the prosthetic aortic valve. The hemoculture was also negative. The patient recovered; CRP values were within normal limits. Life-long antifungal therapy with fluconazol (400 mg/day) was recommended. CONCLUSION: There are no definitive treatment recommendations for fungal endocarditis. Surgical therapy is the first choice in prosthetic valve endocarditis, which however cannot be performed in all patients. In these cases high dose and life-long medical therapy is necessary to prevent re-infection of the valve, even if (transient) deterioration of renal and liver function occurs.

Three-dimensional surface texture visualization of bone tissue through epifluorescence-based serial block face imaging.

Serial block face imaging is a microscopy technique in which the top of a specimen is cut or ground away and a mosaic of images is collected of the newly revealed cross-section. Images collected from each slice are then digitally stacked to achieve 3D images. The development of fully automated image acquisition devices has made serial block face imaging more attractive by greatly reducing labour requirements. The technique is particularly attractive for studies of biological activity within cancellous bone as it has the capability of achieving direct, automated measures of biological and morphological traits and their associations with one another. When used with fluorescence microscopy, serial block face imaging has the potential to achieve 3D images of tissue as well as fluorescent markers of biological activity. Epifluorescence-based serial block face imaging presents a number of unique challenges for visualizing bone specimens due to noise generated by sub-surface signal and local variations in tissue autofluorescence. Here we present techniques for processing serial block face images of trabecular bone using a combination of non-uniform illumination correction, precise tiling of the mosaic in each cross-section, cross-section alignment for vertical stacking, removal of sub-surface signal and segmentation. The resulting techniques allow examination of bone surface texture that will enable 3D quantitative measures of biological processes in cancellous bone biopsies.

Ex vivo characterization of human atherosclerotic iliac plaque components using cryo-imaging.

We characterized atherosclerotic plaque components with a novel cryo-imaging system in lieu of standard histological methods commonly used for imaging validation and research endpoints. We aim to accurately identify plaque tissue types from fresh cadaver specimens rapidly (less than 5 h) in three dimensions for large specimens (up to 4 cm vessel segments). A single-blind validation study was designed to determine sensitivity, specificity and inter-rater agreement (Fleiss' Kappa) of cryo-imaging tissue types with histology as the gold standard. Six naïve human raters identified 344 tissue type samples in 36 cryo-image sets after being trained. Tissue type sensitivities are as follows: greater than 90% for adventitia, media-related, smooth muscle cell ingrowth, external elastic lamina, internal elastic lamina, fibrosis, dense calcification and haemorrhage; greater than 80% for lipid and light calcification; and greater than 50% for cholesterol clefts. Specificities were greater than 95% for all tissue types. The results demonstrate convincingly that cryo-imaging can be used to accurately identify most tissue types. If the cryo-imaging data are entered into visualization software, three-dimensional renderings of the plaque can be generated to visualize and quantify plaque components.

[Joseph Hyrtl as a comparative anatomist (author's transl)]. / Joseph Hyrtl als komparativer antom.

According to his liking Joseph Hyrtl produced a collection of anatomical preparations, which exceeded everything before in completeness; thus he became a worthy successor of the Netherlands traditions. The prevailing part of this collection represents a comparative-anatomical museum; therefore many treatises of his considerable scientific-literary work concern with comparative anatomy. While he was reputed unquestionably to be the founder of the topographical branch of anatomy in the area of the German language, he had to struggle for appreciation in the comparative branch of anatomy, and got formally accepted by nomination as Professor of Comparative Anatomy at the Medical Faculty of Vienna. Yet the separation of the zoological science that had split into an own department at this time was not prevented but confirmed by the authority as the comparative collection was incorporated into the Zootomical Institute of the Philosophical Faculty of Vienna, when Hyrtl had become Professor emeritus; the international reputation of this large comparative-anatomical collection, produced by Hyrtl himself, is to be seen when it had become the fourth position in contemporary rank after the collections at the Universities of London, Paris and Leyden.

Determination of the physical working capacity in children using three different regression models.

Experimental findings of the working capacity at a heart rate of 170 bts/min (W170) were compared to predicted values. Statistical tests were applied to examine the suitability and the error of prediction of three different regression models: a linear regression line, a polynomial regression model, and a "break point" regression model, which were compared to the time course of the heart rate during a linearly increasing work load from 0 to 100 W during 10 min. For this study the results of 28 children, 15 and 16 years old, and students of physical education were investigated. When a linear regression line was compared to these data, systematic deviations between measured data and the values estimated by this model were found. When the W170 was predicted using this model from the data collected during the first 10 min of an exercise procedure for the determination of the heart rate index, the physical working capacity was overestimated. The polynomial regression model and the "break point" regression model agreed with the time course of the heart rate without systematic error and allowed an unbiased prediction of the W170 from the first 10 min of the exercise test.

[Regression analysis of the heart rate increase in children during linearly increasing work load on a bicycle ergometer]. / Regressionsanalyse der Herzfreqauenzzunahme von Kindern bei linear ansteigender Belastung am Fahrradergometer.

E. A. Müller (1950) has introduced a procedure for the measurement of the "Leistungspulsindex" (LPI) based on the determination of a linear regression between heart rate increase and work load. For this purpose the work load on a bicycle ergometer is increased in proportion to time (about 10 W/min) and the heart rate is recorded continuously. We have performed measurements in children (10--11 years of age) and found that the above mentioned regression is markedly nonlinear and can be described best by two overlapping linear regression lines with different slopes (b11 and b12). We propose that under these conditions the regression coefficient b11 of the first part of the relation can be assumed as LPI. In our analysis we found the linear part of the heart rate to increase between the end of min 2 and min 6 (+/- 1.4) of the experiment in boys. In girls we found the linear part of the regression only until min 3.8 (+/- 1.4). One consequence of our results is related to the calculation of the PWC170 by linear extrapolation which appears to be impossible in all cases in which the relation between work load and heart rate is nonlinear. It seems possible to relate that part of the heart rate increase where the slope suddenly changes to the endurance limit.