Miriam Blanco

Multiplex PCR Assay for Detection of Bacterial Pathogens Associated with Warm-Water Streptococcosis in Fish

ABSTRACT A multiplex PCR-based method was designed for the simultaneous detection of the main pathogens involved in warm-water streptococcosis in fish (Streptococcus iniae, Streptococcus difficilis, Streptococcus parauberis, and Lactococcus garvieae). Each of the four pairs of oligonucleotide primers exclusively amplified the targeted gene of the specific microorganism. The sensitivity of the multiplex PCR using purified DNA was 25 pg for S. iniae, 12.5 pg for S. difficilis, 50 pg for S. parauberis, and 30 pg for L. garvieae. The multiplex PCR assay was useful for the specific detection of the four species of bacteria not only in pure culture but also in inoculated fish tissue homogenates and naturally infected fish. Therefore, this method could be a useful alternative to the culture-based method for the routine diagnosis of warm-water streptococcal infections in fish.

Molecular Typing by Pulsed-Field Gel Electrophoresis of Spanish Animal and Human Listeria monocytogenes Isolates

ABSTRACT A total of 153 strains of Listeria monocytogenesisolated from different sources (72 from sheep, 12 from cattle, 18 from feedstuffs, and 51 from humans) in Spain from 1989 to 2000 were characterized by pulsed-field gel electrophoresis. The strains ofL. monocytogenes displayed 55 pulsotypes. The 84 animal, 51 human, and 18 feedstuff strains displayed 31, 29, and 7 different pulsotypes, respectively, indicating a great genetic diversity among the Spanish L. monocytogenes isolates studied. L. monocytogenes isolates from clinical samples and feedstuffs consumed by the diseased animals were analyzed in 21 flocks. In most cases, clinical strains from different animals of the same flock had identical pulsotypes, confirming the existence of a listeriosis outbreak. L. monocytogenes strains with pulsotypes identical to those of clinical strains were isolated from silage, potatoes, and maize stalks. This is the first study wherein potatoes and maize stalks are epidemiologically linked with clinical listeriosis.

First identification of Streptococcus phocae isolated from atlantic salmon (Salmo salar)

Different genera and species of gram-positive, catalase-negative cocci are pathogenic to fish. The numbers of infections caused by these microorganisms have increased during the last decade, and such infections are responsible for significant economic losses in the fish farm industry ([9][1]).

Efficacy of atorvastatin in prevention of atrial fibrillation after heart valve surgery in the PROFACE trial (PROphylaxis of postoperative atrial Fibrillation After Cardiac surgEry)

To evaluate the efficacy of perioperative atorvastatin administration for prophylaxis of postoperative atrial fibrillation (POAF) after heart valve surgery.

Giant Chiari Network, Foramen Ovale, and Paradoxical Embolism

A Chiari network is identified in the course of 1.3% to 4% of all autopsies and in 2% of patients who undergo transesophageal echocardiography. This network is associated with patent foramen ovale (PFO) in up to 80% of cases. Moreover, a number of scientific articles have linked this association to the development of stroke. The patient, a 78-year-old man with a history of embolic stroke and no evidence of cerebrovascular disease, complained of progressive breathlessness and dyspnea even on minimal exertion (New York Heart Association class III). A transesophageal echocardiogram revealed severe degenerative mitral regurgitation, severe functional tricuspid regurgitation, and a prominent Chiari network, in the shape of an inverted conewith a cul-de-sac (Figure A, white arrow), the distal end of which reached the PFO (Figure B, white arrowheads). We also observed turbulent flow from the left atrium to the right atrium through the PFO (Figure B, white arrow). The patient underwent mitral valve replacement, tricuspid valve repair, and PFO closure by means of simple suture with cardiopulmonary bypass. In the right atrium, we observed a large Chiari network (6.2 cm 6 cm), which we resected completely (Figures C and D, black arrow. TV, tricuspid valve). Although this malformation is uncommon, the characteristics of the Chiari network described here might explain the pathophysiology of a paradoxical embolism. The cul-de-sac would promote blood stasis and thrombosis, the inverted cone morphology would enable the mobilization of the thrombus toward the fenestrated region (Figure D, arrow), and the proximity of this region to the PFO could explain the embolism, especially during atrial diastole and Valsalva maneuvers. TV B A

Postoperative stroke related to cardiac surgery in octogenarians

OBJECTIVES Demographics of cardiac surgery patients are changing, with an increase in aged patients. We aim to identify risk factors, mortality, morbidity and increasing postoperative costs due to postoperative stroke in octogenarians following cardiopulmonary bypass (CPB). METHODS A total of 418 consecutive patients older than 80 years (Group A) who underwent cardiac surgery with CPB between 2000 and 2012 were matched according to gender, surgical procedure and comorbidities with 426 younger patients (Group B). Risk factors for postoperative stroke were retrospectively evaluated. RESULTS We identified postoperative stroke in 4.1% of patients in Group A and in 3.5% in Group B (P = 0.65). Early stroke was diagnosed in 13 patients in Group A (76.5%) and 10 patients in Group B (66.7%) (P = 0.53). In multivariate analysis, preoperative anaemia (P = 0.033; odds ratio [OR]: 3.84; 95% CI: 1.11-13.28) was the only risk factor associated with postoperative stroke in Group A. In Group B, preoperative peripheral vascular disease (P = 0.0003; OR: 7.30; 95% CI: 2.47-21.55) and postoperative atrial fibrillation (P = 0.0134; OR: 4.05; 95% CI: 1.33-12.31) were identified as risk factors. CONCLUSIONS Incidence of postoperative stroke after CPB was not significantly higher in our octogenarian population. Although in younger patients peripheral vascular disease and cardiac rhythm disturbances were significant risk factors, it seems that factors related to intraoperative brain oxygenation (secondary to preoperative anaemia) are the most critical determinant of stroke in the elderly.

Right Ventricular Wound And Complete Mammary Artery Transection

DOI: 10.5935/abc.20180185 Many patients die immediately after suffering a heart wound; on the other hand, many others die before the surgery, during surgery or later, due to complications.1 We admitted a 33-year-old man after a suicide attempt occurring one hour before, with eleven knife-wounds localized in the left-anterior chest wall (Figure:1-A). Physical exam showed hypotension, dyspnea, high central venous pressure and mild external bleeding. Hemodynamic monitoring, tracheal intubation, vasopressor perfusion, fluid therapy and urgent echocardiogram and tomography were undertaken. ACT showed severe pericardial effusion and moderate left pleural effusion (Figure:1-B, white arrows). Emergency cardiac surgery was performed through median sternotomy. Multiple pericardial tears were visualized. The pericardial clot was removed (Figure:1-C) and the right ventricular wound was closed using a monofilament suture (Figure:1-D, black arrow). In the inner chest wall, a complete left mammary artery transection was observed with severe bleeding into the left pleural cavity (Figure:1-E, white arrow). The mammary artery was repaired, and the bleeding was controlled. The postoperative course was uneventful. Heart wounds are serious health problems. The dramatic statistics have shown that many problems connected with traumatic cardiac lesions are not ultimately resolved. Knife stabs to the right ventricle are perhaps the most common penetrating injury to the heart, but the additional complete transection of the mammary artery is very uncommon. The most important factor for survival is the urgency treatment and the immediate surgical repair.

Isolated Infective Endocarditis of the Left Ventricular Outflow Tract and Multiple Septic Embolisms

Fig 2. Iventricular outflow tract (LVOT) and papillary muscles (PM) is very uncommon, but it can cause serious adverse events such as PM rupture or multiple embolisms [1]. A 50-year-old woman with a history of hypertension was admitted to the emergency room because of an acute confusional syndrome with fever. Physical examination showed multiple papular erythematous spots on the trunk and lower extremities (Fig 1A) suggesting septic microembolisms. Cerebrospinal fluid analysis revealed marked leukocytosis and neutrophilia. Magnetic resonance imaging of the brain showed multiple corticosubcortical embolic lesions in both cerebral hemispheres (Fig 1B, black arrows). The echocardiogram revealed a mobile mass (0.8 ce) anchored between the LVOT wall and the anterolateral PM (Fig 2A, red arrow). Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Surgical removal of the intracardiac mass from the LVOT and the anterolateral PM was performed (Fig 2B, red arrow). In the image, the aortic leaflets are folded over the aortic wall with a prosthetic heart valve sizer. The aortic and mitral valves were not affected. The postoperative period was uneventful, and the patient presented no neurologic deficits at discharge. Infective endocarditis was confirmed by histopathologic examination (Fig 2C, red arrow). Bacterial infective endocarditis restricted to the LVOT and the PM is exceptional. Multiple embolisms caused by

Heart Failure for Superinfected Giant Pericardial Hydatid Cyst

65-year-old woman with rheumatoid arthritis and Areceiving treatment with corticosteroids and immunosuppressive drugs was admitted to our hospital with progressive dyspnea, fevers, and orthopnea in the right lateral position. She exhibitmoderate edemas andbilateral pleural effusion and cardiomegaly on chest radiography. Transthoracic echocardiography revealed a giant pericardial cystic mass (13 8 6 cm), compressing heart chambers (Fig 1A). Computed tomography (Fig 1B) and magnetic resonance imaging confirmed a cystic lesion (Fig 1C; Videos 1, 2). Blood culture results were negative, and hydatid serology was positive for immunoglobulin G. Surgery using cardiopulmonary bypass was performed. Pericardium exposure showed the cystic structure, starting in the front side of the right atrium and extending along the ventricle. During cannulation, the cyst was broken, but no daughter cysts were identified; instead, hemorrhagic and granulomatous content was apparent (Fig 1D). The content was carefully aspirated and the capsule was dissected.

Complete heart block as isolated symptom of aortic intramural haematoma

Miriam Blanco*, Pablo E. Garc ıa-Granja, Ana Revilla, Gregorio Laguna, and Yolanda Carrascal Cardiac Surgery Department, Clinic University Hospital of Valladolid, Ram on y Cajal Avenue, Valladolid 47003, Spain; Cardiology Department, ICICOR, Clinic University Hospital of Valladolid, Ram on y Cajal Avenue, Valladolid 47003, Spain; and CIBERCV, ICICOR, Clinic University Hospital of Valladolid, Ram on y Cajal Avenue, Valladolid 47003, Spain * Corresponding author. Tel: 134 983420000. Ext. 86377, Fax: 134 983420000, Email: maomyriam@gmail.com