Mediterranean Sea surface radiocarbon reservoir age changes since the last glacial maximum

Sea surface reservoir ages must be known to establish a common chronological framework for marine, continental, and cryospheric paleoproxies, and are crucial for understanding ocean-continent climatic relationships and the paleoventilation of the ocean. Radiocarbon dates of planktonic foraminifera and tephra contemporaneously deposited over Mediterranean marine and terrestrial regions reveal that the reservoir ages were similar to the modern one (approximately 400 years) during most of the past 18,000 carbon-14 years. However, reservoir ages increased by a factor of 2 at the beginning of the last deglaciation. This is attributed to changes of the North Atlantic thermohaline circulation during the massive ice discharge event Heinrich 1.

Prognosis after percutaneous closure of patent foramen ovale for paradoxical embolism

The long-term risk and risk factors for recurrent embolism after percutaneous closure of patent foramen ovale (PFO) were investigated in 152 consecutive patients with presumed paradoxical embolism. During follow-up, the actuarial freedom from recurrent embolism was 95.1% at 1 year, and 90.6% at 2 and 6 years. A residual shunt after percutaneous PFO closure was a predictor for recurrence (RR 5.3; 95% CI 1.3 to 21.0; p = 0.02). Randomized trials comparing medical treatment with percutaneous PFO closure in the prevention of recurrent embolism are in progress.

Palaeolithic paintings. Evolution of prehistoric cave art

Sophisticated examples of European palaeolithic parietal art can be seen in the caves of Altamira, Lascaux and Niaux near the Pyrenees, which date to the Magdalenian period (12,000-17,000 years ago), but paintings of comparable skill and complexity were created much earlier, some possibly more than 30,000 years ago. We have derived new radiocarbon dates for the drawings that decorate the Chauvet cave in Vallon-Pont-d'Arc, Ardèche, France, which confirm that even 30,000 years ago Aurignacian artists, already known as accomplished carvers, could create masterpieces comparable to the best Magdalenian art. Prehistorians, who have traditionally interpreted the evolution of prehistoric art as a steady progression from simple to more complex representations, may have to reconsider existing theories of the origins of art.

Carotid dissection with and without ischemic events: local symptoms and cerebral artery findings

OBJECTIVE

To study whether spontaneous dissections of the cervical internal carotid artery dissection (ICAD) with and without ischemia of the brain or retina differ in the prevalence of vascular risk factors, local neurologic signs and symptoms, and stenoses and occlusions of the cerebral arteries.

METHODS

The authors prospectively studied 181 consecutive patients with 200 ICAD. Diagnosis was based on ultrasonography and MRI or catheter angiography. Vascular risk factors, presenting local (headache, neck pain, Horner syndrome, pulsatile tinnitus, cranial nerve palsy on the side of the ICAD) and ischemic signs and symptoms, and ultrasonographic findings in the carotid and basal cerebral arteries were evaluated.

RESULTS

ICAD with ischemic events (n = 145) had a higher prevalence of hypercholesterolemia (p < 0.05), >80% stenoses and occlusions of the ICA (p < 0.0001), and intracranial obstructions (p < 0.001). ICAD without ischemic events (n = 55) had a higher prevalence of Horner syndrome (p < 0.001), cranial nerve palsy (p < 0.01), and normal ICA findings (p < 0.0001).

CONCLUSIONS

These data suggest that ICAD causing high-grade stenosis and occlusion are more likely to lead to intracranial obstructions and cerebral or retinal ischemic events. Conversely, ICAD without luminal narrowing cause more local signs and symptoms.

[A software tool for automatic image-based ventilation analysis using dynamic chest CT-scanning in healthy and in ARDS lungs]

PURPOSE

Density measurements in dynamic CT image series of the lungs allow one to quantify ventilated, hyperinflated, and atelectatic pulmonary compartments with high temporal resolution. Fast automatic segmentation of lung parenchyma and a subsequent evaluation of it's respective density values are a prerequisite for any clinical application of this technique.

MATERIAL AND METHODS

For automatic lung segmentation in thoracic CT scans, an algorithm was developed which uses (a) different density masks, and (b) anatomic knowledge to differentiate heart, diaphragm and chest wall from ventilated and atelectatic lung parenchyma. With Animal Care Committee approval, the automated technique was tested in 8 anaesthetized ventilated pigs undergoing dynamic CT before and after induction of lavage-ARDS. Images were acquired in one supradiaphragmatic, cross-sectional slice (temporal resolution of 100 ms; slice thickness of 1 mm, high resolution reconstruction algorithm). In 120 CT images the total pixel number and the calculated MLD from the automatically segmentated lung were compared to the values obtained from an interactive lung segmentation.

RESULTS

The software tool was able to read all image series (DICOM standard). Automatic and interactive segmentation were in high agreement (R(2) = 0.99 for the total number of pixels and the MLD). Originally, the most frequent error was misclassification of atelectasis as extrapulmonary solid tissue.

CONCLUSION

An automatic software tool is presented for lung segmentation in healthy lungs and in ARDS. Aerated lung and atelectasis were identified with high accuracy. This post-processing tool allows for a quantitative, CT based assessment of ventilation and recruitment processes in the lung. Thus, it may help to optimize ventilation patterns in patients with ARDS.

Reperfusion demonstrated by apparent diffusion coefficient mapping after local intra-arterial thrombolysis for ischaemic stroke

Diffusion-weighted MRI (DWI) is becoming important for diagnosis and investigation of acute cerebral ischaemia. It has been reported that apparent diffusion coefficient (ADC) maps could be an indicator of reperfusion. Our aim was to use echo-planar technology to investigate this phenomenon. We report 19 patients treated by local intra-arterial thrombolysis for middle cerebral artery stroke within 6 h of the onset of symptoms, in whom we performed follow-up DWI. ADC were found to be higher in the patients with angiographically proven reperfusion.

3D-visualization improves the dry-lab coronary anastomoses using the Zeus robotic system

BACKGROUND

Robotic surgical instruments enable quick and precise movements and may allow complete endoscopic coronary artery bypass grafting. However, cardiac surgeons will have to become familiar with this technology and endoscopic viewing. We present our training program with special focus on 2D- and 3D-visualization.

METHODS

A thoracic skeleton, covered with a neoprene suit, served as model for the chest wall. Either a glove, fixed on a metal plate, or a pig heart were placed inside for training. On the glove, a suture line consisting of two lines of 16 points each, with a distance of 2 mm between each point, was stamped. On the pig heart, the LAD was prepared and incised; subsequently an anastomosis was done using the dissected right coronary artery as a graft. The time required was measured for both models. For suturing, the Zeus System (Computer Motion, Goleta, CA) was used and the third robotic arm positioned the endoscopic camera. The scopes were connected to a 3D-camera and the picture was displayed on a headset with two integrated monitors. Visualization was set to either 2D or 3D. Three surgeons were involved in the study. Each one did at least 12 anastomoses on 2D and 3D.

RESULTS

The three surgeons involved showed a clear and rapid learning curve. The times required for the suture line decreased from 12.5 +/- 1.6 to 8.5 +/- 0.5 minutes with 2D and from 11.9 +/- 5.4 to 7.8 +/- 0.5 minutes for 3D respectively. This decrease did reach statistical significance (p = 0.03). In the pig heart model, the anastomosis times decreased from 33.2 +/- 8.4 to 15.7 +/- 0.3 minutes with 3D-visualization, and from 36.2 +/- 2.2 to 29.5 +/- 3.3 minutes with 2D. The decrease in anastomosis time did again reach significance (p = 0.025). At the end of the study, the times achieved with 2D-visualization were significantly longer than those with 3D (p = 0.01).

CONCLUSIONS

A surgical training program is mandatory to become familiar with these new technologies. Both models showed learning curves over an acceptable time course. 3D-visualization facilitated quick and precise movements, thus resulting in shorter anastomosis times.

Current saturation and electrical breakdown in multiwalled carbon nanotubes

We investigate the limits of high energy transport in multiwalled carbon nanotubes (MWNTs). In contrast to metal wires, MWNTs do not fail in the continuous, accelerating manner typical of electromigration. Instead, they fail via a series of sharp, equally sized current steps. We assign these steps to the sequential destruction of individual nanotube shells, consistent with the MWNT's concentric-shell geometry. Furthermore, the initiation of this failure is very sensitive to air exposure. In air failure is initiated by oxidation at a particular power, whereas in vacuum MWNTs can withstand much higher power densities and reach their full current carrying capacities.

IL-9 and IL-13 production by activated mast cells is strongly enhanced in the presence of lipopolysaccharide: NF-kappa B is decisively involved in the expression of IL-9

Mast cells, due to their ability to produce a large panel of mediators and cytokines, participate in a variety of processes in adaptive and innate immunity. Herein we report that in primary murine bone marrow-derived mast cells activated with ionomycin or IgE-Ag the bacterial endotoxin LPS strongly enhances the expression of IL-9 and IL-13, but not IL-4. This costimulatory effect of LPS is absent in activated mast cells derived from the LPS-hyporesponsive mouse strain BALB/c-LPS(d), although in these cells the proinflammatory cytokine IL-1 can still substitute for LPS. The enhanced production of mast cell-derived IL-13 in the presence of IL-1 is a novel observation. Coactivation of mast cells with LPS leads to a synergistic activation of NF-kappa B, which is shown by an NF-kappa B-driven reporter gene construct. In the presence of an inhibitor of NF-kappa B activation, the production of IL-9 is strongly decreased, whereas the expression of IL-13 is hardly reduced, and that of IL-4 is not affected at all. NF-kappa B drives the expression of IL-9 via three NF-kappa B binding sites within the IL-9 promoter, which we characterize using gel shift analyses and reporter gene assays. In the light of recent reports that strongly support critical roles for IL-9 and IL-13 in allergic lung inflammation, our results emphasize the potential clinical importance of LPS as an enhancer of mast cell-derived IL-9 and IL-13 production in the course of inflammatory reactions and allergic diseases.

Functional interactions within the newborn brain investigated by adaptive coherence analysis of EEG

To assess functional cortical organization in newborns during quiet sleep we investigated instantaneous interhemispheric coherences in six healthy full-term subjects using linked ear reference and average reference. Tracé alternant was the most frequent EEG pattern during quiet sleep of these newborns and consists of burst and interburst periods. The calculation of coherence was performed by means of time-variant autoregressive models on the basis of Kalman filtering. Coherence changes simultaneously with the appearance of these burst and interburst periods. The highest level of coherence was observed during burst periods in comparison with interburst periods. The lowest level of coherence was observed just before the burst started. During burst, maximal coherence was reached at different moments--late in the low frequency band (0.5-1.5 Hz; about 3 s after the burst started) and earlier in higher frequency bands (> 2 Hz, about 2 s). Interhemispheric coherence depended on the region being investigated. A significant level of coherence could be observed over frontal, temporal and occipital regions. Our data demonstrate significant modification of interhemispheric coherence during quiet sleep of full-term newborns and, irrespective of the immaturity of the brain, these coherences differ significantly between cortical regions.

Parallel substrate feeding and pH-control in shaking-flasks

An intermittent feeding system for shaking-flasks was developed to close the gap between batch operated shaking-flasks and fed-batch operated as well as pH-controlled stirred tank reactors. A precise syringe pump was connected via a substrate distribution system to individual 2/2-way miniature valves, one for each of up to 16 shaking-flask. The shaking-flasks were equipped with pH-probes. A process computer controls the intermittent feeding of substrates by tracking predefined individual feeding profiles as well as the base (or acid) addition for individual pH-control of the shaking-flasks. Higher concentrations of aerobic cells with higher cellular activities were achieved in fed-batch operated and pH-controlled shaking-flasks as compared to the conventional batch operation. Physiological effects of an intermittent feeding were studied in a stirred tank reactor with a recombinant E. coli strain, which expressed the GDP-mannose-pyrophosphorylase enzyme under the control of the lac-promoter.

Mycophenolate mofetil as a systemic antipsoriatic agent: positive experience in 11 patients

BACKGROUND

Mycophenolate mofetil (MMF) is a novel immunosuppressive drug. Several case reports have suggested that MMF has a beneficial effect in patients with psoriasis and autoimmune dermatoses.

OBJECTIVES

To investigate the efficacy and safety of oral MMF in severe psoriasis.

METHODS

Eleven patients with severe stable plaque-type psoriasis and a Psoriasis Area and Severity Index (PASI) between 12 and 53 (mean 30.5) were included in the study. They received oral MMF 1 g twice daily for 3 weeks and then 0.5 g twice daily for 3 weeks. The PASI were determined at baseline (week 0) and after 1, 2, 3 and 6 weeks of treatment.

RESULTS

Within 3 weeks of this therapy there was a reduction in PASI of between 40% and 70% in seven of 11 patients, and only one patient achieved a reduction in PASI of < 25% from baseline (mean PASI 15.6). Reducing MMF from 2 g daily to 1 g daily led to further, although only slight, improvement in six of 11 patients during the following 3 weeks. In four of 11 patients, the PASI increased at this lower dosage, and in one patient the drug was withdrawn because of muscle pain, which was possibly drug induced. This side-effect reversed within a few days after stopping the drug. Other side-effects, especially gastrointestinal and haematological toxicity, were not observed in any of the 11 patients treated. Overall, the mean PASI was 16.1 after 6 weeks.

CONCLUSIONS

We conclude that the immunosuppressant MMF 2 g daily is effective and safe in the treatment of severe psoriasis.

Technique for the quantification of transient quadratic phase couplings between heart rate components

A technique for the time-variant analysis of quadratic phase coupling (QPC) in heart rate data is introduced and tested in 6 human neonates during quiet sleep. The set up of the approach is based up on the assumption that QPCs in the heart rate variability (HRV) are related to amplitude modulation effects. The application of the biamplitude deals with the detection of the coupling pattern and the bicoherence is used for the statistical quantification of coupling. By means of the results of bispectral analysis the time-variant processing has been adapted. The frequency-selective complex demodulation of the HRV leads to the envelope of the respiratory sinus arrhythmia (RSA), this has been used as one input for a time-variant coherence analysis. The other input is the low-pass filtered 10-second-rhythm of the HRV. A time-continuous quantification of the QPC, caused by amplitude modulation (10-second-rhythm modulates the RSA), is possible using this approach. According to our observed results in neonatal HRV both a phase co-ordination between the 10-second-rhythm and RSA as well as a non-linear coupling (amplitude modulation) between these HRV components can be seen.

Correlating computed tomography and positron emission tomography scan with operative findings in metastatic colorectal cancer

INTRODUCTION

Several studies have been performed comparing computed tomography scan with positron emission tomography scan in clinical decision making. Unfortunately, therapeutic decisions are being made based on positron emission tomography scan data without a clear understanding of how well the diagnostic findings correlate with the clinical findings.

METHODS

A retrospective review of 41 patients with metastatic colorectal cancer was performed. All patients had both a computed tomography scan and a positron emission tomography scan before surgical exploration. All underwent surgical re-exploration. Findings were divided into hepatic, extrahepatic, and pelvic regions of the abdomen. Computed tomography scan and positron emission tomography scan findings were either confirmed or refuted by the operative findings.

RESULTS

Positron emission tomography scan was found to be more sensitive than computed tomography scan when compared with actual operative findings in the liver (100 vs. 69 percent, P = 0.004), extrahepatic region (90 vs. 52 percent, P = 0.015), and abdomen as a whole (87 vs. 61 percent, P < 0.001). Sensitivities of positron emission tomography scan and computed tomography scan were not significantly different in the pelvic region (87 vs. 61 percent, P = 0.091). In each case, specificity was not significantly different between the two examinations.

CONCLUSION

Computed tomography scan and positron emission tomography scan are both diagnostic tests useful in the evaluation of metastatic colorectal cancer. However, positron emission tomography scanning is more sensitive than computed tomography scanning and more likely to give the correct result when actual metastatic disease is present.

Instantaneous multivariate EEG coherence analysis by means of adaptive high-dimensional autoregressive models

This study presents an efficient algorithm for the fitting of multivariate autoregressive models (MVAR) with time-dependent parameters to multidimensional signals. Thereby, the dimension of the model may be chosen to equal the number of signal channels. The autoregressive (AR) parameter matrices are estimated by an extension of the recursive least squares (RLS) algorithm with forgetting factor. The estimation procedure includes a single trial as well as an ensemble mean approach. The latter approach allows the simultaneous fit of one mean MVAR model to a set of single trials, each of them representing the measurement of the same task. A particular advantage of this ensemble mean approach is that it requires only a low computation effort in comparison to well known procedures applied to single trials. Furthermore, the ensemble mean approach is linked with a high adaptation capability. The properties of the estimator are investigated using simulated time series. It can be demonstrated that the adaptation capability of the estimation (measured by its adaptation speed and variance) does not depend on the model dimension. The mean MVAR fit is applied to 19-dimensional EEG data, recorded during an elementary comparison procedure. The calculation of ordinary and multiple coherence is discussed. The sensitivity of the multiple instantaneous EEG coherence will be demonstrated.

Inhibition of TNF-alpha production contributes to the attenuation of LPS-induced hypophagia by pentoxifylline

Cytokines such as tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) are assumed to mediate anorexia during bacterial infections. To improve our understanding of the role that these two cytokines serve in mediating infection during anorexia, we investigated the ability of pentoxifylline (PTX), a potent inhibitor of TNF-alpha production, to block the anorectic effects of the bacterial products lipopolysaccharide (LPS) and muramyl dipeptide (MDP) in rats. Intraperitoneally injected PTX (100 mg/kg body wt) completely eliminated the anorectic effect of intraperitoneally injected LPS (100 microg/kg body wt) and attenuated the anorectic effect of a higher dose of intraperitoneally injected LPS (250 microg/kg body wt). Concurrently, PTX pretreatment suppressed low-dose LPS-induced TNF-alpha production by more than 95% and IL-1beta production 39%, as measured by ELISA. Similarly, high-dose LPS-induced TNF-alpha production was reduced by approximately 90%. PTX administration also attenuated the tolerance that is normally observed with a second injection of LPS. In addition, PTX pretreatment attenuated the hypophagic effect of intraperitoneally injected MDP (2 mg/kg body wt) but had no effect on the anorectic response to intraperitoneally injected recombinant human TNF-alpha (150 ug/kg body wt). The results suggest that suppression of TNF-alpha production is sufficient to attenuate LPS- and MDP-induced anorexia. This is consistent with the hypothesis that TNF-alpha plays a major role in the anorexia associated with bacterial infection.

The effects of intestinal infusion of long-chain fatty acids on food intake in humans

BACKGROUND & AIMS

Dietary fat intake is related to the degree of obesity, but the specific mechanisms by which fats regulate food intake in humans are unclear. We compared food intake suppression, plasma triglyceride appearance, and cholecystokinin (CCK) response after intestinal infusion of oils enriched with C18 fatty acids of increasing unsaturation.

METHODS

Food intake and appetite changes after upper intestinal infusion of 0.9% saline, 20% Intralipid, and 20% emulsions of oils enriched with stearic, oleic, and linoleic acids were tested in 10 healthy male volunteers. Plasma triglyceride appearance and CCK release were tested separately in 7 additional volunteers.

RESULTS

Intralipid and linoleic acid infusions significantly reduced food intake compared with saline infusion (P<0.05). No changes were observed in appetite ratings. There were no differences in plasma triglyceride response over the initial 75 minutes of intestinal infusion. Plasma CCK concentration increased after all lipid infusions (P<0.001), Intralipid infusion produced the highest increase in plasma CCK (P<0.05), and CCK response was similar between the 3 enriched oil emulsions.

CONCLUSIONS

These results indicate marked differences in the ability of C18 fatty acids to reduce food intake that appear not to be related to rate of absorption but may partially be explained by CCK release.

Correlative Whole-Body FDG-PET and Intraoperative Gamma Detection of FDG Distribution in Colorectal Cancer

Purpose: 18F-Fluorodeoxyglucose-positron emission tomography (FDG-PET) is the superior imaging modality for detection of primary and recurrent colorectal cancer compared to magnetic resonance imaging (MRI) or computerized tomography (CT). We investigated the feasibility of developing intraoperative procedures for detection of FDG in tumor deposits in order to assist the surgeon in achieving an optimal reduction of tumor burden.Procedures: Fourteen patients (45-83 years of age) were scanned using FDG-PET followed by Gamma Detection Probe evaluation at laparotomy. One patient did not have a pre-operative FDG-PET scan. The collimated detector probe contained a CdZnTe crystal (7mm diameter x 2mm thick). We used a lower window setting of 200 KeV and an open upper window setting. Fasted patients were given an IV bolus of FDG (4.0-5.7 mCi) 15-20 minutes prior to preparation for surgery. Catheterization and the diuretic Lasix were used to remove FDG activity from the bladder. The time from FDG injection to intraoperative GDP data acquisition varied from 58-110 minutes.Results: In all patients, the GDP detected background activity in normal tissues (aorta, colon, liver, kidney, abdominal wall, mesentery, and urinary bladder). The GDP correctly identified single or multiple tumor foci in 13/14 patients as noted by an audible signal from the control unit (3 S.D. above counts obtained from normal tissues). These tumor foci corresponded to regions of high FDG uptake as seen on FDG-PET scans. The one case that the GDP did not localize was a recurrent mucin pseudomyxoma-producing tumor (acellular, mucinous deposits). Ex vivo GDP evaluations demonstrated significant tumor:normal adjacent tissue activity (audible signals in 6/6 tumor samples tested).Conclusions: These data demonstrate that tumors identified from pre-operative whole-body PET scans can be localized during surgery utilizing a gamma probe detector and FDG.

Comparison of the ECST, CC, and NASCET grading methods and ultrasound for assessing carotid stenosis. European Carotid Surgery Trial. North American Symptomatic Carotid Endarterectomy Trial

We compared three angiographic methods for grading of carotid stenosis and examined the correlation between angiographic and ultrasound findings. Two observers independently measured 111 carotid stenoses on arteriographic films of 84 patients. The stenoses were graded according to the European Carotid Surgery Trial (ECST), North American Symptomatic Carotid Endarterectomy Trial (NASCET), and Common Carotid (CC) methods. The results obtained by these methods were compared, and the interobserver reproducibility of the measurements was calculated. In addition, all angiographic results were compared to ultrasound findings obtained before angiography. Measurements using the CC method were the most reproducible and those using the NASCET method the least. The NASCET method underestimated the degree of stenosis compared to the other methods. The ECST and CC methods yielded almost identical results (97% agreement). Ultrasound provided an accuracy of 94% compared to ECST and CC methods and 84% compared to the NASCET method. Interobserver reproducibility of angiographic quantification of carotid stenoses was best for the CC and ECST methods and least for the NASCET method. Ultrasound demonstrated better accuracy than the ECST and CC methods.

Quantitation of left-ventricular asynergy by cardiac ultrasound

The clinical evaluation of regional delays in myocardial motion (myocardial asynchrony) has proved problematic, yet it remains an important functional parameter to evaluate. Prior attempts to quantify regional asynergy have met with limited success, often thwarted by the low temporal resolution of imaging-system data acquisition. If a delay in onset of motion of 30-40 msec is clinically important to measure, then data acquisition at frame rates of 50-100 per second is required. This is out of the current temporal resolution of angiographic, nuclear, or magnetic resonance studies. Only cardiac ultrasound can currently achieve the necessary frame rates. Furthermore, quantitative studies into the accuracy with which a trained observer can identify computed regional myocardial asynchrony in a left-ventricular 2-dimensional (2-D) image have shown that regional delays of < 80 msec are not normally recognized in a moving image. This may be improved to 60 msec when either training is undertaken or comparative image review is used. However, this is still out of the temporal resolution required in clinical practice. Thus, visual interpretation of asynchrony is not sufficiently accurate. Two ultrasound data sets based on either integrated backscatter or Doppler myocardial imaging data may provide the solution. Doppler myocardial imaging is a new ultrasound technique which, in either its pulsed or color Doppler format, can achieve the required temporal resolution (with temporal resolutions of 8 msec and 16 msec, respectively). In contrast, color Doppler myocardial imaging, in its curved M-mode format, can display the timing of events during the cardiac cycle for all in-plane myocardial segments. This should allow the quantitation of regional delay for all systolic and diastolic events. Potentially, asynchrony due to regional ischemia, bundle branch block, ventricular premature beats, and ventricular preexcitation could all be identified and the degree of delay quantified. This overview will aim to establish the potential role of these new ultrasound methodologies in the recognition and quantitation of left-ventricular asynergy and how they might best be introduced into clinical practice.

Clinical use of a computer-enhanced surgical robotic system for endoscopic coronary artery bypass grafting on the beating heart

The aim of the study was to perform endoscopic coronary artery bypass grafting on the beating heart using a surgical robotic system. In the study, the surgical system ZEUS was used in combination with 3D visualization for endoscopic coronary artery bypass grafting in 25 patients. In a total of 10 cases, the coronary artery anastomosis was done on the beating heart using endoscopic stabilizers without cardiopulmonary bypass. In all cases, total OR time ranged from 4.0 to 8.0 hours (median 5.5 h); the times for endoscopic coronary artery anastomoses ranged from 14 to 50 minutes (median 25 minutes) with no difference between arrested-heart or beating-heart procedures. All patients had an uneventful angiographic control result. An endoscopic coronary artery anastomosis is possible on the arrested as well as on the beating heart.