Intraoperative angiography in minimally invasive direct coronary artery bypass grafting

Intraoperative angiography in minimally invasive direct coronary artery bypass grafting without cardiopulmonary bypass and in hybrid procedures is reported. Twelve procedures were performed in a specially designed surgical-radiologic suite with a cross-disciplinary organization. In 2 patients the anastomosis was successfully revised on the basis of angiographic findings. In 4 of the 12 patients anastomosis of the left internal mammary artery to the left anterior descending coronary artery performed as a minimally invasive direct coronary artery bypass grafting procedure was combined with percutaneous transluminal coronary angioplasty of lesions in other coronary vessels in the same session. Intraoperative angiography allows a reliable diagnosis of an anastomosis or graft failure and prompt and reliable correction, and it allows the combination of minimally invasive direct coronary artery bypass grafting and angioplasty in one session.

Key factors in the identification of the high-risk patient with unstable coronary artery disease: clinical findings, resting 12-lead electrocardiogram, and continuous electrocardiographic monitoring

This article reviews a range of methods for identifying high-risk patients with unstable coronary artery disease, including clinical evaluation, the resting 12-lead electrocardiogram, continuous vectorcardiography, and a combined risk evaluation using continuous vectorcardiography and measurement of troponin-T. Clinical evaluation is not very accurate for identifying high-risk patients and modern techniques have not been fully validated in clinical trials. The combination of continuous vectorcardiography and biochemical monitoring is a very powerful method of identifying both very high- and very low-risk patients and may be increasingly used in the future.

Prevalence of very mild to severe dementia in Denmark

OBJECTIVES

The prevalence of dementia has been estimated in several countries and a meta-analysis has shown moderate and severe dementia in people aged 65 years and older to be between 4% and 6%. The Odense study is aiming to estimate the prevalence and incidence of dementia and to identify risk factors.

MATERIAL AND METHODS

A total of 3346 persons, equivalent to 64.5% of a random sample of 5237 persons aged 65-84 years living in the municipality of Odense, Denmark, underwent a two phase diagnostic procedure including a screening with CAMCOG, the cognitive section of The Cambridge Examination for Mental Disorders of the Elderly, seven neuropsychological tests, medical examination, and CT scan. The severity of dementia was assessed by the CDR (Clinical Dementia Rating).

RESULTS

The prevalence rate was 7.1%, including the very mildly demented, defined as persons rated questionably demented according to the CDR scale. The prevalence rate of very mild dementia was 2.8%. The proportion of cases with very mild dementia decreased with increasing age while the prevalence rate increased.

CONCLUSION

Inclusion of very mild cases of dementia resulted in a higher prevalence rate than generally reported, and the prevalence rate increased exponentially with age which was mainly due to Alzheimer's disease.

Vectorcardiographic monitoring of patients with acute myocardial infarction and chronic bundle branch block

AIMS

This study was set up to describe vectorcardiographic patterns in patients with bundle-branch block and acute myocardial infarction.

METHODS AND RESULTS

Sixty-five patients admitted to the coronary care unit with bundle-branch block and suspected acute myocardial infarction were monitored by dynamic vectorcardiography with trend analysis. In 28 patients, a clinical diagnosis of acute myocardial infarction was made. In patients with left bundle-branch block and acute myocardial infarction, the pattern of QRS vector-difference evolution was similar to that in patients with the narrow QRS complex, while ST vector-magnitude changes increased over time. Using a cut-off value for QRS vector-difference at 12 h of more than 20 microVs and a specific trend curve pattern, acute myocardial infarction in the presence of left bundle-branch block could be diagnosed with an accuracy of 71%. For patients with right bundle branch block, using a maximum ST vector-magnitude of > 200 microV during the first 4 h, acute myocardial infarction could be diagnosed with a 78% accuracy.

CONCLUSION

Our results indicate that dynamic vectorcardiography is a valuable tool in diagnosing and monitoring acute myocardial infarction in patients with bundle branch block.

Acetylation of or beta-cyclodextrin addition to potato beneficial effect on glucose metabolism and appetite sensations

Functional foods are gaining more and more interest from health scientists. One way to improve the nutritional properties of foods may be to modify the starch component, often included to stabilize the food product. In this study two chemically modified starches-a 1-2% acetylated potato starch and a starch enriched with 2% beta-cyclodextrin-and a native, unmodified potato starch (control) were investigated with regard to 6-h energy expenditure, substrate metabolism, hormone concentrations, and subjective appetite sensations. Subjects were 11 healthy, normal-weight, young men. The starch (50 g) was prepared as a pudding with fruit sauce and whipped cream (3180 kJ, 49% of energy from carbohydrate, and 40% of energy from fat). The meal was given in the morning after a 2-d carbohydrate-rich, weight-maintenance diet. After the modified-starch meals, response patterns for plasma glucose (P < 0.01), insulin (P < 0.05); gastric inhibitory polypeptide (P < 0.05), subjective satiety (P < 0.05), and fullness (P = 0.06) were significantly different from response patterns after the meal with the control starch. Thus, a flattening of the glucose curve, a lower insulin and gastric inhibitory polypeptide response, and higher fullness ratings were observed after the meal with the beta-cyclodextrin starch. Satiety ratings were higher after both meals with modified starch than after the meal with the control starch. In conclusion, a minor modification insulinemic (1-2%) of native potato starch improved the glycemia, insulinemic, and satiating properties of a meal. This was especially true for the beta-cyclodextrin-enriched starch. Slower gastric-emptying rate or delayed intestinal absorption of the modified starch may explain the observed differences.

Electromyography in myopathy

Electromyography (EMG) is the most common procedure for screening patients with myopathies and remains the most important technique for assessing the course of the disease over time. Fibrillation potentials, positive sharp waves, myotonic or complex repetitive discharge, as well as polyphasic potentials are non specific and can occur in both myopathic and neurogenic lesions. The most sensitive and specific parameter for myopathy in conventional EMG is the decreased duration of motor unit potentials (MUP), but this can also be seen in disorders of the terminal motor fibers or the neuromuscular junction. More advanced techniques such as single fiber EMG, macro EMG, scanning EMG and turns/amplitude analysis have opened additional possibilities for analysis of the motor unit and the interference pattern, by which both the sensitivity to early changes and specificity for myopathic alterations is increased. The importance of combining different techniques to improve diagnostic yield and specificity is stressed.

Non-invasive risk stratification within 48 h of hospital admission in patients with unstable coronary disease

AIMS

In this study we evaluated the prognostic value of three methods of early risk estimation in patients with unstable coronary disease.

METHODS AND RESULTS

The methods evaluated were: clinical risk estimation at hospital admission, continuous ST analysis with computerized vectorcardiography for 24 h and serial measurements of creatinine kinase-MB for 48 h. Twenty-seven (14%) of the 195 patients died or had a non-fatal infarction within one year. Clinical risk evaluation correctly identified a subgroup of patients with low risk but did not otherwise predict outcome. Fifty-six (29%) patients had ST vector magnitude episodes on vectorcardiography, 70 (38%) had three or more episodes of ST change vector magnitude and 74 (38%) had a peak creatinine kinase-MB value of 6 microgram.l-1 or more. The even rate for patients with ST vector magnitude episodes (23%) was significantly higher than for those without (10%; P < 0.05). For patients with and without three or more episodes of ST change vector magnitude the event rate was 23% and 9% respectively (P < 0.05) and for patients with and without creatinine kinase-MB > or = 6 microgram.l-1 the event rate was 23% and 8% respectively (P < 0.01). The positive predictive value of having none, either one or both of the ST or creatinine kinase-MB markers positive was incremental.

CONCLUSION

Continuous vectorcardiographic monitoring of ischaemia in combination with serial creatinine kinase-MB measurement considerably improves risk stratification in unstable coronary disease.

[Budesonide and beclamethasone dipropionate inhalation powders. The effect on bone and collagen turnover in children]

The objective of the study was to assess bone and collagen turnover in asthmatic children treated with dry powder budesonide from the Turbohaler and dry powder beclomethasone dipropionate from the Diskhaler in a dose of 800 micrograms/day. Thirteen prepubertal children with asthma were studied. The study was conducted as an open crossover study with two treatment periods and treatment free run-in and wash-out periods. All periods were of two weeks' duration. At day 14 in each period blood samples were taken for assessment of serum osteocalcin, the carboxyterminal propeptide of type I collagen (PICP), and the aminoterminal propeptide of type III collagen (PIIINP). At the same time urine was collected for assessment of creatinine corrected pyridinoline (uPYR/cr) and deoxypyridinoline (udPYR/cr) crosslinks.

RESULTS

Osteocalcin concentrations were not influenced by any of the treatments. During budesonide treatment PICP was reduced by 18% (p = 0.03), PIIINP by 24% (p = 0.0002), uPYR/cr by 16% (p = 0.03) and udPYR/cr by 21% (p = 0.12). During treatment with beclomethasone dipropionate PICP was reduced by 20% (p = 0.01), PIIINP by 36% (p = 0.0002), uPYR/cr by 18% (p = 0.004) and udPYR/cr by 13% (p = 0.02). The suppressive effect of beclomethasone dipropionate on PIIINP was more marked than that of budesonide (p = 0.001). It is concluded that treatment with dry powder budesonide and beclomethasone dipropionate 800 micrograms/day is associated with suppression of bone and collagen turnover. The suppression seems to be more marked during treatment with beclomethasone dipropionate. Long term effects and effects of lower doses of budesonide and beclomethasone dipropionate on bone and collagen markers needs further study.

[Doppler ultrasound of blood flow in the hepatic veins]

The blood flow in the hepatic veins can normally be studied easily by Doppler ultrasound. The pattern of blood flow in normal individuals is described, and its relation to the cardiac cycle and changing pressure in the right atrium. The blood flow shows variations in healthy persons, and may change in cases of heart disease and hepatic disease. Conditions such as atrial fibrillation, tricuspid regurgitation, abnormal relaxation, restrictive cardiomyopathy, constrictive pericarditis and cardiac tamponade are reflected in the hepatic veins, and the pattern of blood flow may help in diagnosis, and in grading the pathology. In cirrhosis and portal hypertension the heart-synchronous variation in velocity is reduced. This is due to increased resistance to blood flow across the liver and the pressure gradient becoming larger than the variations in pressure in the right atrium.

Ischaemia detected by continuous on-line vectorcardiographic monitoring predicts unfavourable outcome in patients admitted with probable unstable coronary disease

BACKGROUND

Several methods have been suggested for risk stratification of patients with unstable coronary syndromes. However, most of these are applied several days after hospital admission.

METHODS

In this study we investigated the prognostic value of continuous ST-segment and QRS vector monitoring with computerized vectorcardiography (VCG), serial measurements of creatine kinase isoenzyme MB (CK-MB), predischarge stress testing and baseline data in patients with unstable angina pectoris or non-Q-wave infarction.

RESULTS

During the 24 h VCG monitoring, 56 (29%) of the 195 patients had ST-vector magnitude (ST-VM) episodes of ischaemia. Seventy-four (38%) patients had a peak CK-MB value of 6 micrograms/l or higher during the 48 h sampling period. Several discrete variables were associated with death or non-fatal infarction at 1 year of follow-up in an univariate analysis. Among these were age > or = 65 years, female sex, St depression on the admission ECG or VCG monitoring, and elevated CK-MB levels, but neither the occurrence, duration nor intensity of chest pain. With Cox's proportional hazards regression analysis, ST-VM episodes on VCG monitoring were identified as independent markers of the risk of death (P = 0.013), death or non-fatal infarction (P = 0.035) and death, non-fatal infarction, unstable angina during the first year, or revascularization before hospital discharge (P = 0.005).

CONCLUSIONS

VCG monitoring of ischaemia provides independent prognostic information in unstable angina. High-risk patients can easily be identified within 24 h of hospital admission. Whether early intervention based on these criteria will result in improved prognosis remains to be shown in future studies.

Serotonin 5-HT2 receptor, dopamine D2 receptor, and alpha 1 adrenoceptor antagonists. Conformationally flexible analogues of the atypical antipsychotic sertindole

Conformationally flexible analogues of the atypical antipsychotic sertindole (1-[2-[4-[5-chloro -1-(4-fluorophenyl)-1H-indol-3-yl]-4-piperidinyl]ethyl]-2-imidazolidi non e) were synthesized. Replacement of the 4-piperidinyl ring in sertindole by a 2-(methylamino)ethoxy group or a 2-(methylamino)ethyl group (e.g. 1-[2-[2-[5-chloro-1-(4-fluorophenyl)-1H -indol-3-yloxy]ethyl-methylamino]ethyl]-2-imidazolidinone and 1-[3-[[2-[5-chloro-1-(4-fluorophenyl)-1H-indol-3-yl] -ethyl]methylamino]propyl]-2-imidazolidinone results in binding affinities for serotonin 5-HT2A and dopamine D2 receptors, as well as alpha 1 adrenoceptors, which are very similar to those of sertindole. (Methylamino)alkyl groups of other chain lengths, 3-(methylamino)propyloxy groups, and 2-(methylamino)ethylsulfanyl groups do not have such properties. The capability of the 2-(methylamino)ethoxy group and the 2-(methylamino)ethyl group to replace the 4-piperidinyl ring in sertindole is reflected in molecular modeling studies using recently published receptor-interaction models for 5-HT2 and D2 receptors. Structure-affinity investigations concerning the substituents in the indole nucleus and the 2-imidazolidinone ring system in the 2-(methylamino)ethoxy and the 2-(methylamino)ethyl analogues of sertindole have led to high affinity serotonin 5-HT2A receptor antagonists with selectivity versus dopamine D2 receptors and alpha 1 adrenoceptors (e.g. 1-[2-[[2-[6-chloro-1-(4-fluorophenyl) -1H-indol-3-yloxy]ethyl]methylamino]-ethyl]-2-imidazolidinone and 1-[3-[[2-[6-chloro-1-(4-fluorophenyl) -1H-indol-3-yl]ethyl]methylamino]propyl]-2-imidazolidinone). The latter derivative has also high selectivity for 5-HT2A receptors versus serotonin 5-HT2C receptors. Replacement of the basic amino group by nitrogen-containing six-membered rings has led to 5-chloro-1-(4-fluorophenyl)-3-[(4-methylpiperazinyl)-ethoxy]-1H-in dole, which has high affinity for dopamine D2, versus low affinity for serotonin 5-HT2A receptors and alpha 1 adrenoceptors.

[Attitudes to treatment with cytostatic agents. Do cancer patients, physicians, nurses and healthy individuals vary in their views?]

Cancer patients' attitudes to chemotherapy were compared with those of doctors, nurses, and healthy controls. 98 cancer patients, 42 healthy subjects, 44 oncologists, 35 surgeons, 32 oncology nurses, and 70 surgical nurses received a questionnaire presenting a hypothetical situation involving a toxic chemotherapy regimen. Each of them was asked to indicate the minimal benefit with respect to chance of cure, prolongation of life and relief of symptoms they would demand in order to accept the treatment. The patients and surgical nurses were the most reluctant towards the treatment. The subgroup of patients under 50 years which matched the oncologists, surgeons, and controls with respect to age, cohabitant status, and children were significantly more willing to accept the regimen than the control persons and professional groups were. Patients under 40 years would accept the toxic treatment even with hardly any benefit in terms of chance of cure (7%, median), prolongation of life (three months), and relief of symptoms (8%). Among the professionals, oncologists were most willing to accept the therapy, whereas surgical nurses and surgeons were the least willing.

Nucleoside transport inhibition by draflazine in unstable coronary disease

OBJECTIVES

In a randomised, double-blind, placebo controlled study, we evaluated the tolerability and safety of draflazine, a nucleoside transport inhibitor, in the treatment of patients with unstable angina and non-Q-wave infarction.

METHODS

Twenty-one patients were randomised to treatment with draflazine 3.5 mg or matching placebo given as an i.v. infusion and haemodynamic and symptomatic tolerability were investigated. Myocardial ischaemia was evaluated by means of vectorcardiography and blood analysis of the MB fraction of creatine kinase.

RESULTS

The study drug was well tolerated by all patients and it did not cause any adverse haemodynamic effects, nor other serious adverse events. Three patients in the placebo group reported five adverse events, as compared to a single adverse event in the draflazine group. Cardiovascular events were detected in 7 patients in the placebo group and in 5 patients receiving draflazine. The mean duration of chest pain during the 24 hour observation period was 91.4 min in the placebo group compared to 75.5 min in draflazine treated patients. Neither the vectorcardiographic nor biochemical measures of ischaemia differed between treatment groups.

CONCLUSION

Nucleoside transport inhibition by draflazine was well tolerated by patients with unstable coronary disease. It seems to be a promising method of adenosine enhancement in acute myocardial ischaemia. The potential cardioprotective effect of the drug needs further evaluation in larger trials.

[Suicidal thoughts and suicidal attempts among 15-24 years old individuals in the Danish educational system]

The purpose of the study is by the instrumentality of an anonymous and voluntary interview study to expose the extent of suicidal ideation and suicide attempts among 15-24-year-olds in the Danish educational system. 3042 persons participated in the study. About 40% of those interviewed had at least once had suicidal ideation and almost one in every twenty confirmed that they had attempted to commit suicide. Furthermore, the study showed that almost one in every ten had experienced suicide in the family. The study showed that frequent or chronical suicidal ideation and self-destructive behaviour can be considered risk factors of suicide attempts and possible predictors of future suicidal behaviour. It also appeared that the students who had experienced suicide in the family had a risk of committing suicide that was three times as high as that of the students who had not experienced suicide in the family. The results of the study also suggest that it is probably only the tip of the iceberg which is detected or registered by the treatment system. To all appearance, close on 75-90% of young suicide attempts are not registered officially. This bears witness of the fact that many of these 15-24-year-olds apparently received no help after their suicide attempt.

Thrombin inhibition with inogatran for unstable angina pectoris: evidence for reactivated ischaemia after cessation of short-term treatment

BACKGROUND

The acute coronary syndromes of unstable angina and non-Q-wave infarction are initiated by coronary plaque rupture and subsequent thrombus formation. Thrombin is central to this response as it activates platelets and the coagulation system. In an open design study we assessed the tolerability and safety of the low molecular weight thrombin inhibitor, inogatran, for unstable angina or non-Q-wave infarction.

METHODS

Thirty-seven patients, treated within 72 h of symptoms, were allocated consecutively to groups to receive a 4 h infusion with one of three doses of inogatran. Thrombin generation and activity were measured with plasma markers at baseline, after the 4 h treatment period and 4 h later. Ischaemia was monitored using continuous vectorcardiography during the 4 h of treatment and during the subsequent 4 h after inogatran infusion had been stopped, to detect any increase in ischaemic events after the period of treatment. In addition, 12 patients received inogatran as an infusion for 72 h.

RESULTS

Inogatran was tolerated well. There were no adverse haemodynamic effects or allergic reactions. Minor bleeding events were detected in 37% of the patients. The biochemical and vectorcardiographic findings indicated suppression of thrombin generation after the 4 h treatment period compared with baseline. During the first 4 h after inogatran treatment, thrombin activity and episodes of ischaemia were increased compared with during the treatment period.

CONCLUSION

Inogatran was tolerated well and was safe, but its discontinuation was followed by a reactivation of thrombin activity and ischaemia. Whether this reactivation represented a rebound phenomenon, or merely resulted from the discontinuation of an effective therapy, cannot be established from the present study.

Lack of prognostic significance of epidermal growth factor receptor and the oncoprotein p185HER-2 in patients with systemically untreated non-small-cell lung cancer: an immunohistochemical study on cryosections

The prognostic role of the epidermal growth factor receptor (EGFR) and the related receptor p185HER-2 in lung cancer is as yet undefined. We investigated the immunohistochemical expression of EGFR (monoclonal antibody R1; Amersham) and p185HER-2 (polyclonal antibody A485; Dako) in cryosections. A total of 186 unselected and systemically untreated patients with non-small-cell lung cancer (NSCLC) diagnosed and treated at Odense University Hospital, Denmark, were included. Median follow-up period was 66 months. EGFR and p185HER-2 was highly expressed in 55% and 26% of cases respectively. Expression of EGFR was independent of p185HER-2 expression. The expression of EGFR was higher in squamous cell carcinomas whereas the level of p185HER-2 staining was higher in adenocarcinomas. Expression of either or both receptors was not correlated with age, histological grading, stage and prognosis. We conclude that immunohistochemical detection of these growth factor receptors failed to demonstrate a prognostic significance in patients operated on for NSCLC.

The WHO-EURO Multicentre Study: risk of parasuicide and the comparability of the areas under study

The 15 areas under study in the WHO/Euro Multicentre Study on Parasuicide vary considerably with regard to socio-economic factors, culture, life-styles, etc. In this paper, the authors discuss whether the traditional high risk factors for suicidal behavior (such as unemployment, abuse, divorce, etc.) take on different weights depending on local societal and cultural settings. Results from analyzing covariations between various background factors characteristic of the different areas under study and the frequency of attempted suicide showed weak or insignificant correlations, indicating that high-risk factors can only be identified from international pooled data with great care.

Bone and collagen turnover during treatment with inhaled dry powder budesonide and beclomethasone dipropionate

OBJECTIVES

To assess bone and collagen turnover in asthmatic children treated with dry powder budesonide from the Turbuhaler and dry powder beclomethasone dipropionate from the Diskhaler in a dose of 800 micrograms/day.

SUBJECTS

Thirteen prepubertal children with asthma.

DESIGN

Open crossover study with two treatment periods and treatment free run-in and wash-out periods. All periods were of two weeks' duration. At day 14 in each period blood samples were taken for assessment of serum osteocalcin, the carboxyterminal propeptide of type I collagen (PICP), and the aminoterminal propeptide of type III collagen (PIIINP). At the same time urine was collected for assessment of creatinine corrected pyridinoline (uPYR/cr) and deoxypyridinoline (udPYR/cr) crosslinks.

RESULTS

Osteocalcin concentrations were not influenced by any of the treatments. During budesonide treatment mean (SEM) PICP was reduced by 18% (8%) (p = 0.03), PIIINP by 24% (3%) (p = 0.0002), uPYR/cr by 16% (6%) (p = 0.03), and udPYR/cr by 21% (13%) (p = 0.12). During treatment with beclomethasone dipropionate mean (SEM) PICP was reduced by 20% (6%) (p = 0.01), PIIINP by 36% (3%) (p = 0.0002), uPYR/cr by 18% (4%) (p = 0.004), and udPYR by 13% (5%) (p = 0.02). The suppressive effect of beclomethasone dipropionate on PIIINP was more marked than that of budesonide (p = 0.001).

CONCLUSION

Treatment with dry powder budesonide and beclomethasone dipropionate 800 micrograms/day is associated with suppression of bone and collagen turnover. The suppression seems to be more marked during treatment with beclomethasone dipropionate. Long term effects and effects of lower doses of budesonide and beclomethasone dipropionate on bone and collagen markers needs further study.

Cancer patients, doctors and nurses vary in their willingness to undertake cancer chemotherapy

Cancer patients' attitude to chemotherapy were compared with those of doctors, nurses and healthy controls. 98 cancer patients, 42 healthy subjects, 44 oncologists, 35 surgeons, 32 oncology nurses and 70 surgical nurses received a questionnaire presenting a hypothetical situation involving a toxic chemotherapy regimen. Each were asked to indicate the minimal benefit with respect to chance of cure, life prolongation and symptom relief they would demand to accept the treatment. The patients and the surgical nurses were most reluctant with regard to the treatment. The subgroup of patients under 50 years which matched the oncologists, surgeons and controls with respect to age, cohabitant status and children were significantly more willing to accept the regimen than the controls and professional groups. Patients under 40 years would accept the toxic treatment with hardly any benefit as chance of cure (7%, median), life prolongation (3 months) and symptom relief (8%). Among the professionals, oncologists were most willing to accept therapy, whereas surgical nurses and surgeons were least willing.

Do nonsteroidal anti-inflammatory drugs decrease the risk for Alzheimer's disease? The Rotterdam Study

Based on reports that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the risk for Alzheimer's disease (AD), we studied the cross-sectional relation between NSAID use and the risk for AD in a population-based study of disease and disability in older people. After controlling for age, education, gender, and use of benzodiazepines, we found a relative risk (RR) for AD of 0.38 (0.15 to 0.95) when comparing NSAID users (n = 365) to NSAID non-users (n = 5,893). To address confounding by indication or contraindication, we compared NSAID users with a subset of NSAID non-users who were using topical medication for ear, eye, or dermatologic conditions (n = 365). In this comparison, the adjusted RR for AD was 0.54 (0.16 to 1.78). These findings are compatible with a possible protective effect of NSAIDs on the risk for AD.

Classification of fish-pathogenic vibrios based on comparative 16S rRNA analysis

No systematic classification of fish-pathogenic vibrios has been accomplished previously despite the use of serological, physiological, and genetical classification systems. In this study, a comparative 16S rRNA analysis of 34 strains (representing seven species) of fish-pathogenic vibrios was performed. The 16S rRNA sequences were obtained by using reverse transcriptase. Nearly complete sequences were obtained for nine strains. On the basis of the results of this analysis, the remaining strains were investigated by analyzing selected stretches containing a total of 560 nucleotides. With the exception of a few strains, including ATCC 43313 (serovar O9), our comparative 16S rRNA analysis confirmed that strains preliminarily identified as Vibrio anguillarum were phylogenetically closely related. Strains of V. anguillarum could be divided into groups, with the main group containing serotype O1 and O2 strains isolated from Atlantic salmon, rainbow trout, turbot, cod, and saithe. The other distinctive group was represented by type strain NCMB 6. This strain was nearly indistinguishable from the type strains of Vibrio ordalii and Vibrio damsela on the basis of the 16S rRNA stretches compared. The results of a comparative 16S rRNA analysis justified the status of Vibrio salmonicida as a distinct species. Originally, this species was characterized biochemically as a very homogeneous species. However, two strains, which were isolated from diseased halibut and from the intestines of healthy cod, could not be distinguished from V. salmonicida strains phylogenetically, although they differed from the original species description in several phenotypic traits. Our results indicate that V. salmonicida and Vibrio fischeri form a cluster that is clearly separated from the cluster that includes V. anguillarum.

[Necrotizing enterocolitis. Occurrence in Western Denmark]

We reviewed the clinical presentation, subsequent course and outcome of 45 newborn infants with neuotizing enterocolitis (NEC) seen on eight neonatal intensive care units during a 10 year period (01.01.82-31.12.91). The average incidence of NEC was found to be 1.2 (0.3-3.8) per 10,000 liveborn infants with a tendency to increase during the period. Eighteen percent had a birth weight of less than 1,000 g. Thirty-six percent had a birthweight between 1,000 and 1,500 g. Twenty-nine percent had a birthweight between 1,500 and 2,500 g. The last group made up of 16% had birth weights above 2,500 g. The mortality was determined by the severity of the disease, being 0% for infants within Bell's stage I, 25% in Bell's stage II and 71% in Bell's stage III. Sixty-nine percent of the infants were diagnosed in stage III, probably because of low attention to NEC in its early stages. The prognosis of surviving infants was good with no gastrointestinal symptoms when evaluated four to five years later.