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Objective: To evaluate the additive and independent prognostic value of abnormal right ventricle (aRV) and pulmonary hypertension (PH) in patients undergoing mitral-tricuspid surgery., Methods: From January 2009 to December 2012, 541 patients underwent mitro-tricuspid surgery. The entire cohort was divided into 6 subgroups: 63 cases had normal RV and no PH (Group A), 180 normal RV but moderate PH (Group B), 101 normal RV but severe PH (Group C), 15 abnormal RV and no-PH (Group D), 86 abnormal RV and moderate PH (Group E) and 96 abnormal RV and severe PH (Group F)., Results: Forty-two (7.8%) patients died in hospital due to any cause: 1.6% in group A, 3.9% in group B, 8.9% in group C, 13.3% in group D, 9.3% in group E, 15.6% in group E, p = 0.005. Among 78 patients with no-PH, mortality was significantly higher in patients with aRV (1.6%vs 13.3%. p = 0.03). Among 344 patients with normal RV, mortality was significantly higher in patients with severe PH (1.6% vs 3.9% vs 8.9%. p = 0.03). Comparing the presence of both abnormal RV and severe PH with the remaining patients, mortality was significantly higher in the first group (15.6% 6.1%, p = 0.004). Multivariable analysis confirmed either the independent or the additive role of RV and PH., Conclusions: In patients undergoing mitral-tricuspid valve surgery, the presence of either RV dysfunction/dilatation or severe pulmonary hypertension, might play an independent prognostic role for mortality. The worst scenario is surely the contemporary presence of both conditions.

Usefulness of the coronary artery study has been questioned in patients with infective valve endocarditis. Fatal events are reported in the literature due to embolization of endocarditic vegetations during cardiac catheterization. For this reason, many authors do not recommend preoperative invasive coronary studies in these patients. We report the case of a 56-year-old patient with prosthetic valve endocarditis with vegetations, and concomitant risk factors for coronary disease. We did preoperative coronary screening using multi-detector computed tomographic scan imaging, which may be useful for noninvasive imaging of the coronary arteries in these patients with high risk of embolization.

MCPA residues were assayed in 18 urine samples collected from northern Italy herbicide spraymen. Urine was collected within less than or equal to 24 hr from workshift start and kept at -20 degrees C until analysis. Twenty-five-milliliter urine specimens were ether-extracted at pH 1 and then the free MCPA was turned into its methyl ester. Detection and quantitation were carried out by high-resolution gas chromatography coupled with low-resolution mass spectrometry (hrGC-lrMS) run in the multiple ion detection (MID) mode. Specimen mass chromatograms were referred to MCPA methyl ester external standards. Detection thresholds were 25 and 10 ppb when S/N ratios of approximately 10 and 2.5, respectively, were adopted for the quantitation ion mass. Mean recovery was better than 80% over the full concentration range tested (10-1000 ppb). Urine analysis yielded the following results: eight outcomes fell in the 10-50 ppb range, five outcomes in the 50-150 ppb range, and five in the 150-500 ppb range.