Background Composite T- grafts between left internal mammary artery ( LIMA) and radial artery (RA) are a common concept in complete arterial myocardial revascularization. The aim of the present study was to investigate whether the use of the great saphenous vein (SV) instead of RA leads to comparably good results in terms of outcome in this context. Methods Patients who underwent myocardial revascularization with a T-graft using RA or a segment of SV to the right coronary artery or circumflex artery between the beginning of 2014 and the end of 2019 at the Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel were included. To minimize surgical variation, only patients were observed by a single senior surgeon in the department. Exclusion criteria were previous cardiac surgery, preoperative extracorporeal circulatory support, off-pump surgery, additional aortocoronary bypasses, and cardiac combination procedures. Results A total of 115 patients were studied. In 55 patients, the T- graft was placed between the LIMA and SV, and in 60 patients, the T-graft was placed between the LIMA and RA. Patients in the SV group were older (70.6 +/- 7.8 vs. 58.5 +/- 10.0 years; p< 0.001), suffered more frequently from non-ST elevation myocardial infarction ( 12.7 vs. 1.7%; p <1/4> 0.027), arterial hypertension (83.6 vs. 61.7%; p 1/4 0.009), and atrial fibrillation (18.2 vs. 1.7%; p 1/4 0.003). They were less likely to be active smokers (16.4 vs. 38.3%; p 1/4 0.009) and less likely to have a history of variceal surgery (0 vs. 15.0%; p 1/4 0.003). Calcification of the ascending aorta was also found more frequently in the saphenous group (18.2 vs. 3.3%, p 1/4 0.009). Operative times and number of distal anastomoses did not differ significantly between the two groups. Postoperative deliriums ( 16.7 vs. 5.0%; p 1/4 0.043) were observed more frequently in venous patients. Wound healing disorders of the leg (11.1 vs. 0%; p 1/4 0.011) did only occur in SV group and wound infections of the arm only in the RA group. Complete follow-up was achieved in 74.8% of cases. Median follow-up was 60.3 (39.6; 73.2) months. Serious adverse cardiac- cerebral events (19.0 vs. 22.7%; p 1/4 0.675) and mortality (14.5 vs. 6.7%; p 1/4 0.167) did not differ significantly between the groups at follow-up. Myocardial infarction (0 vs. 2.5%; p 1/4 1.000) and stroke (0 vs. 7.5%; p 1/4 0.245) were observed exclusively in RA group. Percutaneous coronary intervention was required in single patients of RA group (0 vs. 15.0%; p 1/4 0.028). No patient from either group underwent repeat coronary artery bypass grafting (CABG). The patients of SV group had angiographically competent grafts and open anastomoses. Graft failure was noted in a single patient in RA group, in which case both grafts and native coronary vessels were stented. Kaplan-Meier analysis revealed no significant survival disadvantage for SV group compared with RA group. Conclusion CABG with a composite T- graft between LIMA and a segment of SV may be comparable to bypass surgery with a composite T-graft between LIMA and RA. This might be true in terms of morbidity and mortality over an intermediate-term observation period. The results of our studies give rise to the hypothesis that the decision not to perform aortic bypass anastomosis may be more important than the choice of graft material.

Pediatric melanoma is difficult to clinically detect, which can delay diagnosis. Diagnostic tools, such as dermatoscopes, have evolved, improving evaluation and management of pigmented lesions. We sought to quantify biopsy rates of pigmented lesions and assess clinical suspicion in pediatric patients in a large US health system to assess changes over time. We identified a cohort of patients ages 0-18 years who underwent biopsies of skin lesions in 2004, 2007 and 2010. Using electronic data from a large health plan, biopsy rates for incident pigmented lesions and confidence intervals were calculated. Differential diagnoses recorded by clinicians at time of biopsy were used to classify lesions into categories of low, intermediate, high or unknown clinical suspicion. Kappa coefficients were calculated to compare histology with clinical suspicion. We identified 251 health plan pediatric patients for biopsy rate calculation. Biopsy rates of lesions that were pigmented declined by 44% from 2004 (182.9/100,000) to 2010 (102.0/100,000). Rates declined more in older children, with a 52.9% decline in preadolescents aged 10-14 years old and 53.3% in adolescents aged 15-18 years old. Biopsies of intermediate clinical suspicion declined by 64.3% during the study period with concurrent improvement in the kappa coefficients between clinical suspicion and histology: 0.04, 0.06 and 0.10 respectfully. Pediatric biopsy rates of lesions that were pigmented declined between 2004 and 2010, especially among preadolescents and adolescents. We theorize that clinicians may be more confident in their differential diagnoses due to improved diagnostic ability or patient reassurance related to the use of dermatoscopes. Findings may refute concerns of an increase in medically unnecessary skin biopsies, at least in the pediatric population.

Mia Gallagher1, Maryam Asgari2, Joseph Boscarino3, James Burmester4, Lee Cromwell1, Melody Eide5, Heather Feigelson6, Jennifer Kuntz7, Lois La Grenade8, Eric Macy9 and David Margolis10 1Kaiser Permanente Southeast 2Kaiser Permanente Northern California 3Geisinger Health System 4Marshfield Clinic/Security Health Plan of Wisconsin 5Henry Ford Health System/Health Alliance Plan 6Kaiser Permanente Colorado 7Kaiser Permanente Northwest 8Food and Drug Administration 9Kaiser Permanente Southern California 10University of Pennsylvania

Introduction: Aortic dissection is a rare complication in minimally invasive mitral valve procedure. We describe our new transatrial cannulation technique of the left ventricle for arterial return in acute retrograde type A dissection during minimally invasive mitral valve surgery.

Introduction: The best management for patients requiring coronary artery bypass surgery (CABG) with severe calcification of the ascending aorta remains a topic of debate. We describe our new transatrial cannulation technique of the left ventricle for arterial return in on-pump CABG procedure.

Objectives: The arterial cannulation of patients with acute type A aortic dissection remains controversial. We would like to present a new method by Rahimi for cannulation of the left ventricle transatrial at the inflow site of the upper right pulmonary vein to establish arterial return for cardiopulmonary bypass (CPB) in patients with acute type A aortic dissection.

This article discusses service journalism - the way the news media provide their audiences with information, advice and help about the problems of everyday life - in light of the cheery of the public sphere and the growth of subpolitics fostered by reflexive modernization. Service journalism addresses two main types of everyday problem - grievances and risks - but it tends to subsume the former under the latter due to the effects of promotionalism as an increasingly dominant logic shaping the popularization of media formats and content. Apropos the public sphere debate, we argue that service journalism addresses a hybrid social subject - part citizen, part consumer and part client. Moreover, despite the fact that service journalism tends to individualize problems, it is amenable to politicization inasmuch as it shares common ground - the problems of everyday life - with the social movements and advocacy/activism groups that are the collective, motive forte of subpolitics. Subpolitics politicizes the problems of everyday life in the way that it tends to subsume risk under grievance and break with the exclusionary, binary logic of mediational politics. This allows plural identities, individualistic and collectivistic, to coexist in an ambivalent and fluid way.

Objective. To gain longterm knowledge of incidence rates of ectopic pregnancy, as a basis for analysing risk factors.Material. The incidence of ectopic pregnancy was studied in the county of Hordaland,Western Norway, through 18 years, 1976-1993. The protocols of 1821 cases of ectopic pregnancy were registered. Population data of the county, the number of births and legal abortions were available.Results. There was considerable increase in crude numbers of ectopic pregnancies throughout the period. Grouping the cases in three six-year periods showed an increased crude incidence rate per 100 000 women from 95 during 1976-81 to 154 during 1988-93. The corresponding rates per 1000 births increased from 13.6 to 22.2 and the rates per 1000 reported pregnancies from 11.2 to 18.0. All rates increased also in women aged 40-44 years. During the years 1979-1993 the rates per 1000 reported pregnancies increased by 25%, from 9.4 to 11.8 in age groups below 30 years, while the rates for women over 35 years increased by 98%, from 20.7 to 40.9. Compared to the age group 15-19, women over 35 years had an eightfold risk during the last period. In addition they also contributed to higher numbers of reported pregnancies by 58%.Conclusion. The rates of ectopic pregnancy increased in age groups older than 20 years during 1976-93, moderately in younger age groups, but considerably in older age groups, who also contributed with higher total rates of pregnancy. More older women, with presumably accumulated risk factors getting pregnant, thus explain part of the increased rates of this disease.

A social history of a popularization process of major importance for a national press structure forms the basis of this article. Today's largest circulation newspaper in Norway is the case in point. Vardens Gang (now known under the acronym VG) grew out of the resistance movement during the Second World War, and set out with the ambition of being 'a new kind of newspaper'. However, economic problems soon fuelled a popularization process, and gradually the ground was cleared for a sensational growth in circulation numbers. What happened to the original ideals, and to the new kind of newspaper? Answers are indicated by focusing on changes in the newspaper's modes of addressing its readers and their everyday roles, and by paying particular attention to a 'service and campaign journalism' and to a certain kind of 'newspaper schizophrenia'. On this basis, the author warns against a crude essentialism in the understanding of popular journalism.

EDITORIAL COMMENT: As regular readers of the Journal will know we have published a number of papers recently on the subject of screening for group B beta‐haemolytic streptococcal (GBS) colonization of the vagina in pregnancy. This is the first paper we have published on the important problem of identification in labour of women who are GBS‐carriers so that appropriate antibiotic therapy can be given to them and their infants after delivery. It shows that the current technology is inadequate to quickly and reliably identify GBS‐carrier women.Summary: We have compared an enzyme immunoassay (ICON Strep B, Hybritech) with cultures for emonstration of genital carriage of group B streptococci (GBS) in pregnant women, and studied the relationship between vaginal and rectal carriage of this organism. Pertinent literature has also been reviewed. Two hundred pregnant women at gestational week 17 were included. Swabs from the uterine cervix were tested for GBS by ICON Strep B immunoassay and ordinary cultures on blood agar. Additional swabs from the rectum were tested by cultures. The percentage of women with GBS in cervical secretions was 13.5o7o (27/200) by cultures and 4% (8/200) by the ICON Strep B immunoassay. The overall sensitivity of the immunoassay was 7.4%, and the specificity 96.5%. In conclusion, the sensitivity of rapid enzyme immunoassays is too low for accurate screening of GBS in the genital tract of pregnant women.

An einem ausgewählten Krankengut mit verschiedenartigen Infektionen wurde die Wirkung von lokal appliziertem Gramaxin® geprüft. Nach unseren Ergebnissen sprachen 14 von 21 Patienten sehr gut an, 4 bedurften wegen einer Mischinfektion einer antibiotischen wurden unter einer lokalen Gramaxin-Behandlung nicht beobachtet. Die lokale Anwendung von Gramaxin erwies sich bei Infektionen mit cephalosporinempfindlichen Keimen als besonders effektiv.