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Cases of the new variant Creutzfeldt-Jakob disease (vCJD) in human beings have to be anticipated in Germany. In subclinical vCJD, the accumulation of prions in lymphoid tissue has been identified prior to their manifestation in cerebral tissue. The remarkable resistance of prions to standard methods of sterilisation questions the safety of reusing metallic surgical instruments. The transmission of vCJD via such reusable surgical instruments in tonsillectomies and adenoidectomies cannot be excluded. In this study, 96 tonsillectomies and adenoidectomies were performed with disposable instruments made of a high performance polymer (Aesculap, Tuttlingen). No increase in the number of intra- or postoperative complications was evident. These disposable instruments may represent an alternative to reusable metallic surgical instruments in potentially infected patients or in patients desiring the use of disposable instruments during their operation for safety reasons.

The echocardiographic appearances of the mitral valve after reconstructive surgery for non-rheumatic mitral regurgitation have been studied. Twenty-two patients, divided into 3 groups, were studied. In group 1 there were 12 patients with ruptured chordae tendineae and/or anterior mitral leaflet perforation, who underwent chordal reattachment and plication of leaflets or commissures. After operation common abnormalities were slow (<70 mmis) diastolic EF slope (5 patients), multiple or dense echoes from valvular or subvalvular structures (5 patients), and abnormal posterior leaflet motion in diastole was observed in 3 patients. In group 2 there were 7 patients undergoing closure of an ostium primum atrial septal defect and primary repair by suture of a cleft anterior mitral leaflet. After operation slow EF slope occurred in 5 patients, but dense echoes were seen in only 1, and abnormal posterior leaflet echoes also in only 1. Group 3 consisted of3 patients undergoing Carpentier ring insertion in the mitral annulus, all of whom showed dense echoes from the ring, with a slow EF slope in 2, and abnormal posterior leaflet motion in 2. Residual mitral regurgitation was common, as indicated by persistent mitral murmurs in 14. Systolic prolapse was not seen after operation. We conclude that echocardiographic abnormalities are common after reconstructive surgery for non-rheumatic mitral regurgitation. These abnormalities include multiple, dense valvular and subvalvular echoes, and abnormally slow and restricted diastolic motion of both leaflets suggesting that thickening, fibrosis, and decreased mobility of the valve apparatus occur because of the surgical plications and postoperative inflammatory changes. These structural changes were noted to be frequently accompanied by persistent mitral regurgitation.The effect of operation on the mitral echogram has with ruptured chordae tendineae and/or mitral been evaluated previously, but such studies have leaflet perforation, patients with ostium primum concentrated on operations performed on rheumatic atrial septal defect with a cleft anterior mitral leaflet, mitral valves (Mary et al., 1973; Cope et al., 1975), and patients undergoing Carpentier ring anor on mitral replacement by various prostheses nuloplasty. (Brodie et al., 1976).In mitral regurgitation of non-rheumatic origin, Methods such as ruptured chordae tendineae caused by myxomatous degeneration or leaflet perforations All patients at the University of Iowa and Iowa City secondary to bacterial endocarditis, mitral recon-Veterans Administration Hospitals who had understructive surgery offers an alternative to valve gone mitral reconstructive surgery for nonreplacement (Gerbode et al., 1968; Selmonosky rheumatic mitral regurgitation were identified by and Ehrenhaft, 1969;Manhas et al., 1971). The reviewing the surgical files. Some were being ultrasonic appearances of the mitral valve after followed regularly in our clinics; others were reconstructive procedures for non-rheumatic ab-contacted and invited to return for r...