The UltraCision Harmonic Scalpel offers a surgical treatment of rhinophyma with efficacious intra- and postoperative hemostasis. The combination of simultaneous tissue dissection and hemostasis enables a good overall view and control of the surgical site. Based on its mechanical function, the UltraCision Harmonic Scalpel has only a little thermal effect on neighbouring tissues and a good tactile experience that enables a controlled tissue resection. The UltraCision Harmonic Scalpel combines the advantages of tissue dissection and simultaneous hemostasis with the controlled handling of the traditional scalpel in rhinophyma surgery.

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Lemierre syndrome is a rare condition which may also follow tonsillectomy. Under septic conditions, the resection of the internal jugular vein has to be performed to avoid serious complications.

Infective native valve endocarditis caused by Staphylococcus aureus accounts for approximately 35% of cases in patients without intravenous drug abuse and for 61% of cases in intravenous drug abusers [1]. While coagulase-negative staphylococci are the most commonly isolated organisms in prosthetic valve endocarditis, only 5% of cases of native valve endocarditis are due to these pathogens [2].The species Staphylococcus lugdunensis was described for the first time in 1988 [3].This organism differs from other coagulase-negative staphylocci in that it tends to cause a more virulent form of infective endocarditis, characterized by an acute onset and destructive clinical course with a high mortality rate similar to that of S. aureus endocarditis [4].An analysis of the 22 cases reported in the English language literature until 1997 revealed severe sequelae of S. lugdunensis endocarditis: Seven of eight patients who received only antibiotic treatment died and five of 14 patients with antibiotic treatment and operative valve replacement did not survive. 15 of these 22 patients developed severe cardiac complications such as heart insufficiency, perforation or destruction of valve, rupture of chordae tendineae or myocardial abscess [5].A previously healthy 22-year-old woman became acutely ill 8 days before admission with fever and fatigue.One week prior to the onset of symptoms, she had returned from a 3-week beach holiday in Bali. Further medical history was negative except for rhinitis atopica. Physical examination revealed a patient in good general health with a core temperature of 39.3 °C, heart rate 110/min and blood pressure 140/60 mmHg. A loud pansystolic murmur was heard at the apex. Peripheral signs of bacterial endocarditis were not detected. Transthoracic and transesophageal echocardiography identified a peduncular vegetation, measuring 1.5 ϫ 0.8 cm, on the anterior leaflet of the mitral valve ( Figure 1) with mild regurgitation. Left ventricular diameters and pump function were normal and all other valves showed no evidence of vegetations. Flow in the pulmonary veins was normal. Five days later regurgitation was increased and could be traced back to the pulmonary veins. C-reactive protein was 131 mg/l, the erythrocyte sedimentation rate was 95 mm in the first hour and hemoglobin 11.8 g/dl. ␣1-, ␣2-and ␤-globulins were slightly elevated in serum protein electrophoresis (5.9, 11.2 and 12.9 rel.%, respectively). Leukocyte count and the other values of clinical chemistry were within the normal range. Figure 1. Vegetation at the anterior mitral valve leaflet.

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