Fractures about the orbit in professional American football players

A retrospective review was performed of records for players who suffered fractures about the orbit during participation in officially sponsored activities of the National Football League from 1980 to 1997. Clinical information was obtained on 19 of 29 players who sustained orbital fractures. The most common signs and symptoms included decreased visual acuity (74%, 14), decreased eye movement (42%, 8), hyphema (37%, 7), and infraorbital numbness (21%, 4). The mechanisms of injury were a digital poke (74%, 14) and blunt facial trauma (26%, 5). There were significantly more orbital fractures than zygomatic fractures suffered by offensive linemen as compared with all other positions. Fifteen of 19 players were managed with surgical reconstruction; 4 players were treated nonoperatively. The mean time from injury to surgical procedure was 7.7 days (range, 0 to 42). The mean interval to follow-up was 45.6 months (range, 3 to 146). At follow-up examination, eight (53%) of the patients treated surgically still reported diplopia with upper field gaze. Three of the four patients treated nonoperatively were asymptomatic. The mean time lost from games or practice was 25 days (range, 5 to 56). Ultimately, 17 (89%) players with orbital fractures were able to return to full football activities. Two patients were unable to resume their careers because of residual visual impairment.

Outbreak of human monkeypox, Democratic Republic of Congo, 1996 to 1997

Human monkeypox is a zoonotic smallpox-like disease caused by an orthopoxvirus of interhuman transmissibility too low to sustain spread in susceptible populations. In February 1997, 88 cases of febrile pustular rash were identified for the previous 12 months in 12 villages of the Katako-Kombe Health Zone, Democratic Republic of Congo (attack rate = 22 per 1,000; case-fatality rate = 3.7%). Seven were active cases confirmed by virus isolation. Orthopoxvirus- neutralizing antibodies were detected in 54% of 72 patients who provided serum and 25% of 59 wild-caught animals, mainly squirrels. Hemagglutination-inhibition assays and Western blotting detected antibodies in 68% and 73% of patients, respectively. Vaccinia vaccination, which protects against monkeypox, ceased by 1983 after global smallpox eradication, leading to an increase in the proportion of susceptible people.

Phenolic antioxidants attenuate neuronal cell death following uptake of oxidized low-density lipoprotein

Oxidative stress is implicated in neuronal loss associated with neurodegeneration such as in Parkinson's disease, Alzheimer's disease and age-related cognitive decline. Recent reports indicate that the consumption of flavonoid-rich fruits partly reverses the age-related neuronal and cognitive decline. In this study, cultured striatal neurons were exposed to oxidized lipids in the form of low-density lipoprotein (oxLDL) as a model for the induction of oxidative injury, and the abilities of phenolic antioxidants, flavonoids and hydroxycinnamic acid derivatives, to attenuate this neuronal damage were examined. OxLDL was demonstrated to enter neuronal cells and to be capable of eliciting neurotoxicity in a dose- and time-dependent manner, inducing DNA fragmentation and cell lysis. Flavonoids exert protective effects, which appear to be related to specific structural characteristics, particularly relevant being those defining their reduction potentials and partition coefficients. In summary, these data suggest a possible role for flavonoids in reducing neurodegeneration associated with chronic disorders in which oxidative stress is implicated.

Copper coordination in blue proteins

The spectroscopic and electrochemical properties of blue copper proteins are strikingly different from those of inorganic copper complexes in aqueous solution. Over three decades ago this unusual behavior was ascribed to constrained coordination in the folded protein; consistent with this view, crystal structure determinations of blue proteins have demonstrated that the ligand positions are essentially unchanged on reduction as well as in the apoprotein. Blue copper reduction potentials are tuned to match the particular function of a given protein by exclusion of water from the metal site and strict control of the positions of axial ligands in the folded structure. Extensive experimental work has established that the reorganization energy of a prototypal protein, Pseudomonas aeruginosa azurin, is approximately 0.7 eV, a value that is much lower than those of inorganic copper complexes in aqueous solution. The lowered reorganization energy in the protein, which is attributable to constrained coordination, is critically important for function, since the driving forces for electron transfer often are low (approximately 0.1 eV) between blue copper centers and distant (>10 A) donors and acceptors.

Sex-role traits and self-monitoring as dimensions of control: women with bulimia nervosa vs. controls

OBJECTIVE

The study investigated sex-role traits and self-monitoring styles as two dimensions of self-control amongst women with bulimia nervosa and normal controls.

DESIGN AND METHODS

The participants were 30 women with bulimia nervosa and 40 normal controls who completed questionnaires, which assessed bulimic symptoms, sex-role traits, and Synder's Self-Monitoring Scale.

RESULTS

Women with bulimia nervosa were found to identify more strongly than controls with negative feminine traits and Other Directedness, a style of self-monitoring that focuses on pleasing others.

CONCLUSIONS

These findings reinforce the notion that women with bulimia nervosa lack assertiveness skills and that the strategies they have developed in their interactions with others can be described as a Negative Yielding style of self-control.

Management of unicompartmental arthritis in the anterior cruciate ligament-deficient knee

There exists a group of patients who are difficult to manage because they have both anterior knee instability secondary to anterior cruciate ligament deficiency and unilateral degenerative joint disease. A large majority of these patients report a history of previous meniscal injury or meniscectomy after knee trauma at a relatively young age. Active patients who report symptomatic knee instability or pain associated with athletics or activities of daily living after conservative treatment may be indicated for surgery. Current endoscopic methods of anterior cruciate ligament reconstruction result in low patient morbidity, the elimination of anterior knee instability, and a timely return of function. Osteotomies about the knee joint are an effective means of treating unicompartmental knee arthrosis. Long-term studies have demonstrated that knee osteotomy is a good surgical option for patients with unicompartmental arthritis who are considered too young for total knee arthroplasty. We describe a comprehensive treatment approach to the patient with anterior cruciate ligament deficiency and isolated medial or lateral osteoarthritis. An assessment of pain symptoms, instability symptoms, and lower extremity alignment is used to formulate a treatment plan.

Identification of a novel gene cluster encoding staphylococcal exotoxin-like proteins: characterization of the prototypic gene and its protein product, SET1

We report the discovery of a novel genetic locus within Staphylococcus aureus that encodes a cluster of at least five exotoxin-like proteins. Designated the staphylococcal exotoxin-like genes 1 to 5 (set1 to set5), these open reading frames have between 38 and 53% homology to each other. All five proteins contain consensus sequences that are found in staphylococcal and streptococcal exotoxins and toxic shock syndrome toxin 1 (TSST-1). However, the SETs have only limited overall sequence homology to the enterotoxins and TSST-1 and thus represent a novel family of exotoxin-like proteins. The prototypic gene in this cluster, set1, has been cloned and expressed. Recombinant SET1 stimulated the production of interleukin-1beta, interleukin-6, and tumor necrosis factor alpha by human peripheral blood mononuclear cells. PCR analysis revealed that set1 was distributed among other strains of S. aureus but not in the other staphylococcal species examined. Sequence analysis of the set1 genes from different strains revealed at least three allelic variants. The protein products of these allelic variants displayed a 100-fold difference in their cytokine-inducing potency. The distribution of allelic variants of the set genes among strains of S. aureus may contribute to differences in the pathogenic potential of this bacterium.

The water quality of the River Kennet: initial observations on a lowland chalk stream impacted by sewage inputs and phosphorus remediation

The water quality of seven sites on the upper reaches of the River Kennet round the market town of Marlborough is described and related to the introduction of phosphorus treatment of effluent from Marlborough sewage treatment works (STW). The River Kennet is mainly groundwater-fed from a Cretaceous chalk aquifer and hence the river water is calcium- and bicarbonate-bearing and has a relatively constant composition of many major water quality determinants. In-stream biological activity gives rise to marked diurnal fluctuations in pH (of approx. 0.8 units). Dissolved carbon dioxide and dissolved oxygen also show marked diurnal fluctuations. Dissolved carbon dioxide varies from approximately 10 to 70 times atmospheric pressure, indicating net release of carbon dioxide and the dominance of heterotrophic (respiratory) processes over autotrophic processes (photosynthesis). Much of the excess carbon dioxide is probably associated with carbon dioxide laden groundwater inputs and the relatively short within-stream residence times ensures only limited degassing to the atmosphere. Diurnal fluctuations in dissolved oxygen vary from approximately 20% to 200% saturation. For both dissolved carbon dioxide and dissolved oxygen, the amplitude of fluctuations is much lower during the winter period, when biological activity is at its lowest. The concentrations of soluble reactive phosphorus (SRP), total phosphorus (TP) and boron increase markedly just downstream of the sewage works as a result of this point source input. These concentrations slowly decline further downstream as additional groundwater inputs dilute the effluent further. The introduction of chemical treatment of sewage effluent for phosphorus reduction at Marlborough STW resulted in a marked decrease in within-river SRP and TP concentrations to levels approximately the same as those upstream of the STW. A comparison of SRP and boron concentrations reveals a reduction in in-stream SRP concentrations by approximately 75% following effluent treatment. In terms of within-river processes controlling in-stream phosphorus concentrations, previous studies have indicated that one potentially important mechanism within calcium bicarbonate bearing rivers may be related to co-precipitation of phosphorus with calcium carbonate (calcite). The present study shows that the waters are oversaturated with respect to calcium carbonate, that no equilibrium conditions exist and that phosphorus removal has led to undetectable changes in calcium carbonate oversaturation. Hence, it is concluded that the primary changes in phosphorus levels within the river is directly associated with changing point source contributions from the STW and physical dilution within the river. However (1) the results relate to only the first year of study and subsequent differences may become apparent and (2) reactions between the water column and plant and bottom sediment interfaces may be important in regulating phosphorus fluxes within the river. The results presented in this paper mark a pilot phase of a longer-term initiative and this paper provides a background setting. The paper discusses the longer-term objectives and important gaps in knowledge of the system that requires further address.

Conclusions to the special issue of Science of the Total Environment concerning 'The water quality of UK rivers entering the North Sea'

This paper presents an overview of the water quality functioning of eastern UK rivers draining into the North Sea. It summarises the results of three special issues of Science of the Total Environment and related work and complements a companion bibliography (Neal and Turner, 2000, this volume). The rivers are described in straightforward broad terms, and the reader is guided via the bibliography to the special volumes for the detailed findings. The water quality is shown to be highly variable over space and time. The changes over the past 300 years reflect first the transition from a rural society to the major impact of the industrial revolution and subsequently to one of the worlds' most successful environmental cleanups. The present water quality reflects the relative impacts of diffuse agricultural sources, urban and industrial point source discharges together with background inputs associated with geology: all these can be modified by within-river processes associated with physical mixing, biology and inorganic reactions. The work is set within the context of water quality, modelling and flux outputs to the North Sea and contemporary and future environmental research and management needs. A range of environmental impact studies is included. The detailed information is now available on a major and easily accessible database.

The water quality of the River Thames at a rural site downstream of Oxford

Water quality information is presented for the River Thames 34 km downstream of the market town of Oxford in Oxfordshire to provide an overview of the hydrochemical functioning of a major agriculturally impacted river entering the North Sea. The data, which cover the period from the spring of 1997 to the spring of 1999, relate to three types of data. These types are: (1) weekly spot sampling for determination of major, minor and trace elements, pH, alkalinity and herbicides; (2) tri-weekly spot sampling for pH, alkalinity and dissolved silicon; and (3) continuous measurements of pH and dissolved oxygen. Calcium and bicarbonate provide, respectively, the dominant cation and anion in solution and their compositions remain relatively constant through time, irrespective of flow levels. In contrast, many determinands show seasonally related fluctuations. Concentrations for most of the major anions, sodium, potassium as well as soluble reactive phosphorus and several soluble trace elements such as boron, antimony, arsenic and molybdenum decrease as flow increases. A reverse pattern is observed for nitrate, some herbicides and trace elements associated with particulate phases: concentrations increase with increasing flow. These patterns reflect the influence of: (1) a calcium carbonate rich groundwater system which provides the main stream flow component; (2) dilution of point source pollutant inputs associated with sewage and possibly light industry at high flows for several major, nutrient and trace elements; (3) enhanced nitrate and herbicide runoff from agricultural land at high flows; (4) enhanced microparticulate trace metal levels associated with increased suspended sediment loads at high flows; and (5) biological processes which affect pH, dissolved silicon, dissolved carbon dioxide and dissolved oxygen levels. An examination of soluble reactive phosphorus (SRP) and boron relationships reveals a reduction in concentrations for SRP associated possibly with phosphorus removal from a major sewage treatment works on an upstream tributary of the Thames, the Thame.

Temporal and small-scale spatial variations of dissolved oxygen in the Rivers Thames, Pang and Kennet, UK

Small-scale spatial dissolved oxygen concentrations were measured on three rivers by taking a number of transects along a river reach. Temporal (diurnal) variations were measured by use of continuous (15-min) monitors located at the mid-transect of the spatial observations. Spatial variation of dissolved oxygen concentrations were found to be relatively small (approx. +/- 10% dissolved oxygen) and biologically insignificant compared to diurnal changes under conditions of high productivity (approx. +/- 60% dissolved oxygen). The diurnal curves were analysed in order to estimate values of reaeration, photosynthesis and respiration on a daily basis for almost 3 months using process-based analytical techniques (the Delta and Hornberger and Kelly methods). The River Kennet was shown to be the most productive river followed by the River Pang and then the River Thames. The patterns of reaeration, photosynthesis and respiration and the behaviour of the three rivers are discussed.

The water quality of the Great Ouse

The results of a 1-year detailed water quality study of the Great Ouse are presented. Being recharged to an important degree from groundwater sources within the carbonate bearing bedrock, the waters are enriched in base cations and they are of relatively high alkalinity (approx. 4000 microEq./l) and pH (approximately 8). Many chemical constituents such as sodium, chloride, boron, nitrate and soluble reactive phosphorus vary over time in response to changing flow conditions. For most determinands, concentrations decrease with increasing flow in response to dilution of point and groundwater sources by rainfall. However, for barium and nitrate, concentrations increase with flow and this is indicative of increased runoff from the agriculturally impacted soils. While this feature is certainly expected for nitrate due to fertiliser application, the pattern for barium is at face value unexpected as it would normally be expected to behave like other divalent base cations such as calcium, coming from aquifer leaching. However, it seems that agricultural disturbance of the land can also lead to enhanced runoff: a feature now becoming apparent in several UK studies. The concentrations of micro-organic herbicides vary over time in response to the different times of application and only isoproturon shows a clear response to varying flow conditions. With regards to biological processes, this is manifest by changes in pH, dissolved carbon dioxide and silica. At most times of the year the waters are oversaturated with respect to atmospheric CO2 (EpCO2) by a factor of approximately 6 and at these times pH is approximately 7.7 and silica concentrations are approximately 4 mg-Si/l. However, in the early spring period pH increases to values over 8, EpCO2 declines to about the atmospheric levels and silica declines to approximately 1 mg-Si/l. This change probably reflects the dynamic diatom blooms and decays common in this river.

Rapid screening for putative exported proteins from Staphylococcus aureus using alkaline phosphatase as a reporter molecule

Staphylococcus aureus causes a wide range of infections in humans, ranging from superficial skin infections to the more serious toxin-mediated diseases such as toxic shock syndrome. Owing to the increasing resistance of this bacterium to a wide range of antibiotics, the need to determine the virulence factors involved in infection is becoming more important as these molecules are potential therapeutic targets. In this study, we have screened for putative exported proteins from S. aureus on the basis that these proteins are likely to be the first point of contact between the bacterium and host during infection. We have constructed gene fusions between S. aureus DNA and a truncated version of the Escherichia coli phoA gene, and we report on the characterization of the recombinants exhibiting alkaline phosphatase activity. As well as known S. aureus proteins, we have identified a number of putative open reading frames that encode proteins similar to those from nonstaphylococcal species and also unique proteins that do not have any homologues on the current databases.

The effect of ciprofloxacin on tendon, paratenon, and capsular fibroblast metabolism

The pathologic mechanisms underlying fluoroquinolone-induced tendinopathy are poorly understood. The observed incidence of tendinitis and tendon rupture in patients treated with ciprofloxacin hydrochloride suggests that the fluoroquinolone antibiotics alter tendon fibroblast metabolism. The purpose of this study was to examine the effect of ciprofloxacin on fibroblast metabolism in vitro. Canine Achilles tendon, paratenon, and shoulder capsule specimens were maintained in culture with ciprofloxacin (5, 10, or 50 microg/ml). Fibroblast proliferation, collagen synthesis, proteoglycan synthesis, and matrix-degrading activity were analyzed. Incubation of Achilles tendon, Achilles paratenon, and shoulder capsule fibroblasts with ciprofloxacin resulted in a statistically significant 66% to 68% decrease in cell proliferation compared with control cells at day 3 in culture. Ciprofloxacin caused a statistically significant 36% to 48% decrease in collagen synthesis compared with controls in all fibroblast cultures. Ciprofloxacin caused a statistically significant 14% to 60% decrease in proteoglycan synthesis in all fibroblast cell lines. Compared with unstimulated control fibroblasts, culture media from Achilles tendon, paratenon, and shoulder capsule cells that were exposed to ciprofloxacin demonstrated statistically significant increases in matrix-degrading proteolytic activity after 72 hours in culture. This study demonstrates that ciprofloxacin stimulates matrix-degrading protease activity from fibroblasts and that it exerts an inhibitory effect on fibroblast metabolism. The increase in protease activity and the inhibition of both cell proliferation and the synthesis of matrix ground substance may contribute to the clinically described tendinopathies associated with ciprofloxacin therapy.

Simple rules yield complex food webs

Several of the most ambitious theories in ecology describe food webs that document the structure of strong and weak trophic links that is responsible for ecological dynamics among diverse assemblages of species. Early mechanism-based theory asserted that food webs have little omnivory and several properties that are independent of species richness. This theory was overturned by empirical studies that found food webs to be much more complex, but these studies did not provide mechanistic explanations for the complexity. Here we show that a remarkably simple model fills this scientific void by successfully predicting key structural properties of the most complex and comprehensive food webs in the primary literature. These properties include the fractions of species at top, intermediate and basal trophic levels, the means and variabilities of generality, vulnerability and food-chain length, and the degrees of cannibalism, omnivory, looping and trophic similarity. Using only two empirical parameters, species number and connectance, our 'niche model' extends the existing 'cascade model and improves its fit ten-fold by constraining species to consume a contiguous sequence of prey in a one-dimensional trophic niche.

Drinking restraint versus alcohol expectancies: which is the better indicator of alcohol problems?

OBJECTIVE

The relationship between expectancies and other psychological constructs related to drinking is unclear. The current study assesses the power of drinking restraint, measured by the Temptation and Restraint Inventory (TRI), along with alcohol expectancy and drinking refusal self-efficacy, measured by the Drinking Expectancy Profile (DEP), as indicators of alcohol use and problem drinking.

METHOD

Volunteer students (N = 359), consisting of 113 men with a mean (+/-SD) age of 25.31 +/- 10.61 years and 246 women with a mean age of 23.04 +/- 8.90, completed the TRI, DEP and Alcohol Dependence Scale (ADS) as well as frequency and quantity measures of self-reported drinking.

RESULTS

Drinking Restraint was a stronger indicator of higher scores on the ADS, accounting for 54% and 45% of the variance for men and women, respectively, with Alcohol Expectancies and Drinking Refusal Self-Efficacy being the better indicator of frequency of alcohol consumption, accounting for 20% of the variance for men and 26% for women. Both measures were represented by similar variances within the quantity of drinking measure.

CONCLUSIONS

Drinking restraint and alcohol expectancies were seen to measure kindred but unique cognitive subsets, providing further insight into the progression of alcohol problems. Alcohol expectancies and drinking refusal self-efficacy may be acquired early in the development of drinking behavior, as evidenced by stronger associations with risky drinking; drinking restraint and its associated loss of control factors appear to be more specifically related to problem drinking. Alcohol expectancy and drinking refusal self-efficacy may thus have broader use in the assessment of drinking behavior.

Crimean-congo haemorrhagic fever: a seroepidemiological and tick survey in the Sultanate of Oman

In 1995 and 1996, 4 persons from the Sultanate of Oman were confirmed with clinical Crimean-Congo haemorrhagic fever (CCHF). To assess the prevalence of CCHF virus infection in Oman, a convenience sample of imported and domestic animals from farms, abattoirs and livestock markets was examined by enzyme-linked immunosorbent assay (ELISA) for immunoglobulin G (IgG) antibodies to CCHF virus. Ticks were collected from selected animals, identified, pooled by species, host and location and tested for evidence of infection with CCHF virus by antigen-capture ELISA. Serum samples from individuals working in animal and nonanimal contact-related jobs were also tested for CCHF antibodies. Serological evidence of infection was noted in 108 (22%) of 489 animals. Most of the ticks collected (618 of 912) from all species of sampled livestock were Hyalomma anatolicum anatolicum, a competent vector and reservoir of CCHF virus. 243 tick pools were tested for CCHF antigen, and 19 pools were positive. Of the individuals working in animal contact-related jobs, 73 (30.3%) of 241 non-Omani citizens and only 1 (2.4%) of 41 Omani citizens were CCHF antibody-positive. Butchers were more likely to have CCHF antibody than persons in other job categories. The presence of clinical disease and the serological results for animals and humans and infected Hyalomma ticks provide ample evidence of the presence of CCHF virus in yet another country in the Arabian Peninsula.

Knowledge of fetal alcohol syndrome (FAS) among natives in Northern Manitoba

OBJECTIVE

To investigate knowledge about fetal alcohol syndrome (FAS) among Natives in northern Manitoba. A second objective was to determine if there are age or gender differences in level of knowledge. A third objective was to examine the relationship between knowledge about FAS and reported frequency of drug and alcohol use during pregnancy.

METHOD

A nonrandom sample of 466 Natives from northern Manitoba was interviewed about drug and alcohol use during pregnancy and knowledge of FAS. The sample was proportionately representative of the 26 northern reserves, with an approximately equal number of male and female subjects ranging in age from 13 to 71 years.

RESULTS

Northern Manitoban Natives have lower levels of FAS knowledge than the general public. Of this sample, 80% believed drinking alcohol could adversely affect the unborn baby and 36% had heard of FAS, compared to 90% and 64%, respectively, in the general U.S. population. Natives in their 20s and 30s were more knowledgeable than Natives in their 50s and 60s. Females tended to be more knowledgeable than males. Drug and alcohol use during pregnancy is high (51% of women report drinking during one or more pregnancies) and the relationship between FAS knowledge and drug use during pregnancy appears weak. Young people were the most knowledgeable about FAS but also the most likely to report having used drugs or alcohol during pregnancy.

CONCLUSIONS

The low levels of knowledge about FAS among the Native population supports the need for continued education. However, the results also suggest that education by itself may be insufficient to make dramatic changes in behavior.

Staphylococcus aureus stimulates inducible nitric oxide synthase in articular cartilage

OBJECTIVE

To determine if Staphylococcus aureus stimulates the L-arginine-nitric oxide (NO) synthase pathway in articular cartilage.

METHODS

A heat-killed and sonicated (denatured) S. aureus preparation was added to cultures of bovine articular cartilage. NO production was measured as accumulated nitrite in the culture medium and by the NO synthase-dependent conversion of 3H-L-arginine to 3H-L-citrulline in cartilage homogenates. Inducible NO synthase (iNOS) messenger RNA (mRNA) expression was analyzed by Northern blot. Proteoglycan synthesis was measured by 35SO4 incorporation into glycosaminoglycan.

RESULTS

Nitrite accumulation and 3H-L-citrulline formation in cartilage were elevated by denatured S. aureus (compared with unstimulated control cartilage) and inhibited by the NO synthase inhibitor N(G)-monomethyl-L-arginine. Northern blot analysis revealed increased iNOS mRNA expression in bovine chondrocytes in response to denatured S. aureus stimulation. Denatured S. aureus suppressed the accumulation of 35SO4-labeled macromolecules representing newly synthesized proteoglycans in bovine articular cartilage. The suppressed proteoglycan synthesis was due to the presence of NO.

CONCLUSION

These findings support the hypothesis that a component of S. aureus can stimulate iNOS in articular cartilage, and that NO generated from this enzyme down-regulates cartilage matrix proteoglycan synthesis.

Randomized controlled trial of stented and stentless aortic bioprotheses: hemodynamic performance at 3 years

A randomized prospective trial was undertaken to compare the hemodynamic performance and left ventricular regression after aortic valve replacement with the Toronto SPV stentless bioprosthesis and the Carpentier Edwards SAV (CE) bioprosthesis. Forty patients were randomized after the annular and sinotubular diameters had been measured. Early hemodynamic measurements were made with a thermodilution cardiac output catheter, and echocardiography was used thereafter. Left ventricular mass was assessed using magnetic resonance imaging (MRI) at 1 week, 6 months, and 32 months. The mean annular size was 25.3+/-2.2 mm (CE) and 25.5+/-1.5 mm (Toronto), although it was possible to implant valves with a mean diameter 3 mm larger in the stentless group (26.0+/-1.7 mm cf. 23.0+/-1.7 mm). Hemodynamic performance in the first 24 hours showed no significant difference between the groups, but there was a trend for shorter ventilation time and shorter stays in the intensive therapy unit in the stentless group. Echocardiography showed superior transvalvular gradients in the stentless group at 1 week (mean 5.5+/-3.1 mm Hg cf. 8.9+/-2.5 mm Hg), and this difference was maintained at a mean follow-up time of 32 months (3.5+/-0.6 mm Hg cf. 6.3+/-0.6 mm Hg). Similar regression of left ventricular mass was seen in both groups at 6 months, but at 32 months, measurement in diastole showed a reduction of 38% (P<.01) in the stentless group compared with 20% (P = ns) in the stented group, and measurements in systole showed a 23% (P<.01) and 13% (P = ns) reduction, respectively. This study confirms that a larger stentless valve can be implanted into a given size of aortic annulus with superior residual aortic valve gradients. These lower gradients seem to result in improved long-term regression of left ventricular mass as measured by MRI.