Intravaginal practices (IVP) are those in which women introduce products inside the vagina for hygienic, health, or sexuality reasons. IVP are associated with bacterial vaginosis (BV) and potentially implicated in HIV transmission. This report presents the results of a pilot study of a behavioral intervention to decrease IVP in HIV-infected women in Zambia. At baseline, all of the enrolled women (n =40) engaged in IVP and rates of BV were high. Women receiving the intervention reported a decrease of the insertion of water and cloths inside the vagina. Communication with sexual partners regarding IVP was higher for women receiving the intervention. Results from this study suggest that a behavioral intervention could decrease IVP in HIV-infected women in Zambia and this may have an impact in decreasing HIV transmission from women to sexual partners and newborns.

The relationship between plasma CORT concentration and reproductive state was investigated in New Zealand's common gecko, Hoplodactylus maculatus. This primarily nocturnal gecko has an unusual biennial reproductive cycle in which females are pregnant for about 14 months. In contrast to a previous report for a viviparous lizard, plasma CORT concentrations did not vary significantly in daytime samples among females at four different stages of reproduction (vitellogenic, mid-pregnant, late pregnant prior to winter dormancy, and spent). Significant seasonal variation in concentration (independent of reproductive state) was observed in daytime samples collected over an 8-month period (P < 0.001), perhaps reflecting seasonal patterns of growth and/or lipid deposition. Plasma CORT concentrations in summer were compared between night and day in spent and mid-pregnant females. A significant difference in concentration was detected in mid-pregnant females (P < 0.01), but unexpectedly, the concentration was higher by day than by night. No relationship of CORT with time of day was detected in spent females. There was a significant positive correlation between CORT and body temperature in day samples, but not in night samples. In contrast to many previous reports for reptiles, concentrations in females held in cloth bags showed no significant elevation during up to 2.5 hr in captivity. All groups sampled in this study had relatively low mean concentrations of CORT (< or = 6.4 ng/ml), even those held captive for up to 2.5 hr. We conclude that plasma CORT plays no obvious role in maintaining the long gestation period in H. maculatus and that relationships among CORT, activity period, and body temperature need examination in a wider range of nocturnal and diurnal reptiles before consistent patterns can be identified.

Hypothermic fatalities in humans are characterized by a range of often subtle pathological findings that typically include superficial erosive gastritis (Wischnewski spots). Experimental studies have been successfully performed using animal models to replicate this finding, however study animals have inevitably been subjected to a variety of additional stressors including food deprivation, restraint and partial immersion in water while conscious. As it is recognised that stress on its own may cause superficial erosive gastritis, a model has been developed to enable the study of the effects of hypothermia in isolation. 42 Sprague-Dawley rats were allowed free social contact and were fed and watered ad libitum prior to being anaesthetized with isoflurane. Once unconscious, rats were placed on drape cloth covering metal mesh platforms in a styrofoam box packed with ice. The apparatus enabled both maintenance of a specific low temperature (26 °C) in 14 animals, and continued reduction of core temperatures in the remaining 28 (who all died of hypothermia under anaesthesia). Examination of the gastric mucosa in both groups macroscopically and microscopically failed to demonstrate typical Wischnewski spots in any of the 42 animals. Thus, in this model, death from hypothermia occurred without the development of these lesions. These results suggest that stress may be a significant effect modifier in the development of Wischnewski spots in lethal hypothermia.

Several experiments have been conducted on the effect of clothing on evaporative heat loss. 1) The movement of sweat from production to evaporation was observed in nude subjects, on subjects wearing underwear and underdrawers, and on subjects wearing two layers of clothing during a two-hour heat exposure period. The percentage of evaporated sweat was found to be inversely proportional to total sweat loss. When this relation was taken into consideration, it was revealed that the percentage of evaporated sweat was smaller if more layers of clothing were added, or if water-proof or vapor-proof materials were added. 2) Using a so-called "sweating cylinder," the cooling power of water dissipated from the surface of the cylinder was measured when the cylinder was covered with one, two, or three layers of various kinds of cloths. The cooling efficiency (actual evaporative cooling/latent heat of total water lost) was about 95% when the cylinder was uncovered. As more layers of covering cloth were added, the cooling efficiency became less. When the covering cloth touched the wet surface of the cylinder directly and absorbed water, the cooling efficiency was remarkably reduced because a large portion of the water absorbed in the cloth remained unevaporated.

BACKGROUND

Unplanned extubations are common, but can be life-threatening.

METHODS

We conducted a prospective evaluation of all intubated patients in our surgical intensive care unit to examine the effects of three parameters on the likelihood of accidental extubation. The parameters were the method of endotracheal tube fixation, the use of sedation/paralysis, and the use of hand restraints. During the baseline period, tubes were secured with cloth or velcro ties, sedation was used conservatively, and hand restraints were used routinely. A change in one study parameter was made prior to each period. Thus, in period II, tubes were secured using waterproof tape; in period III, tubes were secured with waterproof tape and sedation/paralysis was used liberally; and in period IV, tubes were secured with waterproof tape and limited use was made of hand restraints.

RESULTS

Accidental extubations were significantly less frequent when tubes were secured with waterproof tape (P < 0.0001). No difference was seen when sedation was instituted liberally. Restricted use of hand restraints was associated with significantly increased accidental extubations (P < 0.001).

CONCLUSIONS

Our data support the use of water resistant tape to secure endotracheal tubes and the routine use of hand restraints.

During 1391-1392, Spinello Aretino painted a cycle of frescoes in Pisa's cemetery on the theme "Storie dei Santi Martiri Efisio e Potito", highly prized by contemporaries and by Vasari. Twenty years ago, one of these frescoes, "Conversione di S. Efisio e Battaglia" (Conversion of S. Efisio and Battle), because of discolouring and bad damage caused by humidity and atmospheric pollution, was removed from the walls using the "tear-off" technique, consisting in covering the surface with a strong cloth bound to the surface with generous layers of formaldehyde-treated glue. As luck would have it, this large fresco (3.50x7.80 m) was abandoned in a storehouse for more than 20 years. When the curators attempted to remove the cloth, much to their dismay they found that the glue resisted any attempt at digestion, even when treated with concoctions of the most aggressive proteolytic enzymes available on the market. It is likely that during the long storage the glue became slowly cross-linked by the formaldehyde to the point of forming an intricate mass of untreatable proteinaceous material. Thus, although poor Spinello died presumably as a bona fide Christian, his painting was condemned to wear the burka, Muslim-fashion, for the rest of its life. When we recently treated the fresco with a suspension of viable Pseudomonas stutzeri cells, these bacteria, although agnostic, were able to fully digest the hardened glue and restore to life Spinello's glorious painting. We show here how proteomics helped us solve the riddle of how these bacteria acted on the burka-obscured fresco.

This study investigated the ability of 10 different microfibre cloths to remove microbial contamination from three surfaces commonly found in hospital settings (stainless steel, furniture laminate and ceramic tile), under controlled laboratory conditions. Tests were conducted using organisms known to cause healthcare-associated infections, i.e. meticillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (in spore form) and Escherichia coli. For all the cloths tested, there was significant statistical evidence to suggest a difference in cleaning performance between them on first and single use (P<0.001). However, the overall performance of the nine re-useable cloths did not differ in practice with differences in log₁₀ reductions of <1. The performance of the disposable microfibre cloth was notably worse. The performance of all cloths decreased with repeated use on a succession of contaminated surfaces. After repeated washing, re-usable cloth performance improved at 75 washes, and reduced after 150 washes, although, in most instances, performance after 150 washes was better than at first wash. For all cloths, price was not an indication of performance. Based on these laboratory findings, it is concluded that use of the microfibre cloths investigated is an effective way to reduce the levels of MRSA, E. coli and C. difficile (in spore form) on a range of surfaces found in the clinical environment and could therefore be of benefit to these environments.

Transmission of Rickettsia typhi to rats by the bites of Xenopsylla cheopis (Rothschild) fleas was investigated. Procedures rigorously excluded the possibility of contamination of the host skin by flea faeces. Fleas with R. typhi infection (21-25 days post-infection) which fed through bolting cloth (45 min exposure to ten fleas) transmitted rickettsiae with a success rate of 20%. Infective fleas allowed free access to their host for 8 h (10-15 fleas/rat) gave transmission rates of 45-68%. They were also capable of inoculating R. typhi through a membrane of rat skin on a feeder. Only fleas which had been infected for 21 days or longer transmitted R. typhi orally. Oral transmission appeared to be the result of regurgitation of rickettsiae present in the foregut lumen rather than through salivary secretions.

Chromated copper arsenate (CCA) is commonly used to preserve wood, but its use poses risk of arsenic exposure. In order to evaluate the extent of exposure to As from physical contact with CCA-treated wood, dislodgeable As from treated wood surfaces (as well as Cu and Cr) was determined as a function of weathering time using dampened polyester wipe materials. Six sets of 2.5-m-long CCA-treated boards, three-four boards per set, were purchased from lumber yards and cut into 30- or 60-cm coupons. A total of 44 such coupons were placed outdoors and the dislodgeable CCA components from the surfaces of the wooden coupons were periodically determined over a 1- or 2-year period by a systematic wipe method followed by nitric acid extraction of the CCA components from the cloth. In all 316 samples, appreciable amounts of the three elements, Cu, Cr and As, were detected. The amounts of surface-dislodgeable As, the most potentially hazardous element and the one of major concern in this study, varied from 5 to 122 microg/100 cm(2) with an average value of 37+/-22 microg/100 cm(2). There was considerable variation in As dislodged among coupons, boards, sets and time. Test coupons that tended to release relatively higher (or lower amounts) over time initially, continued to do so over time. However, the amounts of arsenic dislodged over time did not follow a simple pattern. While the As dislodged tended to decrease with time during the first year, it approached the initial value or increased somewhat during the second year, presumably due to surface rejuvenation effects caused by erosion and weathering. When all the data were normalized to the initial values, no trend emerged, as indicated by the average normalized value of 1.0+/-0.4 for As dislodged over time. Apparently, on installations constructed with CCA-treated wood, arsenic may remain available for a number of years.

Microscopic leukemia infiltration of kidneys is a common autoptic finding in children for ALL before starting specific treatment. However, a palpable renal enlargement is uncommon. The authors have performed an intravenous pyelogram (IVP) in 139 pediatric cases of acute leukemia, 117 of whom ALL, the remaining 22 ANLL. ALL patients were divided in 3 groups; Group 1 was made of 18 children treated with IGG-74 protocol, independently by any prognostic factor; Group 2 included 46 patients presenting one or more negative factors; Group 3 was of 53 cases with no unfavourable factor. Abnormal IVP was found in 4/18 (22,2%) Group 1, 9/46 (19,5%) Group 2, 2/53 (3,8%) Group 3 ALL patients. The most common anomaly was a bilateral renal enlargement with normal or slightly compromised renal function. Only 3 out of 117 ALL children had palpable renal masses. All 15 children acquired CR within one month from starting therapy together with normalization of IVP. Six out of 15 of these cases died, one is alive with disease, 8 are alive in CR. Except for two cases, all presented other negative prognostic factor associated with abnormal IVP. One of 22 ANLL children had an abnormal IVP: only one kidney was involved with the unique mechanism of intraparenchimal hemorrhage and hydronephrosis due to the filling of renal pelvis and ureter by multiple coarse cloths. In conclusions, major renal alterations are present in about 10% of ALL children, rarely in ANLL. This finding is commonly associated with unfavorable prognostic factors.

Proteases have prospective financial and environment-friendly applications; hence attention is focused currently on the finding of new protease producing microorganism so as to meet the requirements of industry. A thermophilic bacterial strain producing extracellular protease activity was isolated from soil and identified as Bacillus cereus by analysis of 16S rRNA. Protease production by the microorganism was improved by studying the impact of the type of nitrogen and carbon source, fermentation period, growth temperature and initial pH of the culture medium in cultivation optimization experiments. The enzyme was purified to homogeneity in two step procedure involving Sephadex G-75 and Q-Sepharose chromatography. The molecular weight of purified enzyme was found to be 58 kDa by SDS-PAGE. Protease exhibited a pH and temperature optima of 7.5 and 60°, respectively. The enzyme was active in the pH range of 6.0-9.0 and stable up to 70°C. Histological analysis of protease treated goat and cow skin pelts showed complete removal of non leather forming structures such as hair shaft, hair follicles and glandular structures. The protease showed the stain removing property from blood stained cotton cloth and found to be compatible with six commercially available detergents. The protease could release peptides from natural proteins after digestion of coagulated egg albumin and blood clot.

Deferred imitation of object-related actions (e.g., picking up a cloth with a set of tongs) was assessed in 3 enculturated juvenile orangutans (Pongo pygmaeus) and 3 enculturated juvenile chimpanzees (Pan troglodytes). For each task, animals were given 4 min to explore the objects (baseline), followed by a demonstration of the target behavior, and 10 min later, were re-presented the objects (deferred phase). Each animal displayed deferred imitation on at least one trial, with each species demonstrating deferred imitation on approximately half of all possible trials. The findings were interpreted as reflecting cognitive abilities in juvenile great apes that permit deferred imitation under humanlike rearing conditions.

Experiments were carried out on healthy volunteers exposed to a 7-day water immersion. The subjects were kept dry by use of a water proof, highly elastic cloth. During the experiment different cardiovascular, fluid-electrolyte and biochemical parameters were recorded. During the 7-day immersion, physiological parameters changed on a phasic basis. An acute period of adaptation began within the first minutes of immersion and ended by the third day. Later some of the parameters showed relative normalization. The experimental results suggest that the hypophyseal-adrenal system and renal function are closely coupled regulatory mechanisms for adaptive reactions of the cardiovascular system and for fluid-electrolyte metabolism during acute adaptation of the human body to reduced gravity.

With the experimental apparatus designed and made available by Nicholes, we evaluated the bacterial filtration efficienty (B.F.E.) of the non-woven fabric and cotton cloth masks. The apparatus was supplied by Nicholes (U.S. Military Specification 36954 C mask, surgical, disposable). The study presented here was performed as a round robin test with Nicholes. By using this apparatus, comparison was made as to the B.F.E. of the six different kinds of surgical face mask before and after prolonged use. The result was obtained that the disposable mask made of glass fiber mat combined with non-woven fabric proved to be the highest in performance with a B.F.E. of 98.1-99.4%. It is useful both in preventing hospital infection and in general clinical practice. The B.F.E. of the conventional cotton cloth masks is not only lower but variable over a wide range of 43.1-93.6%.

Biodiesel production through transesterification of lipids generates large quantity of biodiesel waste (BW) containing mainly glycerin. BW can be treated in various ways including distillation to produce glycerin, use as substrate for fermentative propanediol production and discharge as wastes. This study examined microbial fuel cells (MFCs) to treat BW with simultaneous electricity generation. The maximum power density using BW was 487 ± 28 mW/m(2) cathode (1.5A/m(2) cathode) with 50mM phosphate buffer solution (PBS) as the electrolyte, which was comparable with 533 ± 14 mW/m(2) cathode obtained from MFCs fed with glycerin medium (COD 1400 mg/L). The power density increased from 778 ± 67 mW/m(2) cathode using carbon cloth to 1310 ± 15 mW/m(2) cathode using carbon brush as anode in 200 mM PBS electrolyte. The power density was further increased to 2110 ± 68 mW/m(2) cathode using the heat-treated carbon brush anode. Coulombic efficiencies (CEs) increased from 8.8 ± 0.6% with carbon cloth anode to 10.4 ± 0.9% and 18.7 ± 0.9% with carbon brush anode and heat-treated carbon brush anode, respectively.

OBJECTIVE

To investigate a local "epidemic" of incidents of strangulation by hanging from continuous cloth towels in dispensers.

METHODS

The coroner's office in all provinces and territories were contacted. Five cases of hanging from continuous cloth towels in Canadian schools were identified and reviewed.

RESULTS

There were four deaths, and one near-death, all males age 7 to 12. Two cases were attributed to a "choking game" that provides a sensation (impending loss of consciousness) described as "cool". In three cases, the child was alone at the time. All deaths were due to strangulation from hanging and all occurred in school washrooms. One child (playing with two friends) recovered after admission to an intensive care unit. Towel dispensers were removed from the two index schools. In one province the Ministry of Education encouraged removal of towel dispensers from all schools and education of students of the dangers of "choking games".

CONCLUSIONS

Thrill seeking from partial asphyxiation appears to underlie these incidents. Awareness of such cases should prompt appropriate education strategies to highlight the serious consequences of this form of risk taking behavior in young males. In Canada, these incidents have resulted in changes in the design of, and legislation regarding, cloth towel dispensers.

This prospective, nonrandomized study compared the effect of two peripheral catheter dressings (a combination transparent polyurethane film/soft cloth surgical tape dressing, and adhesive tape) on the incidence of complications in children and adolescents. A total of 407 catheter dressings were studied: 212 in the control group (adhesive tape) and 195 in the study group (transparent dressing). Catheter insertion site assessments at 24-hour intervals showed increased site visibility, better dressing adherence and less dressing reinforcement in the study group. There were few differences in the observed incidence of phlebitis or extravasation. The new combination dressing may be considered for use in children when prolonged catheterization is anticipated.

This report describes how Nigeria, a country that at one time had the highest number of cases of dracunculiasis (Guinea worm disease) in the world, reduced the number of cases from more than 653,000 in 1988 to zero in 2009, despite numerous challenges. Village-based volunteers formed the foundation of the program, which used health education, cloth filters, vector control, advocacy for safe water, voluntary isolation of patients, and monitored program interventions and cases reported monthly. Other factors in the program's success were strong governmental support, advocacy by a former head of state of Nigeria, technical and financial assistance by The Carter Center, the U.S. Centers for Disease Control and Prevention, the United Nations Children's Fund, the World Health Organization, and many other partners and donors. The estimated cost of the Nigerian program during 1988-2009 is $37.5 million, not including funding for water supply projects or salaries of Nigerian governmental workers.

We investigated the effect of acute oral treatment with a water-alcohol extract of the inflorescence of Erythrina mulungu (EM, Leguminosae-Papilionaceae) (100, 200 and 400 mg/kg) on rats submitted to different anxiety models: the elevated T-maze (for inhibitory avoidance and escape measurements), the light/dark transition, and the cat odor test. These models were selected for their presumed capacity to demonstrate specific subtypes of anxiety disorders as recognized in clinical practice. Treatment with 200 mg/kg EM impaired avoidance latencies (avoidance 1 - 200 mg/kg EM: 18 +/- 7 s, control group: 40 +/- 9 s; avoidance 2 - 200 mg/kg EM: 15 +/- 4 s, control group: 110.33 +/- 38 s) in a way similar to the reference drug diazepam (avoidance 1: 3 +/- 0.79 s; avoidance 2: 3 +/- 0.76 s), without altering escape. Additionally, the same treatments increased the number of transitions (200 mg/kg EM: 6.33 +/- 0.90, diazepam: 10 +/- 1.54, control group: 2.78 +/- 0.60) between the two compartments and the time spent in the lighted compartment in the light/dark transition model (200 mg/kg EM: 39 +/- 7 s; diazepam: 61 +/- 9 s; control group: 14 +/- 4 s). The dose of 400 mg/kg EM also increased this last measurement (38 +/- 8 s). These results were not due to motor alterations since no significant effects were detected in the number of crossings or rearings in the arena. Furthermore, neither EM nor diazepam altered the behavioral responses of rats to a cloth impregnated with cat odor. These observations suggest that EM exerts anxiolytic-like effects on a specific subset of defensive behaviors, particularly those that have been shown to be sensitive to low doses of benzodiazepines.

BACKGROUND

Ovarian cancer is predominant of epithelial cell origin and often present at an advanced stage with poor prognosis. Most animal models of ovarian carcinoma yield thecal/granulose cell tumors, rather than adenocarcinomas. The best reported induction rate of adenocarcinoma in rats is 10-45% by an ovarian implantation of 7, 12-dimethylbenz[a]anthracene (DMBA) coated silk suture. We provided an improved procedure to construct the model by the ovarian implantation of DMBA-coated cloth strip.

METHODS

A sterile suture (as S group) or a piece of cloth strip (as CS group) was soaked in DMBA before ovarian implantation in Wistar rats. Tumor size, incidence rate and pathological type were analyzed.

RESULTS

Ovarian tumors in rats of CS group were first noted at 16 wk post implantation and reached a cumulative incidence of 75% (96/128) at 32 wk, while the tumor incidence rate in S group at 32 wk was only 46.25% (37/80). The tumor size in CS group (3.63 ± 0.89 cm) was larger than that of S group (2.44 ± 1.89 cm) (P < 0.05). In CS group, there were only two types of tumor formed: adenocarcinoma (90/96) and sarcoma (6/96). While in S group, there were different types, including adenocarcinoma (21/37), squamous carcinoma (3/37), granulosa cell tumor (3/37), sarcoma (4/37), undifferentiated carcinoma with no adeno character (2/37), benign ovarian tumor (2/37), and malignant teratoma (1/37).

CONCLUSIONS

The model in our study yields much higher incidence and specificity of epithelial derived tumors and showed histological similarities to human ovarian cancers, which would be more suitable for therapeutic research.

The baobab milk and fermented baobab/acha flour mixtures were analyzed chemically for their proximate, ascorbate, mineral and antinutrient composition. The dry pulp scraped from baobab fruits was kneaded, made into solution, extracted through cheese-cloth and stored frozen until analyzed. The acha and baobab grains were cleaned, fermented for 24 to 120 hours, dried and hammermilled into fine flours. The unfermented flours served as controls. The standard assay methods of AOAC were selected for use for the analysis of the nutrients and the antinutrients. The mixtures were composed of 70% acha and 30% baobab flours (70:30 protein basis). The baobab milk contained more protein (1.5%) and minerals (Fe, 17.8 mg; Ca 134.2 mg) than those of human milk (protein, 1.3%, Fe, 0.2 mg, Ca 30 mg) and cow milk (Fe, 0.1 mg; Ca 1.20 mg) and most leading national commercial infant formulas e.g. cerelac (Fe, 10.0 mg). The composite flours contained more nutrients than the baobab or the acha flour alone. The BF96 had greater advantage over other BF flours as a supplement to acha. The mixtures are within the reach of lower income group and can be incorporated into their diets.

We newly developed an indoor cultivation technique for Wolfiporia cocos (Wolf) Ryvarden et Gilbertson (Syn. Poria cocos Wolf), not with soil, but using mushroom culture bottles with pine logs, and clarified some cultural characteristics of sclerotia in the laboratory. To determine the optimum conditions for sclerotia growth, the weight of sclerotia and concentration of CO2 in three different air filters; cloth, paper and urethane resin, and closed bottles were tested. When the cloth air filter was used, the growth rate was the fastest and the yield was maximal. These results suggested that the aeration was an important environmental factor for cultivation. To clarify the characteristics of culture in the cloth air filtered and closed bottles, the weight of sclerotia, the compositions of pine logs and the contents of pachymic acid and dehydropachymic acid were examined during 24 weeks. The growth of scleroia and the wood decaying efficiency in the cloth air filtered bottles were better than those in the closed bottles. Also, it was found that W. cocos was a brown rot fungus due to the alkaline solubility of pine logs in the wood decay process. In addition, the contents of pachymic acid and dehydropachymic acid and the TLC pattern between the cultivated and commercial sclerotia did not differ remarkably.

We describe seven years' experience with the University of Cape Town lenticular mitral valve prosthesis in 122 patients. All the patients had severe mitral valve disease. In 98 severe mitral stenosis was present with or without incompetence and in 24 the dominant or sole lesion was mitral incompetence. Other valves, particularly the tricuspid, were also frequently affected. The disability was severe or total in almost every patient. One hundred and five patients were discharged from hospital, and in 90 per cent of these the clinical improvement was most gratifying, with the disappearance of pulmonary oedema, paroxysmal dyspnoea, angina pectoris, and congestive cardiac failure. Return to full normal activity including physical work was the rule. The hospital mortality was 14 per cent and a further 38 per cent died during the follow-up period. The major post-operative complication was systemic embolism which could occur at any time after operation. The most important factor influencing the frequency of this complication was the nature of the valve seat. A bare steel seat was associated with a 100 per cent embolism, and a significant reduction occurred when a cloth-covered seat of Dacron-velour was introduced. Anticoagulant therapy appeared to prevent large or fresh clots but had no effect on the deposition of fibrin or platelet thrombi. The only other factor of importance was the age of the patient: after the age of 50 life expectancy and trouble-free long-term survival was reduced.

The two principal considerations with prosthetic valves are durability and thromboembolism. With the widespread interest in recently developed prosthetic valves (porcine, tilting disc, Cooley), the long-term results at one institution with a single prosthesis were considered of particular importance. Accordingly, a 97% follow-up has been completed on 1375 patients (pts) undergoing prosthetic valve replacement with the Starr-Edwards cloth-covered steel ball prosthesis at New York University between October 1967 and December 1975. Operative procedures were as follows: aortic valve replacement (AVR): 470 pts; mitral valve replacement (MVR): 362 pts; combined AVR and MVR: 129 pts; other combined procedures: 414 pts. Overall operative deaths were 13.7%, 9% for AVR, 10.8% for MVR, and 18.6% for combined AVR and MVR. At seven years, AVR survival was 64%, and MVR survival 64.5%. There has been widespread pessimism, usually without significant data, about the cloth-covered prosthesis, because of concern of cloth wear, hemolysis and other complications. Therefore, a particularly significant finding by actuarial analysis was that 85% of surviving patients with isolated AVR remained free of emboli for five years. In pts surviving isolated MVR, 80% remained free of emboli for five years. Of those having embolic episodes, 33% were not on anticoagulants. Fatal hemorrhage from anticoagulants occurred in 0.8% of pts. Endocarditis occurred in 5.7% of the entire group, with 1.3% requiring reoperation. Clinically significant hemolysis occurred in 5.1% of the group, with only 0.2% requiring reoperation. Hence, the total frequency of clinically significant cloth-wear was less than 0.5%. These data indicate both the reliability and the limitations of the Starr-Edwards cloth-covered steel ball valve and can be used in comparing experiences with the more recently developed prostheses.