Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Evidence-based Practice Intentions and Long-term Behaviours of Physiotherapy Graduates Following an Intensive Education Programme

BACKGROUND

Assisting physiotherapists to implement research evidence into clinical practice is essential to ensure the quality of practice and encourage lifelong learning and professional progression. However, many physiotherapists report barriers to implementing research, and there is little evidence regarding the sustainability of intended evidence-based practice (EBP) behaviours following EBP education programmes. This paper reports on intended and actual long-term EBP behaviours of physiotherapy students who completed an intensive EBP training programme embedded within a post-graduate coursework programme.

METHODS

An intensive 3-week course in quantitative health research methods and EBP was delivered annually from 2007 to 2014 as part of the programme to national and international students. Following the course, students were asked about their intention of using evidence to inform their future clinical practice. An online survey was used to evaluate EBP behaviours of graduates.

RESULTS

Of a possible total of 202 students, contact details for 193 students were sourced, and 65 students responded to the survey (34% response rate). At course completion, 174 students (86%) indicated that they intended to use research to guide their clinical decisions at least once a week. At follow-up, most graduates reported frequently using research to inform their clinical practice; indicated by a mean score of 6.5 (±1.9) from a possible range of 0 (not at all) to 10 (all the time). On average, students reported spending 2.2 (±2.2) hours accessing and reading research evidence per week. The most common barriers to implementing evidence were lack of time, limited access to evidence sources and a perceived lack of generalizability of research findings to specific patient groups.

CONCLUSION

Graduates of an intensive EBP training programme embedded within an existing post-graduate physiotherapy programme regularly implemented EBP in clinical practice. Barriers to evidence implementation were time, access to research and perceived lack of generalizability of research findings. Copyright © 2016 John Wiley & Sons, Ltd.

Embedding Evidence-based Practice Education into a Post-graduate Physiotherapy Program: Eight Years of pre-Post Course Evaluations

BACKGROUND AND PURPOSE

Little has been published about the effectiveness of training postgraduate physiotherapy coursework students in research methods and evidence-based practice (EBP) theory. Graduate qualities in most universities include lifelong learning. Inclusion of EBP in post-graduate coursework students' training is one way for students to develop the knowledge and skills needed to implement current best evidence in their clinical practice after graduation, thereby facilitating lifelong learning. This paper reports on change in confidence and anxiety in knowledge of statistical terminology and concepts related to research design and EBP in eight consecutive years of post-graduate physiotherapy students at one Australian university.

METHODS

Pre-survey/post-survey instruments were administered to students in an intensive 3-week post-graduate course, which taught health research methods, biostatistics and EBP. This course was embedded into a post-graduate physiotherapy programme from 2007 to 2014. The organization and delivery of the course was based on best pedagogical evidence for effectively teaching adult physiotherapists. The course was first delivered each year in the programme, and no other course was delivered concurrently.

RESULTS

There were significant improvements in confidence, significantly decreased anxiety and improvements in knowledge of statistical terminology and concepts related to research design and EBP, at course completion. Age, gender and country of origin were not confounders on learning outcomes, although there was a (non-significant) trend that years of practice negatively impacted on learning outcomes (p = 0.09). There was a greater improvement in confidence in statistical terminology than in concepts related to research design and EBP.

CONCLUSION

An intensive teaching programme in health research methods and biostatistics and EBP, based on best practice adult physiotherapy learning principles, is effective immediately post-course, in decreasing anxiety and increasing confidence in the terminology used in research methods and EBP. Copyright © 2016 John Wiley & Sons, Ltd.

Accuracy of probing attachment levels using a CEJ Probe versus traditional probes

BACKGROUND

Current interest in the assessment of probing attachment level measurements has been stimulated by recent introduction of novel periodontal probes as well as by the reclassification of periodontal diseases. Clinical attachment level (CAL) is currently the "gold standard" for diagnosing and monitoring periodontal diseases.

AIM

To evaluate the performance of the newly introduced cementoenamel junction (CEJ) Probe in detecting CAL using the CEJ as a fixed reference point, and to compare the CEJ Probe with the Florida Disk Probe and a standard Manual Probe (North Carolina Probe).

MATERIALS AND METHODS

Three examiners probed 12 periodontal patients to determine intra- and inter-consistency of both the probes and the examiners, over a 4-week time interval. Subjects ranged in age from 22 to 74 years. The experimental design was structured to balance the intra- and inter-examiner consistency at the same site during the two visits.

RESULTS

Using the PROC MIXED of SAS, a strong interaction (p<0.001) between the examiner and probes was found. The consistency of probing (repeatability of measurements) depended upon the type of periodontal probe used as well as the skill (experience) of the examiner. Overall, the CEJ Probe displayed a more consistent performance. The CEJ Probe demonstrated greater intra-examiner consistency than the Disk Probe for two examiners (p<0.01). The CEJ Probe also showed increased inter-examiner consistency (p<0.01).

CONCLUSIONS

The CEJ Probe has the potential to offer the dental team an efficient, accurate mechanism to chart and monitor attachment level measurements over time. Additional studies, using large numbers of examiners, are needed to assess more clearly the performance of each individual probe.

Pulmonary sarcoidosis and the acute respiratory distress syndrome (ARDS)

A 50 year old man presented with 3 weeks of exertional dyspnoea. His chest radiograph on admission revealed diffuse bilateral interstitial infiltrates. He did not respond to antibiotics but subsequently improved on high dose corticosteroids. Bronchoscopic examination with transbronchial biopsy specimens revealed the presence of non-necrotising granulomas. This case demonstrates an unusual clinical presentation of life threatening pulmonary sarcoidosis characterised by the development of acute respiratory distress syndrome (ARDS) with acute respiratory failure.

Antiviral efficacy and pharmacokinetics of oral adefovir dipivoxil in chronically woodchuck hepatitis virus-infected woodchucks

The antiviral efficacy of orally administered adefovir dipivoxil was evaluated in an 18-week study (12 weeks of treatment and 6 weeks of recovery) conducted with woodchucks chronically infected with woodchuck hepatitis virus (WHV). Adefovir dipivoxil is a prodrug of adefovir designed to enhance its oral bioavailability. Following administration of 15 mg of adefovir dipivoxil per kg of body weight in four WHV-infected animals, the mean maximum concentration of adefovir in serum was 0.462 microg/ml, with an elimination half-life of 10.2 h, and the oral bioavailability of adefovir was estimated to be 22.9% (+/-11.2%). To study antiviral efficacy, the animals were divided into three groups. There were six animals each in a high-dose group (15 mg/kg/day) and a low-dose group (5 mg/kg/day). A vehicle control group consisted of five animals because WHV DNA was detectable only by PCR at the time of the study in one of the original six animals. Efficacy was evaluated by determining the levels of WHV DNA in serum. The geometric mean WHV DNA level for the high-dose group diminished by >40-fold (>1.6 log(10)) after 2 weeks of treatment and >300-fold (>2.5 log(10)) at 12 weeks. There was a >10-fold reduction in five of six low-dose animals by 2 weeks, but levels were unchanged in one animal. By 12 weeks of treatment there was a >45-fold (>1.6 log(10)) reduction of WHV DNA levels, and serum WHV DNA levels were below the limit of quantification in three of six animals. Viral DNA levels returned to pretreatment levels during the 6-week recovery period. There were no clinically significant changes in body weight, hematology, or serum chemistry values, including bicarbonate or lactate, in any of the treated animals. No histologic evidence of liver injury was apparent in the biopsies. Under the conditions of this study, adefovir dipivoxil was an effective antihepadnaviral agent.

The tethered agonist approach to mapping ion channel proteins--toward a structural model for the agonist binding site of the nicotinic acetylcholine receptor

BACKGROUND

The integral membrane proteins of neurons and other excitable cells are generally resistant to high resolution structural tools. Structure-function studies, especially those enhanced by the nonsense suppression methodology for unnatural amino acid incorporation, constitute one of the most powerful probes of ion channels and related structures. The nonsense suppression methodology can also be used to incorporate functional side chains designed to deliver novel structural probes to membrane proteins. In this vein, we sought to generalize a potentially powerful tool - the tethered agonist approach - for mapping the agonist binding site of ligand-gated ion channels.

RESULTS

Using the in vivo nonsense suppression method for unnatural amino acid incorporation, a series of tethered quaternary ammonium derivatives of tyrosine have been incorporated into the nicotinic acetylcholine receptor. At three sites a constitutively active receptor results, but the pattern of activation as a function of chain length is different. At position alpha149, there is a clear preference for a three-carbon tether, while at position alpha93 tethers of 2-5 carbons are comparably effective. At position gamma55/delta57 all tethers except the shortest one can activate the receptor. Based on these and other data, a model for the receptor binding site can be developed by analogy to the acetylcholine esterase crystal structure.

CONCLUSION

Through the use of nonsense suppression techniques, the tethered agonist approach has been made into a general tool for probing receptor structures. When applied to the nicotinic receptor, the method places new restrictions on developing models for the agonist binding site.

Radial carpal bone fractures in 15 dogs

Between 1977 and 1992, 15 adult dogs were presented to the Universities of Bristol, Glasgow, Liverpool and London with fractures of the radial carpal bone which had occurred without a known episode of violent trauma. Eleven of the dogs were boxers and the other breeds affected were a Pharaoh hound, rottweiler, springer spaniel and a greyhound. The condition was bilateral in three cases. Eleven dogs were treated surgically by cast immobilisation (four cases), fragment removal (one case), lag screw fixation (three cases), pan-carpal arthrodesis (one case) and lag screw reduction followed by pan-carpal arthrodesis (two cases). The remaining four dogs were treated conservatively with rest and tactical use of non-steroidal anti-inflammatory drugs. Follow-up periods ranged from two months to 11 years. Varying degrees of lameness, which tended to be exacerbated by exercise, persisted in all cases. The radial carpal bone appears to have at least three separate centres of ossification which eventually fuse; their planes of fusion correspond approximately to the two main fracture lines. These areas of fusion could be weak points within the radial carpal bone.

When staff training isn't enough: an evaluation of a collaborative approach

This paper describes an evaluation of a training workshop for staff working with people who have severe physical and learning disabilities and who need extensive support with eating and drinking. Training involved joint input from speech and language therapy, dietetics, occupational therapy and physiotherapy and was evaluated at three levels: participants' satisfaction, gains in knowledge and video-tapes of mealtimes pre- and post-training to assess changes in practice. Results indicated very positive staff perceptions of the workshops and highly significant increases in knowledge, both immediately (p < 0.001) and after six months (p < 0.001). However there was no evidence of significant change in practice. Results are discussed in the context of bringing about changes in staff behaviour.

Effects of sedation with detomidine hydrochloride on echocardiographic measurements of cardiac dimensions and indices of cardiac function in horses

Twenty-six horses were sedated with detomidine hydrochloride (Domosedan, SmithKline Beecham Animal Health, Tadworth, Surrey, UK) at a dose of 10 micrograms/kg bwt, administered i.v. Echocardiograms were recorded before and after sedation, measurements of cardiac dimensions were made and functional indices were calculated. The pre- and post sedation values were compared. No significant change was detected following sedation in the ejection time (ET), left ventricular dimension, left atrial diameter at the sinotubular junction at end-systole or end-diastole or at the sinus of Valsalva at end-diastole. Sedation was found to result in a statistically significant increase in end-systolic left ventricular diameter and internal area and aortic diameter measured at the sinus of Valsalva. Left ventricular free-wall thickness and interventricular septal thickness at end-systole, fractional shortening, fractional area change and heart rate were significantly reduced following sedation. A significant increase in pre-ejection period (PEP), duration of electromechanical systole (EMS) and PEP/ET (ejection time) was detected.

Echocardiographic measurements of cardiac dimensions and indices of cardiac function in normal adult thoroughbred horses

Cardiac dimensions and indices of cardiac function were measured in 29 clinically normal adult Thoroughbreds (TB) which performed minimal exercise using guided M-mode and two-dimensional (2-D) echocardiography, from a variety of image planes and measurement methods, and standardised imaging planes based on intracardiac anatomical landmarks. The different methods of measuring these variables were compared. The variables which were considered to be most valuable for quantitative echocardiography were measured in a further 9 horses. Comparable measurements of cardiac dimensions can be obtained from a variety of different imaging planes, using either 2-D or guided M-mode echocardiography from the left or right side of the chest, although differences in measurement methods must be taken into account. The results of this study give a useful range of dimensions and indices of cardiac function in normal adult TBs for comparison with those recorded from horses with suspected cardiac disease. Comparisons are only valid if there is meticulous attention to correct orientation of imaging planes with regard to internal landmarks and that comparable measurement locations and timing are used.

Hamartomatous polyps in the intestine of two dogs

Partly obstructing, proliferative mucosal masses in the small intestine of two dogs were shown histologically to be hamartomatous polyps. They were characterized by an extension of smooth muscle from the muscularis mucosae into the lamina propria of the lesion. This is the first report of such lesions in domestic animals. In one of the dogs the lesion had become malignant.

Angiostrongylus vasorum infection in seven dogs

Angiostrongylus vasorum infection was diagnosed in six dogs by the identification of larvae in sputum or faeces, or by the identification of adult worms post mortem. In another dog strong evidence of the condition was obtained but no parasites were identified. In four cases the main clinical signs were coughing and dyspnoea, but one dog had exercise intolerance and no history of coughing. One dog in which larvae were found in the faeces had no clinical signs that were related to the infection. Another dog had flaccid hindlimb paralysis and forelimb hypermetria-clinical signs of the disease which have not been reported previously. Four of the cases came from south Wales, one of them being the first case of the infection to be reported from this area.

Molecular cloning and characterization of a cDNA encoding feline interleukin-6

With the discovery that the cat is susceptible to infection by a lentivirus quite similar to the virus that causes the human acquired immune deficiency syndrome, the cat has become an important animal model with which the interactions between host and immunodeficiency virus can be studied. To facilitate investigation of the feline immune response and the response of cytokine expression to infection by feline immunodeficiency virus, our laboratory has focused on the isolation and molecular cloning of cDNA representative of feline lymphokines, cytokines, and monokines. Herein, we describe the molecular cloning and characterization of a cDNA encoding feline interleukin (IL)-6. The nucleotide sequence of feline IL-6 was found to exhibit 81%, 76%, 63%, and 61% homology with pig, human, rat, and mouse IL-6, respectively, while the predicted amino acid sequence exhibits 66%, 53%, 37%, and 30% homology with pig, human, rat, and mouse IL-6, respectively.

Radiographic assessment of gastric mucosal fold thickness in dogs

One hundred two dogs without known gastric lesions were evaluated to establish a reference range of gastric rugal fold thickness (millimeters). Mucosal folds were measurable for 63 examinations, and the length of the second lumbar vertebra was measured for 61 of the 63 (centimeters). Body weight was available in the case records of 29 dogs. Measurements of the mucosal folds were related to body weight (n = 29) and length of the second lumbar vertebra (n = 61) by use of linear regression analysis. Reference range of normal gastric mucosal fold thickness, 1 to 8 mm, was defined by this study for dogs of any breed weighing between 2 and 50 kg.

Temporal analysis in children

This study investigated the development of temporal resolution as a function of frequency region using a modified masking period pattern paradigm. This paradigm also allowed age-dependent comparisons of within-channel (temporal resolution) versus across-channel (comodulation masking release [CMR]) processing of temporal information to be made in the same listeners. The results indicated that temporal resolution improves with age. At low frequencies, this improvement continues beyond 10 years of age, whereas at high frequencies performance approaches adult levels by about age 6. Although it is reasonable to expect an association between CMR and temporal acuity, the measure of CMR did not show a significant age effect. The possibility was raised that the poorer temporal resolution of children may not reflect simply a deficiency in peripheral processing of temporal information.

A review of the usefulness of myelography in 50 dogs

Fifty dogs showing clinical signs of spinal disease were investigated by myelography, using iopamidol. In 27 cases the technique was considered worthwhile. Of the 19 dogs not subjected to surgery or euthanasia as a result of the findings, three suffered seizures during recovery from anaesthesia, eight deteriorated in neurological condition and one suffered permanent respiratory arrest as a result of extensive subarachnoid haemorrhage.

Congenital urinary incontinence in cats: a review of 19 cases

Nineteen cases of feline congenital urinary incontinence (10 cats with ureteral ectopia and nine with incompetence of the urethral sphincter mechanism) are reviewed. The 10 cats with ureteral ectopia are considered together with 13 from previous reports. There was no apparent breed predisposition. Most of the 23 cats were presented for urinary incontinence but two of them were continent. Thirteen were females and ectopia was unilateral in 13 and bilateral in 10. Twenty-eight of 31 ectopic ureters terminated in the urethra. The commonest complication was hydroureter/hydronephrosis (10 cases). Eighteen of the cats were treated surgically, 13 by ureteral transplantation, four by ureteronephrectomy and one by ligation of the renal blood vessels; 16 of them were cured by surgery. Congenital urethral sphincter mechanism incompetence has not been reported previously in the cat. Nine cases are presented and the urethras of all were markedly hypoplastic. A common concomitant abnormality was vaginal aplasia, with the uterine horns terminating in the dorsum of the bladder. Bacteriuria was more common in this group than in the cats with ureteral ectopia.

Characterization of the immune response to a secondary encephalitogenic epitope of basic protein in Lewis rats. II. Biased T cell receptor V beta expression predominates in spinal cord infiltrating T cells

The immune response of Lewis rat lymph node T cells to guinea pig myelin basic protein (GP-BP) in experimental allergic encephalomyelitis is directed primarily against a region of basic protein encompassed by residues 72-89. T cells that respond to this epitope are restricted by the RT1.B class II molecule of the MHC and use V beta 8.2 exclusively in their TCR. A second region of GP-BP, residues 87-99, also induces experimental allergic encephalomyelitis in Lewis rats but this response is restricted primarily by RT1.D. Elsewhere we describe the biologic characteristics of T cell clones responding to the synthetic peptide, s87-99, and to a related peptide, s85-99. We present a detailed analysis of TCR V beta gene expression among these clones, derived from the lymph node and spinal cord of immunized animals, and among spinal cord derived T cell clones reactive to GP-BP 72-89. We find that spinal cord-derived clones, reactive to s85-99 and to s87-99, use V beta 6 predominantly. In contrast, T cell clones derived from lymph nodes and reactive to the same peptides express multiple V beta genes including V beta 6. This difference in heterogeneity of V beta usage at the clonal level is also seen in T cell lines derived from spinal cord and immune lymph node. DNA sequence comparison of the CDR3 regions in V beta 6+ spinal cord clones revealed a conserved amino acid motif also found in the majority of V beta 6 sequences from the spinal cord anti-s85-99 line. Although V beta 6 was expressed in some lymph node-derived clones, only one contained a CDR3 region similar to that seen in spinal cord isolates. All spinal cord-derived T cell clones reactive to GP-BP 72-89 used V beta 8.2 and most (five of six) contained the AspSer residues in CDR3 previously shown to be associated with V beta 8.2 receptors expressed by the majority of lymph node T cells responding to GP-BP 72-89. These data indicate that TCR V beta usage in peripheral T cells responding to an autoantigen does not always predict the V beta usage among T cells at the site of an autoimmune attack. Possible explantations for the relative homogeneity in TCR V beta expression seen in T cell clones derived from the spinal cord are discussed.

Characterization of the immune response to a secondary encephalitogenic epitope of basic protein in Lewis rats. II. Biased T cell receptor V beta expression predominates in spinal cord infiltrating T cells

The immune response of Lewis rat lymph node T cells to guinea pig myelin basic protein (GP-BP) in experimental allergic encephalomyelitis is directed primarily against a region of basic protein encompassed by residues 72-89. T cells that respond to this epitope are restricted by the RT1.B class II molecule of the MHC and use V beta 8.2 exclusively in their TCR. A second region of GP-BP, residues 87-99, also induces experimental allergic encephalomyelitis in Lewis rats but this response is restricted primarily by RT1.D. Elsewhere we describe the biologic characteristics of T cell clones responding to the synthetic peptide, s87-99, and to a related peptide, s85-99. We present a detailed analysis of TCR V beta gene expression among these clones, derived from the lymph node and spinal cord of immunized animals, and among spinal cord derived T cell clones reactive to GP-BP 72-89. We find that spinal cord-derived clones, reactive to s85-99 and to s87-99, use V beta 6 predominantly. In contrast, T cell clones derived from lymph nodes and reactive to the same peptides express multiple V beta genes including V beta 6. This difference in heterogeneity of V beta usage at the clonal level is also seen in T cell lines derived from spinal cord and immune lymph node. DNA sequence comparison of the CDR3 regions in V beta 6+ spinal cord clones revealed a conserved amino acid motif also found in the majority of V beta 6 sequences from the spinal cord anti-s85-99 line. Although V beta 6 was expressed in some lymph node-derived clones, only one contained a CDR3 region similar to that seen in spinal cord isolates. All spinal cord-derived T cell clones reactive to GP-BP 72-89 used V beta 8.2 and most (five of six) contained the AspSer residues in CDR3 previously shown to be associated with V beta 8.2 receptors expressed by the majority of lymph node T cells responding to GP-BP 72-89. These data indicate that TCR V beta usage in peripheral T cells responding to an autoantigen does not always predict the V beta usage among T cells at the site of an autoimmune attack. Possible explantations for the relative homogeneity in TCR V beta expression seen in T cell clones derived from the spinal cord are discussed.

Planning palliative care services

An audit was conducted to assess the use of, and satisfaction with, local services for the care of the dying, which have developed over the past seven years in South Glamorgan. These services include hospice inpatient, outpatient and day care facilities, home care specialist nursing, volunteer services and domiciliary medical consultations. All general practitioners in the district were surveyed about the services by postal questionnaire; respondents represented most of the practices in the district. The results show a variable level of uptake of services for those well established (excluding paediatric oncology), including a high level of satisfaction with the available services. The results identify a lack of provision for patients dying from a non-malignant disease.

Measurement of cardiac dimensions with two-dimensional echocardiography in the living horse

Two-dimensional echocardiography (2DE) was performed on 22 unsedated Thoroughbred and part Thoroughbred horses weighing between 411 and 650 kg to establish normal reference values for 2DE measurements. Animals stood during examinations performed with a 3.5 MHz mechanical sector transducer using various transducer positions and tomographic planes. Right ventricular diameter (RVD), ventricular septal thickness (VSTh), aortic diameter (AoD), area of the chordal lumen of the left ventricle (CTA), left ventricular diameter (LVD) and left atrial diameter (LAD) were determined at ventricular end-diastole (Ed) and/or end-systole (Es). Fractional shortening (FS) of the left ventricle and end-systolic left atrial to aortic ratio (LAD-Es:AoD-Es) also were calculated. Echocardiographic data were related to body weight by linear regression analysis. Intra-observer variability was checked in five horses by measuring each parameter during each of 10 consecutive cardiac cycles. The 2DE data were compared with M-mode values in published reports. In the 18 horses whose weight did not exceed 551 kg, repeatable recordings of good quality were obtained, and 2DE measurements could be made using intra-cardiac reference points. Increasing body weight proved to impose substantial limitations on measurements taken with the available machine and transducer. This problem might be overcome by using probes of lower frequency or equipment with higher quality image display at greater depth. The following parameters correlated significantly to body weight: VSTh-Es (r = 0.69; P less than 0.01). AoD-Es (r = 0.64; P less than 0.01) and CTA-Es (r = 0.84; P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Inflammatory middle ear disease of the dog: the clinical and pathological features of cholesteatoma, a complication of otitis media

During a study of inflammatory middle ear disease in the dog cholesteatoma was found to accompany otitis media in seven of the 62 ears examined (11 per cent). The clinical, radiological and pathological findings in these animals imply that cholesteatoma in the dog is an aggressive lesion which must be differentiated from uncomplicated otitis media.

Evoked potential abnormalities in progressive spastic paraparesis associated to HTLV-1

The electrophysiological features of progressive spastic paraparesis (PSP) associated with HTLV-1 in Chile, a non-tropical country, are presented. Twenty-two of 45 PSP subjects were positive for HTLV-1 antibodies. Trimodal evoked potentials were all normal in only 2 of these cases (9.1%). Somatosensory evoked potentials (SSEPs) were abnormal in 19 patients (86.3%) with a mean amplitude of 1.31 uV SD 0.92. Visual evoked potentials (VEPs) and brainstem auditory evoked potentials (BAEPs) were normal in all patients except four. Peripheral nerve conduction was normal in all but one who showed discrete slowness of the motor conduction velocity in the peroneal nerves. EMG was normal in 15 cases in whom it was performed. SSEP's were abnormal in 2 (8.7%) of 23 HTLV-1 negative cases with a mean amplitude of 2.4 uV SD 1.5, which is statistically different with respect to the positive cases (p less than 0.001). These results support an involvement of the spinal cord not restricted to the pyramidal tracts but also including subclinical damage of the posterior columns in PSP associated to HTLV-1.

Anatomical validation of two-dimensional echocardiography in the horse

This study was performed on 15 horses to validate the cardiac anatomy as imaged with two dimensional echocardiography (2DE) and to determine the accuracy of intracardiac measurements. 2DE images were recorded in five horses in life with a Diasonics DRF100 ultrasound system and a 3.5 MHz transducer in different tomographic planes. After slaughter, the hearts were fixed in 10 per cent formalin. To compare in vivo and in vitro results, the specimens were suspended in a water-filled tank and 2DE images were made using the same transducer positions as in life. In vitro 2DE and autopsy measurements of the same planes and parameters were also taken on a further 10 hearts, and the results were statistically compared. The in vivo 2DE images corresponded well with both in vitro 2DE recordings and anatomical sections. Repeatable imaging of each tomographic plane was possible on the post mortem hearts using intracardiac reference points. Comparison of parameters measured during in vitro 2DE and autopsy demonstrated a significant correlation between all 2DE and autopsy data (r: 0.879 to 0.926; P less than 0.001). Repeated 2DE measurements of each parameter showed a good reproducibility with coefficients of variation (CV%) varying between 4.6 to 10.6 per cent. The results suggest that 2DE is a reliable method for accurate anatomical evaluation of the equine heart and show the potential application of quantitative two dimensional echocardiography in the living horse.

Left ventricular volume determination in the horse by two-dimensional echocardiography: an in vitro study

This study was designed to evaluate the accuracy of two-dimensional echocardiography (2DE) in determining the left ventricular volume (LVV) of the horse in vitro. After examining the shape of the left ventricular silicon rubber casts of four equine hearts, two modified Simpson's rule methods (Model A and Model B) as combinations of conical shapes and one biplane area-length method as a single cone (Model C) were chosen for volume calculations. One long axis and three short axis planes were used for linear and area 2DE measurements, respectively. The ventricular length (L) was calculated from the chordal length (CL) by using a linear regression equation (L = 5.54 + 1.83 CL) obtained by anatomical measurement of these two parameters on 40 normal hearts. The LVV was calculated in 15 formalin-fixed hearts from 2DE measurements with the three geometric models. Left ventricular casts were then made using silicon rubber, and their volumes were determined by water displacement. The calculated volumes were plotted against cast volumes with linear regression analysis. All calculated LVVs correlated well with the cast LVVs (R = 0.921 to 0.957; P less than 0.001). The highest correlation was provided by Model A which best represented the shape of the left ventricle. This model consisted of a truncated cone bordered by the area at the level of the mitral valve and by the area at the level of the chordae tendineae, plus a cone the base of which was the area at the level of the papillary muscles. The results demonstrate the applicability of 2DE for equine LVV determinations in vitro, similar to other species.(ABSTRACT TRUNCATED AT 250 WORDS)

Overnight urinary growth hormone measurement in the diagnosis of acromegaly

Several studies report higher urinary GH excretion in acromegalic patients compared to control subjects. We investigated the diagnostic potential of overnight urinary GH excretion in acromegaly, using a recently developed enzyme-linked immunosorbent assay. Overnight urine samples were obtained from 117 control subjects and nine patients with untreated acromegaly. GH excretion was higher in acromegalic patients compared to control subjects, with geometric mean total overnight values of 46.35 and 5.73 microU respectively. The range for total overnight urinary GH in control subjects was 0.75-21.75 microU and two of the nine patients with untreated acromegaly had GH measurements within this range. Urinary GH measurements were corrected using predictive clinical variables but this resulted in minimal improvement in discrimination between control subjects and acromegalic patients. Lack of complete discrimination between control subjects and acromegalic patients limits the usefulness of a single overnight urinary GH measurement as a screening test for acromegaly.

Internal derangement of the TMJ: changes associated with mandibular repositioning and orthodontic therapy

Because of its apparent success in relieving symptoms, especially pain, anterior mandibular repositioning therapy is a popular mode of nonsurgical treatment for patients with painful, clicking internal derangement of the temporomandibular joint. Posterior open bites are a frequent consequence of such therapy and may necessitate either continued appliance wear or closure by equilibration, prosthetics, or orthodontics. The anatomic and functional changes that occur subsequent to mandibular repositioning during orthodontic closure of the posterior open bite are not well understood. A case of a patient with a Class II, deep bite malocclusion and painful internal derangement of the TMJ is presented. Transcranial and cephalometric radiographs, arthrograms, and mandibular movement recordings were obtained before treatment and after both repositioning therapy and orthodontic treatment. Regarding occlusal improvement and pain relief, the treatment was successful. However, not all of the changes that occurred during repositioning therapy were maintained after orthodontic treatment. The strategy used in this case (mandibular repositioning/orthodontic finishing) was evaluated by an examination of these anatomic and functional changes with a discussion centered on the possible mechanisms involved.

Equine paranasal sinus cysts: a report of 15 cases

The clinical and radiographic features of 15 cases of paranasal sinus cysts are described. Breed, sex and side frequency were unremarkable but two distinct categories of age incidence emerged. Onset of signs had occurred before one year of age in three cases, while all but two of the remaining 12 animals were older than nine years. The most common clinical signs were nasal airway obstruction, facial swelling and nasal discharge, often occurring in combination. Radiographic changes were recorded in all horses. Sinus opacification was a consistent finding and in several cases the bone surrounding the sinus had increased in thickness. Increase in intra-maxillary sinus pressure was demonstrated by septal displacement on ventro-dorsal radiographs in almost half the cases. Less common signs included expansion, free fluid accumulation within the affected sinus, dental distortion and displacement and mineralisation. Two horses were destroyed without treatment but in 13 animals surgical exploration was performed. Two of these were destroyed, one at the time of surgery and one five days postoperatively. In the remaining 11 cases, all accessible parts of the cyst were removed through a facial flap and drainage to the nasal meati was established. All these horses recovered satisfactorily and were followed up for periods between three months and six years without evidence of recurrence. Thirteen cysts arose in the caudal maxillary sinus and one each in the frontal and rostral maxillary compartments. Histopathological examination of portions of the cyst walls suggests that, like ethmoidal haematomas, they may originate from episodes of haemorrhage beneath the upper respiratory tract mucosa.

Radiographic examination of the facial, nasal and paranasal sinus regions of the horse. II. Radiological findings

The radiographic findings in 167 horses subjected to radiography of the facial area, nasal cavity and paranasal sinuses are recorded. Cases were grouped according to clinical diagnosis and the common and disparate radiographic features between and within groups are discussed. Dental disease occurred most frequently and accounted for about 30 per cent of cases, most of which had periapical infection. This disorder presented as two distinct clinical entities in almost equal numbers affected teeth with roots rostral to the maxillary sinus usually produced facial swelling, whereas those with roots within the sinus were generally associated with nasal discharge as a result of secondary sinusitis. In the former group periapical changes could readily be identified on radiographs, but in the latter group affected teeth could be recognised with confidence in only about half the cases. Primary sinusitis was the commonest specific condition recorded and accounted for 32 cases, three of which were mycotic. Using lateral erect projections, comparison of the radiographic features of primary sinusitis and sinusitis secondary to dental disease showed some useful differentiating signs. In four ponies, rhinitis associated with sinusitis led to disruption of the intra-nasal structures but mycotic rhinitis, nasal ulceration and an intra-nasal foreign body produced no radiographic abnormalities. Sixteen cases of suture periostitis were recorded, with varying degrees of new bone formation, and of 13 animals presented for evaluation of trauma, pre-diagnosed fractures were demonstrated in 10 and complications due to sinusitis in three.(ABSTRACT TRUNCATED AT 250 WORDS)