Disease associated with equine coronavirus infection and high case fatality rate.

BACKGROUND: Equine coronavirus (ECoV) is associated with clinical disease in adult horses. Outbreaks are associated with a low case fatality rate and a small number of animals with signs of encephalopathic disease are described. OBJECTIVES: The aim of this study is to describe the epidemiological and clinical features of two outbreaks of ECoV infection that were associated with an high case fatality rate. ANIMALS: 14 miniature horses and 1 miniature donkey testing fecal positive for ECoV from two related disease outbreaks. METHODS: Retrospective study describing the epidemiological findings, clinicopathological findings, and fecal viral load from affected horses. RESULTS: In EcoV positive horses, 27% (4/15) of the animals died or were euthanized. Severe hyperammonemia (677 µmol/L, reference range ≤ 60 µmol/L) was identified in one animal with signs of encephalopathic disease that subsequently died. Fecal viral load (ECoV genome equivalents per gram of feces) was significantly higher in the nonsurvivors compared to animals that survived (P = .02). CONCLUSIONS AND CLINICAL IMPORTANCE: Equine coronavirus had a higher case fatality rate in this group of miniature horses than previously reported in other outbreaks of varying breeds. Hyperammonemia could contribute to signs of encephalopathic disease, and the fecal viral load might be of prognostic value in affected horses.

Treatment of Coccidioides immitis pneumonia in two horses with fluconazole.

Pulmonary coccidioidomycosis in horses can often lead to severe systemic disease and its treatment has previously been expensive and has carried a poor prognosis. This paper describes the successful treatment of two horses with pulmonary coccidioidomycosis with a fluconazole product produced by a compounding pharmacy.

Evaluation of incidental renal and adrenal masses.

Incidental renal or adrenal masses are sometimes found during imaging for problems unrelated to the kidneys and adrenal glands. Knowledgeable family physicians can reliably diagnose these masses, thereby avoiding unnecessary worry and procedures for their patients. A practical and cost-efficient means of evaluating renal lesions combines ultrasonography and computed tomographic scanning, with close communication between the family physician and the radiologist. Asymptomatic patients with simple renal cysts require no further evaluation. Patients with minimally complicated renal cysts can be followed radiographically. Magnetic resonance imaging is indicated in patients with indeterminate renal masses, and referral is required in patients with symptoms or solid masses. The need for referral of patients with adrenal masses is determined by careful assessment of clinical signs and symptoms, as well as the results of screening laboratory studies and appropriate radiologic studies. Referral is indicated for patients with incidental adrenal masses more than 6 cm in greatest diameter. Appropriate laboratory screening tests include the following: a 24-hour urinary free cortisol measurement for patients with evidence of Cushing's syndrome; a 24-hour urinary metanephrine, vanillylmandelic acid or catecholamine measurement for patients with evidence of pheochromocytoma; and a serum potassium level for patients with evidence of hyperaldosteronism.

The status of physician office labs since CLIA '88.

Although the CLIA regulations were expanded to include the physician office lab just more than a decade ago, the in-office laboratory has survived and actually now represents the largest number of labs registered with CLIA. One reason for the increase in office labs is the increased number of "Waived" laboratory tests. While seemingly cumbersome, the CLIA regulations have helped to assure quality and accuracy of the more complex laboratory testing. Additional concerns for physicians include cost of laboratory equipment, availability of trained testing personnel, government regulation, and insufficient reimbursement. Some physicians believe that performing needed lab testing at the time of the visit can actually save time. In addition, their patients prefer the convenience of office laboratory testing, and hence, in-office testing helps to improve patient satisfaction.

Vasectomy techniques.

Vasectomy can be performed by means of various techniques, although each vasectomy technique requires isolation and division of the vas and operative management of the vasal ends. Removal of at least 15 mm of vas is recommended, although division of the vas without removal of a segment is effective when this technique is combined with other techniques for handling the vasal ends, such as thermal luminal fulguration and proximal fascial interposition. Ligation of the ends without the aid of surgical clips may result in necrosis and sloughing of the ends, which may cause early failure. Leaving the testicular end of the vas open has been shown to be effective and to result in a lower incidence of epididymal congestion and sperm granuloma. The no-scalpel technique offers shorter operating time, less pain and swelling, and faster recovery.

Influence of an interventional program on resource use and cost in pediatric asthma.

OBJECTIVE: Asthma is the most common chronic condition of childhood, for which morbidity, mortality, and cost are increasing. This study was performed to determine whether patient education and assignment to a primary care provider improve outcomes and cost in the management of pediatric asthma. STUDY DESIGN: A prospective pilot study of 61 patients was conducted with a retrospective review. Data were obtained from health and pharmacy records. PATIENTS AND METHODS: Sixty-one unassigned pediatric asthma patients who were noted to be frequent users of emergency department services and who had no primary care provider were identified. This cohort received asthma education and was assigned a provider trained in the national asthma guidelines. Hospital admissions, Emergency Department and clinic visits, use of beta 2 agonists and anti-inflammatory drugs, number of chest radiographs, and continuity of care were recorded for a mean of 58.1 months before and 11.2 months after the intervention. A cost analysis was done. RESULTS: All measured parameters showed favorable changes after intervention, with the decrease in the number of prescriptions of monthly inhaled anti-inflammatory drugs and chest radiographs ordered being statistically significant (P = 0.007 and P = 0.040, respectively). Monthly admissions, Emergency Department visits, and clinic visits declined after intervention when evaluated after 22.8 months of follow up. Annual resource savings after intervention was estimated to be $4845.29 per patient for this military hospital. CONCLUSIONS: A combined intervention consisting of provider and patient education and assignment to a primary care provider was associated with improved care and economic outcomes in this group.

Accuracy of quantitation of aortic stenosis using femoral arterial recordings corrected for both temporal delay and systolic amplification.

Our study demonstrates the feasibility of substituting FA recordings, corrected for both temporal delay and systolic amplification, for central aortic recordings in assessing aortic valve stenosis. This method is accurate in estimating the transaortic valve gradient, the calculated valve area, and the calculated valve resistance, and obviates the risks and costs of 2 FA punctures.

Extraskeletal Ewing's sarcoma of primary cardiac origin.

A 13-year-old boy presented with cardiac tamponade. Echocardiography revealed a large mass extending from the right and left ventricles into a large pericardial effusion. Pathology confirmed the first reported case of a primary cardiac extraskeletal Ewing's sarcoma.

Serum osteocalcin is increased in patients with hyperthyroidism and decreased in patients receiving glucocorticoids.

Osteocalcin (OC) is a vitamin K-dependent protein which is synthesized by osteoblasts and is present in the circulation. We measured serum OC concentrations in 10 patients receiving corticosteroids (CS) for chronic obstructive pulmonary disease and in 9 hyperthyroid (HT) patients. Mean values ( +/- SE) were as follows: There was a significant correlation between OC and alkaline phosphatase (r = 0.607; P = 0.006) when CS and HT groups were combined. Elevated serum OC concentrations in hyperthyroid patients may reflect increased osteoblastic activity, while decreased levels in corticosteroid-treated patients may reflect decreased osteoblastic activity.

Separation of brain-damaged from psychiatric patients with the combined use of an ability and a personality test: a validation study with a Puerto Rican population.

The purpose of this study was to validate the results obtained by Watson, Gasser, Schaefer, Buranen, and Wold (1981) by utilizing the Smith Symbol-Digit Modalities Test (Form W) and the MMPI (Psychiatric-Organic) scale in combination. Forty recently admitted/readmitted male patients were given both the SDMT and the MMPI (P-O) at a point in their hospitalization in a private inpatient psychiatric hospital in Puerto Rico. The combined use of the Smith and the P-O scale, with the criteria originally developed by Watson et al. (1981), provided a modest level of discrimination by correctly identifying 80% of the brain-damaged sample (organic group) and 55% of the functional sample (psychiatric group) subjects. This combination of tests yielded an overall mean hit rate of 67.5%. These results moderately support the findings obtained by Watson et al. (1981).

Human dermal microvasculature: II. Enzyme histochemical and cytochemical study.

An enzyme histochemical and cytochemical study of normal dermal microvasculature showed that respiratory enzymes, lipase and non-specific esterase occurred in all vascular segments. Lysosomal enzymes were also widely distributed and acid phosphatase activity was localized in lysosomes, Golgi apparatus and small portions of endoplasmic reticulum of both endothelial cells and pericytes. Alkaline phosphatase activity, however, was confined to the arterial side and tip of the capillary loop where it occurred in vesicles along the luminal surface of the endothelium and in junctions between endothelial cells. The localization of nucleoside phosphatase activity within the endothelium varied according to substrate; with adenosine triphosphate as substrate, the reaction product occurred in vesicles distributed throughout the endothelial cells; with adenosine diphosphate it was limited to vesicles along the luminal surface; and with adenosine monophosphate, activity was mostly localized to the lateral surfaces of endothelial cells. These findings suggest functional variation between different vascular segments and between various components of the endothelium. Attempts to demonstrate a specific Na+K+ adenosine triphosphatase (transport ATPase) within the endothelium were not successful.

Human dermal microvasculature: I. Its segmental differentiation. Light and electron microscopic study.

Light microscopic examination of I micrometer thick epoxy resin sections of human skin preserved in fixative normally used for electron microscopy allows division of the microvasculature of the reticular and superficial dermis into several distinct segments. More precise delineation of these components can be achieved by correlative study using electron microscopy. Measurement of vessel diameter in tissue sections is of limited value in vessel classification because there is a wide overlap between different vascular segments and the results are influenced by the type of fixative used for processing the tissue. Detailed observation of the morphological characteristics of the endothelium and its investment, including the elastic and basal laminae, is consider preferable for identifying individual vascular segments. Differences in body region do not appear to have any obvious influence on vessel structure although there are regional differences in vessel density and arrangement. In comparison with earlier studies on animal tissues or human skin, no structures resembling arteriovenous shunts or precapillary sphincters were observed in the present investigation. However, closed fenestrae and other structures thought to be transendothelial channels were often found at the tips of capillary loops adjacent to the epidermis.