Recommendations for a standardised educational program in robot assisted gynaecological surgery: Consensus from the Society of European Robotic Gynaecological Surgery (SERGS).

BACKGROUND: The Society of European Robotic Gynaecological Surgery (SERGS) aims at developing a European consensus on core components of a curriculum for training and assessment in robot assisted gynaecological surgery. METHODS: A Delphi process was initiated among a panel of 12 experts in robot assisted surgery invited through the SERGS. An online questionnaire survey was based on a literature search for standards in education in gynaecological robot assisted surgery. The survey was performed in three consecutive rounds to reach optimal consensus. The results of this survey were discussed by the panel and led to consensus recommendations on 39 issues, adhering to general principles of medical education. RESULTS: On review there appeared to be no accredited training programs in Europe, and few in the USA. Recommendations for requirements of training centres, educational tools and assessment of proficiency varied widely. Stepwise and structured training together with validated assessment based on competencies rather than on volume emerged as prerequisites for adequate and safe learning. An appropriate educational environment and tools for training were defined. Although certification should be competence based, the panel recommended additional volume based criteria for both accreditation of training centres and certification of individual surgeons. CONCLUSIONS: Consensus was reached on minimum criteria for training in robot assisted gynaecological surgery. To transfer results into clinical practice, experts recommended a curriculum and guidelines that have now been endorsed by SERGS to be used to establish training programmes for robot assisted surgery.

[Notifiable animal diseases diagnosed at the Institute of Veterinary Pathology of the University of Zurich between 1988 and 2004]. / Meldepflichtige Tierseuchen diagnostiziert am Institut für Veterinärpathologie der Universität Zürich zwischen 1988 und 2004.

One of the essential tasks of veterinary pathology is the gross and microscopic examination of animals post mortem. Frequently requests are made for the cause of disease or death in the absence of a precise history or an otherwise specific assignment e.g. whether a notifiable disease is involved. The general examination is supplemented by a spectrum of additional examinations depending on the case whereas attempts are made to keep the costs within limits and to answer the client's request with justifiable effort. 36,365 necropsy cases and 9192 organs submitted between 1988 and 2004 were analysed to give indications on the number and type of notifiable diseases that were diagnosed in the course of routine diagnostic procedures. Notifiable animal diseases were discovered in 2918 cases (6.4% of all investigated cases) namely 2426 farm animals (9.1% of all farm animals) and 492 animals of other species (2.6% of all other animal species). These data illustrate the considerable value of pathological-anatomical examinations and compliment the figures from other databases.

Impact of restricting fluoroquinolone prescription on bacterial resistance in an intensive care unit.

The purpose of this study was to assess the effect of reducing prescription of fluoroquinolones in an intensive care unit (ICU) upon bacterial resistance, particularly as regards Pseudomonas aeruginosa. For six months between January 2001 and June 2001, administration of fluoroquinolones was kept to a minimum. A bacteriological screening of patients was performed to assess the incidence of fluoroquinolone-resistant bacteria. There was a 75.8% restriction in prescriptions of fluoroquinolones. There was no significant change in bacterial ecology between the periods preceding (12 months) and following (12 months) restriction. There was a significant recovery of sensitivity of P. aeruginosa to ciprofloxacin (P

Evaluation of biochemical methods for estimating the sodium intake of dairy cows.

Samples of blood and urine were taken from 334 dairy cows in 29 herds, and the concentrations of sodium and potassium were measured in the serum and urine. The herds were split into five groups according to the amount of supplementary salt they were given: three groups given 10 to 20, 30 to 50 or 70 to 100 g salt per day, and two groups fed an ad libitum supply, given either in bowls or in the form of salt blocks, which were replaced either regularly or irregularly. The groups which received 70 to 100 g of salt daily or were supplied regularly ad libitum had significantly higher urinary sodium concentrations than the other groups. The group receiving 10 to 20 g a day had a significantly higher ratio of potassium:sodium in their urine than all the other groups, in which the ratio decreased as the level of supplementary salt increased. There were wider differences between the groups in terms of the urinary potassium:sodium ratio than in terms of the urinary sodium concentration but less variability within each group.

The federal system of Veterinary Services in Switzerland.

The Veterinary Service is described in the context of the federal state system in Switzerland. The Federal Veterinary Office (FVO) plays a leading role in this Service. Apart from its responsibility for legislation, the most important task of the FVO is the dissemination of information throughout Switzerland. The responsibility for ensuring that the laws are implemented lies with the 26 cantons. Veterinary public health is a key function of the Veterinary Service, where the core focus is on the implementation of the 'stable to table' concept. Animal protection is also an important function. A certified Veterinary Service requires a high-quality system based on professionalism, objectivity and evaluation. In this paper, the various strengths and weaknesses of the system in Switzerland are discussed and the disadvantages are analysed in depth.

[Reference values in the cerebrospinal fluid of calves between four and eight weeks of age]. / Referenzwerte im Liquor cerebrospinalis bei Kälbern im Alter von vier bis acht Wochen.

Reference values for the following parameters were established in the cerebrospinal fluid of 27 calves between four and eight weeks of age: specific weight, protein concentration, erythrocyte count, total leucocyte count with cell differentiation, creatin kinase activity, glucose and sodium. If possible, the findings were compared with those of other authors in calves and adult bovines. With 24.3 cells per microliter the 90% quantile of the total leucocyte count was seated significantly above comparable values for adult bovines. Hence, in individual cases markedly higher leucocyte counts can be expected in the cerebrospinal fluid of calves. In agreement with other authors, the protein concentration in calves was lower than in adult bovines. The reference range for creatin kinase activity was increased whereas the one for sodium was only slightly increased compared to earlier investigations in calves and in adult bovines.

Preliminary study of the deposition of aerosol in the maxillary sinuses using a plastinated model.

In spite of the widespread use of aerosols in respiratory diseases, very few studies have been performed in the field of ear, nose, and throat (ENT) disorders. The conditions for penetration of aerosols inside the sinus cavities are thus still not understood fully. The aim of this study was to investigate the penetration of aerosols inside maxillary sinuses in vitro, using plastinated models. Three plastinated specimens of the nose and sinuses were made from three different corpses. These specimens were validated by CT scans and were used to study deposition of aerosol in the maxillary sinuses. We performed scintigraphic images of the models in above, face, and profile views using a technetium (99mTc)-labelled solution to show aerosol deposition. We also counted the radioactivity deposited on gauze compresses placed inside the maxillary sinuses. In addition, we constructed a measuring unit with miniature humidity sensors placed inside the sinuses. We recorded the changes in relative humidity observed during nebulization. Results from these studies showed that scintigraphic images of the specimen, whatever the incidence of the views, were not accurate enough to differentiate the aerosol deposition in the maxillary sinuses from that in the nasal cavity. Using indirect counting on gauze compresses made possible the quantification of local aerosol deposition, and we found that aerosols entered into the sinuses. This confirmed that aerosols could reach the middle meatus, which is the main area for sinusitis disorders. The increased activity compared to background varied from 17 to 127%. The humidity sensors recorded changes in relative humidity during the nebulization. These humidity changes fitted a nonlinear model represented by the equation: y = b0 (1 - e(-b1t)), where b0 is the plateau and b1 is the speed to reach the plateau. These techniques may be useful in the future for in vitro characterization of aerosol penetration into the maxillary sinuses.

Evaluation of a new rapid urine screening analyser: CellFacts.

The aim of this study was to evaluate a new urine screening analyser in a Hospital Bacteriology Laboratory: the Cellfacts Urine Screening Analyser (Microbial Systems Limited (MSL), Coventry, England). A cohort of 1036 urine specimens were analysed by both the CellFacts and routine traditional methods. Using the CDC urinary tract infection decision levels, and compared to reference methods, the sensitivity and specificity were respectively 88.9% and 76.2%, and the predictive negative value and predictive positive value respectively 93.3% and 64.8%. Compared to the microscopy, the correlations of white blood cell count and red blood cell count were good, respectively (r = 0.8, p < 0.0001) and (r = 0.6, p < 0.0001). These results indicate that, although several positive samples were not reported, CellFacts facilitates efficient, rapid screening of infected urine specimens. This leads to perform a cytobacteriological analysis only on those results screened as positive by the automatic analysis system.

Studies on the supply of immunoglobulin G to newborn camel calves (Camelus dromedarius).

A major problem in camel productivity is the high mortality rate of camel calves in the first 3 months. The causes for mortality are mainly poor management practice and infectious diseases. The purpose of this research, carried out on a ranch in Kenya, was to determine the immunoglobulin G (IgG) concentration in camel colostrum as well as the extent of the calves' passive immunization by maternal antibodies. IgG concentration in colostrum and in the serum of the calf were measured during the first 3 d of life. Evaluation was carried out by comparing the respective values with those for horses and cattle. The average IgG concentration in the camel colostrum was higher than that found in literature for horses and cattle. IgG concentration in the serum of the camel calves reached its maximum 24 h after birth. In 39% of the examined calves, this maximum concentration was below 4 g/l, which is considered to be the critical value in horses and cattle. 61% of the calves achieved an IgG concentration of over 4 g/l. Since there is no correlation between IgG level in colostrum and early mortality, the results indicate that low colostrum intake during the first 24 h of life and not low IgG concentration in colostrum is presumably one of the main causes of early calf mortality. Therefore, it was recommended that the care of the newborn calves by herdsmen should be improved.

[The supply of newborn camel foals (Camelus dromedarius) with immunoglobulin G]. / Untersuchungen über die Versorgung von neugeborenen Kamelfohlen (Camelus dromedarius) mit Immunglobulin-G.

A major problem in camel breeding in East Africa is the high mortality rate of young camel calves. The purpose of this research was to examine the quality of camel colostrum and extent of the calves passive immunization by maternal antibodies. In 31 camel birth on a ranch in Kenya, IgG concentrations in the colostrum and in the serum of the calf during the first three days of life were measured. IgG concentration in the serum of the calf reaches a maximum 24 hours after birth. In 39% of the examined calves, this maximum concentration was below 4 g/l. In 61% of the calves, an IgG concentration of more than 4 g/l was reached. No correlation was found between diseased animals and the IgG concentrations in the serum of the calves involved. A minor IgG concentration can be excluded as a reason for calves mortality. The high percentage of insufficient IgG concentration in the serum of the calves therefore must be caused by insufficient intake of colostrum. Future measures in order to decrease calves mortality must therefore try to improve the management of calves, especially the sufficient intake of colostrum.

[Reassessment of the herd consultation in facilities with accumulated abortions in cattle]. / Uberprüfung der Bestandesberatung in Betrieben mit gehäuftem Verwerfen beim Rind.

One hundred and ninety-eight dairy herds in which an abortion problem had been investigated by laboratory examination alone or in conjunction with a farm visit were reassessed via a questionnaire at least 1 year after the initial investigation. The overall response rate to the questionnaire was 78%, but more owners responded after a farm visit. One hundred and twenty-five questionnaires (63%) could be evaluated. Significantly more (p = 0.01) complete or tentative diagnoses were made in herds that were visited. The abortion problem had resolved in 88%, 79% and 88% of herds with a complete, a tentative and no diagnosis, respectively. In 65% of herds, the suggested control measures were followed by the attending veterinarian or the owner. Resolution of the abortion problem was more common in herds in which the proposed control measures were followed, in herds in which a complete diagnosis had been made, and in herds that had been visited during the initial investigation. The success in resolving the abortion problem, that could be attributed to the initial investigation, was 21% when a complete diagnosis had been made and 11% when only a tentative diagnosis had been made. Most (67%) herd owners would favour an accompanying farm visit, as opposed to laboratory examinations alone, if another abortion problem occurred, but only if a considerable portion of the cost could be deferred.

[Back fat thickness and fertility in Brown Swiss cows]. / Rückenfettdicke und Fruchtbarkeit bei Braunviehkühen.

In a total of 94 cows the mean back fat thickness (BFT) on Day 275 of pregnancy and 2 to 3 days after calving (peripartal) as well as between Days 42 and 44 post partum (postpuerperal) has been examined sonographically. Based on their BFT levels all examined cows have been divided into three groups: overconditioned, optimal conditioned and underconditioned cows. Cows which were peripartal overconditioned had more often ovarian cysts (p < 0.05) and were culled more frequently (p < 0.1) because of infertility than peripartal cows which were optimal or underconditioned. Nevertheless, the interval from calving to conception of peripartal cows being in different physical conditions was not significantly different. Postpuerperal cows which were overconditioned had more often ovarian cysts (p < 0.05) and were more frequently (p < 0.05) slaughtered because of infertility than postpuerperal cows which were optimal or underconditioned. Postpuerperal cows which were over- or underconditioned had a significantly longer interval from calving to conception than cows which were optimal conditioned 6 weeks after calving. The correlation coefficient between peripartal and postpuerperal BFT was 0.82 (p < 0.05). The decrease of BFT between the peripartal and postpuerperal timepoint had no significant influence on the frequency of ovarian cysts, the interval from calving to conception and the infertility caused culling rate.

Clinical, haematological and biochemical findings in milk-fed calves with chronic indigestion.

The principal clinical signs in 59 milk-fed calves with chronic indigestion were general malaise and depression, poor appetite, poor body condition, dehydration, a dull and scaly hair coat, alopecia and clay-like faeces. All the calves had metabolic acidosis, which was associated with an inability to stand up in more than half of them. There were significant differences in the severity of acidosis between the calves that could stand and those that could not. Other signs in some of the calves were dehydration, leucocytosis, and increased activities of liver enzymes.

Acid-base disorders in milk-fed calves with chronic indigestion.

Acid-base disorders were investigated in 50 calves with chronic indigestion and metabolic acidosis. In the calves that were unable to stand up, the acidosis was significantly more severe than in the calves that could stand up. The anion gap and four different components of the base excess were calculated by the method described by Fencl. The anion gap was high in more than half of the calves, and it was significantly associated with the base excess due to unidentified anions. However, in seven of the calves, the excess of unidentified anions would not have been detected without the calculations, which made it possible to measure the effect of sodium, chloride, plasma protein and unidentified anions on the acid-base balance. Twenty-four of the calves had a combination of hyperchloraemic and high anion gap metabolic acidosis. Changes in sodium and plasma protein concentrations had a minor impact on the calves' acid-base status.

[Chronic indigestion in milk-fed calves]. / Chronische Indigestion beim Milchkalb.

Calves with chronic indigestion have disturbed general attitude and condition, decreased appetite, loss of hair, clay-like faeces and ruminal and metabolic acidosis. Possible causes include dysfunction of the oesophageal-groove reflex, reflux of abomasal contents into the rumen and abnormal ruminal motility. The anion gap may be increased or within normal limits. Metabolic acidosis is significantly more severe in calves that are unable to stand than in calves that can stand. Treatment of chronic indigestion consists primarily of intravenous administration of sodium bicarbonate, transfaunation of the rumen and oral administration of electrolyte solutions.

Phase II study of a radiotherapy/etoposide combination for patients with newly malignant gliomas.

PURPOSE: Etoposide, a semisynthetic derivative of podophyllotoxine, is a topoisomerase II inhibitor. This drug is currently used in several types of human cancer. The aim of this study was to evaluate the efficacity and tolerance of a near-concurrent association of radiotherapy and etoposide for newly malignant gliomas. METHODS: From May 1995 to December 1996, 30 malignant glioma patients were included in this phase II study; 16 patients underwent surgical tumor resection, and a stereotactic biopsy was performed in 14 patients. Standard cranial irradiation and six courses of etoposide (100 mg/m2, x days 1-3) were administered. The first course of etoposide was administered on days 1-3 of radiotherapy and was resumed in the week following the end of radiotherapy. Treatment was consolidated by further courses of etoposide every 4 weeks. RESULTS: Only 26 patients could be evaluated for the purpose of our study. The median age was 60.1 years, and the median Karnofsky performance score (KPS) was 80.2. The rate of objective response for evaluable patients was 34.6%, and four complete responses (CR) and five partial responses (PR) were noted. The median survival (MST) was 12 months, and the average overall survival was 12.5 months. Hematological toxicity was mild, and grade 3 or 4 neutropenia (white blood cell count < 1500/ml) was noted in three patients, without any sepsis or bleeding. CONCLUSIONS: The results obtained in this study are comparable to the best reported results on the combination of radiotherapy and nitrosoureas. The near-concurrent combination of radiotherapy and etoposide seems to be effective and well tolerated in the treatment of newly malignant gliomas.

[Determination of bone markers in dairy cows with parturient paresis]. / Bestimmung von Knochenmarkern bei Milchkühen mit Gebärparese.

The collagen metabolites hydroxyproline (HYP), deoxypyridinoline (DPD) and pyridinoline (PYD) are suitable markers for bone resorption in humans and several animal species. In a field trial cows with symptoms of periparturient paresis (group A) and healthy control cows without symptoms (group B) were compared and urine and blood samples were collected on day 1, 2, 3, 4, 5, 9 and 14 after parturition. In group A the mean +/- SE serum Ca concentration on day 1 was 1.4 +/- 0.1 mmol/l whereas those of group B were 2.0 +/- 0.1 mmol/l. A significant increase of the corrected urinary HYP concentration was observed from parturition to day 14 (from 2.8 to 8.8 mumol/mmol creatinine) and the concentrations at the different times were higher in group A than in group B. The mean corrected total and free DPD and total PYD concentration in urine increased after parturition to reach a peak at day 9. For DPD and PYD the mean concentrations between the two groups did not differ significantly. The DPD and PYD are useful tools to follow bone resorption in dairy cows, although in our study no difference between the two groups could be found which means that both groups were able to mobilize Ca from bone.

[Multifactorial effect of intrinsic animal factors, season and herd effect on the parameter of metabolic profile in dairy cows: energy and protein metabolism]. / Multifaktorieller Einfluss von tiereigenen Faktoren, Jahreszeit und Betrieb auf die Parameter des metabolischen Profils bei Milchkühen: Energie- und Protein-Stoffwechsel.

In this study, we investigated in a multivariate approach the multifactorial relationships between intrinsic factors, season, time of sampling during the year, and herd effect on one side, and selected biochemical markers of the energy and protein metabolism on the other side. A total of 370 cows (158 in summer and 212 in winter) were investigated within 0-160 days post partum. The following metabolites were chosen: glucose, nonesterified fatty acids, b-hydroxybutyrate, cholesterol and urea. Multiple linear regression models with only intrinsic factors had generally low coefficients of determination (r2). Season had a significant effect on all metabolites excepted glucose, but introduction of this factor in the models did not increase r2 markedly. Herd effect was highly significant for all blood parameters. Despite the reduction of the number of cases, models within season showed higher r2 than the overall models. This leads to the conclusion that, according to the season, some factors have different effects which neutralize themselves during the whole year. Many interactions herd x factors were significant for each metabolite. This means that the effect of the factors is different among herds. These interactions were especially strong for glucose, b-hydroxybutyrate and urea nitrogen, which usually show short-term responses to feeding changes. The regression models showed generally high coefficients of determination. It is concluded that these factors and interactions have to be introduced as covariates in models designed to investigate the relationships between biochemical markers and clinical findings.