Endovascular management of critical limb ischemia.

Endovascular management of critical limb ischemia has advanced significantly in the recent past, especially the ability to treat tibial artery lesions with reasonable results. The indications, results, and technical aspects or endovascular management of CLI is reviewed herein. An algorithm for clinical management of CLI in patients with tibial occlusive disease is also presented.

Cell-autonomous recognition of the rust pathogen determines rp1-specified resistance in maize.

The Rp1 gene of maize determines resistance to the leaf rust pathogen Puccinia sorghi. X-ray treatment of heterozygous (Rp1 Oy/rp1 oy) maize embryos generated seedlings with yellow sectors lacking. Rp1. Yellow sectored seedlings inoculated with rust spores gave rust pustule formation in yellow (Rp1-lacking) sectors and hypersensitive resistance in green tissues, thereby demonstrating that the Rp1 gene product is cellautonomous in its action. In cases where the hypersensitive reaction was initiated in green (Rp1) tissue next to a yellow sector, the hypersensitive response appeared to be propagated poorly, if at all, through Rp1-lacking cells.

Syndactyly in a litter of cats.

In this case report, we describe the clinical and radiographic features of a litter of kittens affected with complex syndactyly. We also provide guidelines for the diagnosis, possible treatment and prevention of propagation of this condition. This is the first report of syndactyly in a litter of kittens and syndactyly affecting both the pectoral and pelvic limbs.

Irradiation-hyperthermia in canine hemangiopericytomas: large-animal model for therapeutic response.

Results of irradiation-hyperthermia treatment in 11 dogs with naturally occurring hemangiopericytoma were reported. Similarities of canine and human hemangiopericytomas were described. Orthovoltage X-irradiation followed by microwave-induced hyperthermia resulted in a 91% objective response rate. A statistical procedure was given to evaluate quantitatively the clinical behavior of locally invasive, nonmetastatic tumors in dogs that were undergoing therapy for control of local disease. The procedure used a small sample size and demonstrated distribution of the data on a scaled response as well as transformation of the data through classical parametric and nonparametric statistical methods. These statistical methods set confidence limits on the population mean and placed tolerance limits on a population percentage. Application of the statistical methods to human and animal clinical trials was apparent.

Morphological and functional evaluation of a dog with dimelia.

Weight bearing patterns were investigated on a young Cocker Spaniel with dimelia (mirror hand) of the left forelimb, using a pressure sensing walkway (PS walkway). The dog had two left forelimb paws, both originating from the carpus, with symmetrical duplication of metacarpal bones and phalanges. In addition, the left radial head was subluxated and asynchronous growth of the left radius and ulna was noted. The PS walkway demonstrated minimal weight-bearing of the extra (medial) paw and longer metacarpal pad contact of the affected limb. The radiographic changes and the weight-bearing pattern during gait suggested that more weight was loaded on the lateral paw of the affected limb. Treatment was not recommended because of the relatively good limb function and the absence of overt pain. This is the first reported case of canine dimelia and foot pressure patterns in a canine congenital musculoskeletal deformity.

Arthrodesis of the talocalcaneal joint for the treatment of two horses with talocalcaneal osteoarthritis.

Two horses with lameness due to tolocalcaneal osteoarthritis that failed to respond to conservative management were treated by tolocalcaneal arthrodesis using cortex screws placed in lag fashion. The affected joint of one horse was arthrodesed by compressing and stabilizing the medial facet of the joint with three screws. In the second horse, the medial and lateral facets of the affected tolocalcaneal joint were each compressed and stabilized with two screws. The lameness of both horses improved markedly following surgery.

Altered exercise gas exchange and cardiac function in patients with mild chronic obstructive pulmonary disease.

Patients with advanced COPD have significantly reduced gas exchange and pulmonary function; however, little is known regarding physical work capacity and exercise gas exchange in patients with mild COPD. A total of 39 individuals (20 men and 19 women) without evidence of COPD (controls) and 51 individuals (29 men and 22 women) with mild COPD (FEV1 > or = 60 percent of predicted; and ratio of FEV1 over forced vital capacity of 60 to 70 percent) were tested to determine resting pulmonary function and resting and peak exercise gas exchange in response to progressive maximal cycle ergometer testing. In general, those with mild COPD had similar smoking histories and essentially equivalent resting gas exchange studies as compared to the controls. Measured maximal oxygen consumption was less in both the male (p < 0.003) and the female patients (p < 0.001). This was due, in part, to a lower maximal ventilation in the men with obstruction (p < 0.04), resulting from a significant reduction in tidal volume (p < 0.05). Women presented with similar decreases in maximal ventilation (p < 0.04) and maximal tidal volume (p < 0.01), while no difference in maximal respiratory rate was noted in either group (p > 0.05). Breathing reserve was 32 percent and 53 percent less for the male and female patients with obstruction than for controls. Maximal heart rates were less in the individuals with obstruction, where they reached 93 percent (p < 0.02) and 96 percent (p < 0.003) of the age- and sex-specific maximal heart rates for men and women as compared to 101 percent and 99 percent obtained in the controls. Achieved absolute work loads for men and women (in kilogram.meters per minute) were lower in the groups with obstruction (p < 0.002 and 0.0003) as well. These results demonstrate that work capacity and gas exchange are significantly decreased in individuals with even mild COPD. The reduction in functional work capacity is secondary to a loss of pulmonary function, as well as chronic deconditioning. Increased dyspnea may be responsible for the premature cessation of exercise observed in patients with mild COPD. Thus, early intervention with exercise training may be warranted to counter the deleterious effects of deconditioning and declining pulmonary function in patients with mild COPD.

Reduced diffusing capacity as an isolated finding in asbestos- and silica-exposed workers.

From a cohort of 286 patients referred to an Occupational Medicine Clinic because of exposure to asbestos and/or silica, we identified 53 patients with a reduced diffusing capacity (Dco) (less than 75 percent predicted) as their only abnormality. Specifically, their clinical evaluation, chest roentgenograms, and remaining pulmonary function test results were all normal. These patients were divided into non-smokers (n = 13) and smokers (n = 40). The significance of the isolated reduction in diffusing capacity in these patients (n = 53) was explored with graded exercise testing (n = 19) and bronchoalveolar lavage (BAL) (n = 50). The results obtained from the patients with reduced diffusion were compared with those obtained from comparable smoking (n = 35) and nonsmoking patients (n = 37) in the original cohort who had normal chest roentgenograms and normal results of pulmonary function studies, including normal Dco values (greater than or equal to 75 percent of predicted value). Patients with low diffusion demonstrated a tendency for elevated alveolar to arterial O2 differences both at rest and during exercise, and a significant reduction in exercise capacity (VO2 max) was observed in the smoking patients with reduced diffusion when compared with their smoking counterparts with normal diffusion. All other exercise testing indexes were normal in the study groups and there was no correlation between the percent predicted Dco value and any of the exercise variables. In contrast, BAL revealed significant differences between patient groups. Both the smoking and nonsmoking patient groups with low Dco values had greater numbers of total BAL cells, alveolar macrophages, neutrophils, lymphocytes, and eosinophils in their BAL fluid than did their comparable controls with normal diffusion values. These differences were statistically significant (p less than .05) for total BAL cells and total macrophages in the nonsmoking patients and for total BAL cells, total macrophages, and total lymphocytes in the smoking patients expressed as either the total cell number per BAL or total cells per milliliter of BAL. In contrast to the observed exercise testing results, there was significant and inverse correlation between Dco values and each BAL cell type for all four groups combined as well as nonsmokers alone. The Dco values from smokers were significantly and inversely correlated with total BAL cells and total macrophages. These results suggest that the finding of a reduced Dco may be related to an active inflammatory process in the lung caused by occupational dust exposure.(ABSTRACT TRUNCATED AT 400 WORDS)

Use of ultrasound imaging and fluoroscopic imaging to study gastric retention of enzyme-digestible hydrogels.

Ultrasound and fluoroscopic imaging techniques were used to monitor the gastric retention of enzyme-digestible hydrogels in the canine stomach. When water was present in the stomach, ultrasound imaging was very effective in monitoring the position of the hydrogel in the stomach, solvent penetration into the gel, and the gastric tissue-gel interactions during peristalsis. Rubbery or fully swollen hydrogels appeared as sonolucent objects with ultrasound imaging. Partially swollen hydrogels displayed a sonolucent outer layer due to solvent penetration and a centrally located bright echo resulting from the acoustic impedance mismatch at the glassy/rubbery interface. The degree of gastric tissue-gel interactions during peristalsis was inversely related to the extent of lumenal distention with water. The effectiveness of peristaltic contractions in driving the hydrogel toward the pyloric sphincter increased as the water was emptied from the stomach. In the absence of water, imaging of the gel with ultrasound became difficult. For this reason, gels were loaded with diatrizoate meglumine/sodium diatrizoate to visualize in real-time using fluoroscopic imaging. Fluoroscopic imaging allowed only indirect assessment of the hydrogel movement during peristalsis and the degree of hydrogel swelling. The gastric retention of the hydrogel under fasted conditions was influenced by the degree of gel deformation in response to peristaltic contractions. Hydrogels with a low degree of deformation during peristalsis showed long gastric retention times. The utilization of ultrasound imaging and fluoroscopic imaging for monitoring dynamic events in the stomach provided information on hydrogel properties which are important to gastric retention. The use of these imaging techniques in the development of long-term oral drug delivery systems is described.

Gastric retention properties of superporous hydrogel composites.

In many applications, usefulness of conventional hydrogels is limited by their slow swelling. To improve the swelling property of the conventional hydrogels, we have synthesized superporous hydrogels (SPHs) which swell fast to equilibrium size in minutes due to water uptake by capillary wetting through numerous interconnected open pores. The swelling ratio was also large in the range of hundreds. The mechanical strength of the highly swollen SPHs was increased by adding a composite material during the synthesis. The composite material used in the synthesis of SPH composites was Ac-Di-Sol((R)) (croscarmellose sodium). The gastric retention property of the prepared SPH composites was tested in dogs both in fasted and fed conditions. The SPH composites were placed in a hard gelatin capsule (size 000) for oral administration. All dogs tested were fasted for 36 h before experiments. Under the fasted condition, the SPH composite remained in the stomach for 2-3 h after before breaking into two pieces and being emptied. When food was given before the experiment just once following 36 h of fasting, the SPH composite remained in the stomach for more than 24 h, even though the fed condition was maintained only for the first few hours. Our study indicated that SPH composites possessed three properties necessary for gastric retention: fast swelling; superswelling; and high mechanical strength. While more improvements need to be made, the SPH composites provide the basis for the development of effective long-term gastric retention devices.

Abdominal binding and counterpulsation in cardiopulmonary resuscitation.

During the past 15 years, many different studies have documented improved blood pressure and blood flow above the diaphragm when some type of abdominal compression was added to conventional CPR, either in animals or in humans. Rhythmically interposed abdominal compressions seem to provide even greater hemodynamic benefit than continuous abdominal binding. Both total flow and the distribution of flow to vital organs above the diaphragm are improved, while the chances of liver entrapment and damage during chest compression are reduced. The technique of interposed abdominal compression can be performed with the bare hands of a second or third rescuer. It requires no special equipment, and could be easily incorporated into existing training programs for basic rescuers. In this sense the technique may constitute a logical evolution in basic life support, if subsequent clinical research confirms that it improves outcome.

Environmental and nutritional factors affecting geosmin synthesis by Anabaena sp.

A cyanobacterium isolated from a source-water reservoir during a spring odor and taste episode and identified as Anabaena sp. consistently produced geosmin during laboratory culture on modified BG-11 liquid medium. Maximal geosmin/biomass occurred at 20 degrees C and a light intensity of 17 microE/m2/s; geosmin/chla values directly correlated with increasing light intensity (r2 = 0.95, P < 0.01). It was concluded that at 20 degrees C, increasing light intensity favors less chla synthesis and higher geosmin synthesis; at 17 microE/m2/s, increasing temperature stimulates chla production (to 25 degrees C) while repressing geosmin synthesis (above 20 degrees C). Nutritional factors promoting biomass, chla, and geosmin synthesis by Anabaena sp. were also investigated. For cultures grown at 17 microE/m2/s and 20 degrees C for 20 days, both ammonium-N and nitrate-N generally enhanced the growth of Anabaena sp. Nitrate-N promoted more chla production (r2 = 0.99) than ammonium-N. Geosmin synthesis was directly correlated with ammonium-N concentrations (r2 = 0.89), with low nitrate-N (123.5 micrograms/l) favoring maximal geosmin production (2.8 micrograms/l). Increasing nitrate-N concentrations promoted a three-fold increase in chla content with geosmin synthesis decreased by two-fold. Geosmin/mg biomass was directly related to ammonium-N concentration; high nitrate-N levels suppressed geosmin production. No geosmin was detected at or below 118 micrograms phosphate-phosphorus/l. Geosmin, dry weight biomass, and chla production were correlated with increasing phosphorus (P) concentration (r2 = 0.76, 0.96 and 0.98, respectively). No geosmin was detected when copper was present in growth media at or above 6.92 micrograms Cu2+/l (CuSO4.5H2O). Dry weight biomass and chla production were negatively correlated with Cu2+ ion concentrations.

Small intestinal submucosa as a small-diameter arterial graft in the dog.

Autogenous saphenous vein, human umbilical vein, modified bovine collagen, Dacron, and PTFE have been used as small-diameter arterial grafts with moderate success. We tested autogenous small intestine submucosa as a small-diameter arterial graft in both a carotid and femoral artery (mean ID 4.3 mm) of 18 dogs (total of 36 grafts). All dogs received aspirin and warfarin sodium for the first 8 weeks after surgery. Graft patency was evaluated by Doppler ultrasound techniques and angiography. Two grafts ruptured and 5 grafts occluded by 21 days after surgery. One graft became occluded at 14 weeks. Fifteen dogs were sacrificed at periodic intervals until 48 weeks after surgery. Patent grafts had no evidence of infection, propagating thrombus, or intimal hyperplasia. Graft aneurysmal dilation occurred in 4 grafts (11%). The grafts were composed of a dense organized collagenous connective tissue with no evidence of endothelial cell growth on the smooth luminal surface. Three dogs are alive at 76 to 82 weeks after surgery. Overall, graft patency was 75%. Graft patency after cessation of anticoagulation therapy was 92.3% (12 of 13 grafts). We conclude that autogenous small intestinal submucosa can be used as a small-diameter arterial graft in the dog and is worthy of further investigation.

Cisplatin toxicity in cats.

Cisplatin (cis-diamminedichloroplatinum; Platinol, Bristol, Syracuse, NY) was administered to 11 cats, divided into three groups of experimental and clinical patients. In group 1, cisplatin was administered at a dose of 60 mg/m2 to four cats. In an attempt to avoid renal toxicity, saline diuresis was induced by administering 0.9% saline solution intravenously at a rate of 20 ml/kg/hr for 4 hours before and 2 hours after cisplatin administration. All four cats became dyspneic and died 48-96 hours after cisplatin administration. Postmortem findings included severe hydrothorax, pulmonary edema, and mediastinal edema. In group 2, four experimental cats entered a trial comparing the effects of saline diuresis and cisplatin (60 mg/m2) with the effects of saline diuresis and placebo (0.9% saline solution). The cats in the saline control group remained completely normal, while the cats that received cisplatin developed clinical signs and gross postmortem pulmonary changes identical to those in the first group of cats. Histopathologic examination showed that the alveolar septa were thickened and congested, and contained macrophages, occasional neutrophils, thrombi, and small foci of necrosis and fibrin. Microangiopathic changes were seen in the alveolar capillaries. In the third group, three additional cats were treated with a lower dose of cisplatin. Two cats that received 40 mg/m2 of cisplatin developed pulmonary changes similar to, but less severe than, those seen in the cats that received the higher dose of cisplatin. One cat treated with 20 mg/m2 of cisplatin showed no pulmonary changes ante mortem or post mortem. This series of 11 clinical and experimental cases identifies an apparent species-specific, dose-related, primary pulmonary toxicity of cisplatin in cats.

Isolation, characterization, and molecular cloning of cryptic plasmids isolated from Edwardsiella ictaluri.

Fifty-five isolates of Edwardsiella ictaluri were examined for the presence of plasmid DNA by a rapid alkaline extraction procedure. All 49 isolates from channel catfish and a single isolate from Bengal danio carried 2 plasmids with molecular masses of approximately 3.2 and 3.7 megadaltons (Mdal). Five E ictaluri isolates from other fish contained 1 to 3 plasmids, which had molecular masses ranging from 2.5 to 45 Mdal. The 2 plasmids (3.2 and 3.7 Mdal) from the type strain of E ictaluri (ATCC 33202) were ligated into pUC19 cloning vectors, and restriction endonuclease maps of each insert were prepared.

Plasmid profiles of six species of Campylobacter from human beings, swine, and sheep.

Twenty-four isolates representing 6 species of Campylobacter were screened for plasmids. A large plasmid with an approximate molecular weight of 38 Mdal was detected in 5 C jejuni isolates originally recovered from diarrheic human beings, in one isolate of C coli recovered from diarrheic pigs, and in 1 isolate of C sputorum ssp mucosalis and 2 isolates of C hyointestinalis recovered from pigs with proliferative enteritis. One isolate of C coli and 1 isolate of C hyointestinalis contained an additional smaller plasmid with an approximate molecular weight of 1.6 Mdal; this plasmid was partially mapped by restriction endonuclease digestion. Fifteen Campylobacter isolates contained no detectable plasmids: 2 C coli, 2 C sputorum ssp mucosalis, 2 C fecalis, 1 C fetus ssp fetus, and 8 C hyointestinalis isolates. In summary, 37.5% of the Campylobacter isolates contained a 38-Mdal plasmid, with 8% having both 38 Mdal and 1.6-Mdal plasmids; 62.5% contained no detectable plasmids.

Outer membrane protein profiles of Edwardsiella ictaluri from fish.

Outer membrane proteins (OMP) prepared with sodium N-lauroyl sarcocinate (SLS) from 33 Edwardsiella ictaluri isolates from fish were examined by electrophoresis. Twenty-eight isolates from channel catfish (Ictalurus punctatus) had similar OMP profiles. Ten bands (71 kilodaltons [kD] to 19.5 kD) were identified in all isolates from channel catfish. One major 35-kD protein comprised most of the protein content of the outer membrane of isolates from channel catfish. Differences existed among isolates in the amount of protein within minor OMP bands. Edwardsiella ictaluri ATCC 33202 contained larger quantities of the 38.5- and 37-kD proteins than did the other isolates. Outer membrane protein profiles of E ictaluri derived from Bengal danio (Danio devario) and walking catfish (Clarias batrachus) were identical to OMP profiles of isolates from channel catfish. In contrast, OMP profiles from single isolates from green knife fish (Eigemannia virescens) and white catfish (Ictalurus catus) were different. Variations in incubation time, SLS extraction time, SLS extraction number, and in vivo and in vitro passage had no effect on the OMP profile of E ictaluri ATCC 33202. An increase in duration of sample solubilization did affect the OMP profile of E ictaluri ATCC 33202 by decreasing the amount of protein in 52-, 46-, and 43.5-kD bands. Accompanying the decrease were increased staining intensity in the 31.5- and 28.5-kD bands and the appearance of 4 new bands (34, 33, 25.5, and 22.5 kD). Edwardsiella ictaluri, a gram-negative bacterium in the family Enterobacteriaceae, is the cause of enteric septicemia of catfish.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebrospinal fluid changes after iopamidol and metrizamide myelography in clinically normal dogs.

Cerebrospinal fluid samples from 2 groups of clinically normal dogs were compared after iopamidol (n = 9) and metrizamide (n = 8) myelography. Iopamidol (200 mg of I/ml) and metrizamide (170 mg of I/ml) were administered by cerebellomedullary injection at dosage of 0.45 ml/kg of body weight. In dogs of both groups, postmyelographic CSF changes included high specific gravity, Pandy score, protein concentration, and WBC count. The high specific gravity and Pandy score were false-positive effects attributed to nonionic contrast media. Although postmyelographic protein concentration and total WBC count were greater in CSF samples from dogs given metrizamide than in those given iopamidol, differences were not statistically significant. The differential WBC counts were consistent with mild, acute leptomeningitis; these findings were supported by results of histologic examination. Iopamidol and metrizamide should be considered low-grade leptomeningeal irritants in dogs.

Ectopic ureter in a dog: extension from the kidney to the urinary bladder and to the urethra.

An ectopic ureter extending to the urinary bladder and to the proximal portion of the urethra was diagnosed in a 6-month-old dog with urinary incontinence. The diagnosis was made by use of excretory urography. The kidney and ureter were removed. When urinary incontinence continued, positive-contrast cystography was performed. The ectopic ureter was found to bypass the bladder via a submucosal extension that emptied into the urethra.