An Advanced Surgical Dressing for High-risk Patients Undergoing Breast Cancer Surgery: a Case-control Study.

Oncological breast surgeries, classified as breast conserving surgery, oncoplastic surgery, and mastectomies (standard or with tissue sparing and reconstruction), are burdened with an overall complication rate up to 33%. Aquacel Ag Surgical is a combined hydrofiber-hydrocolloids dressing. The aim of this study is to evaluate the incidence of surgical site complications in patients presenting with three or more risk factors (or two, of which at least one classified as "high risk"), undergoing breast cancer surgery with/without reconstruction, comparing advanced (Aquacel Ag Surgical) with traditional dressing. METHODS: This is a retrospective, monocentric, case-control study based at the breast unit of the Città della Salute e della Scienza Hospital of Turin, Italy. Forty-two patients who underwent breast surgeries and met the inclusion criteria were enrolled, from February 1 to July 31, 2018. The primary endpoint was comparing the incidence of surgical site complications (skin alterations, infection, and wound dehiscence) in the two groups. The secondary endpoints were evaluating patient's quality of life, aesthetic outcomes, and compliance to the dressings. RESULTS: The distribution of risk factors at the baseline between the two groups was balanced, without statistically significant differences. Wound complications' incidence at 1 week was lower in the advanced dressing group (P = 0.015). On the bivariate descriptive analysis, advanced dressing proved to be easier to remove for the operator (P = 0.026). The aesthetic outcomes vouched for better scores in the advanced dressing group. CONCLUSION: In the presented study Aquacel Ag Surgical dressing reduces surgical site complications in the first week after surgery in patients affected by three or more risk factors (or two with at least one classified as "high risk").

How long before resistance makes it impossible to control some field strains of Haemonchus contortus in South Africa with any of the modern anthelmintics?

This paper describes an exceptional spectrum of multiple anthelmintic resistance in two strains of Haemonchus contortus in South Africa, one from Howick in KwaZulu-Natal, and the other from Badplaas, in Mpumalanga. Apparently for the first time, a helminth strain is described with resistance to compounds from all five of the modern anthelmintic groups used for nematode control in sheep; also, two strains of H. contortus show resistance to the two substituted phenols, dinitrophenol and nitroxynil. Only closantel at 5 mg kg-1 of nine compounds tested appears to have undiminished efficacy against the Howick strain, but even in the case of closantel, the residual activity and minimal effective level need to be tested before it can be concluded that its efficiency is unaffected. The exceptional resistance of the Howick strain is demonstrated by the fact that sequential daily drenching of sheep infected with the strain, with levamisole at 18 mg kg-1, oxfendazole at 20 mg kg-1, levamisole at 20 mg kg-1 and a mixture of fenbendazole at 10 mg kg-1 plus trichlorfon at 132 mg kg-1 on the fourth day, failed to clear sheep of the infection. There are strong indications that side-resistance occurs between dinitrophenol and nitroxynil, on the one hand, and the salicylanilides, on the other, and it is suggested that, before long, strains of H. contortus will be found with high levels of resistance to all the currently available anthelmintics.

Wildlife parasites: lessons for parasite control in livestock.

For sustainable livestock production it is suggested that the parasitologist take a leaf out of Nature's book in the search for solutions to the mounting problems concerning parasite control. While the farmer has come to regard all parasites affecting livestock as entirely without benefit, indigenous parasites and diseases are normal and play an essential role as interacting components of a natural environment in an ecosystem such as the 19,000 km2-sized Kruger National Park, Republic of South Africa. The parasites help to select their hosts for fitness and are assisted by predators and intra-species territorial aggression which continually eliminate the weak individuals from the system. It is essential to guard against the introduction of foreign parasites or infectious agents which have no real ecological niche or role in an established ecosystem, however, as they cause untoward interactions, sometimes of a violent nature. The policy must be to block off or, failing that, to control or eliminate these foreign parasites and diseases as far as possible. Often, when Man intervenes in an ecosystem, it leads to stress, overcrowding and stagnation and predisposes to disease and death. Intensification of the system, as in farming units, denies Nature the chance to manage on its own, because of clashing interests with Man. Frank parasitism and disease should almost invariably be seen as indicators of an imbalance in the ecosystem and should be rectified. Chemicals and vaccines should be used to produce sufficient food for all, but without exploiting Nature, or else Nature will be unable to continue catering for Man's needs.

Quality control in generic anthelmintics: is it adequate?

We became increasingly concerned about indications of possible substandard efficacy of some generic anthelmintics, particularly after P.C. van Schalkwyk (personal communication, 1990) had found some batches of imported generic products obtained from international brokers to be poorly active, despite apparently normal physical characteristics. Therefore, considering the serious consequences this would have for sheep farming, it was decided to test the efficacy of some of the generic rafoxanide products available on the South African market. One of the three commercial formulations (of highly reputable companies) tested against a known susceptible strain of Haemonchus contortus in sheep was markedly substandard, with an arithmetic mean efficacy of 66.2% (Class B, Reinecke, 1973), compared to Class A efficacy of the other two, which also differed significantly from one another (Mann-Whitney; P = 0.01). Larger differences were found between the three products against a natural infection with a partially resistant strain of H. contortus than against the susceptible strain, with corresponding arithmetic mean efficacies of 28.7% (Class X, or ineffective), 71.3% (Class B) and 87.7% (also Class B). It is concluded that the most likely reason for the observed differences is that international brokers do not disclose the sources of supply of different batches of active ingredient (with the result that the companies buying anthelmintics from them have no way of telling when a source of supply is changed); that the efficacy of such batches differs; and that efficacy testing of individual batches in some cases is inadequate. It is suggested that registering authorities should consider simplified efficacy testing of each new batch of active ingredient before it may be marketed.

Helminth parasites of Cape mountain zebras from Cape Providence, South Africa.

Parasites were collected from 13 Cape mountain zebras (Equus zebra zebra) in the Mountain Zebra National Park, South Africa, during four seasons of 1983 and 1984. Eighteen nematode species belonging to the families Atractidae, Habronematidae, and Strongylidae, and one species of cestode were recovered. The most abundant nematodes were Cyathostomum tetracanthum, Cylicostephanus longiconus and Probstmayria vivipara. Only one of the 10 cyathostome nematodes recovered, C. longiconus was present in every zebra.

Nematode parasites from Burchell's zebras in South Africa.

Twenty-five Burchell's zebras (Equus burchelli antiquorum) which were culled at monthly intervals in the Kruger National Park were examined for helminths. Twenty-nine species of nematodes belonging to the families Atractidae, Habronematidae, Onchocercidae, Oxyuridae, Strongylidae, Strongyloididae and Trichostrongylidae were recovered. The cyathostomes (small strongyles) most abundant were Cyathostomum tetracanthum, Cylicostephanus calicatus, Cylindropharynx sp. (? C. intermedia Theiler, 1923) and Cylicocyclus auriculatus. Cyathostomum alveatum, Cyathostomum montgomeryi, Cylicostephanus calicatus and Cylindropharynx sp. (? C. intermedia Theiler, 1923) were the most prevalent cyathostomes (small strongyles) while Craterostomum acuticaudatum was the most prevalent of the large strongyles. Of all the species recovered those most abundant were Crossocephalus viviparus and Probstmayria vivipara with intensities of 100 to 3,857,772 and 18,400 to 104,120,467, respectively. Four new species, two Triodontophorus spp. (Strongylidae) and two Habronema spp. (Habronematidae) were identified. Furthermore, this study furnishes a first report of Triodontophorus minor in zebras. The fourth stage cyathostomes as well as the adults of 11 of the 14 species were present in significantly greater intensities in autumn and winter.

Cryopreservation of sheathed third-stage larvae of Ancylostoma caninum (hookworm of dogs) and Ancylostoma tubaeforme (hookworm of cats).

Sheathed infective third-stage larvae of Ancylostoma caninum and Ancylostoma tubaeforme were successfully cryopreserved in liquid nitrogen. The survival rates, as assessed by motility, were A. caninum 49.2% and A. tubaeforme 51,5% after 30 d of cryopreservation.

Studies on the parasites of zebras. IV. Cylicodontophorus reineckei n.sp. (Nematoda: Strongylidae) from the Burchell's zebra, Equus burchelli antiquorum H. Smith, 1841 and the mountain zebra, Equus zebra hartmannae Matschie, 1898.

A new species of nematode, Cylicodontophorus reineckei, was collected from Burchell's zebra, Equus burchelli antiquorum H. Smith, 1841, in both the Etosha National and Kruger National Parks and from mountain zebra, Equus zebra hartmannae Matschie, 1898, in the Namib Naukluft Park in South West Africa/Namibia. These nematodes have an external leaf-crown with longer elements than those of the internal leaf-crown and a well-developed dorsal gutter. The very well-developed oesophageal funnel is both wider and deeper than the buccal capsule.

Clinical evaluation of anaemia in sheep: early trials.

Trials were conducted on a farm in Mpumalanga Province in South Africa to test the possibility of grading the colour of the ocular mucous membranes of sheep as an indication of the extent to which the animals are affected by Haemonchus contortus infection. The range of observed colour shades were classified into five categories, from red, through red-pink, pink and pink-white to white. Over a period of 125 days routine drenching of a flock of 388 sheep on irrigated kikuyu (Pennisetum clandestinum) pasture was terminated. During this time the animals were examined at practically weekly intervals and haematocrit determinations done for all the sheep with pale conjunctivae. Only those sheep having a haematocrit of 15% or lower were treated. Compared to a previous drenching tempo of close to every 3 weeks during the Haemonchus season on the farm, drenching was reduced by approximately 90%, as 70% of the sheep did not require salvage drenching and only 10% of the flock had to be given more than one salvage treatment. At the time of the trial the five clinical classifications were not related to predetermined haematocrit categories. However, when compared to categories that were set in later trials, 94% of the clinical estimates in the present trial were either in the correct haematocrit category, or, if not, the sheep were probably not disadvantaged by the errors. In 2.6% of cases the incorrect estimate may have placed the sheep concerned in jeopardy, as the haematocrit values were so low that salvage drenching was required, while the sheep were not regarded as anaemic. Changes in the mean haematocrit values of drenched and undrenched sheep were mirrored reciprocally by the changes in clinical colour estimates. Lactating ewes were by far the most susceptible class of sheep, as only 44.6% of them were able to manage without drenching, compared to 83% of dry, and 70.6% of pregnant ewes. Correlations between the haematocrits and clinical estimates were highly significant, although the associations were not high enough to give reasonable surety that the haematocrit values of individual animals could be predicted with confidence from their clinical classifications. Exceptionally large numbers of worms were recovered from seven of the 14 sheep that were culled because of age at the end of the trial, but these were reflected neither in their faecal worm egg counts, nor, with one exception only, in clinical signs.

Molineus cati n. sp. (Nematoda, Trichostrongylina, Molineoidea), a parasite of feral cats, Felis catus Linnaeus, 1758 in South Africa.

A new species of the genus Molineus Cameron, 1923 was recovered from feral cats, Felis catus Linnaeus, 1758, in Mpumalanga Province, South Africa. Because of a caudal bursa with rays of the 2-1-2 type, but with the extremities of rays 4 nearer those of rays 3 than those of rays 5, the new species is closely related to seven Neotropical Molineus spp., four parasitic in Primates, two parasitic in Mustelidae and one a parasite of Procyonidae. Amongst these species, only Molineus barbaris Cameron, 1936, a parasite of Tayra barbara (Mustelidae) from Trinidad and Molineus vexillarius (Dunn, 1961), a parasite of Tamarinus nigricollis (Primates) from Peru have rays 4 longer than two-thirds the length of rays 3, like the new species. However, the new species is differentiated from the other two in that rays 9 arise at the level of the bifurcation of the dorsal ray and not after the division as is the case with M. barbaris and M. vexillarius.

Scanning electron microscopy of Strongylus spp. in zebra.

The external ultrastructure of the anterior and posterior extremities of the nematodes, Strongylus asini , Strongylus vulgaris, Strongylus equinus and Strongylus edentatus, was studied with scanning electron microscopy (SEM). Fresh specimens of S. asini were collected from the caecum, ventral colon and vena portae of Equus burchelli and Equus zebra hartmannae ; S. vulgaris from the caecum, colon and arteria ileocolica of E. burchelli ; S. equinus from the ventral colon of E. z. hartmannae and S. edentatus from the caecum and ventral colon of both zebras , during surveys of parasites in zebras in the Etosha Game Reserve, South West Africa/Namibia, and the Kruger National Park, Republic of South Africa. The worms were cleaned, fixed and mounted by standard methods and photographed in a JEOL JSM - 35C scanning electron microscope (SEM) operating at 12kV . The SEM showed the following differences: the tips of the external leaf-crowns varied and were fine and delicate in S. asini , coarse and broad in S. vulgaris and, in S. equinus and S. edentatus, closely adherent, separating into single elements for half their length. The excretory pores showed only slight variation, and the morphology of the copulatory bursae did not differ from those seen with light microscopy. The genital cones differed markedly: S. asini had a ventral triangular projection and laterally 2 finger-like projections: in S. vulgaris there were numerous bosses on the lateral and ventral aspects of the cone; in S. equinus 2 finger-like processes projected laterocaudally ; and in S. edentatus 2 pairs of papilla-like processes projected laterally on the ventral aspects, and a pair of rounded projections and a pair of hair-like structures adorned the dorsal aspects.(ABSTRACT TRUNCATED AT 250 WORDS)

Recovery of helminths postmortem from equines. I. Parasites in arteries, subperitoneum, liver and lungs.

The entire gastro-intestinal tract and viscera of the abdomen and thorax, including the heart, aorta and its branches to the viscera, are removed from the carcass. All the branches of the aorta, with the exception of the A. gastrica sinistra, are dissected from the intestinal tract, and subsequently each branch is isolated from the mesentery, fat, pancreas, kidneys, etc. Usually, the A. ileocolica is grossly enlarged due to chronic arteritis with thrombus formation caused by 4th stage larvae, 4th moult and 5th stage Strongylus vulgaris. Descriptions of methods to examine the subperitoneal tissues, liver and lungs are included.

Recovery of helminths postmortem from equines. II. Helminths and larvae of gasterophilus in the gastro-intestinal tract and oestrids from the sinuses.

The tongue, pharynx, oesophagus and gums are examined for larvae of gasterophilus spp., and the nose and sinuses for oestrid larvae. The gastro-intestinal tract is divided into separate specimens-stomach, small intestine, caecum, ventral colon, dorsal colon, descending colon and rectum- and each is examined separately. Aliquots of ingesta of 1/4 by mass of the stomach and 1/10 by mass of the small intestine, caecum, ventral colon and dorsal colon are collected for microscopic examination. Each part of the wall of the caecum, ventral and dorsal colon is washed and specimens are collected for subsequent examination. The gut wall of the caecum and colon is examined macroscopically for larval stages. Ingesta in the descending colon are examined macroscopically for Gasterophilus larvae.

Studies on the parasites of zebras. V. Nematodes of the Burchell's and Hartmann's mountain zebras from the Etosha National Park, South West Africa/Namibia.

Nine Burchell's and 6 Hartman's mountain zebras were culled during the 3 climatic periods characteristic of the Etosha National Park, South West Africa/Namibia, and were examined for helminths. The Burchell's zebras ranged in age from 4 1/2 to 19 years and the mountain zebras from 3 1/2 to 13 years. Twenty-five species of nematodes, belonging to the families Atractidae, Strongylidae, Oxyuridae, Onchocercidae and Habronematidae, were recovered. Of the family Cyathostominae, the following species were the most numerous in the Burchell's zebras: Cyathostomum montgomeryi (7 120-67 042), Cylicocyclus triramosus (11-34 540), Cylicostephanus minutus (4 698-40 019) and Cylindropharynx sp. (? intermedia) (3 591-40 018). The atractids present were: Crossocephalus viviparus (20-5 045 212) and Probstmayria vivipara (5 140-3 801 300). Three of the above cyathostome species were also most abundant in mountain zebras: Cylicocyclus triramosus (54-19 782), Cylicostephanus minutus (555-12 396) and Cylindrophrynx sp. (? intermedia) (3-5 325). New reports include Cylicostephanus longiconus in the Burchell's zebras and Cyathostomum alveatum, Cyathostomum montgomeryi, Cylicostephanus bidentatus and Draschia megastoma in the mountain zebra. The overwintering of 4th stage cyathostomes in the gut walls and their emergence which differ in the 2 hosts, are discussed.

Development of a novel self-medicating applicator for control of internal and external parasites of wild and domestic animals.

Four trials, three in the United States and one in South Africa, were conducted to evaluate the potential value of a novel self-medicating applicator in the passive control of gastrointestinal nematodes in cattle and deer, and of files and ticks on cattle using oil-based treatments. The results of the trials demonstrated that this applicator is an effective and practical device for the passive treatment of both deer and cattle for trichostrongyle infections using the endectocide, moxidectin (Cydectin. Fort Dodge Animal Health, USA), of cattle for hom fly (Haemotobia irritans) infestations using the insecticide, cyfluthrin (CyLence, Bayer AG, Germany) and of cattle for tick infestations (in particular Amblyomma hebraeum and Rhipicephalus appendiculatus) using the acaricides deltamethrin and amitraz (Delete All, Intervet, South Africa).

Studies on Strongylus asini. I. Experimental infestation of equines.

Infective larvae were harvested from a culture of eggs collected from adult Strongylus asini recovered from a free-ranging Burchell's zebra, Equus burchelli, in the Kruger National Park. Worm-free zebra, horse and donkey foals were successfully infested, but infestation failed in a mule foal. At slaughter, 117-125 days post-infestation, S. asini in their 4th moult were recovered from the liver and portal veins. This is the first report of successful experimental infestation of these hosts with S. asini.

Two field strains of Haemonchus contortus resistant to rafoxanide.

Two field strains of Haemonchus contortus, one from Pretoria on the Highveld and the other from White River in the Lowveld of the Transvaal, showed pronounced resistance to rafoxanide at a dosage rate of 7.5 mg/kg live mass per os. Both of these strains originated from kikuyu pastures under irrigation. Resistance in South Africa to rafoxanide and other anthelmintics, namely, closantel, ivermectin and the benzimidazoles is reviewed. It is concluded that apart from avoiding farming practices where integrated worm control is not possible, there is at present no solution to the problem of worm resistance in the country.

The problem of escalating resistance of Haemonchus contortus to the modern anthelmintics in South Africa.

During the past decade in South Africa there has been a continual increase in sheep of strains of gastrointestinal helminths resistant to the modern anthelmintics. Five strains of Haemonchus contortus are described in this paper. Despite the fact that 2 of the 5 strains were tested for susceptibility only to ivermectin, a total of 10 instances of resistance were found. Four of the 5 strains were resistant to ivermectin, 2 to closantel, 2 to rafoxanide and 2 to the benzimidazoles. One of these strains was concurrently resistant to 3 different anthelmintic groups, namely, the ivermectins, the benzimidazoles and the salicylanilides. Resistance to ivermectin developed in 2 strains of H. contortus after a history of only 3 treatments with this compound in one instance and 11 treatments in the other. In the latter case drenching with ivermectin was well interspersed with that of other anthelmintics. This rapid development of resistance suggests that there may be cross-resistance between ivermectin and another anthelmintic group. Two of the ivermectin resistant strains were recovered from separate properties in the south-western Cape Province, where Ostertagia circumcincta, which is usually the dominant parasite in this region, was virtually eliminated by the anthelmintic treatment. On each of these properties it was apparently replaced by a resistant strain of H. contortus. A serious threat to control is the dissemination of worm strains with multiple resistance to anthelmintics. The strain of H. contortus resistant to 3 anthelmintic groups has already been widely dispersed, as the farmer concerned suddenly decided to give up farming with sheep and to sell his flock.

Resistance of field strains of Haemonchus contortus to ivermectin, closantel, rafoxanide and the benzimidazoles in South Africa.

After a first description in 1975 of a strain of Haemonchus contortus resistant to the benzimidazole anthelmintics in South Africa, further strains of the same species developed resistance to rafoxanide and closantel, and a strain of Ostertagia species became resistant to the benzimidazoles. Recently five further strains of H contortus have been found which show resistance to these anthelmintics. Of these, four showed varying degrees of resistance to ivermectin and one was resistant to three anthelmintic groups. One of the strains became resistant to ivermectin very rapidly despite effective rotation of this anthelmintic with chemically unrelated anthelmintic compounds.

[Our experience with a new material for skin graft areas]. / La nostra esperienza su un nuovo materiale da medicazione per le aree di prelievo cutaneo.

The authors describe a new method of medicating disepidermised areas from which a dermo-epidermic graft has been removed to cover burn areas or following post-traumatic loss of substance. This method consists of the use of a thin microfibrillar film of a polysaccharidic type, which serves as a temporary substitute for the skin, offering selective permeability, the possibility of transpiration and gaseous exchange, but at the same time being impermeable to liquids and microorganisms. A study was performed to evaluate the efficacy and tolerability of this new dressing, involving 30 patients of both sexes aged between 9 and 87 years old. The site, dimensions, and type of graft were assessed in each patient together with the duration of pain and the time taken for the lesion to heal. This study has highlighted the positive function performed by medication with microfibrillar film in facilitating the cicatricial process, achieving complete re-epithelisation within an average of 8-9 days, with a considerable reduction in pain and satisfactory esthetic and functional result. No collateral effects or complications relating to the use of this material are reported in any of the cases studied.