Is the caudal auricular axial pattern flap robust? A multi-centre cohort study of 16 dogs and 12 cats (2005 to 2016).

OBJECTIVE: To determine the frequency and type of healing complications arising after the use of the caudal auricular axial pattern flap to close defects on the head in dogs and cats. MATERIAL AND METHODS: Multi-centre retrospective cohort study. Centres were recruited by the Association for Veterinary Soft Tissue Surgery Research Cooperative. Medical records of 11 centres were reviewed, and data from all dogs and cats treated with a caudal auricular axial pattern flap were retrieved. The following data were recorded: signalment, reason for reconstruction, flap dimensions, anatomic landmarks used, histological diagnosis, flap healing and whether revision surgery was required. RESULTS: Twenty-eight cases were included: 16 dogs and 12 cats. Flap length: width ratio was approximately 3:1 and flap length extended to the scapular spine in most cases. Optimal wound healing occurred in five of 16 (31%) dogs and six of 12 (50%) cats. Wound dehiscence without flap necrosis occurred in one of 16 (6%) dogs and one of 12 (8%) cats. Wound dehiscence with flap necrosis occurred in 10 of 16 (63%) dogs and five of 12 (42%) cats. Revision surgery was performed in eight of 16 (50%) dogs and three of 12 (25%) cats. CLINICAL SIGNIFICANCE: The caudal auricular axial pattern flap can provide full thickness skin coverage for large defects on the head in dogs and cats. Partial flap necrosis is a common complication, and revision surgery may be required in order to achieve final wound closure.

Noninvasive ventilation during percutaneous gastrostomy placement in Duchenne muscular dystrophy.

Noninvasive positive pressure ventilation (NPPV) is used for respiratory support in a number of diseases causing acute or chronic respiratory failure. We describe a novel use of NPPV to provide respiratory support during sedation for percutaneous placement of a gastrostomy tube in a patient with Duchenne muscular dystrophy (DMD). The patient had severe respiratory insufficiency, progressive dysphagia, and undernutrition. In addition to the case in this report, we have used NPPV to provide respiratory support to DMD patients during five other gastrointestinal endoscopies without complication. The technique is highly labor intensive and requires physicians and respiratory therapists familiar with NPPV. The primary risk associated with this technique is lack of definitive airway protection during the procedure, which must be balanced against the risks of intubation in an anesthetized patient with neuromuscular disease. The potential benefit to selected patients is substantial, such as initiation of gastrostomy tube feeding in our patient, with subsequent improvement in his quality of life and nutritional status.

Persistent pulmonary consolidation treated with intrapulmonary percussive ventilation: a preliminary report.

Intrapulmonary percussive ventilation (IPV) is a novel form of chest physiotherapy delivered by a percussive pneumatic device (IPV, Percussionaire, Sand Point, ID). There are few published reports about the use of IPV for diseases other than cystic fibrosis. We report our experience with three pediatric patients and one adult patient with persistent pulmonary consolidation refractory to conventional therapies. Three of the four patients had neuromuscular disease; one patient had segmental atelectasis due to aspiration. Three of the four patients showed clinical and radiographic improvement within 48 hours of starting IPV. The fourth patient experienced brief episodes of third-degree atrioventricular block, hypoxemia, and bradycardia during two IPV treatments. IPV was safely restarted and he slowly improved. We conclude that while IPV requires further clinical evaluation, it appears to be a safe and effective therapy for selected patients. However, close observation is essential during and after IPV treatments, especially in patients who have difficulty mobilizing or expectorating sputum.

Cravings and aversions of pregnant adolescents.

Adolescents from 31 eastern Tennessee counties were interviewed during the third trimester of pregnancy (n = 97) and at 1-year postpartum (n = 64) to assess cravings and aversions, beliefs about dietary cravings, and how these factors influence dietary intake. Characteristics of cravings and aversions were assessed using a semistructured interview. Beliefs about cravings during pregnancy were measured with a 13-item Likert-type scale (alpha = 0.79). Two 24-hour recalls and 2 days' food records provided dietary data. Most adolescents (86%) reported cravings during pregnancy. They most frequently reported cravings for sweets, especially chocolate; fruits and fruit juices; fast foods; pickles; ice cream; and pizza. Many participants (66%) experienced aversions during pregnancy toward previously liked foods. The most common aversions were to meats, eggs, and pizza. Fewer cravings and aversions were noted during the first year postpartum. No significant relationship existed between craving and aversions and belief scores. Adolescents craving sweets during pregnancy consumed more sugar and energy than those who did not crave sweets. Cravings generally resulted in increased intake, and aversions led to decreased food consumption. On the basis of these results, we suggest that nutritional assessment of pregnant adolescents include questions about cravings and aversions.

Pediatric noninvasive nasal ventilation.

Noninvasive nasal ventilation is an effective but underutilized method of chronic respiratory support for patients with respiratory insufficiency due to neuromuscular disease. Noninvasive nasal ventilation corrects nocturnal hypoxia and hypercapnia, resolving symptoms of chronic alveolar hypoventilation. Noninvasive nasal ventilation can allow selected patients with acute respiratory failure to avoid intubation and it can facilitate endotracheal extubation. Practical guidelines and the rationale for pediatric noninvasive nasal ventilation therapy will be discussed in this review.

Management of the respiratory complications of neuromuscular diseases in the pediatric intensive care unit.

Pediatric neuromuscular diseases such as Duchenne muscular dystrophy and spinal muscular atrophy cause pulmonary compromise. In severely affected patients, upper respiratory tract infections exacerbate lower respiratory tract secretion retention, with the potential for pneumonia, pulmonary atelectasis, and respiratory failure. In the pediatric intensive care unit, effective treatment includes noninvasive positive pressure ventilation and manual and mechanical mucus clearance techniques. A practical approach to commonly encountered respiratory complications in pediatric neuromuscular diseases is presented in this review.

Treatment of type I spinal muscular atrophy with noninvasive ventilation and gastrostomy feeding.

Type I spinal muscular atrophy (SMA) is a rapidly progressive, degenerative neuromuscular disease of infancy. In severe SMA, weakness, hypotonia, and bulbar involvement lead to progressive respiratory insufficiency and swallowing dysfunction, which are frequently complicated by aspirations. There are few studies reported in the literature that address the respiratory management of type I SMA. This article reports the results of treating four patients with infantile SMA with noninvasive positive pressure ventilation and gastrostomy feeding. All patients had gastroesophageal reflux disease, which was managed medically. Despite these therapies, survival was only 1 to 3.5 months after presenting with severe aspirations. The treatment strategy, which can be effective in less rapidly progressive neuromuscular diseases, did not alter the very poor prognosis of type I SMA. The treatment options are reviewed, and a strategy designed to optimize quality of life for infants with this fatal disease is presented.

Alterations in adolescents' sensory taste preferences during and after pregnancy.

PURPOSE: The purpose of this study was to determine adolescents' preferences during and after pregnancy for foods that differed in fat, sugar, and salt content, components that are associated with much of the flavor in food and, hence, are related to food acceptance. METHODS: Sensory taste preferences for 16 foods were assessed by 52 white adolescents during the third trimester of pregnancy and again 11-13 months postpartum. The study design was a randomized, incomplete block design. Each subject evaluated the same eight foods at each interview using a 10-cm hedonic scale, which was scored 0 = "dislike extremely" to 10 = "like extremely." Three pairs of foods differed in fat content (e.g., ice cream vs. ice milk), two pairs differed in sugar content, but neither contained a sugar substitute (e.g., peaches in heavy syrup vs. natural juices), and three pairs differed in salt content (e.g., salted vs. unsalted peanuts). Differences in preferences were determined with least-squares analysis of variance. RESULTS: Although preferences for 13 of the 16 foods did not differ between pregnancy and postpartum assessments, whole milk, skim milk, and salted peanuts were ranked significantly higher (p = 0.02, 0.007, and 0.05) during pregnancy. Hedonic scores were higher (p = 0.002 and 0.005) for whole milk over skim at both assessments, but ice cream was not preferred significantly over lower fat frozen products. During pregnancy, but not after, salted peanuts, chips, and crackers were preferred (p = 0.0003, 0.0001, and 0.03) over the unsalted/low-salt products. CONCLUSIONS: The adolescents' increased sensory taste preferences for milk and salty snack foods during pregnancy, as well as personal taste preferences, should be recognized by clinicians, and nutrition recommendations should be individualized to enhance compliance.

Recommendations of dietitians for overcoming barriers to dietary adherence in individuals with diabetes.

PURPOSE: The purposes of this research were to (1) identify factors that contribute to the barriers to dietary adherence in individuals with diabetes identified in a 1998 study and (2) obtain recommendations from registered dietitians for strategies to overcome these barriers. METHODS: A 10-item, open-ended telephone questionnaire was used to obtain information. The sample included 75 registered dietitians who participated in a previous survey to identify barriers and agreed to a follow-up telephone interview. RESULTS: Of the 75 participants, 28% reported spending 5 hours or less per week counseling individuals with diabetes, 64% spent between 6 and 30 hours, and 8% spent more than 31 hours per week. Almost half of the participants (47%) were certified diabetes educators. Factors identified as the greatest contributors to the barriers being evaluated included lack of time, lack of symptoms, lack of education (including follow-up), poor self-esteem/lack of empowerment, and misinformation from family/peers/others with diabetes. The primary recommendations for overcoming each of these barriers included individualizing meal plans and planning ahead, teaching about complications, and setting obtainable goals. CONCLUSIONS: The registered dietitians who were surveyed emphasized the importance of individualizing dietary counseling.

Motivational strategies used by dietitians to counsel individuals with diabetes.

The purposes of this study were to determine the use and perceived effectiveness of motivational strategies used by dietitians and to evaluate dietitians' perceptions of barriers to client compliance. A three-part questionnaire with 32 motivational strategies, 16 barriers to adherence, and demographic information was designed and mailed to 862 members of the American Dietetic Association's Diabetes Care and Education Dietetic Practice Group. Statistical analyses included frequency distributions, chi-square analysis, and factor analysis. Only 13 of the 32 motivational strategies were used frequently by 50% or more of the dietitians. The main strategy based on perceived effectiveness was "Tailor the diet to the client's lifestyle." Strategies perceived as effective also were used frequently by a majority of the dietitians. There were differences in use of strategies based on practice setting, CDE certification, and education level. The most significant barrier to adherence was "Complications with lifestyle/competing demands." Factor analysis revealed nine factors for motivational strategies and five factors for barriers to adherence.

Impact of dining room environment on nutritional intake of Alzheimer's residents: a case study.

This case study, in a Veterans Affairs Alzheimer's unit, was conducted to evaluate noise and lighting conditions at mealtimes and to assess the food intake of ambulatory dementia residents. The case study compared the noise, lighting, and nutritional intake of 16 Alzheimer's residents eating the same cycle menu in the extended-care (EC) dining room and the Alzheimer's unit (AU) dining room five weeks later. Noise was significantly lower in the EC (p < or = .02). Lighting was significantly higher in the EC (p < or = .001). Intake of calories and protein was slightly higher, with some days significantly higher, in the AU. Total five-day fluid intake at breakfast was significantly higher in the AU (p < or = .02). Although residents' total food and fluid intake was higher in the AU, the project identified a need to decrease noise and increase lighting in the AU. Lighting enhancement and noise reduction may further improve intake, which, in turn, may promote improved nutritional status.

The efficacy of n-butyl-cyanoacrylate tissue adhesive for closure of canine laparoscopic ovariectomy port site incisions.

OBJECTIVES: To evaluate the efficacy of n-butyl-cyanoacrylate used to close port site skin incisions following canine laparoscopic ovariectomy and to assess owner attitudes to surgical adhesive. METHODS: The case records of dogs undergoing laparoscopic ovariectomy at a single centre during a 42-month period were examined. Dogs with incisions closed with n-butyl-cyanoacrylate were included. Cases with less than 8 weeks follow-up were excluded. Data relating to dehiscence, swelling, erythema, discharge or hypersensitivity postoperatively were recorded and reviewed. Postal questionnaires were sent to the dogs' owners. RESULTS: A total of 289 dogs satisfied inclusion criteria. No complications occurred in 602 of 695 (86 · 6%) incisions. Complications occurred in 93 of 695 (13 · 4%) incisions: 33 of 695 (4 · 7%) dehisced, 38 of 695 (5 · 5%) swelled postoperatively, 59 of 695 (8 · 5%) developed erythema and 29 of 695 (4 · 2%) developed a discharge. Complications were significantly more likely for a 10 mm incision than for a 5 mm incision (P < 0 · 001). There were no reported cases of hypersensitivity relating to the use of n-butyl-cyanoacrylate, nor any long-term adverse reactions. When owners scored incisions for scarring using a visual analogue scale (0: excellent, 10: poor) the mean and median scores were 0 · 7 and 0, respectively. CLINICAL SIGNIFICANCE: This study suggests that n-butyl-cyanoacrylate is an acceptable method for closing laparoscopic port sites in dogs.