[Impact of symptom onset to first medical contact time on the prognosis of patients with acute ST-segment elevation myocardial infarction].

Objective: To investigate the impact of symptom onset to first medical contact (SO-to-FMC)time on the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI). Methods: The clinical data of 341 consecutive STEMI patients, who were hospitalized to our hospital and received primary percutaneous coronary intervention(PCI) from August 2011 to April 2016, were retrospectively analyzed. The patients were divided into ≤90 min group (201 cases) and >90 min group (140 cases) according to the SO-to-FMC time. The treatment time, mortality and incidence of major adverse cardiac and cerebro-vascular events(MACCE) were analyzed. The risk factor of 1-year mortality after PCI and 1-year incidence of MACCE during the post-discharge follow-up period were analyzed by binary logistic regression analysis. The predictor of 4.5-year mortality after PCI was analyzed by multivariate Cox regression analysis. Methods The door to balloon time (104(88, 125) min vs. 111(92, 144)min, P=0.023), first medical contact to balloon time(146(119, 197) min vs. 177(125, 237)min, P=0.005), and symptom onset-to-balloon time(200(170, 257) min vs. 338(270, 474)min, P<0.001)were all significantly shorter in the ≤90 min group than in>90 min group. The 30-day mortality (2.99% (6/201) vs. 7.86%(11/140), P=0.042), 1-year mortality (2.89 (5/173) vs. 9.57(11/115), P=0.015), 1-year incidence of MACCE during the post-discharge follow-up period(1.16%(2/173) vs. 6.96%(8/115), P=0.021), and 4.5-year cumulative mortality(3.00% vs. 11.20%, P=0.007) after PCI were significantly lower in the ≤90 min group than in the >90 min group. Moreover, the 4.5-year incidence with free of MACCE (97.20% vs. 88.80%, P=0.025) during the post-discharge follow-up period was significantly higher in the ≤90 min group than in the >90 min group. In-hospital mortality was similar between the two groups (2.49%(5/201) vs. 6.43%(9/140), P=0.071). Results: The door to balloon time (104(88, 125) min vs. 111(92, 144)min, P=0.023) , first medical contact to balloon time(146(119, 197) min vs. 177(125, 237)min, P=0.005), and symptom onset-to-balloon time(200(170, 257) min vs. 338(270, 474)min, P<0.001) were all significantly shorter in the ≤90 min group than in >90 min group. The 30-day mortality(2.99% (6/201) vs. 7.86%(11/140), P=0.042), 1-year mortality (2.89(5/173) vs. 9.57(11/115), P=0.015), 1-year incidence of MACCE during the post-discharge follow-up period (1.16%(2/173) vs. 6.96%(8/115), P=0.021), and 4.5-year cumulative mortality (3.00% vs. 11.20%, P=0.007) after PCI were significantly lower in the ≤90 min group than in the >90 min group. Moreover, the 4.5-year incidence with free of MACCE (97.20% vs. 88.80%, P=0.025) during the post-discharge follow-up period was significantly higher in the ≤90 min group than in the >90 min group. In-hospital mortality was similar between the two groups (2.49%(5/201) vs. 6.43%(9/140), P=0.071). Results of binary logistic regression analysis showed that the SO-to-FMC time >90 min was the risk factor of 1-year mortality(OR=2.90, 95%CI 1.22-6.92, P=0.016) and 1-year incidence of MACCE (OR=5.19, 95%CI 1.21-22.20, P=0.026) during the post-discharge follow-up period. Multivariate Cox regression analysis demonstrated that the SO-to-FMC time >90 min was the risk factor of 4.5-year mortality after PCI in patients with STEMI (HR=2.88, 95%CI 1.10-7.53, P=0.031). Conclusion: Shorting the SO-to-FMC time can significantly reduce the treatment time of STEMI patients, short and long-term mortalities and the incidence of MACCE, and improve the prognosis of patients with STEMI.

Direct access colonoscopy in primary care: is it a safe and practical approach?

BACKGROUND: Implementation of colorectal cancer screening programme and provision of cancer service within certain timeframe has significantly increased the workload on endoscopy services. Direct access colonoscopy in primary care centers helps offload burden on conventional colonoscopy in secondary care, thereby reducing waiting times. The aim of this study was to assess the safety and efficacy of direct access colonoscopy service. MATERIALS AND METHODS: Provision of colonoscopy service in our healthcare trust was analysed retrospectively during a two-year period. Safety and feasibility of direct access colonoscopy was analysed against conventional colonoscopy. The groups were compared for findings at colonoscopy, procedural outcomes, and complications. RESULTS: A total of 3468 colonoscopies were analysed. Of those, 1189(34.3%) were performed as direct access colonoscopy and 2279(65.7%) as conventional colonoscopy. No abnormality was detected in 408/1189(34.3%) and 825/2279(36.2%) patients in the direct access colonoscopy and conventional colonoscopy groups, respectively (p = 0.52). Colorectal cancer detection rate was similar between the groups; conventional colonoscopy vs direct access colonoscopy, 3.1% (68/2279) vs 3.2% (39/1189) (p = 0.85). However, there was significantly higher detection rate of polyps greater than 1 cm in conventional colonoscopy group compared to direct access colonoscopy group, 22.6%(518/2289) vs 12.6% (150/1189) (p = 0.02). Complication rates were comparable between the groups. CONCLUSION: Direct access colonoscopy in primary care centers is safe and feasible. Colorectal cancer detection remains comparable to that of conventional colonoscopy in secondary care despite relatively lower polyp detection rate.

Lower limb compartment syndrome following laparoscopic colorectal surgery: a review.

AIM: In spite of recent advances in technology and technique, laparoscopic colorectal surgery is associated with increased operating times when compared with open surgery. This increases the risk of acute lower limb compartment syndrome. The aim of this review was to gain a better understanding of postoperative lower limb compartment syndrome following laparoscopic colorectal surgery and to suggest strategies to avoid its occurrence. METHOD: A MEDLINE search was performed using the keywords 'compartment syndrome', 'laparoscopic surgery' and 'Lloyd-Davies position' between 1970 and 2008. All relevant articles were retrieved and reviewed. RESULTS: A total of 54 articles were retrieved. Of the 30 articles in English, five were reviews, six were original articles and 19 were case reports, of which only one was following laparoscopic colorectal surgery. The remaining 24 were non-English articles. Of these, two were reviews and 22 were case reports, of which only one was following laparoscopic colorectal surgery. The incidence of acute compartment syndrome following laparoscopic colorectal surgery is unknown. The following are believed to be risk factors for acute lower limb compartment syndrome: the Lloyd-Davies operating position with exaggerated Trendelenburg tilt, prolonged operative times and improper patient positioning. Simple strategies are suggested to reduce its occurrence. CONCLUSION: Simple preventative measures have been identified which may help to reduce the incidence of acute lower limb compartment syndrome. However, if suspected, timely surgical intervention with four-compartment fasciotomy remains the standard of care.

Estimation of heavy metals in commonly used medicinal plants: a market basket survey.

Popularity of herbal drugs is increasing all over the world because of lesser side effects as compared to synthetic drugs besides it cost effectiveness and easy availability to poor people particularly in developing countries. Keeping in view the increased market demand of herbal drugs, it is essential to ensure their chemical quality prior to use. Raw drugs and herbs are usually collected from different places, which might be contaminated with various contaminants. It is pertinent to estimate the levels of heavy metals and other micronutrients, which could be affected by their presence in the surrounding environments. Heavy metals are known to pose a potential threat to terrestrial and aquatic biota. Keeping this in view, samples of ten plants or plant parts used in drug making were collected from local markets of Punjab for heavy metal and micronutrient estimation. It was found that the samples were contaminated having cadmium, lead, chromium, iron, manganese, and zinc. The highest mean level of cadmium (23.1 µg/kg) was found in Haritaki sample. Chromium concentration of the plant samples ranged between 7.25 and 1.34 µg/kg with the highest values was in Daruharidra and lowest in Pippali. The levels of these heavy metals were within permissible limits.

Traditional Ayurvedic and herbal remedies for Alzheimer's disease: from bench to bedside.

INTRODUCTION: Alzheimer's disease (AD) is a progressive, neurodegenerative disorder prevalent worldwide among elderly populations. Owing to limited efficacy, side effects, and poor patient compliance for current rationally designed therapies, options are being searched from alternate therapies such as Indian (Ayurvedic), Chinese, or other traditional systems. Areas covered: Following a comprehensive literature search, the authors provide a review encompassing: (1) pathophysiological changes involved in AD, (2) Ayurvedic holistic approach and herbal medicines to manage dementia and AD, and (3) traditional plants and their phytoconstituents effective in AD with description of possible mechanism of action. Expert opinion: Traditional remedies could be adjunct therapeutic options to allay wide-ranging pathological cascades of AD. Ayurveda offers a holistic approach of treatment along with a list of nootropic herbs and formulations that are the rich sources of antioxidants, anti-amyloidogenic, neuroprotective, adaptogenic, anti-inflammatory, and immunomodulatory compounds that are found to modulate neuroendocrine-immune activities, enhance memory, intellect, rejuvenate brain functions, and improve quality of life. A strong knowledge base of traditional systems coupled with contemporary science may provide new functional leads for age-associated neurodegenerative disorders at preventive, promotive, and curative levels, and evolution of new drug therapies and development processes, though further research is needed.

Herbal and Holistic Solutions for Neurodegenerative and Depressive Disorders: Leads from Ayurveda.

Neuropsychiatric and neurodegenerative disorders such as Alzheimer's disease, Parkinson's disease, schizophrenia, epilepsy, depression and anxiety pose a sizable global health problem, accompanying substantial burden of disorders, suicides, physical comorbidities, high fiscal expenses, and poor quality of life. There is a recent upsurge in global interest toward the area of traditional therapies and phytomedicines are widely admired by researchers owing to their natural source and fewer side effects. On the contrary, conventional synthetic drugs have been reported with undesirable but inevitable ill effects having poor patient compliance. Thus, herbal medicines are being preferred over synthetic drug therapies as an effective remedy for many brain disorders. Ayurveda provides a holistic approach to treatment along with several nootropic herbs having multi-dimensional bioactivities in various disorders. Scattered information is available pertaining to traditional Ayurvedic remedial options for various mental disorders. Present review encompasses: (i) common brain disorders and the associated changes (ii) Ayurvedic holistic approach to manage neurodegenerative and depressive disorders, and (iii) important Ayurvedic single herbs and polyherbal formulations with description of their traditional usage and administration. Concomitantly, it opens up for future investigations and standardization on Ayurvedic nootropic herbs.

Pharmacognostic, physicochemical and chromatographic characterization of Samasharkara Churna.

BACKGROUND: Samasharkara Churna, a polyherbal Ayurvedic formulation, is prescribed for treating various conditions such as asthma and cough. Literature review suggested that characterization parameters of Samasharkara Churna are not reported. OBJECTIVE: To report characteristic parameters of Samasharkara Churna to conform its identity, quality and purity. MATERIALS AND METHODS: Samasharkara Churna was evaluated for pharmacognostic, physicochemical, microbiological, and chromatographic parameters. RESULTS: The chromatographic analysis was able to showed presence of all ingredients in Samasharkara Churna. CONCLUSION: The characterization parameters presented in this paper may serve as standard reference for the quality control analysis of Samasharkara Churna.

Early peri-operative glycaemic control and allograft rejection in patients with diabetes mellitus: a pilot study.

BACKGROUND: Hyperglycemia alters the inflammatory response to infection and ischemia. We hypothesize that perioperative glycemic control could also influence the risk for allograft rejection. METHODS: Consecutive patients with established diabetes undergoing their first cadaveric renal transplantation and receiving steroid-sparing immunosuppression were identified (n=50). Records of capillary glucose observations over the first 100 hr following surgery and transplantation variables pertaining to graft function, acute rejection, and postoperative infection were identified and entered into multivariate analysis. RESULTS: Perioperative glycemic control was associated with an increased incidence of infection and acute rejection. Only 3 of 27 patients (11%) with optimal glycemic control during the 100 hr following surgery (mean<11.2 mmol/L) had rejection episodes compared with 58% of patients with poor control (>11.2 mmol/L). All patients with poor glycemic control experienced postoperative infection. CONCLUSIONS: This pilot study suggests that hyperglycemia may be associated with an increased risk of both allograft rejection and postoperative infection in patients with diabetes.

Combined anti-vascular cell adhesion molecule-1 and anti-leukocyte function-associated molecule-1 monoclonal antibody therapy does not prolong allograft survival in an ovine model of renal transplantation.

This study investigates the therapeutic efficacy of an anti-vascular cell adhesion molecule (VCAM)-1 monoclonal antibody (mAb), alone or in combination with an anti-leukocyte function-associated-1 mAb, in prolonging allograft survival in an ovine model of renal transplantation. The kinetics of VCAM-1 induction and expression during renal allograft rejection have also been studied. Sheep receiving anti-ovine VCAM-1 antibody demonstrated graft failure at a mean of 8.4 (+/- SD; 0.7) days after transplantation compared with 9.3 (+/- 0.5) days after transplantation for the group given control antibody and 7.7 (+/- 0.3) days after transplantation in the animals given the combined anti-VCAM-1 and anti-leukocyte function-associated-1 mAb therapy. VCAM-1 expression was detected in the allografts at day 1 after transplantation, with peak expression detected by day 5. Tubular expression of VCAM-1 was minimal, with sparse focal staining at the basolateral surfaces. The degree of mononuclear cell infiltrate in the allografts paralleled the progressive increase in VCAM-1 expression after transplantation, and there was no difference in the level of mononuclear cell infiltrate compared with controls.

The safety and efficacy of laparoscopic live donor nephrectomy: a systematic review.

BACKGROUND: The aim of this systematic review was to compare the safety and efficacy of laparoscopic live donor nephrectomy with the "gold" standard of open live donor nephrectomy. SEARCH STRATEGY: Three search strategies were devised to enable literature retrieval from the Medline, Current Contents, Embase, and Cochrane Library databases up until, and including, February 2000. STUDY SELECTION: Inclusion of a report was determined on the basis of a predetermined protocol, independent assessment by two reviewers, and a final consensus decision. English language reports were selected and acceptable study designs included randomized-controlled trials, controlled clinical trials, case series, or case reports. Each report was required to provide information on at least one of several safety and efficacy outcomes as detailed in the protocol. DATA COLLECTION AND ANALYSIS: Twenty-five reports met the inclusion criteria. They were tabulated and critically appraised in terms of the methodology and design, sample size, outcomes, and the possible influence of bias, confounding, and chance. RESULTS: High level evidence comparing the safety and efficacy of laparoscopic live donor nephrectomy with open donor nephrectomy was not available at the time of this review. Limited low level evidence suggested that the laparoscopic approach might be advantageous regarding the donor's hospital stay, convalescence, pain, and resumption of employment. CONCLUSIONS: The ASERNIP-S Review Group concluded that the evidence-base for laparoscopic live donor nephrectomy was inadequate to make a safety and efficacy recommendation. Clinical and research recommendations were developed regarding the introduction and current practice of this procedure in Australia.

Cytogenetic studies in primary infertility.

Chromosome studies were conducted on 117 men with primary infertility (54 with oligospermia and 63 with azoospermia) and 25 fertile volunteers who acted as controls. No chromosomal abnormalities were observed except for nine cases of Klinefelter's syndrome. From this study, it is apparent that chromosomal abnormalities other than Klinefelter's syndrome are not etiologic factors in the infertility of oligo- or azoospermic men.

Evaluation of ketorolac, ibuprofen-paracetamol, and dextropropoxyphene-paracetamol in postoperative pain.

STUDY OBJECTIVE: To compare the analgesic efficacy of ketorolac, ibuprofen-paracetamol (acetaminophen), and dextropropoxyphene-paracetamol in postoperative pain. DESIGN: Randomized, double-blind, parallel, single-dose study. SETTING: Multicenter, with five centers participating. PATIENTS: One hundred sixty patients with moderate to severe postoperative pain requiring oral analgesics were enrolled. Seventeen patients were excluded from final analysis due to deviation from protocol. INTERVENTIONS: Ketorolac tromethamine 10 mg, a combination of ibuprofen 400 mg plus paracetamol 325 mg, or a combination of dextropropoxyphene 65 mg plus paracetamol 400 mg was given orally to patients with moderate to severe baseline pain. MEASUREMENTS AND MAIN RESULTS: Pain intensity and pain relief scores were rated at baseline, at 30 minutes, and hourly to 6 hours. Until the end of first hour, analgesia was similar for all three regimens. Ketorolac had a significantly higher analgesic effect than the two combinations between hours 2 and 6. Analgesia was similar for the two combinations. For all three test drugs the frequency of adverse effects was similar. CONCLUSIONS: Ketorolac 10 mg is a superior analgesic to ibuprofen-paracetamol or dextropropoxyphene-paracetamol in the treatment of postoperative pain.

Early peri-operative hyperglycaemia and renal allograft rejection in patients without diabetes.

BACKGROUND: Patients with diabetes have an increased risk for allograft rejection, possibly related to peri-operative hyperglycaemia. Hyperglycaemia is also common following transplantation in patients without diabetes. We hypothesise that exposure of allograft tissue to hyperglycaemia could influence the risk for rejection in any patient with high sugars. To investigate the relationship of peri-operative glucose control to acute rejection in renal transplant patients without diabetes, all patients receiving their first cadaveric graft in a single center were surveyed and patients without diabetes receiving cyclosporin-based immunosuppression were reviewed (n = 230). Records of the plasma blood glucose concentration following surgery and transplant variables pertaining to allograft rejection were obtained. All variables suggestive of association were entered into multivariate logistic regression analysis, their significance analysed and modeled. RESULTS: Hyperglycaemia (>8.0 mmol/L) occurs in over 73% of non-diabetic patients following surgery. Glycaemic control immediately following renal transplantation independently predicted acute rejection (Odds ratio=1.08). 42% of patients with a glucose < 8.0 mmol/L following surgery developed rejection compared to 71% of patients who had a serum glucose above this level. Hyperglycaemia was not associated with any delay of graft function. CONCLUSION: Hyperglycaemia is associated with an increased risk for allograft rejection. This is consistent with similar findings in patients with diabetes. We hypothesise a causal link concordant with epidemiological and in vitro evidence and propose further clinical research.

A simple technique for closure of the last laparoscopic working port.

Closure of the last laparoscopic working port can be frustrating, particularly in the very obese. A technique is described that simplifies this procedure, using a grasping forcep to transfer the abdominal wall suture.

Intraoperative vascular localization to facilitate endopyelotomy after renal transplantation.

BACKGROUND: Pelviureteric junction (PUJ) obstruction after renal transplantation is uncommon. Surgical correction can be technically challenging due to dense perinephric adhesions and variable hilar vascular anatomy. Endopyelotomy is well established in the treatment of PUJ obstruction in native kidneys. METHODS: The present paper reports the first experience of antegrade visual cold-knife endopyelotmy performed in a renal allograft. In orientating the incision at the PUJ, preoperative imaging was supplemented by intrarenal Doppler ultrasound, using a probe designed for transoesophageal cardiac monitoring. To the authors' knowledge this approach has not previously been reported. RESULTS: Renal vascular relationships were readily indentified by identifying arterial and venous waveforms. CONCLUSIONS: For this uncommon procedure the use of intrarenal Doppler ultrasound provides greater security in avoiding inadvertent vascular injury.

Bull-specific effect on fertilization rate and viable embryo recovery in the superovulated buffalo (Bubalus bubalis).

This study was conducted to compare fertilization rate and viable embryo recovery rate in superovulated buffalo (n = 64) following insemination with semen from buffalo bulls (n = 5) having different fertility rates as determined by AI. Frozen-thawed semen from fertile bulls with similar post-thaw progressive motility and sperm morphology was used to inseminate buffalo at superovulatory estrus. Fertilization and viable embryo recovery rates differed among bulls, but this bull-specific effect was not related to the overall herd fertility rate as determined by AI in normal cyclic animals. These results indicate that individual bulls differ in their contribution to fertilization of superovulated donors and also to embryonic development, as determined by viable embryo recovery. Moreover, the results also suggest that buffalo bulls can be screened for optimal fertility and embryo recovery rates in superovulated donors. Further studies are warranted to ascertain the factors which contribute to such bull-specific effects.

Factors affecting pregnancy rate following nonsurgical embryo transfer in buffalo (Bubalus bubalis): a retrospective study.

The objectives of this study were to determine the pregnancy rate and factors affecting it following nonsurgical embryo transfer in buffalo. Donor buffalo were superovulated with FSH, and embryos collected nonsurgically were evaluated for stage of development and quality. They were transferred nonsurgically to 91 recipients on Days 5 to 7 of the natural (n = 52) or induced (n = 39) estrus (estrus = Day 0). The overall pregnancy rate of 24/91(26.4%) was higher than in earlier reports for buffalo but was much lower than in cattle. Pregnancy rates were not affected by season (autumn vs winter), side of transfer (right vs left uterine horn), or type of estrus (spontaneous vs induced). The pregnancy rate was high 11/27(40.7%) when donors and recipients were closely synchronized, while it was compromised when recipients were in estrus at +12 h (1/7, 14.3%) and at -12 h (5/27, 18.5%). Asynchrony beyond 12 h on either side resulted into conception failure. The pregnancy rate tended to increase with the increase in CL size of recipients, while stage of embryonic development had no effect. The transfer of an 8-cell embryo with a 16-cell embryo led to the birth of heterosexual twins, indicating that the uterine milieu of Day 5 to 6 recipients may be tolerated by the out-of-phase 8-cell embryo, at least in the presence of a more mature embryo. Embryo quality had the greatest effect on pregnancy rate as it was higher (P < 0.005) after the transfer of Grade I than Grade III embryos (6/10, 60.0% vs 3/36, 13.9%). Assessment of returns to estrus indicated that among nonpregnant recipients, 17/67 (25.4%) embryos never matured sufficiently to prevent luteolysis through maternal recognition of pregnancy (MRP), while 14/67 (20.8%) embryos probably died following MRP. These results indicate that efforts to increase pregnancy rate following embryo transfer in buffalo should include prevention of luteolysis during the first week of transfer and a reduction in the incidence of embryonic mortality.

Rate of transport and development of preimplantation embryo in the superovulated buffalo (Bubalus bubalis).

This study was designed to ascertain the rate of transport and development of preimplantation embryo in the superovulated buffalo in order to determine the optimum time for their nonsurgical collection. Eighteen Murrah-type buffalo were superovulated with 600 mg NIH-FSH-P1. Luteolysis was induced by administration of PGF2 alpha at 72 (PG + 72) and 84 h (PG + 84) after initiating gonadotrophin treatment and fixed-time AI was done beginning at 36 h post PG + 72 administration and at 12-h intervals thereafter, upto 72 h. Six control buffalo received treatment similar to experimental group except that in place of FSH they received normal saline. For embryo collection, experimental animals were humanely killed at 6-h intervals corresponding to 156 (n = 2), 162 (n = 2), 168 (n = 2), 174 (n = 3), 180 (n = 3), 186 (n = 3) and 192 h(n = 3) after PG + 72 treatment, whereas the control animals were humanely killed at 156 (n = 2), 174 (n = 2) and 192 h (n = 2). Superovulated buffalo had higher number of ovulations than untreated controls (8.78 +/- 5.00 vs 0.67 +/- 0.51) and total ova/embryos recovered was 4.11 +/- 2.46 and 0.67 +/- 0.51, respectively. The high estradiol-17 beta (E2) levels with its prolonged rise may, by leading to reverse peristalsis in the oviduct with a consequent loss of some embryos in the peritoneal cavity, be one of the reasons for our inability to recover nearly 84/158 ova/embryos in the superovulated buffalo. In superovulated animals, nearly all the ova/embryos reached the uterus between 168 and 174 h post PG + 72 treatment or about 134 h (circa 5.5 d) after the onset of superovulatory estrus, suggesting that the ideal time for non-surgical embryo collection in the buffalo is between Days 7 to 8 after PG + 72 treatment or Days 5.5 to 6.0 of the superovulated cycle (estrus = Day 0). Embryo development of superovulated buffalo showed considerable variation as various stages of embryos (8 cell to expanded blastocyst) were recovered from the same donor buffalo, and the rate of development appeared to be 24 to 36 h faster than in cattle.

Quantification of phenylbutazone in equine sera by use of high-performance liquid chromatography with a nonevaporative extraction technique.

OBJECTIVE: To develop a sensitive, rugged high-performance liquid chromatography (HPLC) method for the measurement of phenylbutazone (PBZ) in equine sera, using a rapid, nonevaporative extraction technique. SAMPLE POPULATION: Sera from 5 nonexercising adult horses. PROCEDURE: After addition of sodium chloride and acetonitrile to serum samples, reverse-phase HPLC analysis for PBZ and oxyphenbutazone (OXY) was performed directly on extracts, using diode array UV spectrophotometric detection. Probenecid was used as an internal standard. Data were evaluated by standard means of statistical analysis. RESULTS: Recoveries of PBZ, OXY, and probenecid from spiked samples were acceptable (ie, > or = 80%) and within run retention times were reproducible. Chromatograms were free of interfering substances, and linearity of calibration curves was observed throughout operational ranges. Coefficients of variation at each fortified PBZ concentration were in the 5 to 10% range. The method was applicable to analysis of PBZ and OXY in serum extracts from horses dosed with PBZ (4.4 mg/kg of body weight, IV) in a controlled environment. Track samples analyzed by use of this method and a conventional liquid/liquid extraction method gave comparable results (mean deviation, 1.6%) for PBZ concentrations. CONCLUSION: The HPLC protocol described is suitable for measuring PBZ and OXY in equine sera to regulate PBZ administration in horses involved in pari-mutuel racing.

Expanded polytetra fluoroethylene (PTFE) graft in hemodialysis.

Currently, PTFE grafts are regarded to be the alternative method of choice for patients with failed conventional fistulae. Observation over a longer period is necessary to assess the long term patency rate. Our experience in the use of PTFE grafts in providing vascular access for selected patients is reviewed. Thirty grafts were implanted in twenty-six patients over a sixteen-month period. Complications noted were thrombosis (six patients) and infection (two). Twenty patients were successfully hemodialysed without complications. Two additional patients had access provided for long term parenteral therapy or transfusion.