Genetic aspects for the behaviour of lactating sows towards humans.

With the keeping of lactating sows in loose housing systems, ensuring work safety for stockpersons is gaining importance. Aim of the present study was to develop tests characterising the behaviour of lactating sows in farrowing environments with more freedom to move. The behaviour towards humans in different management procedures was examined. Emphasis was given to integrate tests into daily routines. The study was conducted in a nucleus herd with 771 purebred Landrace sows. Data were collected from October 2016 until December 2018. Sows were kept in individual indoor pens with movable farrowing crates in which the animals were restrained from 7 days antepartum (ap) to an average of 7 days postpartum (pp). The Dummy Arm Test (DAT; 1444 observations) was used to assess the sows' reaction towards a stockperson handling the piglets around day 4 pp (closed crates). With the Towel Test (TT; 2846 observations), the reaction of sows to a novel object and an unexpected situation was assessed. The Trough Cleaning Test (TCT; 2805 observations) described the sows' response to common procedures such as trough cleaning. TT and TCT were conducted on days 3 pp (closed crates) and 10 pp (open crates). Variance components of behavioural traits were estimated univariately with a linear animal model, and genetic correlations between traits were derived using a multivariate animal model in ASreml 3.0. Most sows showed no or only a slight reaction to human interactions without attempting to attack them. However, a strong defensive reaction of sows was recorded in 4.0% (TCT), 4.5% (TT), and 10.7% (DAT) of observations. This behaviour of sows was observed more frequently in the open than in the closed pen system. Estimates of heritabilities (h2 ± SE) were h2 = 0.17 ± 0.05 for behaviour of sows towards humans (DAT), h2 = 0.19 ± 0.04 for response of sows towards unexpected situations (TT), and h2 = 0.13 ± 0.04 for reactions of animals to TCT. Genetic correlations (rg ± SE) ranged from rg = 0.59 ± 0.37 between TT and TCT to rg = 0.77 ± 0.30 between TT and DAT. Our results show that the developed tests are suitable for assessing the behaviour of sows towards humans. Behavioural traits derived from these tests could be used as new phenotypes for the genetic selection of gentle and easy-to-handle sows. The genetic correlations of all tests studied were positive indicating related reaction patterns.

In vitro combination chemotherapy demonstrating potentiation of vincristine cytotoxicity by prednisolone.

Human lymphoid cells grown in long-term tissue culture have been used to study the cytotoxic effects of the combination of vincristine and prednisolone. The potentiating effects of this drug combination in vitro cannot be consistently shown if the drugs are addeded without attention to the growth rate of the cultured population. If the cultured cells have achieved maximum density and have remained at this density for more than 24hr, they are readily killed by vincristine alone and no further kill is achieved by adding prednisolone. Rapidly growing cell cultures, however, are relatively ristant to vincristine. The addition of prednisolone to such cultures restores their sensitivity to vincriestine, but the combination is no more effective than is vincristine alone in stable cell populations. These findings indicate that the effects of vincristine on the mitotic spindle, which produce metaphase arrest, do not account entirely for its ability to destroy cells. A second mechanism of action of vincristine at low concentrations is proposed.

Serious infections in adults following splenectomy for trauma.

Postsplenectomy sepsis in children is a well-recognized hazard. Few reports discuss the risk of sepsis in the asplenic adult. Case reports of 47 adults with serious infections following splenectomy for trauma were examined. We conclude that fulminant sepsis after splenectomy for trauma in adults is indeed a potential risk and that all such patients should receive penicillin prophylaxis and pneumococcal vaccine.

Acute leukemia and immunosupressive drug use: a review of patients undergoing immunosuppressive therapy for non-neoplastic diseases.

We have reviewed 61 reported cases of acute leukemia developing in patients who had previously received immunosuppressive agents for non-neoplastic disorders. In three patients the diagnosis of acute leukemia was made less than six months after the first exposure to immunosuppressive drugs and was, therefore, considered coincidental. Among the remaining 58 patients, most diagnoses were of myeloblastic or myelomonocytic leukemia. The underlying diagnoses in most of the 58 patients were rheumatoid arthritis or renal disease or renal transplant. Thirty patients had received alkylating agents exclusively, 10 had received antimetabolites only, while the remaining 18 patients had received multiple therapeutic modalities including antimetabolites, alkylating agents, and/or radiation. Most patients had also received large amounts of corticosteroids. Although we do not have the overall denominator of population at risk, the relatively high proportion of patients who had received alkylating agents before developing acute leukemia doses suggest a causal relationship, and one might, therefore, hesitate before using such drugs in non-life-threatening diseases.

Rarity of failure of penicillin prophylaxis to prevent postsplenectomy sepsis.

All splenectomized individuals are at risk of developing pneumococcal sepsis, but most reports fail to mention how many patients are given prophylactic penicillin therapy. Fourteen reported cases of postsplenectomy bacterial sepsis in patients receiving prophylactic penicillin therapy are reviewed. In only five cases, the patients had penicillin-sensitive pneumococcal infection. Hence, the exact frequency of the failure of penicillin prophylaxis cannot be calculated, but it appears to be very rare. Continuous antibiotic prophylaxis used indefinitely and pneumococcal vaccine are both strongly recommended for all children and adults undergoing splenectomy.

The ethics of practice guidelines.

Practice guidelines, which are assistive tools for clinicians, have a long tradition in clinical medicine. Traditionally, these documents were developed by physicians to improve quality of care and can provide practitioners with valuable medical information and improve objectivity in medical decision making. Guidelines development by nonphysician groups is increasing. Guidelines are now intended to assist in decreasing costs, in reducing liability risk, and in utilization review, among other activities. Despite this enthusiasm for guidelines, their development is variable and validity remains largely untested. The intended clinical and nonclinical applications of guidelines require critical analysis. Practice guidelines are not inherently unethical. However, applications of nonmedical values combined with intense pressures on health care provision create an environment for guideline misuse. The ethical implications of practice guidelines are examined in our article.

Specialty choices and board certifications of 'fifth pathway' graduates.

We studied the specialty choices and board certification status of 258 graduates over a ten-year period of a single "fifth pathway" program. Not including obstetrics and gynecology as a primary care specialty, 54% of our graduates chose primary care specialties. Including obstetrics and gynecology, the number increased to 63%. Thirty-five of 158 graduates through 1978 are specialty board certified and another 49 are board eligible. We believe that our program has fulfilled the need of assisting Americans studying medicine abroad, primarily in Mexico, to overcome their clinical deficits and become integrated into the mainstream of American medicine. The future role of fifth pathway programs must be reevaluated in light of the 1980 Graduate Medical Education National Advisory Committee report, which concluded that by 1990, there will be an overabundance of physicians in the United States.

Remedial medical education.

Continuing medical education plays an essential role in efforts to improve physician performance. This article deals with remedial or personalized physician education. The experience of selected institutions and state organizations that have and/or continue to provide such remedial education is reviewed. The emphasis of remedial or focused physician education is educational enhancement, not suspension or revocation of license.

Multiple myeloma in three siblings.

All three siblings of a family developed multiple myeloma. Two siblings had a history of monoclonal gammopathy; in one of these two siblings and in the third sibling, the disease progressed rapidly. A review of the literature shows that of 38 previously reported pairs of siblings with plasma cell disorders, eight families had a third affected sibling and four another affected relative. This clinical clustering suggests that some cases of multiple myeloma may have a hereditary basis and that other family members may be at risk for developing the disease.

Streptococcus mitis endocarditis. Report of 17 cases.

Seventeen patients with Streptococcus mitis endocarditis were treated at a municipal hospital over a three-year period. Thirteen patients were intravenous drug addicts. Streptococcus mitis has a predilection for right-sided endocarditis in intravenous drug addicts and left-sided endocarditis in non-drug addicts. Streptococcus mitis is highly susceptible to therapy with penicillin G potassium (minimal inhibitory concentration less than or equal to 0.1 mg/L of penicillin in all of these 17 cases), and four to six weeks of therapy is safe and effective.

Malaria. A city hospital experience.

We reviewed the charts of 24 patients with malaria seen at the Queens Hospital Center, Jamaica, NY, over the past five years. Twenty-three patients were foreign citizens. Eighteen patients were infected with Plasmodium vivax and six with Plasmodium falciparum. Malaria was suspected on admission in 19 of the 23 hospitalized patients. Five patients were admitted with unrelated diagnoses, and four of these experienced diagnostic delay. All diagnoses were confirmed with thin blood smears. Twenty-one patients were febrile, and 18 patients had prominent gastrointestinal tract symptoms. Serum glucose level was increased in nine patients, and hypoglycemia occurred in one. Four patients also had intestinal parasites. Malaria should be suspected in travelers with gastrointestinal tract symptoms, and patients with malaria may have other parasitic infections. Most patients with P vivax infections can be treated as outpatients, since the course is usually uncomplicated.

Chronic lymphocytic leukemia and lymphosarcoma associated with multiple myeloma: report of three cases.

Three patients had the rare occurrence of multiple myeloma coexisting with chronic lymphocytic leukemia or lymphosarcoma. It is not possible at present to resolve the question as to whether these two diseases represent part of the spectrum of a single B-cell disease or wether multiple myeloma and lymphoproliferative disorders are two separate entities, which may rarely occur by coincidence in the same patient.

Transient histiocytosis with striking phagocytosis of platelets, leukocytes, and erythrocytes.

Two cases of infection (miliary tuberculosis and a presumed viral infections) are described in which phagocytosis of erythrocytes, leukocytes, and platelets by reticuloendothelial cells was a prominent feature in bone marrow aspirates, associated with a clinical picture of fever, anemia, malaise, and hepatosplenomegaly. All these findings were "transient," and disappeared on treatment of the underlying infection.

Financial risk and hospital cost for elderly patients. Age- and non-age-stratified medical diagnosis related groups.

The purpose of this study was to analyze hospital resource consumption for Medicare patients in non-age- and age-stratified medical diagnosis related groups (DRGs). This study of patients in 74 non-age-stratified DRGs (N = 3643) and 113 age-stratified DRGs (N = 2898) demonstrated that older medical patients (usually greater than or equal to 75 to 80 years of age) had (on average) higher total hospital costs, a longer hospital length of stay, more diagnoses per patient, a greater percentage of outliers, and a higher mortality compared with younger patients in these same DRGs. These findings raise the question of the equity of DRG payment vis-à-vis older Medicare patients in both non-age- and age-stratified medical DRGs. Financial disincentives to treat older medical patients may limit both their access and quality of care in the future.

Age, resource consumption, and outcome for medical patients at an academic medical center.

At the national level debate is growing about the effects of the diagnosis related group (DRG) hospital payment system on patient access and quality of care. Recent changes to the DRG system have dropped any stratification by age and have delayed any other major change to improve payment equity. We characterized hospital resource consumption and outcome by age for all medical admissions (N = 31,838) to a large academic medical center (January 1, 1985, through December 31, 1987) using the DRG format. Mean hospital cost per patient, hospital length of stay, percentage of outliers, and mortality increased with age. The mean DRG case-mix index and the number of diagnostic codes per patient also rose with age. The DRG payment for all patients would have produced an aggregate profit of $34,426,951 ($1081 profit per patient); however, patients aged 71 years or older generated loses (the highest with patients aged 85 years or older--a $2177 loss per patient). As the financial position of American hospitals continues to deteriorate, these data suggest that the current DRG payment scheme may be inequitable for the medical patient aged 71 years or older, thus providing financial disincentives to treat the elderly medical patient and perhaps limiting their access and quality of care in the future.

Disclosure and prevention of medical errors. Committee on Bioethical Issues of the Medical Society of the State of New York.

Medical errors occur and are sometimes unavoidable. Physicians generally, but not always, have ethical and moral obligations to disclose their errors to the patient. Because common medical errors can be expected, physicians are obligated to work within health systems toward reducing systems flaws that promote errors. However, the obligations of physicians to disclose errors made by others are less clear. This article discusses the professional ethics involved in disclosing and preventing medical errors.

Non-destructive estimation of the intramuscular fat content of the longissimus muscle of pigs by means of spectral analysis of ultrasound echo signals.

The eating quality of porcine meat is supposed to increase with increasing intramuscular fat content (IMF). The aim of this study was to investigate the use of acoustic parameters obtained by spectral analysis of ultrasound echo signals to non-destructively predict intramuscular fat content of porcine longissimus muscle. Ultrasound is regarded as a promising non-destructive technique to characterize tissue. Ultrasound data acquisition was performed at slaughter with a clinical B-mode device equipped with a 3.5 MHz center-frequency transducer on 115 warm carcasses about 45 min postmortem. Acoustic parameters quantifying attenuation, backscattering and cepstral structure were calculated off-line from the recorded primary raw ultrasound echo signals. Their relationship to IMF content was investigated. IMF level significantly influenced powerspectrum amplitudes and backscatter parameters. With partial least-squares regression (PLS), the IMF content could be predicted with root mean standard error of prediction RMSEP of 0.36% IMF. The ultrasound parameters were able to correctly classify nearly 80% of the carcasses into HIGH and LOW level class, respectively. Results indicate the potential use of ultrasound spectral analysis for non-destructive evaluation (NDE) of pig carcasses in order to estimate the IMF content.

The ethics of randomized clinical trials.

Randomized clinical trials pose a number of fundamental ethical problems to which morally sensitive investigators must give careful consideration. The randomized double-blind clinical trial is ethically justified and the preferred method of demonstrating therapeutic effectiveness and safety. Alternate methods such as crossover and self-controlled designs, the use of historical controls, observational methods, and practitioner's clinical trials also exist and have their place in certain circumstances. The use of randomized double-blind clinical trials must assure adequate explanation of the research plan to the patient, the documentation of informed consent, adequate consideration of safety, and an acceptably low risk/benefit ratio.

Idiopathic intracranial hypertension: report of seven cases.

We describe seven patients with idiopathic intracranial hypertension (IIH), a disorder, mostly in young women, characterized by papilledema, elevated cerebrospinal fluid (CSF) pressure, normal CSF composition, and normal neuroradiologic studies. Obesity, the most consistent etiologic association, was present in two of our patients. Hypothalamic compression in IIH may induce increased appetite and result in weight gain. Use of trimethoprim/sulfamethoxazole has been reported to be associated with IIH and was seen in one of our patients. IIH is an important diagnostic consideration in the differential diagnosis for a patient with headache, visual disturbances, and papilledema.

Hodgkin's disease and acute leukemia. Report of eight cases and review of the literature.

Eight cases of Hodgkin's disease and acute leukemia are reported. An additional 74 cases of acute myelocytic leukemia or one of its variants, 11 cases of acute lymphocytic leukemia, 12 cases of chronic myelocytic leukemia and 37 cases of chronic lymphocytic leukemia associated with Hodgkin's disease are reviewed from the literature. In 3 of the 82 patients with acute myelocytic leukemia and Hodgkin's disease, the two diseases occurred simultaneously. Of the remaining 79 patients, 76 had received radiation therapy for their Hodgkin's disease and acute myelocytic leukemia had developed 1.2 to 19 years later (mean 6.5 years). Thirty-four of these patients also received antineoplastic chemotherapy. Only three patients with Hodgkin's disease were treated with multiple chemotherapy alone; in these, Hodgkin's disease developed 1.2, 1.5 and 3.2 years later. In 4 of 11 patients with acute lymphocytic leukemia and Hodgkin's disease, the two disorders occurred simultaneously. The other seven patients were all treated with radiation for their Hodgkin's disease, and acute lymphocytic leukemia developed 2 to 8 years later (mean 4.5 years). Three of the 7 patients also received alkylating agents. It is concluded that the development of acute leukemia, mostly acute myelocytic leukemia but also acute lymphocytic leukemia, during the course of Hodgkin's disease, is most likely related to radiation therapy. There is as yet insufficient evidence to implicate intensive chemotherapy in the causation of acute leukemia since in only three patients with Hodgkin's disease treated with chemotherapy alone has the development of acute leukemia been reported. It is possible, however, that chemotherapy potentiates the effect of radiotherapy. 2t is also possible that acute leukemia is part of the natural history of Hodgkin's disease and is occurring with greater frequency because of improved survival in Hodgkin's disease since the introduction of better radiotherapeutic and chemotherapeutic treatment regimens.