Effectiveness of Canine Hip Dysplasia and Elbow Dysplasia Improvement Programs in Six UK Pedigree Breeds.

Hip and elbow dysplasia are common disorders in larger dog breeds and crosses, and a known contributory factor to osteoarthritis, lameness and reduced mobility. Screening schemes evaluating the severity of hip and elbow dysplasia in the UK are administered by the British Veterinary Association (BVA) and the Kennel Club (KC). The BVA/KC Hip Dysplasia scoring scheme is over 50 years old, having originated in 1965, and has operated in its current form since 1983. The BVA/KC Elbow Dysplasia grading scheme commenced more recently in 1998 and is based on the International Elbow Working Group guidelines. Hip score and elbow grade data on a considerable number of dogs in the UK have been generated from these two screening schemes. This study analyses data from dogs of six breeds scored from 1990 to present, to establish any determinable trends in hip score and elbow grade parameters, and to examine whether the implementation of such schemes has had a positive influence on hip and elbow health. A range of criteria, including the rate of participation in the screening schemes, hip score and elbow grade parameters (e.g., median, mean, standard deviation), and estimated breeding values (EBVs) were analyzed, both in the overall population and also among breeding animals. The results show a general decline in hip score parameters (median, mean, standard deviation, and 75th percentile), revealing a reduction in the prevalence and severity of hip dysplasia. There was a more modest decline in mean elbow grade within breeds. The proportion of sires and dams (of dogs born per year) with no hip score or elbow grade fell substantially over time, demonstrating good participation in the screening schemes. In most breeds, the scores of sires and dams are demonstrably improving. There is a declining genetic trend as ascertained by EBVs for both hip scores and elbow grades in most breeds, implying that the improvement observed is due in part to selection for improvement in hip and elbow health as described by the respective screening schemes.

Common complications of advanced cancer.

Complications due to cancer and its treatment are common and increase in incidence and severity as the disease progresses. Central nervous system complications affect 15% to 20% of patients, and up to 75% have bone metastases at some point during the disease process. Endocrine abnormalities include hypercalcemia, adrenal insufficiency, and inappropriate antidiuretic syndrome. Hematologic disorders, malignant effusions, and gastrointestinal (GI) problems may cause significant morbidity.

A technique to continuously measure arteriovenous oxygen content difference and P50 in vivo.

In hypoxemic high-altitude polycythemic natives whose arterial O2 saturation (SaO2) normally ranges between 70 and 80%, three polyurethane catheters with both optical and polarographic sensors were inserted into the radial artery to measure SaO2 and O2 tension (PaO2), and three thermodilution fiber-optic balloon-tipped catheters were floated into the pulmonary artery to measure mixed venous O2 saturation (SvO2). Correlation of the in vivo SaO2, PaO2, and SvO2 values with the in vitro measurements was high (r = 0.97, 0.99, and 0.98, respectively). Both catheters were inserted in one polycythemic subject before and 4 days after isovolemic hemodilution. Data from the sensors were used to calculate arteriovenous O2 content difference (CaO2 - CvO2) and the O2 half-saturation pressure of hemoglobin (P50). The mean +/- 1 SD of the in vivo and in vitro P50 calculated with the Hill equation was 27.61 +/- 2.15 Torr and 27.35 +/- 1.60 Torr, respectively. The mean +/- 1 SD of the absolute difference between the in vivo and in vitro measurements was 1.16 +/- 1.21 Torr. The in vivo CaO2 - CvO2 correlated well with the in vitro measurements (r = 0.93), and the mean +/- 1 SD of the error in the catheter CaO2 - CvO2 measurements was 0.47 +/- 0.50 ml/dl. This technique appears to provide a useful measurement of blood gas exchange parameters and should be applicable to the study of exercise physiology and clinical regulation of O2 transport.

Advances in cancer pain management.

Control of malignant pain and related symptoms is paramount to clinical success in caring for cancer patients. To achieve the best quality of life for patients and families, oncologists and palliative care clinicians must work together to understand problems related to psychologic, social, and spiritual pain. Pain is the primary problem targeted for control using the World Health Organization's (WHO) analgesic ladder. This article focuses on increased knowledge of analgesic action that may enable expansion of the WHO analgesic ladder to fulfill the broader objectives of palliative medicine. We discuss clinical experience with several classes of drugs that are currently used to treat cancer pain: 1) nonsteroidal anti-inflammatory drugs (NSAIDs), with emphasis on cyclooxygenase-2 (COX-2) inhibitors; 2) opioid analgesics, with specific emphasis on methadone and its newly recognized value in cancer pain; 3) ketamine, an antagonist at N-methyl d-aspartate (NMDA) receptors; and 4) bisphosphonates, used for pain resulting from bone metastases. New concepts that compare molecular actions of morphine at excitatory opioid receptors, and methadone at non-opioid receptor systems, are presented to underscore the importance of balancing central nervous system excitatory (anti-analgesic) versus inhibitory (analgesic) influences.

Advances in cancer pain management.

Control of malignant pain and related symptoms is paramount to clinical success in caring for cancer patients. To achieve the best quality of life for patients and families, oncologists and palliative care clinicians must work together to understand problems related to psychologic, social, and spiritual pain. Pain is the primary problem targeted for control using the World Health Organization's (WHO) analgesic ladder. This article focuses on increased knowledge of analgesic action that may enable expansion of the WHO analgesic ladder to fulfill the broader objectives of palliative medicine. We discuss clinical experience with several classes of drugs that are currently used to treat cancer pain: 1) nonsteroidal anti-inflammatory drugs, with emphasis on cyclooxygenase-2 inhibitors; 2) opioid analgesics, with specific emphasis on methadone and its newly recognized value in cancer pain; 3) ketamine, an antagonist at N-methyl-d-aspartate receptors; and 4) bisphosphonates, used for pain resulting from bone metastases. New concepts that compare molecular actions of morphine at excitatory opioid receptors, and methadone at nonopioid receptor systems, are presented to underscore the importance of balancing central nervous system excitatory (anti-analgesic) versus inhibitory (analgesic) influences.

Effect of prazosin on hypoxemia-induced blood flow redistribution in the newborn piglet.

We examined the effect of the alpha 1-adrenergic antagonist prazosin on blood pressure, left ventricular output and blood flow redistribution during normoxemia and mild hypoxemia in the chronically instrumented, unanesthetized newborn piglet employing the radiolabeled microsphere technique. Prior to prazosin, hypoxemia caused increases in aortic pressure and blood flows to the brain, myocardium and diaphragm, accomplished by small, statistically insignificant decreases in flows to the carcass and viscera without an increase in cardiac index. Prazosin treatment during normoxemia caused a fall in blood pressure and resulted in greater blood flows of left ventricular origin to the carcass, myocardium and lung. Hypoxemia after prazosin administration increased not only aortic pressure and blood flows to the brain, myocardium and diaphragm, but also, unlike the situation before drug treatment, cardiac index. Thus, in the newborn piglet, the maintenance of critical organ oxygen delivery during hypoxemia is not blocked by prazosin, but is accomplished by an increase in cardiac index rather than simply by redistribution of blood flow.

Blood volume and blood pressure in infants with respiratory distress.

Mean aortic blood pressure volume were measured in true premature infants with respiratory distress syndrome. Seven infants had Type I RDS (hyaline membrane disease) and ten had transient tachypnea of the newborn (Type II RDS). Blood volume in the infants with Type I RDS was significantly lower than in the infants with Type II RDS. The difference was due to a low red cell volume. Mean aortic blood pressure was within the range of normal in all infants and therefore did not reflect the low blood volume of infants with Type I RDS. Normal mean aortic blood pressure does not indicate normal blood volume or normal circulation in infants with RDS.

Facial Nerve Monitoring under Neuromuscular Blockade.

The characteristics of facial nerve electromyography at various levels of neuromuscular blockade are unclear. Partial blockade is well known to facilitate anesthetic safety and management. However, the use of neuromuscular blockage in many skull base procedures is avoided to allow intraoperative facial nerve monitoring.We studied the influence of various levels of neuromuscular blockade on facial nerve stimulation in the New Zealand white rabbit. The facial nerve was exposed in the middle ear of six rabbits. Using electromyographic-type facial nerve monitor, we recorded the facial electromyography signals in these rabbits at increasing levels of vecuronium-induced neuromuscular blockade. All animals demonstrated reliable facial electromyography response at all levels of partial neuromuscular blockade (P < .02). Five of the six animals could be monitored throughout complete blockade. These results clearly demonstrate that rabbit facial electromyography monitoring is possible under neuromuscular blockade. The effect of neuromuscular blockers on facial electromyography monitoring deserves further study, as partial blockade would greatly facilitate the management of anesthesia in otologic, neurotologic, and skull base surgery.

Accuracy and clinical utility of an oxygen saturation catheter.

Twenty-three fiberoptic catheter oximeters were placed in the umbilical arteries of 22 neonates to determine the accuracy and reliability of the sensor and clinical utility of continuous measurement of arterial oxygen saturation. Comparison of fiberoptic saturation readings with 1039 bench measured blood samples revealed a correlation coefficient of 0.97 with a mean error of 0.74 +/- 2.17 (SD) saturation. Although 11 catheters remained reasonably accurate (in error less than 3% saturation) for up to 488 h of use, 12 required in vivo calibration at a median time of 31 h after initial insertion. Clinical use of the catheter oximeter was evaluated in 11 infants by comparison to matched controls. Control infants required 55% more arterial blood samples for care, twice the number of transfusions, and spent twice the amount of time with a PaO2 greater than 110 torr. The catheter oximeter was found to be a useful clinical tool. Saturation values up to 95% reflected accurately and reliably an infant's arterial saturation status, providing constant and comprehensive assessment of clinical variations and the effects of therapy. The most useful feature was its rapid and accurate response to hypoxic incidents and to efforts to correct these conditions for improved care of infants in life-threatening situations.