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BACKGROUND: Von Willebrand factor (vWF) antigen concentration, a marker of endothelial activation, is increased in human patients with multiorgan failure, sepsis, or both, and is an independent predictor of survival. HYPOTHESIS/OBJECTIVES: vWF antigen concentrations are significantly higher in dogs with sepsis. ANIMALS: Fourteen dogs hospitalized with sepsis. Sepsis was defined as microbiologic or cytologic evidence of infection combined with systemic inflammatory response syndrome. Control dogs were healthy dogs, without evidence of disease. METHODS: Prospective, observational study. Dogs admitted to the intensive care unit with a diagnosis of sepsis were considered eligible for enrollment into the study. Exclusion criteria included a previous diagnosis of von Willebrand disease or a recent history of a plasma transfusion. Citrated plasma samples were collected for analysis of vWF antigen by ELISA. All samples were drawn from dogs during hospitalization. Data between populations were analyzed using nonparametric statistical analysis with a P value < .05 considered significant. RESULTS: Twenty-five dogs were enrolled; 14 dogs with sepsis and 11 control dogs. The median vWF antigen concentration in dogs with sepsis was 156% (range, 117-200%), which was significantly higher than healthy dogs (105%; range, 44-155%, P < .005). There was no difference between survivors and nonsurvivors with a median vWF antigen concentration of 144% (range, 136-201%) in survivors (n = 7) and 159% (range, 122-174%) in nonsurvivors (n = 7) (P = .5). CONCLUSIONS AND CLINICAL IMPORTANCE: vWF is increased in dogs with sepsis, possibly reflecting endothelial activation. Further exploration of endothelial function is warranted in critically ill dogs.
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Enfermedades de los Perros/sangre , Sepsis/veterinaria , Factor de von Willebrand/inmunología , Animales , Enfermedades de los Perros/metabolismo , Perros , Factor de von Willebrand/metabolismoRESUMEN
BACKGROUND: Portal vein thrombosis (PVT) in cats is sparsely reported. PURPOSE OF STUDY: To evaluate the clinical signs and diseases associated with PVT in cats. ANIMALS: 6 client-owned cats. METHODS: Medical records for cats with a portal vein thrombus diagnosed on abdominal ultrasound or at necropsy were reviewed. Signalment, historical data, underlying disorders, clinical findings, clinicopathologic and histopathologic data, diagnostic imaging findings, treatment, and outcome were recorded. RESULTS: All 6 cats identified with PVT also had hepatic disease. Evidence of a congenital portosystemic shunt was present in 3/6 cats. Two cats had primary or metastatic hepatic neoplasia. One cat had acute cholangitis, acute pancreatitis, and locally extensive acute centrilobular hepatic necrosis. Two cats were suspected to have acute thrombi and 4 cats had chronic thrombi. CONCLUSION AND CLINICAL SIGNIFICANCE: PVT might be an important concurrent finding in cats with hepatic disease.
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Enfermedades de los Gatos/patología , Vena Porta/patología , Trombosis/veterinaria , Animales , Anticoagulantes/uso terapéutico , Enfermedades de los Gatos/diagnóstico por imagen , Enfermedades de los Gatos/tratamiento farmacológico , Gatos , Femenino , Hígado/patología , Masculino , Vena Porta/diagnóstico por imagen , Estudios Retrospectivos , Trombosis/diagnóstico por imagen , Trombosis/tratamiento farmacológico , Trombosis/patología , UltrasonografíaRESUMEN
PURPOSE: To analyze the outcome and complication rates for patients treated with curative-intent pulsed low dose rate (PLDR) brachytherapy and external beam radiation therapy (EBRT) for uterine cervical carcinoma. METHODS AND MATERIALS: Fifty-two patients have been treated, of whom 6 were excluded from analysis due to limited follow-up. Six patients were stage Ib, 3 were IIa, 11 IIb, 3 IIIa, 14 IIIb, 1 IVa, and 9 were treated for local recurrences following primary surgery for stage Ib disease. Thirty-six patients had squamous cell carcinoma, 8 adenocarcinoma, 1 adenosquamous, and 1 carcinosarcoma. Thirty-one had a staging laparotomy prior to radiation therapy. Brachytherapy was interstitial in 18 patients, and intracavity in 28. The median EBRT central pelvis dose was 45 Gy in 25 fractions. Median total prescribed doses (EBRT plus PLDR) were 75.8 Gy to the implant volume with interstitial, and 84.1 Gy to the A points with intracavitary, at a median dose rate of 0.55 Gy per pulse per hour. Six patients had laparotomy-documented periaortic node involvement, and received EBRT to this site, 45 Gy in 25 fractions. Thirty patients received concomitant weekly cisplatin chemotherapy (40 mg/m2). RESULTS: With a median follow-up of 25 months (range 6 to 55 months) actuarial 4-year disease-free survival (DFS) rates are 66% for the entire group: stage Ib 100%, stage II 69%, stage III/IVa 68%, and 43% in patients treated for recurrences after surgery for initial stage Ib disease. Pelvic nodes contained tumor in 13 of the 31 patients (41.9%) who underwent laparotomy, as did periaortic nodes in 6 (19.4%). Patients with negative pelvic nodes had a 4-year actuarial DFS of 75% versus 59% with positive pelvic (and negative periaortic) nodes, and 50% with positive periaortic nodes. Using the RTOG late radiation morbidity scoring criteria, there were no grade V complications. Grade IV complications occurred in 2 patients (4.3%). One was a rectovaginal fistula and the other a vesicovaginal fistula, each occurring subsequent to a biopsy revealing benign tissue. One patient (2.2%) had a grade III complication (frequent hematuria), and 5 (10.9%) had grade II complications. CONCLUSIONS: PLDR brachytherapy is a safe and effective brachytherapy method in the treatment of cervix carcinoma. It combines the physics benefits of dose optimization and the radiobiologic advantages of low dose rate brachytherapy. It eliminates radiation exposure to staff and visitors as well as the need for a source inventory. Although further follow-up will be required, it appears to provide outcome which compares favorably to other methods of brachytherapy delivery, and results in a low rate of complications.
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Braquiterapia/métodos , Carcinoma/radioterapia , Neoplasias del Cuello Uterino/radioterapia , Adolescente , Adulto , Anciano , Análisis de Varianza , Braquiterapia/efectos adversos , Carcinoma/mortalidad , Carcinoma/patología , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática , Persona de Mediana Edad , Estadificación de Neoplasias , Dosificación Radioterapéutica , Neoplasias del Cuello Uterino/mortalidad , Neoplasias del Cuello Uterino/patologíaRESUMEN
PURPOSE: To assess the efficacy and complications of Gamma Knife radiosurgery for trigeminal neuralgia. METHODS AND MATERIALS: The Barrow Neurological Institute (BNI) Gamma Knife facility has been operational since March 17, 1997. A total of 557 patients have been treated, 89 for trigeminal neuralgia (TN). This report includes the first 54 TN patients with follow-up exceeding 3 months. Patients were treated with Gamma Knife stereotactic radiosurgery (RS) in uniform fashion according to two sequential protocols. The first 41 patients received 35 Gy prescribed to the 50% isodose via a single 4-mm isocenter targeting the ipsilateral trigeminal nerve adjacent to the pons. The dose was increased to 40 Gy for the remaining 13 patients; however, the other parameters were unvaried. Outcome was evaluated by each patient using a standardized questionnaire. Pain before and after RS was scored as level I-IV per our newly-developed BNI pain intensity scoring criteria (I: no pain; II: occasional pain, not requiring medication; III: some pain, controlled with medication; IV: some pain, not controlled with medication; V: severe pain/no pain relief). Complications, limited to mild facial numbness, were similarly graded by a BNI scoring system. RESULTS: Among our 54 TN patients, 52 experienced pain relief, BNI score I in 19 (35%), II in 3 (6%), III in 26 (48%), and IV in 4 (7%). Two patients (4%) reported no relief (BNI score V). Median follow-up was 12 months (range 3-28). Median time to onset of pain relief was 15 days (range 0-192), and to maximal relief 63 days (range 0-253). Seventeen (31%) noted immediate improvement (= 24 h). Prior to RS, all patients were on pharmacologic therapy felt to be optimal or maximal. Twenty-two (41%) were able to stop medications entirely (BNI score I or II). Another 16 (30%), with BNI Score III relief, decreased medication intake by at least 50%. Patients with classical TN pain symptoms were more likely to stop medications than those with atypical features, 49% (21 of 43) versus 9% (1 of 11). This difference was significant at p = 0.040. Statistically, the finding most predictive for pain relief was new facial numbness following RS. Each of the 5 patients with new numbness after RS developed BNI score I relief, contrasting with 35% for the 49 patients with no new numbness (p = 0.019). Complications have been limited to delayed, mild facial sensory loss. Before RS, 17 patients had numbness from prior invasive procedures, none of whom reported a worse numbness score after treatment. Thirty-seven patients had no facial numbness at the time of RS, of whom 5 developed facial hypesthesia. Each rated this as "mild, not bothersome." There have been no other sequellae. CONCLUSION: RS is an effective treatment, and is the least invasive nonpharmacologic therapy for TN. It carries a small risk of mild facial hypesthesia, a side effect which, somewhat ironically, may be desirable, because it appears to correlate favorably with an excellent pain response. We currently include radiosurgery among the appropriate options for TN patients who have failed optimal medical management, with or without prior invasive neurosurgical procedures. We present here BNI scoring systems for pain intensity and facial numbness. These have proved simple and reliable, have facilitated data collection, rendered analysis more objective, and improved our ability to discuss results with patients and colleagues.
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Radiocirugia/métodos , Neuralgia del Trigémino/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Dosificación Radioterapéutica , Neuralgia del Trigémino/tratamiento farmacológicoRESUMEN
1. Dementia patients who retain musical and game-playing skills exhibit impaired performance on explicit memory tests of knowledge about their retained skill. 2. Dementia patients who retain skill at playing dominoes can answer complex questions about the play of the game almost as well as normal elderly domino players when the questions are presented with real dominoes. 3. The aim of this study was to determine if skilled dementia patients could answer questions about domino play when the stimuli were two-dimensional drawings of dominoes. 4. Seventeen dementia patients and eight normal elderly domino players were tested on two forms of the Domino Quiz: first with real dominoes, then with two-dimensional drawings; other neuropsychological tests were given at the same time. 5. Fourteen of the 17 patients and all of the controls showed no decline in answering questions about domino play when two-dimensional drawings were used. These patients showed retained symbolic processing of information about dominoes despite declines in overall mental status, generation of words from specific semantic categories, and recognition memory for domino terminology. 6. Because the 14 patients with retained domino skill performed as accurately as controls on both administrations of a letter cancellation task, the ability to process familiar symbols may be important to their game-playing skill.
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Cognición , Demencia/psicología , Memoria , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Juego e Implementos de Juego , Percepción VisualRESUMEN
PURPOSE: To explore data on high-risk male and female adolescents' attitudes towards female condoms, compared with male condoms. METHODS: Exploratory survey research was utilized with a convenience sample of 65 high-risk adolescents at an emergency homeless shelter. A peer-led intervention was conducted and pre-test and post-test interviews explored barriers to female condom use. The intervention consisted of 15- to 30-minute small group sessions, discussing female condoms' construction; purpose of the rings; efficacy preventing pregnancy and sexually transmitted infection (STIs); and how to lubricate, insert, and use. Content and Chi-square analyses were utilized. RESULTS: Sixty-three percent used male condoms as their primary contraceptive method; almost half (48%) said they always used male condoms, but 44% reported having sex without a male condom at least once in the 2 weeks prior to pre-test. Ninety-five percent had heard of the female condom, half 'good' and 24% 'bad' things, but only 15% had ever used one. At post-test all respondents gave reasons they might use female condoms in the future, and 77% gave reasons why they might not. Most (73%) adolescents said they would still prefer the male to the female condom. The major potential barriers to adolescents' female condom use were not having female condoms available and/or females feeling uncomfortable inserting them. CONCLUSIONS: Female condoms should be offered to adolescents as an additional choice rather than as replacements for male condoms. Further research is needed to assure access, availability, and comfort with female condoms and male participation in their use.
PIP: The aim of this study was to explore data on high-risk male and female adolescents' attitudes towards the female condom as compared with the male condom. Exploratory survey research was utilized with convenience sample of 65 high-risk adolescents at an emergency homeless shelter. A peer-led intervention was conducted and pre- and post-test interviews explored barriers to female condom use. The intervention consisted of 15- to 30-minute small-group sessions, discussing the female condom's construction; purpose of the rings; its efficacy in preventing pregnancy and sexually transmitted infections; and how to lubricate, insert, and use it. Content and Chi-square analyses were utilized. 63% used the male condom as their primary contraceptive method; almost half (48%) said they always used a male condom, but 44% reported having sex without using one at least once in the 2 weeks prior to the pre-test. 95% had heard of the female condom (half had heard "good" things and 24% had heard "bad" things), but only 15% had ever used one. At post-test all respondents gave reasons they might use a female condom in the future, and 77% gave reasons why they might not. Most (73%) adolescents said they would still prefer the male condom to the female condom. The major potential barriers to adolescents' female condom use were not having a female condom available and/or females feeling uncomfortable inserting them. The female condom should be offered to adolescents as an additional choice rather than as a replacement for the male condom. Further research is needed to assure access to, availability of, and comfort with the female condom and male participation in its use.
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Conducta del Adolescente/psicología , Actitud Frente a la Salud , Condones Femeninos/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Jóvenes sin Hogar/psicología , Jóvenes sin Hogar/estadística & datos numéricos , Psicología del Adolescente/estadística & datos numéricos , Asunción de Riesgos , Educación Sexual/métodos , Conducta Sexual/psicología , Conducta Sexual/estadística & datos numéricos , Adolescente , Distribución de Chi-Cuadrado , Conducta de Elección , Condones/estadística & datos numéricos , Femenino , Humanos , Masculino , New England , Grupo Paritario , Embarazo , Encuestas y CuestionariosRESUMEN
This study provided preliminary evidence of the reliability and validity of a set of scales fro rating the parenting behaviors of physically abusive mothers. Thirty-two male and 32 female undergraduates viewed a video-tape of either an abusive or matched control mother interacting with her son. Two tapes of abusive mothers, representative of the Intrusive mother type, and two matched control tapes were used. Subjects rated the mother's behavior on rating scales matching an observational coding system developed by Oldershaw, Walters, and Hall (1989). Mean ratings of between six to eight raters displayed sufficiently high reliability. As expected, ratings correlated with behavior frequency data. Observers' ratings discriminated between abusive mothers and nonabusive controls, providing evidence of construct validity of the scales. The potential utility of a rating scale instrument for the clinical assessment of parenting behaviors is discussed.
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Maltrato a los Niños/psicología , Conducta Materna , Madres/psicología , Responsabilidad Parental/psicología , Determinación de la Personalidad/estadística & datos numéricos , Adulto , Maltrato a los Niños/diagnóstico , Preescolar , Femenino , Humanos , Lactante , Control Interno-Externo , Masculino , Relaciones Madre-Hijo , Psicometría , Reproducibilidad de los Resultados , Grabación de Cinta de VideoRESUMEN
BACKGROUND: Portal vein thrombosis (PVT) has been reported infrequently in dogs. OBJECTIVES: To characterize the presentation, associated disease conditions, and outcome in dogs with PVT. ANIMALS: Client-owned dogs with a diagnosis of PVT and a complete medical record. METHODS: Records were retrospectively analyzed for presentation, history, physical examination, clinicopathologic data, diagnostic imaging, treatment, and outcome. RESULTS: Thirty-three dogs were included. Common clinical signs were vomiting, diarrhea, abdominal pain, ascites, and signs of hypovolemic shock. Associated disease conditions included hepatic (14/33), neoplastic (7/33), immune (5/33), and infectious (4/33) diseases, protein-losing nephropathy (3/33), hyperadrenocorticism (2/33), protein-losing enteropathy (1/33), and pancreatitis (1/33). Fourteen dogs were receiving glucocorticoids at the time of diagnosis. Twenty-nine dogs had at least 1 predisposing condition for venous thrombosis, and 11 had 2 or more. Thrombocytopenia (24/33), increased liver enzyme activity (23/33), and hypoalbuminemia (20/33) were common laboratory abnormalities. Clinical syndromes at the time of PVT diagnosis included shock (16/33), systemic inflammatory response syndrome (SIRS), (13/33) and disseminated intravascular coagulation (3/33). Twenty-four dogs had acute and 9 had chronic PVT. Multiple thrombi were found in 17/33 dogs. Nineteen dogs survived to discharge. Dogs treated with anticoagulant therapy were more likely, whereas those with acute PVT, multiple thromboses or SIRS were less likely to survive. CONCLUSIONS AND CLINICAL IMPORTANCE: Hepatic disease is a common pre-existing condition in dogs with PVT. PVT should be considered in dogs with risk factors for venous thrombosis presenting with abdominal pain, ascites, and thrombocytopenia. Studies evaluating anticoagulant therapy in the management of PVT are warranted.
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Enfermedades de los Perros/patología , Vena Porta/patología , Trombosis de la Vena/veterinaria , Animales , Anticoagulantes/uso terapéutico , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/tratamiento farmacológico , Perros , Femenino , Masculino , Vena Porta/diagnóstico por imagen , Estudios Retrospectivos , Ultrasonografía , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/patologíaRESUMEN
In 2003 the Texas Board of Health approved a modification to the Texas Administrative Code that permitted pet owners to have their dogs (Canis familiaris) and cats (Felis catus) vaccinated against rabies every 3 years, provided a triennial vaccine was used. The change had been opposed by hundreds in the veterinary community, some concerned that its implementation would be followed by a decrease in rabies vaccination rates. To determine if this decrease had occurred, rabies vaccination rates for 4 years before and after migration to the 3-year vaccination interval were examined. Data for dogs and cats, ≥ 4 months of age, were collected from the Texas Department of Health Rabies Incident Report database. Each animal's record included its current rabies vaccination status. The number of animals that were currently vaccinated against rabies was tallied and the percent vaccinated was calculated. From 1999 through 2002, 46% of dogs were vaccinated against rabies. From 2004 through 2007, 56% of dogs were vaccinated against rabies. From 1999 to 2002, 18% of cats were vaccinated against rabies. From 2004 to 2007, 30% of cats were vaccinated against rabies. There has been a significant increase in the numbers of dogs (P < 0.001), and cats (P < 0.001), vaccinated against rabies since the introduction of the triennial vaccination interval. This observational study documents the positive changes in rabies vaccination rates following migration from a 1-year to 3-year vaccination interval.
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Enfermedades de los Gatos/prevención & control , Enfermedades de los Perros/prevención & control , Vacunas Antirrábicas/administración & dosificación , Rabia/veterinaria , Vacunación/veterinaria , Animales , Enfermedades de los Gatos/virología , Gatos , Enfermedades de los Perros/virología , Perros , Esquema de Medicación , Cooperación del Paciente/estadística & datos numéricos , Rabia/prevención & control , Texas , Vacunación/estadística & datos numéricosAsunto(s)
Electrocardiografía , Corazón/fisiología , Animales , Perros , Electrofisiología , Métodos , Modelos TeóricosRESUMEN
The public communication of science and technology has become increasingly important over the last several decades. However, understanding the audience that receives this information remains the weak link in the science communication process. This essay provides a brief review of some of the issues involved, discusses results from an audience-based study, and suggests some strategies that both scientists and journalists can use to modify media coverage in ways that can help audiences better understand major public issues that involve science and technology.
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Comunicación , Participación de la Comunidad , Periodismo , Ciencia , HumanosRESUMEN
This study examines calcification in planulae and polyps of the hydroid Hydractinia symbiolongicarpus. We observed that established colonies produce a crystalline mat on their substratum and that crystals visible by polarized light microscopy occur in the vacuoles of the gastrodermal cells of both polyps and planulae. The crystalline mat was found by infrared spectroscopy to contain calcium carbonate in the form of aragonite. The composition of the vacuolar crystals and the cellular mechanisms for manufacturing them were explored by alteration of calcium levels in the environment and by the use of pharmacological agents (acetazolamide, caffeine, DIDS, diltiazem, nifedipine, procaine, Ruthenium Red, ryanodine and verapamil) that affect cellular uptake and transport of calcium and bicarbonate. The results indicated that the crystals in the vacuoles contained calcium carbonate. The gastrodermal cells are hypothesized to serve as a physiological sink for excess calcium that enters the organism during motility, secretion and metamorphosis of the planula, and to create a crystalline substratum for the colony of polyps.
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Calcificación Fisiológica , Hydra/fisiología , Animales , Bicarbonatos/administración & dosificación , Bicarbonatos/metabolismo , Calcio/administración & dosificación , Calcio/metabolismo , Carbonato de Calcio/análisis , Carbonato de Calcio/metabolismo , Cristalización , Hydra/crecimiento & desarrollo , Larva/fisiología , Espectrofotometría InfrarrojaRESUMEN
Forty-three patients with trigeminal neuralgia (TN) unresponsive to pharmacologic treatment and/or prior invasive procedures underwent stereotactic radiosurgery with the Gamma Knife (GK). Outcome was evaluated by a standardized questionnaire mailed to each patient. The mean follow-up was 9 months. Fifteen patients (35%) reported no trigeminal pain and were no longer taking medication. Three patients (7%) experienced occasional pain, but were no longer taking medication. In 15 patients (35%), pain improved and was adequately controlled by medication, often in lower dosages than preoperatively. Pain was reduced in 9 patients (21%), but their symptoms were still inadequately controlled by drug therapy, and 1 patient (2%) reported no pain relief after treatment. Three patients (7%) described new facial numbness, but in none was this bothersome. GK radiosurgery for TN appears to have minimal morbidity, although the success rate may be slightly lower than that of other operative procedures. More patients and longer follow-up are needed before drawing final conclusions regarding efficacy and complications.