Postpartum excretion of internal teat sealant after selective dry cow treatment of dairy cows.

To comply with antibiotic restriction policies in the European Union, internal teat sealants (TS) are increasingly used at drying off (DO) in selective dry cow treatment protocols to maintain udder health. Post-calving TS residue attachment to milking equipment and associated cleaning difficulties is a reason for some farmers to stay away from blanket TS use. Our objective was therefore to improve insight in TS excretion visibility and to compare quantity, pattern, and presence versus absence of TS excretion post-calving between the typical 2 cow categories at DO: High (H) and Low (L) SCC cows, treated with antibiotic (AB) plus TS (H-ABTS) or TS only (L-TS), respectively. In herds in the Netherlands (n = 3), and Germany (n = 4), cows were enrolled at DO, and categorized as H-ABTS (n = 93), or L-TS (n = 99). Post-calving, quarter level TS visibility, quantities, patterns, and percentage of TS infused and excreted post-calving were recorded from 50 mL of pre-milk of every quarter at each of the first 15 or 16 milkings. Udder quarter health status was determined by bacteriological culture and somatic cell counting of quarter milk samples taken at DO and at d 3 post-calving and by clinical mastitis incidence from DO until 30 DIM. Univariable and multivariable models were created to explore associations of TS excretion presence versus absence at the first 3 milkings. Irrespective of SCC category, both laboratory personnel, and farmers saw TS residues at the first milking in an equal 72% of quarters. Compared with laboratory as the gold standard, farmer sensitivity to spot TS in pre-milk was 74.5% at the first milking, decreasing to a maximum of 8.3% at the last 3 milking's. At the first milking, TS excretion quantities showed a bimodal distribution pattern and the mean percentage of TS infused (3.83 g) that was excreted in pre-milk at the first milking, was higher in the L-TS (45.5%) compared with the H-ABTS cow category (32%). At the second and third milking, mean adjusted TS percentage excreted was higher in the H-ABTS (8.5% and 1.8%, respectively) compared with the L-TS category (4.6% and 0.4% respectively). The multivariable model of the first 3 milkings showed parity at both the first and second milking, and study group at both the second and third milking, was significantly associated to TS presence. The univariable model showed no association between TS presence at the first milking and udder health. In conclusion, in pre-milk of the first milking, TS residue excretion was bimodal, higher in L-TS cows, more likely present in multiparous cows, and not associated with udder health. At the second and third milking, excretion was higher in H-ABTS cows and TS presence was only more likely in multiparous cows at the second milking.

Panendoscopy: a valuable procedure?

The significance of panendoscopy, performed as part of the routine diagnostic procedure, must be questioned when the incidence of synchronous primary tumors found by this procedure is only 1% to 2%, as in patients with head and neck cancer in the Dutch population. In order to detect a group of patients with a higher probability of secondary tumors, patients were selected for panendoscopy on the following criteria: localization and histology of the index tumors, as well as on smoking and drinking habits. In spite of this selection, the yield of panendoscopy was still below 2%. Until other criteria for the selection of a subset of patients with a high incidence of synchronous tumours are found, the indication for panendoscopy as part of a routine diagnostic procedure has to be constantly questioned, and panendoscopy should therefore be performed only when this procedure is part of a prospective study.

[Cause, diagnosis and course in 215 patients with vocal cord paralysis]. / Oorzaak, diagnostiek en beloop bij 215 patiënten met stembandverlamming.

OBJECTIVE: To assess the different causes, the diagnostic process and natural course of vocal cord paralysis. DESIGN: A retrospective study. SETTING: Department of ENT, University Hospital Nijmegen, the Netherlands. METHOD: Between 1982 and 1990, 215 patients with the symptoms of vocal cord paralysis were routinely examined. In 40 patients additional examination was needed to determine the diagnosis. RESULTS: A substantial part of all cases (43%) were caused by previous medical intervention, for instance thyroid or thoracic surgery. Neoplasms of the head and neck region or thoracic cavity were a cause in 25%. In spite of extensive examination the cause of a vocal cord paralysis remained unclear in 18%. Physical examination combined with chest X-ray were the main diagnostic methods. Spontaneous recovery of a vocal cord paralysis was seen in 18% of all patients, but in the subgroup with paralysis after prolonged intubation or a viral infection it occurred in 46% and 62%, respectively. CONCLUSION: A vocal cord paralysis can have many causes. Physical examination and chest X-ray are important tools for diagnosis.

Seasonal variation in airway hyperresponsiveness and natural exposure to house dust mite allergens in patients with asthma.

Nonspecific airway hyperresponsiveness is a fundamental characteristic of patients with asthma and can be influenced by several stimuli. In nine patients with asthma and an isolated allergy to house dust mite, the variation of natural exposure to the house dust mite allergen Der p I and the corresponding changes in nonspecific airway hyperresponsiveness were followed up for 1 year. The concentration of Der p I in floor dust from living rooms and bedrooms (as a measure of exposure) reached maximum levels in late summer and the beginning of autumn (August to October), whereas the lowest levels were found during the months of March to May (delta Der p I = +2.31 micrograms/gm and -1.33 micrograms/gm respectively, both compared with the year average). Airway hyperresponsiveness (as measured by the provocative concentration of histamine causing a 20% fall in forced expiratory volume in 1 second [PC20] threshold) also showed a seasonal variation, with most severe hyperresponsiveness during the months of August to November, almost the same period in which the exposure to house dust mite allergens reached maximal levels (delta PC20 histamine = -1.47 mg/ml in November vs +1.79 mg/ml in March, both compared with the year average). Our results support the view that seasonal changes of exposure to environmental allergens such as house dust mite allergens will have an effect on the level of airway hyperresponsiveness in patients with allergic asthma.