[Iatrogenic anisocoria after using a scopolamine patch for PONV prophylaxis]. / Iatrogene Anisokorie nach Scopolaminpflaster zur PONV-Prophylaxe.

This is a case report of a 29-year-old female patient who developed unilateral mydriasis following the use of a scopolamine patch for the prevention of postoperative nausea and vomiting (PONV).Given a medical history showing multiple risk factors for PONV, a preauricular scopolamine patch was applied prior to the induction of anesthesia. General anesthesia was induced with 150 mg propofol and 25 µg sufentanil and maintained with total intravenous anesthesia, using propofol (5 mg/kg per h) and remifentanil (2-3 µg/kg per h).Following an uneventful surgery of 90min duration, the patient was extubated and transferred to the recovery room, where the patch was removed. During the orthopedic ward round the following day, the clinical examination revealed anisocoria of the left eye in the form of unilateral mydriasis. In order to determine the cause of this clinical presentation, further neurological and ophthalmological examinations and investigations were carried out. In addition, magnetic resonance imaging was conducted to rule out a central nervous cause. The results of the investigations were negative and no pathology was identified. In addition, the symptoms resolved within 24 h of onset without any therapeutic intervention. Therefore, a suspected diagnosis of a pharmacologically induced anisocoria from the scopolamine patch was made, whereby the substance accidentally reached the affected left eye.Previous studies showed that scopolamine patches may reduce early emetic symptoms. Case reports describing the occurrence of anisocoria following the application of scopolamine patches have been previously published. In all of these cases the patches were used to prevent PONV and each case was comprehensively investigated using various diagnostic and clinical tools. It should be noted, however, that a dysfunctional accommodation is listed as a common side effect of the drug, affecting more than 1 in 10 patients.Even though the efficacy of scopolamine patches for the prevention of PONV is proven, clinicians should be aware of the common ophthalmological side effect. Particularly with respect to various surgical disciplines, where anisocoria may indicate an underlying surgery-related complication, the application of scopolamine patches should be well- considered.

Postoperative delirium: why, what, and how to confront it at your institution.

PURPOSE OF REVIEW: The current article reviews the importance of postoperative delirium (POD), focusing on the older surgical population, and summarizes the best-practice guidelines about POD prevention and treatment which have been published within the last several years. We also describe our local experience with implementing a perioperative delirium risk stratification and prevention pathway, and review implementation science principles which others may find useful as they move toward risk stratification and prevention in their own institutions. RECENT FINDINGS: There are few areas of consensus, backed by strong experimental data, in POD best-practice guidelines. Most guidelines recommend preoperative cognitive screening, nonpharmacologic delirium prevention measures, and avoidance of deliriogenic medications. The field of implementation science offers strategies for closing the evidence-practice gap, which we supplement with lessons learned from our own experience implementing a perioperative delirium risk stratification and prevention pathway. SUMMARY: POD continues to be a serious perioperative complication commonly experienced by older adults. Growing appreciation of its prognostic implications and evidence behind multidisciplinary, collaborative, and focused prevention strategies rooted in implementation science have prompted several major groups to issue consensus guidelines. Adopting best practices POD risk stratification and prevention pathways will improve perioperative care for older adults.

Effects of a sexy appearance on perceived competence of women.

The present study replicates P. Glick, S. Larsen, C. Johnson, and H. Branstiter's (2005) previous research showing that a sexy appearance may be detrimental to women in high-status jobs. The authors used a larger sample and different stimulus materials and evaluation measures. As in the original experiment, participants rated sexually and professionally dressed women in both low- and high-status positions on perceived ability. The results were consistent with the original study and showed that high-status, sexually dressed women receive lower ratings in competence.

Field trial for assessment of avian influenza vaccination effectiveness in Indonesia.

The aim of this field study was to determine the efficacy of vaccination against highly pathogenic avian influenza (HPAI) virus strain H5N1 in Indonesia. A limited, prototype clinical trial was performed using a standardised treatment group, in which poultry flocks were vaccinated at least twice with a selected H5N1 vaccine, and a control group comprising flocks treated with non-standardised procedures chosen by the farmer. Each group consisted of six flocks comprising either layers or native chickens. Haemagglutination inhibition (HI) antibody levels were determined by regular serum sampling, and outbreak surveillance relied on non-AI-vaccinated sentinel birds. After three vaccinations high antibody titres were produced in the treatment group, and the percentage of layers with an HI titre > 40 was approximately 90%. Although no conclusions can be drawn regarding reduction of virus transmission, this study demonstrated that 11 farms remained free from AI during the observation period, and that a surveillance programme based on differentiating infected from vaccinated animals (DIVA) can be implemented.

Long-lived immunity to canine core vaccine antigens in UK dogs as assessed by an in-practice test kit.

OBJECTIVES: To determine the utility of an in-practice test kit to detect protective serum antibody against canine distemper virus, canine adenovirus and canine parvovirus type 2 in a sample of the UK dog population. MATERIALS AND METHODS: Serum samples from 486 dogs, last vaccinated between less than 1 month and 124 months previously, were tested with the VacciCheck™ test kit for protective antibodies against distemper, adenovirus and parvovirus type 2. RESULTS: A high proportion of the dogs tested (93·6%) had protective antibody against all three of the core vaccine antigens: 95·7% of the dogs were seropositive against canine distemper virus, 97·3% against canine adenovirus and 98·5% against canine parvovirus type 2. The small number of dogs that were seronegative for one or more of the antigens (n = 31) may have had waning of previous serum antibody or may have been rare genetic non-responders to that specific antigen. CLINICAL SIGNIFICANCE: UK veterinarians can be reassured that triennial revaccination of adult dogs with core vaccines provides long-lived protective immunity. In-practice serological test kits are a valuable tool for informing decision-making about canine core revaccination.

Applying community health principles to veterinary practice.

Primary healthcare is the preferred approach to addressing human health problems and reducing the costs of healthcare in communities. ERWIN HOHN: and ADI NELL: believe that these principles should also be applied to animal healthcare systems.

Effect of Caloric Restriction on Metabolic Dysfunction of Young Rapacz Familial Hypercholesterolemic Swine (Sus scrofa).

The Rapacz familial hypercholesterolemic (FH) swine model is well-characterized and used for studies of both spontaneous and inducible atherosclerosis but has not been used for studies of metabolic dysfunction to date. We examined whether parameters of metabolic syndrome including weight and adiposity, serum cholesterol, and glucoregulatory function could be modulated by restriction of caloric intake in the FH swine. Three groups of FH swine (n = 6 per group) were fed without restriction (AL), 80% of AL caloric intake, or 60% of AL caloric intake for 8.8 ± 0.5 mo beginning 2 wk after weaning. Caloric intake influenced the rate and magnitude of body weight gain and change in adiposity, as determined by dual-emission X-ray absorptiometry. At the conclusion of the study, pigs in the AL group reached a total least-square mean body weight of 94.2 kg and fat mass of 31.1%, whereas those fed 80% AL were 71.6 kg and 24.3% fat, and swine fed 60% AL were 46.1 kg and 14.1% fat. Serum cholesterol was greater in AL than 60% AL pigs at the end of the study. At 10 mo of age, intravenous glucose tolerance testing, performed to assess glucoregulatory function, indicated significant differences in serum glucose clearance profiles and insulin sensitivity between the AL- and 60% AL-fed swine. The AL-fed animals showed almost 5-fold lower insulin sensitivity when compared with animals fed 60% AL caloric intake. These results highlight the value of the FH swine model to study metabolic dysfunction due to changes in caloric intake.

The optimal processing of plasma samples for the determination of bicyclo-PGE in patients with malignant maxillofacial tumors.

Prostaglandins (PGs) have been shown to be increased in several tumor tissues. PGE2 and PGF1-alpha Radioimmunoassays (RIAs) have been widely used for quantitative PG-measurements in cancer patients. Our results indicate that optimal processing of plasma samples for the determination of bicyclo-PGE2 is of the highest importance in order to get reproducible results. Therefore it is necessary to fulfill the following requirements: 1. 30 minutes rest before sampling; 2. Avoid venous occlusion; 3. Use constant needle diameter; 4. Precooled anticoagulant; 5. Addition of a cyclooxygenase inhibitor is necessary; 6. Control of processing temperature; 7. Storage at -70 degrees C less than -20 degrees C; 8. Control of storage time; 9. The samples have to be examined after thawing once; 10. Only blood samples processed under the above discovered optimal conditions are of clinical relevance; 11. An international standardization for the processing of plasma samples seems to be necessary considering all these requirements; 12. In 41 patients with maxillo-facial carcinomas the PG-value was significantly higher than in the controls; 13. A RIA-evaluation methodologically properly done may be used as an additional aid for clinical monitoring of the patients.

Enhancement of human dental cyst PGI2 formation by platelet derived growth factor and its role in cyst growth and bone resorption.

Various prostaglandins, particularly PGE2 and PGI2, appear to play a major role in osteolytic processes. Radiochromatographic studies have demonstrated that 6-oxo-PGF1-alpha is a major product of exogenously added arachidonic acid in human dental cysts. As platelets may also act as inflammatory cells, platelet-derived growth factor might also have a PGI2-stimulating influence in such cysts. Eleven human dental cysts were examined by a radioimmunoassay and bioassay which can show PGI2 synthesis in human dental cysts without addition of PDGF. Incremental PDGF addition caused a highly significant increase in the rate of PGI2 synthesis. PGDF thus stimulates PGI2 synthesis in chronic inflammatory processes in vitro and may thereby elicit or accelerate osteolysis.

[Analysis of the fluoride content of drinking water in Austria 1993]. / Fluoridgehaltuntersuchung des Trinkwassers in Osterreich 1993.

This study was undertaken to determine the concentration of fluoride ions in drinking water in Austria. The results show that the fluoride ion concentration is sufficient (0.7-1.0 ppm F-) to prevent caries only in very few parts of Lower Austria, Upper Austria, Salzburg, Tirol, Carinthia, and Styria. Hence, additional fluoridation is necessary to achieve successful prophylaxis of caries.

[Measuring drinking water fluoridation in Vorarlberg]. / Messung des Trinkwasserfluoridgehaltes in Vorarlberg.

A pilot study was undertaken in Vorarlberg to determine the concentration of fluoride ions in drinking water. The results showed that 91.3% of the population was supplied by drinking water containing under 0.3 ppm fluoride and the remaining 8.7% by drinking water containing 0.3-0.6 ppm fluoride. Hence, the fluoride concentration was too low to prevent caries in all areas of Vorarlberg. Exogenous fluoridation of the drinking water or table salt in all districts of Vorarlberg is discussed. Measurements are planned for the whole of Austria, which may lead to a general recommendation for fluoridation of the water or salt nationwide.

[Stimulation of platelet mitogen-induced prostaglandin I2 synthesis in periodontal tissue of cyclosporin A treated patients]. / Stimulation der Plättchenmitogen-induzierten Prostaglandin I2-Synthese in periodontalem Gewebe von Cyclosporin A-behandelten Patienten.

Cyclosporine A (CsA) is a highly potent immunosuppressive agent that has proven to be particularly useful in organ transplantation. Like phenytoin and the calcium antagonists, this drug may be associated with gingival hyperplasia. This study examined the interaction of platelet derived growth factor (PDGF) with prostaglandin I2 (PGI2)--a potent mediator in inflammation and bone resorption. PGI2 synthesis was examined by bioassay in gingival tissue from rats, rabbits and humans. Gingival tissue from CsA-treated patients generates less PGI2. PDGF causes a dose-dependent increase in PGI2 release in both CsA-treated and control subjects. The actual and percentage increase in PGI2 synthesis, however, was significantly higher in control tissue. While PDGF on the other hand modulated cellular proliferation, it causes on the other hand liberation of PGI2 from gingival tissue, thus interfering with its own action and further synthesis. If the PGI2 response is insufficient as after CsA therapy, the proliferative action might dominate. These findings therefore suggest an important pathogenetic role of PDGF and possibly other growth factors in CsA-induced gingival hyperplasia. "CsA gingivitis" seems to be a predominantly proliferative process, whereby inflammatory reactions appear only as a secondary phenomenon.

[Influence of risk factor "hot foods over 37 degrees Celsius" on oral flora and the pathogenesis of gingivitis and periodontitis]. / Der Einfluss des Risikofaktors "Nahrung mit mehr als 37 degrees C" auf die Keimzahl der Mundhöhle und die Entstehung von entzündlichen Parodontopathien.

Austrian law prescribes that hot food and beverages must be served at a minimum temperature of 75 degrees C. Within a group of 50 volunteers, we studied hot food at a temperature higher than 37 degrees C as a risk factor for the pathogenesis of gingivitis and periodontitis. In the first part of the investigation the effects of heat on bacterial growth in the mouth were evaluated. Bacterial growth was significantly reduced after drinking hot tea (70 degrees C) (p < 0.001). The ability of the volunteers to estimate the temperature of a direct heat stimulus in the mouth was tested in the second part of the study. 82% of the volunteers underestimated the temperature of tea (70 degrees C) by about 15 degrees C. In the third part of the study the periodontal state of the volunteers was determined by index measurements. Moreover, eating behaviour was assessed by a questionnaire. No statistically significant correlation between eating behaviour (hot/cold) and periodontal inflammation was found.

[Collection, preparation and storage of human plasma for radioimmunologic determination of thromboxane B2]. / Abnahme, Präparation und Aufbewahrung menschlichen Plasmas zur radioimmunologischen Bestimmung von Thromboxan B2.

There are at present several methods available for the quantitative determination of thromboxane B2. However, they give results differing in precision and biological information. If it were possible to exclude sampling and storage artefacts, radioimmunological plasma thromboxane B2 measurement would be the method of choice for routine clinical determinations. The optimum conditions for processing the plasma for such purposes were assessed in 10 healthy volunteers (6m, 4f, 24-37a). They include a 30-minute resting period before blood sampling, constant needle diameter, blood withdrawal without venous occlusion, proper anticoagulation and cyclooxygenase inhibition. Storage at -70 degrees C for less than 2 weeks and the avoidance of repeated freezing and thawing are further prerequisites. In contrast to widely-held opinion, the plasma levels of thromboxane B2 obtained using these precautions are of practical value, roughly comparable to those employing the platelet proteins beta-thromboglobulin and platelet factor 4. However, practically speaking determinations are limited to a small number of carefully handled samples. Hence, the method cannot be unreservedly applied to daily routine clinical use.

Identification and distribution of a novel Malassezia species yeast on normal equine skin.

This study aimed to investigate the distribution of Malassezia species yeasts on the skin of healthy horses. Acetate tape samples were obtained from the lip, axilla, interbulbar region, groin and anus of 12 healthy horses. The samples were stained and examined microscopically and sites harbouring yeast-like organisms were identified. Contact plates were applied to the skin at these sites and cultured at 26 degrees C and 32 degrees C. No growth was obtained on horse blood, Sabouraud's dextrose or modified Dixon's agar. A pure growth of a Malassezia-type organism was obtained on Sabouraud's dextrose agar enriched with oleic acid when it was incubated at 30 degrees C. It was identified by 26S ribosomal DNA D1/D2 sequence analysis as a member of the genus Malassezia, and most closely related to Malassezia sympodialis. However, the level of sequence divergence indicated that it was a novel species.

Local benefit of prostaglandin E2 in radiochemotherapy-induced oral mucositis.

In 15 patients suffering from maxillofacial cancer with radiochemotherapy-induced oral mucositis the local application of prostaglandin E2 (PGE2) tablets, 0.5 mg four times a day at a 4-h interval was performed. Plasma determination of the bicyclo-prostaglandin E2 metabolite showed no significant amount of the locally applied substance in the circulation. It is claimed that for this particular indication, PGE2 is a potent locally acting compound without affecting circulating levels.

Root canal system in the mesiobuccal root of the maxillary first molar: an in vitro comparison study of computed tomography and histology.

OBJECTIVES: The purpose of this study was to investigate a new diagnostic approach to the examination of the canal configuration of the mesiobuccal root of the maxillary first molar. MATERIALS AND METHODS: High-resolution computed tomography (CT) was compared with histology in vitro. There were 152 teeth investigated and classified according to Weine and Vertucci. RESULTS: CT describes the exact canal configuration, verifying information identical to histology, and thus serving as the "gold standard" in vitro. With regard to canal position, 9 (5.92%) of the teeth examined were Vertucci type 1, 48 (31.58%) were Vertucci type 2, 91 (59.87%) were Vertucci type 4, 1 (0.66%) was Vertucci type 5, 1 (0.66%) was Vertucci type 6. Of the 152 teeth examined, 3 (1.97%) could not be classified using Weine, 2 (1.31%) could not be classified according to either Weine or Vertucci, and no Vertucci types 3, 7 or 8 were identified. CONCLUSIONS: CT offers complete information on the number and configuration of root canals. As the root canal configuration of the adult does not change rapidly, CT investigations can be used for multiple subsequent treatments.

Anaesthesia for caesarean section in a patient with syringomyelia. A case report.

A 27-year-old White woman with syringomyelia underwent a caesarean section. The pre-operative preparation and anaesthetic management are presented, and the specific problems discussed.

Lectin binding to chronic inflammatory gingival tissue: possible adhesion mechanisms based on lectin-carbohydrate interactions.

In this study, we analyzed the expression of different leukocyte surface antigens, of the adhesion molecules ELAM-1 and GMP-140 and binding of various lectins and neoglycoproteins in inflamed gingival tissue. Cell suspensions from collagenase-digested gingiva were analyzed by flow cytometry in a FACScan. The expression of ELAM-1, GMP-140, carbohydrate structures and lectins in gingival specimens was also studied by immunohistochemistry. Gingival tissue of patients with active periodontal disease contained between 5% and 50% CD45+ mononuclear cells, consisting mainly of CD19+ cells (B lymphocytes). CD62, resembling GMP-140, and ELAM-1 were strongly expressed on endothelial cells of these patients. Control subjects usually contained almost no CD45+ cells in their gingiva and no CD62+ or ELAM-1-positive endothelial cells could be found in 5 of 6 control persons. Analysis of the glycosylation pattern revealed staining of infiltrating cells by peanut agglutinin (PNA; specificity for galactose), whereas soy bean agglutinin (SBA; specificity for N-acetyl-galactosamine) bound to epithelial cells. An endogenous lactosyl-specific lectin could be detected on endothelial cells by binding of lactosyl-BSA. Ulex europeus I agglutinin (UEA-1, specific for fucose) showed selective staining of endothelial and epithelial cells. Expression of a fucose-binding lectin, demonstrated by binding of fucosylated BSA, could be found on infiltrating cells. The adhesion molecules ELAM-1 and GMP-140 seem to be involved in cell adhesion during chronic inflammation of the gingiva. Interaction of other carbohydrate residues with endogenous lectins might resemble additional adhesion mechanisms in inflamed gingiva.