Antimicrobial usage and risk of retreatment for mild to moderate clinical mastitis cases on dairy farms following on-farm bacterial culture and selective therapy.

AIMS: To assess antimicrobial usage for treatment of mild to moderate clinical mastitis, and risk of retreatment, following implementation of an on-farm bacterial culture system and selective therapy based on culture results, and to assess compliance with treatment decision tree protocols and the level of agreement between results from on-farm culture and laboratory-based microbiology methods. MATERIALS AND METHODS: Herdowners from seven dairy herds were asked to collect milk samples from cases of mild to moderate clinical mastitis between July 2015 and May 2016. All samples were cultured on-farm using a commercially available selective media and were also submitted for laboratory-based culture. Within sequential pairs of cows with mastitis, half were assigned to be treated without regard to culture results (Blanket group), and half were treated based on the on-farm culture results (Selective group) according to decision tree diagrams provided to the farmers. Culture results, treatments, and retreatments for clinical mastitis were recorded. The sum of the daily doses of antimicrobials used per cow, the number of retreatments and interval to first retreatment were compared between treatment groups. RESULTS: The geometric mean sum of daily doses for quarters assigned to the Selective (1.72 (95% CI=1.55-1.90)) group was lower than for the Blanket (2.38 (95% CI=2.17-2.60)) group (p=0.005). The percentage of cows retreated for clinical mastitis did not differ between the Selective (21.7 (95% CI=10.5-25.9)%) and Blanket (26.1 (95% CI=20.9-31.3)%) groups (p=0.13), and there was no difference between groups in the hazard that cows would be retreated within 60 days of enrolment (hazard ratio=0.82 (95% CI=0.39-1.69); p=0.59). Compliance with the treatment protocols was higher amongst quarters assigned to the Selective (199/233; 85.4%) compared with the Blanket (171/249; 68.7%) group (p<0.001), and varied between farms from 64-94%. The overall agreement between results from on-farm and laboratory culture was 188/331 (56.9%; kappa=0.31; p<0.001), but varied between farms from 44.7-88.2% (p<0.001). CONCLUSIONS: Use of on-farm culture with selective antimicrobial therapy resulted in approximately 25% lower antimicrobial usage, but was not associated with an increase in the proportion of cows retreated for clinical mastitis. CLINICAL RELEVANCE: This study has demonstrated that on-farm culture and selective therapy based on culture results can be implemented on-farm. However, farms varied in their implementation of both the treatment protocols and microbiology procedures. Where such systems are to be used on-farm, specific training and on-going monitoring is required.

Pulmonary embolism. How V/Q scanning helps in diagnosis.

Ventilation-perfusion (V/Q) scanning is a useful predictor of pulmonary embolism. However, chest films and arterial blood gas studies are essential for proper interpretation of V/Q studies. The combination of clear, rapid reporting and good clinical judgment leads to improved management of patients in whom pulmonary embolism is suspected and avoids severe, life-threatening consequences.

[2-dimensional echocardiographic analysis of the volume and function of the right ventricle in the apical and subcostal 4 chamber image]. / Zweidimensionale echokardiographische Volumen- und Funktionsanalyse des rechten Ventrikels im apikalen und subkostalen 4-Kammer-Blick.

To determine the diagnostic accuracy of two-dimensional echocardiography in the evaluation of RV dimensions and function, biplane angiography of the right ventricle and 2-D echo was performed in 60 consecutive patients and analyzed by two independent investigators. In 42 of 60 patients (group A) the RV could be visualized in the rotated apical 4 chamber view and in 18 patients in the subcostal 4 chamber view with good quality, which made it possible to define the right ventricular endocardium in the real-time proceeding. In 20 of these 42 patients the RV could be registered in the apical 4 chamber view with complete definition of the endocardium also in the stop frame (group B). Quantitative analysis was performed in the end-diastolic and end-systolic stop frame, using the area-length method. The correlation of echocardiography and angiography for the end-diastolic volumes was poor in group A (r = 0.62) and superior in group B (r = 0.73). The correlation coefficient for end-systolic volumes was r = 0.70 in group A and r = 0.92 in group B. End-diastolic and end-systolic volumes were systematically underestimated by echocardiography. RV ejection fraction did not correlate between both methods. The subcostal 4 chamber view was not sufficient in determining RV volumes and function. The results demonstrate that the right ventricle can be visualized in 70% of patients with sufficient quality. RV dimensions and volumes can be determined with high accuracy in these patients.

Periosteal reaction induced by prostaglandins.

Prostaglandin administration is the main therapy for ductal-dependent congenital heart disease prior to definitive therapy. We report a case in which tetralogy of Fallot and Noonan syndrome were diagnosed, complicated by small pulmonary arteries, which occasioned a delay in surgery. Treatment was started with prostaglandins, which were given for a total of 2 months, and a diffuse periosteal reaction occurred secondary to the administration of intravenous prostaglandin E1.

Assessment of primary and metastatic ovarian cancer by positron emission tomography (PET) using 2-[18F]deoxyglucose (2-[18F]FDG).

The potential of positron emission tomography (PET) to distinguish benign from malignant ovarian tissue was evaluated by comparing the results of F-18 fluoro-2-D-deoxyglucose (F-18-FDG) PET scans with computed tomography and surgical findings. If sufficiently sensitive, this method might play a role in localizing metabolically active tumor sites for diagnosis, staging, and follow-up of ovarian cancer. Fifty-one patients had imaging studies prior to laparotomy for suspected ovarian cancer. PET scans were done with an ECAT 931-08-12 or ECAT EXACT (Model 921, Siemens/CTI, Knoxville, TN) after iv injection of 185-370 MBq of F-18-FDG. (ECAT is a trade name for "emission computerized axial tomograph.") Data were acquired in dynamic scanning mode and time activity curves (TACs) were evaluated in multiple regions of interest identified by visual interpretation of the PET scans. Scan interpretation, standardized uptake values, and TAC profiles were related to surgical and histological findings. The results of this pilot study show good correlation between PET and histological findings. The positive predictive value of PET for ovarian cancer was 86% and, perhaps more important, the negative predictive value was 76%. This early work indicates that PET may be useful in the management of patients with ovarian neoplasms by identifying occult foci of metabolically active tumor that do not appear on morphological studies.