Effects of level and form of dietary zinc on dairy cow performance and health.

A basal mixed ration supplying 36 mg of Zn/kg of dry matter (DM) was supplemented with 1 of 4 concentrates differing in level and form of dietary Zn. The concentrates were fed at 2 kg/cow per day and contained 300 mg of Zn/kg (to supply the total recommended level, according to NRC (2001); R) or 60 mg of Zn/kg (to supply 0.66 of the total recommended level; L), either supplemented as ZnO (I) or organically chelated Zn (O). Forty-four Holstein-Friesian dairy cows (12 primiparous and 32 multiparous), on average 31 d (SD +/- 11.4) into lactation, were allocated to 1 of the 4 treatments. All cows remained on the treatment for 14 wk. The data was analyzed by ANOVA as a 2 x 2 factorial design. Dry matter intake averaged 23.5 kg/d and did not differ between treatments. Cows supplemented with organically chelated Zn at the recommended level of inclusion (RO) had a higher milk yield (37.6 kg/d) than those fed inorganic Zn at the recommended level (RI; 35.2 kg/d) or organically chelated Zn at the low level (LO; 35.2 kg/d), but was not different from those fed inorganic Zn at the low level (LI; 36.0 kg/d). Milk composition was unaffected by dietary treatment. Animals that received the low level of Zn (LI and LO) had higher somatic cell counts [3.97 and 3.93 versus 4.35 and 4.55 (log(e)) for RI, RO, LI, and LO, respectively] and milk amyloid A levels than those receiving the recommended levels (RO and RI). There was no effect of treatment on body condition score, body weight, or locomotion score. Hoof hardness improved over the duration of the study but there were no differences between treatments. Similarly, blood plasma mineral levels for Zn, Cu, Mo, and Fe were not affected by treatment, whereas there was a trend for increased ceruloplasmin levels in cows receiving the recommended compared with the low level of Zn, but there was no effect of mineral form. There was also no effect of treatment on superoxide dismutase activity or blood hematology. It is concluded that supplementing Zn at the recommended level reduced somatic cell counts and milk amyloid A levels, whereas supplementation in an organic form at the recommended level also increased milk yield.

[Retrospective study of 130 patients with organconfined prostate cancer treated with brachytherapy]. / Estudio retrospectivo de 130 pacientes con cáncer prostático organoconfinado tratados con braquiterapia prostática.

INTRODUCTION: The prostate brachytherapy with I 125 seeds has an indication in patients with organconfined prostate cancer. Our objective is to describe the population treated in our institution with permanent I125 seeds implants, the dosimetric characteristics of the technique and the preliminary results of our group-study in terms of evolution and toxicity. MATERIAL AND METHODS: Between May 2000 and March 2003, 130 patients with permanent implants of I125 seeds were treated. Beforehand we did prostate volumetric with transrectum prostate echography in order to assess the configuration of the implant, number of seeds and their place in the prostate with the objective to get a fine coverage of PTV (planet target volume). Stage distribution: 75.72% T1c; 24.28% T2a; Gleason<6, 94%. The PSA pretreatment average was 6.38 ng/ml. The average prostate volume was 30 cc. The 16.67% of the patients included had hormonal treatment previously to get the implants. The average age was 64 years. The characteristic techniques of the implants were: the average width of the needle as 24 (14-35) and the average of the seeds 76 (46-111). Finally the average activity was 0.39 mCi/seed, which means average total implant activity of 80 mCi. RESULTS: We analyzed 130 patients with average follow up 6 months. A 1 to 2 year surveillance was carried out on 98.9% and the global free disease surveillance (biochemic relapse) of 98.9% at the year and of the 87.8% at the end of the 2 years. The relapse in the low risk patients was 98.8% after the first year and 88.7% at the end of 2 year. On the contrary in the middle risk was of 100% and 83% respectively, although the amount of patients in significantly less. As a relevant acute secondary effects we found slight rectitys or GI (RTOG scale) in 1.4 and that needs synthomatic medication or GII (RTOG scale) in 0.8%. We found slide hematuria or GI (RTOG scale) in the 53% and other measures or GII (RTOG scale) in the 2.64% was needed. Finally we had to set a urinary prove for acute retention in 4.3%. CONCLUSION: The prostate brachyterapy is a complex procedure that needs a multidisciplinary team participation in order to be able to carry out. It avoids a long term hospitalization and allows for the patient to have daily activity within a short period of time. Despite the fact of the brief follow-up, the results over biochemical relapse and toxicity were similar to the ones in the literature. Tolerance to the implant was good. It would necessary a longer follow-up in order to be able to come to long term conclusions.

Percutaneous management of a bladder-drained pancreas transplant pseudocyst by a transcystic approach.

BACKGROUND: We describe a 35-year-old male type 1 diabetic who underwent a cadaveric combined kidney-bladder-drained pancreas transplant with a duodenocystostomy for exocrine drainage who developed a large pelvic pseudocyst associated with a dilated pancreatic duct and an elevated serum amylase level. METHODS: Due to the risk of surgical revision and the possibility of creating a cutaneous fistula with conventional percutaneous drainage, a pseudocyst-to-bladder drainage was performed. After the procedure, the catheter was capped to allow drainage of the pancreatic secretions into the bladder. RESULTS: After drainage, the patient's serum amylase and lipase normalized along with resolution of the pseudocyst. The tube was removed after 19 weeks with no evidence of a recurrent pseudocyst and a normal serum amylase level. CONCLUSION: The percutaneous pseudocyst-cystostomy obviated the need for surgical revision of the exocrine gland drainage and thus eliminated the morbidity and the potential risk of graft loss associated with such surgery.

Solvolysable deoxycorticosterone conjugates in human urine.

The nature of the urinary conjugate converted by solvolysis, to free unconjugated deoxycorticosterone (DOC) was studied. A comparison of 11 solvolysis techniques has shown that the method employed in this study yielded 86% of the highest yield by any of the techniques tried. Three successive chromatographic systems on paper showed that no appreciable amounts of contaminants were present in the free DOC eluates, following solvolysis. By preparing authentic [3H]DOC sulphate and subjecting it to solvolysis it was shown that more than 90% of the tritiated DOC was recovered, after chromatography of the free DOC extract. This suggests that much of the solvolysable DOC in human urine is present in the form of the sulphate conjugate. The levels of DOC, excreted as the solvolysable conjugate in a variety of urine specimens, were shown to be much higher than those of free DOC, the former being 4-8 to 127 times higher than the amount of the latter. This highly variable ratio suggests that the site of production of solvolysable DOC is different from that for free DOC. The only correlation between free and solvolysable DOC was shown in dexamethasone-suppressed patients, in whom the mean percentage remaining after suppression was 30-6% for free DOC, 24-1% for solvolysable DOC and 22-2% for cortisol. As solvolysable DOC is present in much larger amounts in urine, care is necessary in the storage of urine samples in which free DOC estimates are to be made, as we found that urine specimens left at room temperature for 1 week could show rises of as much as 400% of their starting free DOC levels.

Iatrogenic arteriovenous fistula: a complication of percutaneous subclavian vein puncture.

A case of iatrogenic subclavian arteriovenous fistula is reported. An intracath had been inserted percutaneously into the left subclavian vein to monitor the central venous pressure during aortic valve surgery. On the second postoperative day a thrill and continuous murmur were detected at the left subclavian region. Left subclavian arteriogram and catheterization studies confirmed the diagnosis of subclavian arteriovenous fistula. The lesion was treated surgically with satisfactory results.

Double-blind study of the safety, tolerance, and diagnostic efficacy of iopromide as compared with iopamidol and iohexol in patients requiring aortography and visceral angiography.

RATIONALE AND OBJECTIVES: Nonionic contrast media have been shown to be more effective, better tolerated, and safer than standard high-osmolality contrast media when given intravascularly. The aim of this study was to assess the diagnostic efficacy, tolerance, and safety of a new nonionic contrast agent, iopromide (370 mg I/mL), in comparison with two available similar agents, iopamidol (370 mg I/mL) and iohexol (350 mg I/mL), in two randomized, double-blind clinical studies of patients undergoing abdominal aortography and visceral angiography. METHODS: The iopromide group included 80 patients, and the comparator group consisted of 36 iopamidol and 45 iohexol patients. The quality and diagnostic efficacy of all three contrast agents was rated equally as either good or excellent. RESULTS: On a scale of 0 (none) to 3 (severe) for heat and pain, respectively, the mean scores were 1.08 and 0.43 for iopromide in comparison with 1.15 and 0.35 for the comparator media. Minor adverse clinical experiences were noted in 23% of the iopromide group versus 20% of the comparator group. Nausea and vomiting were more common in the comparator group (7% versus 3%), and headache was noted only in the iopromide group (4%). There were no clinically significant changes in laboratory values in any group. Three severe adverse experiences occurred, but all were deemed unrelated to the contrast agents. CONCLUSION: Based on the results of this study, iopromide appears to be efficacious, safe, well tolerated, and comparable with iohexol and iopamidol for use in abdominal aortography and visceral angiography.

Simplification of urinary aldosterone measurement by radioimmunoassay.

An anti-aldosterone serum has been used to measure urinary aldosterone concentration. A single stage of paper chromatography provides an extract of sufficient purity. Further purification by additional chromatography in a different solvent system only improves the purity by 3% +/- 8 (SD). Blanks are negligible and recovery of added aldosterone is 104% +/- 10 (SD).A simplified rapid screening assay capable of revealing gross deviations from the normal is also suggested. The diagnostic value of the assay is indicated.

Comparison of image analysis and flow cytometric determination of cellular DNA content.

A good correlation (r = 0.94) was obtained between the DNA indices (DI) using flow cytometry and image analysis of nuclei cytospins extracted from paraffin wax embedded tumour sections. Some of the limitations and problems associated with image analysis which came to light included an unacceptably high coefficient of variation (CV) and a "left-shift" in the DI in most DNA histograms obtained when using image analysis of 5 microns sections. In contrast, the DNA histograms generated using image analysis of cytospun nuclei from paraffin wax blocks were of good quality and similar to those obtained using flow cytometry. Variability in Feulgen staining was common and an important source of error despite rigorous control of the staining technique. This could be overcome by using internal controls such as fibroblasts rather than external controls (rat hepatocytes) to determine the diploid DI with image analysis. A thorough understanding and appreciation of the methodological problems associated with image analysis and flow cytometric determination of DNA content is required before these methods find widespread clinical application.

Magnetic resonance angiography of the aorta, iliac, and femoral arteries.

BACKGROUND: Successful management of patients with peripheral vascular disease requires detailed vascular imaging, usually performed by contrast arteriography. Recently, magnetic resonance angiography (MRA) has been shown to be a noninvasive technique with greater sensitivity than contrast arteriography for detecting distal runoff vessels in patients with peripheral arterial occlusive disease. However, to supplant the need for contrast arteriography and provide a completely noninvasive evaluation of patients with occlusive disease, accurate imaging of the inflow vessels and the runoff vessels is necessary. METHODS: We used both conventional arteriography and MRA in preoperative studies of the aorta, iliac, and femoral vessels of 47 patients. Conventional arteriography and MRA studies were compared for their ability to detect vessel patency and the presence of hemodynamically significant stenoses. Independent interventional plans were developed based on the information provided by each technique. The findings of conventional and MRA studies were verified by intraoperative arteriography or direct operative exploration. RESULTS: Results of the two studies were identical in 41 (87%) of 47 patients or 600 (98%) of 614 segments imaged. MRA accurately detected patent and occluded arterial segments (sensitivity 99.6%, specificity 100%, positive predictive value 100%, negative predictive value 98.6%) and hemodynamically significant stenoses. Therapeutic plans based on either MRA or conventional arteriography were identical for each patient. CONCLUSIONS: MRA provides comparable results to contrast arteriography in the proximal arterial system and superior results for imaging the distal vasculature. This noninvasive technique may replace contrast arteriography in a large number of patients in the future.

Effects of maternal sedation during fetoscopy.

While instituting a new program in fetoscopy, the authors explored the effects of sedation with meperidine (Demerol) and promethazine HCl (Phenergan) during fetoscopy conducted on 10 mothers at 14 to 18 weeks' gestation. Each received 100 mg of meperidine and 50 mg of promethazine HCl approximately 30 minutes before the procedure. In 3 instances, a repeat half-dose injection was made at 30 minutes for adequate analgesia. Sex of the fetus was determined accurately in 9 instances. In 9 of 10 cases, visualization was satisfactory; technical problems in 1 case precluded visualization. Complications included 2 superficial fetal limb hematomas and 2 instances of minimal fetal bleeding from an unknown site. Three patients required perforation of anterior placentas. Amniotic fluid was invariably clear but became progressively turbid. Sedation allowed a longer period for clear amniotic fluid by decreasing fetal movements progressively over the first hour; fetal activity showed a prompt return thereafter. The clarity of the amniotic fluid was adversely influenced by external manipulation of the fetus. The authors conclude that sedation has obvious benefits for the mother and may facilitate evaluation of the fetus during fetoscopy.

Transfemoral removal of a chronically implanted pacemaker lead: report of a case.

A transfemoral angiographic technique was used to remove a chronically implanted, infected pacemaker wire that could not be withdrawn by using direct traction. The case and a description of the technique are detailed, and the principles of nonsurgical extraction of chronically implanted pacemaker wires are discussed.

Minipuncture angiography.

The frequency of arterial trauma or hematoma can be reduced by using smaller puncturing needles (21-gauge) and catheters (4- or 5- French). Versatile ultrafine guide wires are now available for selective and superselective catheterization. This miniaturization of angiographic equipment allows many vascular procedures to be performed safely on an outpatient basis or in short procedure units.

An improved fine needle catheter introducing set for safer central vein cannulation.

The serious clinical complications of central venous catheterization are mostly due to laceration of vital thoracocervical structures by large caliber introducing needles. A new percutaneous sheath catheter introducing kit requiring only a 21-gauge needle for its introduction has been devised for the purpose of significantly reducing the incidence of life-threatening pneumothoraces and arterial injuries.

Sensory recovery in noninnervated radial forearm free flaps in oral and oropharyngeal reconstruction.

BACKGROUND: Reinnerveration of free flaps used in oral and oropharyngeal reconstruction may provide a high level of sensory return. Spontaneous recovery of sensation in noninnervated flaps may also occur. OBJECTIVE: To evaluate the extent of spontaneous sensory return among patients who underwent radial forearm free flap reconstruction in the oral cavity and oropharynx. METHODS: A total of 40 patients were evaluated by 2 independent examiners. The median patient age was 60 years, and the median time from surgery was 47 months. A total of 29 patients had received postoperative radiotherapy. The mean flap size was 25 cm2. The following sensory modalities were tested: light touch, pinprick, hot and cold, and moving and static 2-point discrimination. RESULTS: Recovery of sensation of at least 1 modality was noted in 32 patients (80%), however, only 5 patients (13%) had return of all 5 modalities. Eight patients (20%) had no sensory return. There was a trend to improved sensory recovery in flaps placed in the alveolar and retromolar trigone areas; however, on multivariate analysis, sensory return could not be predicted by any of the following factors: patient age, flap site, flap size, length of follow-up, and use of postoperative radiotherapy. CONCLUSIONS: Complete sensory recovery was uncommon, unpredictable, and variable, although some recovery of sensation occurred in 80% of patients. It is not valid to rely on spontaneous sensory recovery for sensory innervation of free flaps. Correlation of sensory return with function is still needed.

Lymphangiography as a staging tool for cervix cancer: limited value after hip arthroplasty.

Lymphangiography (LAG) is often used in the work-up of cervical carcinoma. A patient with a history of bilateral hip arthroplasty, who presented with Stage IIIB squamous cell carcinoma of the cervix, was sent for lymphangiography. The LAG was deemed suboptimal, most likely because of altered lymphatic drainage engendered by the previous orthopaedic procedures. As the American population ages and hip arthroplasty becomes more common, the value of LAG in such patients will need to be reconsidered.

Wettability of the corneal surface: a reappraisal.

Previous attempts by others to measure the wettability of the corneal epithelium concluded that the surface was strongly hydrophobic, but used methods which seem likely to damage the epithelial cell surface. These experimental techniques were repeated and the effects on the surface analysed by scanning electron microscopy. It is concluded that such methods cannot establish either the hydrophobicity or hydrophilicity of the cornea.

Selective embolization of vascular complications following renal biopsy of the transplant kidney.

The incidence of postbiopsy vascular lesions of the transplanted kidney is unknown. The complications of these lesions should be promptly recognized and treatment initiated when indicated. We have found transplant angiography and selective arterial embolization to be a safe and effective modality.

Use of the vascular closure staple clip applier for microvascular anastomosis in free-flap surgery.

We report our initial experience using the vascular closure staple clip applier (a nonpenetrating titanium clip applied in an interrupted, everting fashion) for microvascular anastomosis in free-flap surgery. In total, 153 anastomoses were performed in 87 free flaps (174 potential anastomoses) using the vascular closure stapler between October of 1997 and June of 1999. In 66 flaps, both the arterial and venous anastomosis were performed with the clip applier, whereas in 21 flaps only the venous anastomosis was performed using the clips. A total of 146 anastomoses were performed in an end-to-end fashion, and seven were performed end-to-side. Of the 87 flaps there were 53 TRAM flaps, seven bilateral TRAM, five latissimus dorsi, four gastrocnemius, three rectus abdominis, two radial forearm fibula, and four Rubens fat-pad flaps. Seventy flaps were used for breast reconstruction, seven flaps for lower limb reconstruction, four flaps for head and neck reconstruction, and six flaps for chest wall/trunk reconstruction. There were no postoperative anastomotic complications of bleeding, thrombosis, or need for revision (100 percent patency rate), with a significantly reduced time for completion of anastomoses. The clip applier is a safe, reliable method for performing microvascular anastomoses, allowing reduced operating time and possible cost savings in free-flap surgery.

Challenge differentially affects cytokine production and metabolic status of growing and finishing swine.

Growing (35 kg body weight) and finishing (85 kg body weight) swine challenged with endotoxin (Escherichia coli O55:B5) at a dose of either 2 or 20 microg/kg produced tumor necrosis factor (TNF)alpha in a dose-response relationship as measured by bioassay. Peak TNFalpha plasma levels were observed 1-2 hr post-challenge, returning to basal values 4 hr post-challenge. However, both an enzyme-linked immunosorbent assay specific for swine TNFalpha and total human TNFalpha demonstrated no dose-response relationship; peak plasma levels of immunoreactive TNFalpha were also observed 1-2 hr post-challenge. Maximal plasma interleukin-6 levels occurred 1-2 hr post-challenge and remained elevated through 8 hr post-challenge; there was no effect of lipopolysaccharide dose or metabolic status. Although the metabolic status of the animals also affected glucose levels, with growing animals exhibiting greater sensitivity compared with finishing animals, endotoxin-induced decreases in blood glucose levels were primarily dose-dependent. In contrast, changes in plasma urea nitrogen and free fatty acid (FFA) levels were strictly related to the metabolic status. Urea nitrogen levels were unchanged in growing swine, whereas they were increased in finishing swine and remained elevated 24 hr post-challenge. FFA levels in growing and finishing swine increased 3-6 hr post-challenge. FFA levels returned to basal values for finishing swine 24 hr post challenge, but in growing swine remained elevated 24 hr post-challenge. Plasma aspartate transaminase levels were increased through 24 hr post-challenge; animals given a dose of 20 microg/kg exhibited the greatest increase. Similarly, swine challenged with a dose of 20 microg/kg also exhibited the greatest increase in levels of conjugated bilirubin; there was no effect on unconjugated (free) bilirubin. These results demonstrate that endotoxin challenge of swine result in a pattern of changes that are dependent on both the dose of endotoxin used and the metabolic status of the animal examined.

Transcatheter embolization of hepatic arteriovenous fistula in Osler-Weber-Rendu disease--a case report.

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) is associated with arteriovenous fistulas throughout the body that can cause hemodynamic abnormalities. Owing to their size and extent, surgical repair is often not feasible. A patient referred for presumed valvular heart disease is described. On the basis of oximetry data at cardiac catheterization, a large intrahepatic arteriovenous fistula was discovered by aortography. This finding and a history of recurrent epistaxis were consistent with Osler-Weber-Rendu disease. Owing to the size of the fistula, embolization of the right hepatic artery with Gianturco coils was chosen as treatment, with resultant symptomatic improvement and decreased arteriovenous shunting.