Acute fasciolosis in an alpaca: a case report.

BACKGROUND: The popularity of new world camelids, particularly alpacas, is growing rapidly in Ireland, presenting a clinical challenge to veterinary practitioners who may not have worked with these species previously. To the authors' knowledge, the clinical course of a case of acute fasciolosis in an alpaca has not previously been reported, and fasciolosis has not been reported at all in alpacas in Ireland, making this case report a valuable addition to the current literature. CASE PRESENTATION: A three-year-old male castrated huacaya alpaca was admitted to UCD Veterinary Hospital with a two-day history of colic and tenesmus. He had been treated with albendazole, dexamethasone and potentiated amoxycillin by the referring veterinary practitioner with no response. On initial clinical exam, sensitivity to abdominal palpation was the only abnormality. However, the alpaca proceeded to show abnormal lying positions, tenesmus and reduced faecal output over the next 24 h. A general blood panel demonstrated moderate anaemia, marked hyperglobulinaemia and moderately increased hepatocellular and hepatobiliary enzyme activity. Abdominal radiography revealed enlargement of the first forestomach compartment without evidence of gastrointestinal obstruction or peritonitis. An abdominal ultrasound exam revealed an elongated, heterogenous mass in the caudoventral abdomen that appeared to be contiguous with the liver. FNA of this mass revealed that it was in fact a liver lobe with biliary stasis and inflammation. Faecal sedimentation demonstrated Fasciola hepatica eggs. In spite of treatment with triclabendazole and supportive treatment including blood transfusion, the alpaca's condition continued to deteriorate and he was euthanised. On post-mortem exam, acute fasciolosis was diagnosed. CONCLUSIONS: The clinical presentation and course of a case of acute fasciolosis in an individual alpaca is described, including the results of a range of diagnostic tests that were carried out. The final diagnosis is supported by a description of post-mortem findings. This information will serve as a resource for veterinary practitioners involved in the diagnosis and treatment of similar cases.

The effect of growth rate on reproductive outcomes in replacement dairy heifers in seasonally calving, pasture-based systems.

The effect of average daily gain (ADG) on reproductive outcomes in replacement dairy heifers was investigated. All heifers were managed in the typical Irish spring calving, pasture-based system, where the herd calves in 1 block between January and April and the majority of the diet comprises grazed grass. Heifer calves (n = 399) from 7 herds were weighed at birth and at the beginning of the breeding season, and ADG was calculated. Service dates and pregnancy diagnosis results were recorded, and conception dates were calculated. Days open (DO) was defined as the number of days between the beginning of the breeding season and conception. Genetic data were retrieved from the Irish Cattle Breeding Federation database. A Cox proportional hazard model was constructed to identify variables with a significant effect on DO. An accelerated failure time model was used to predict survival curves and median survival times for different combinations of the significant variables. The ADG ranged from 0.41 to 0.91 kg/d, with a median of 0.70 kg/d. Frailty effect of farm within year, maintenance subindex of the economic breeding index, and ADG had a significant effect on DO. Derived from the final accelerated failure time model, the predicted median DO for a heifer with an ADG of 0.40, 0.70, or 0.90 kg/d aged 443 d at the beginning of the breeding season and with a maintenance subindex in the second tercile were 27, 16, and 11 d, respectively.

Overcoming antibody expression and screening limitations by smart design: applications to PSA immunoassay development.

Improving the functional and structural properties of target proteins can often be a challenge for researchers. This paper highlights the importance of antibody construct on screening performance, and ultimately, the clone that is selected. We report the reformatting of phage-selected single chain antibody variable region fragments (scFvs) into single chain antibody fragments (scAbs) for improved screening and binding studies. The generation of a scAb, which had a fused human kappa light chain constant domain (C(k)), was shown to significantly improve expression levels in Escherichia coli. Antibody expression levels were compared between the two antibody constructs (scFv and scAb) by ELISA and a 100-fold improvement was observed. The C(k) domain in the expressed scAb also facilitated high throughput analysis by a Biacore capture assay approach. Individual functional scAbs were ranked on the basis of their remaining binding percentage after 5 min dissociation. Selected antibodies were further characterised by kinetic analysis and a sandwich-based immunoassay developed. The scAb construct enhanced expression levels significantly, facilitating antibody screening and immunoassay development for prostate-specific antigen (PSA), a marker for prostate cancer.

Rapid temperature-dependent antibody ranking using Biacore A100.

The ability to select antibodies with stable thermodynamic profiles can greatly enhance the performance of point-of-care (POC) devices allowing reproducible "on-the-spot" analysis for markers of clinical and environmental relevance. We show that by ranking antibodies based on their kinetic profiles at two different temperatures, greater information content is acquired, facilitating the selection of antibodies with desired binding characteristics. Observed binding patterns highlight the importance of temperature to assay design, which should be fully taken into consideration to ensure that the appropriate antibody is selected for the desired test.

The effect of dairy heifer pre-breeding growth rate on first lactation milk yield in spring-calving, pasture-based herds.

Optimising heifer growth rate may offer an opportunity to improve lifetime milk yield per cow, enhancing the environmental and economic efficiency of dairy farming operations. The effect of dairy heifer pre-breeding average daily weight gain (ADGPB) on first lactation milk yield was investigated. This observational study employed a data set comprising 265 Holstein-Friesian, or Holstein-Friesian-cross-Jersey heifers from seven commercial, spring-calving, pasture-based dairy herds, where the major component of the diet was grazed grass. These were weighed at birth and prior to breeding and ADGPB was calculated. Milk recordings were performed throughout the heifers' first lactation and 305-day yield figures calculated from these records. Yields were corrected to 4% fat and 3.1% protein to create standardised 305-day milk yield (SMY), which was the outcome of interest. Median ADGPB was 0.72 kg/day. Median 305-day yield was 5 967 kg. Linear regression was used to investigate the effect of weight and genetic, age and first calving factors on SMY. Pre-breeding average daily weight gain, age at first calving and predicted transmitting abilities for milk protein production and calving interval were all significant in the final model, which also included the random effects of farm and month of calving within year. ADGPB was quadratically related to first lactation SMY, with an ADGPB of 0.82 kg/day corresponding to the maximum predicted SMY. The model predicted that a heifer growing at 0.82 kg/day would produce 1 120 kg more SMY than a heifer growing at 0.55 kg/day, 218 kg more than a heifer growing at 0.7 kg/day and 103 kg more than a heifer growing at 0.90 kg/day. Manipulation of heifer growth rate may offer a viable method of increasing first lactation milk yield.

Arrhythmias after the Mustard operation for transposition of the great arteries: a long-term study.

This study presents follow-up data on 95 patients with transposition of the great arteries who underwent a Mustard intraatrial baffle operation. The patients were followed up serially by means of scalar electrocardiograms and 24 hour Holter monitoring studies. The latter study was effective in documenting abnormal rhythm patterns when the standard electrocardiogram was within normal limits. Twenty percent of the patients had atrial arrhythmias at the time of hospital discharge. new rhythm disturbances were recognized during each year of follow-up; 75% of the patients had atrial rhythm disorders by the sixth year. Slow junctional rhythm was the most common rhythm disturbance found. Complete heart block did not occur. Supraventricular tachycardia occurred within the context of the tachycardia/bradycardia syndrome in 8 of 10 patients, and in all it was documented after hospital discharge. The incidence of sudden death in this series was 3%. Six of the patients have had pacemaker insertions and there have been no deaths among these individuals. It was observed that the slow atrial or junctional rhythms that appeared after intraatrial correction of transposition of the great arteries rarely progressed to life-threatening rhythm disorders in childhood or adolescence, but the prognosis in adult life remains unknown. The three deaths in the series occurred in patients with a history of supraventricular tachyarrhythmias. Elimination of arrhythmias caused by extensive intraatrial surgery is one of the potential advantages of the arterial switch operation for correction of transposition of the great arteries.

Survival and risk factor analysis for the Norwood procedure for hypoplastic left heart syndrome.

The optimal approach to hypoplastic left heart syndrome (HLHS) is controversial. The palliative Norwood operation, cardiac transplantation, and no surgical intervention have all been advocated. Centers that perform the Norwood operation have met with varied results, and conflicting reports exist regarding factors predictive of stage I outcome. From January 1990 to January 1996, 67 patients with HLHS were admitted with intent to perform the staged Norwood procedure. Fourteen patients did not undergo surgery. In the 53 patients treated surgically, outcome was reviewed, and 10 potential risk factors for first stage mortality were analyzed. Forty-one infants survived the Norwood I operation to hospital discharge (77% of the surgically treated patients and 61% of the entire group, including those who did not undergo operation) with 6 additional deaths 3 to 5 months after operation. Univariate analysis showed cardiopulmonary bypass time and circulatory arrest time to be significant risk factors for hospital mortality. Multivariate analysis revealed only cardiopulmonary bypass time as significant (p <0.01). Of the 15 prenatally diagnosed newborns who underwent surgery, 11 survived (p = 0.72). Ten of 11 patients with preoperative organ damage survived (p = 0.42). Among the 35 bidirectional Glenn (Norwood II) and Fontan (Norwood III) procedures performed, there were 2 deaths. The 5-year actuarial survival for patients who underwent operations was 61%. The Norwood procedure is a favorable option for the infant with HLHS. Surgical survival may be affected by a prolonged cardiopulmonary bypass time, but is not affected by other factors analyzed, including prenatal diagnosis and preoperative organ damage.

Long-term follow-up of two infants with an implanted cardiac pacemaker.

The clinical course of two patients with congenital heart block who had pacemaker implantation at age 7 and 8 months, respectively, is reviewed. One patient at age 10 years has had nine pulse generators inserted; the other has had six implantations, the most recent a lithium iodine pacemaker, during 8 1/2 years of observation. Both patients have shown normal physical development and emotional maturation despite multiple hospitalizations and pacemaker replacements, thus demonstrating that electrical pacing, initiated in infancy, can be maintained through childhood without adverse effects.

Surgical management of ventricular septal defects in infants.

Infants with ventricular septal defect (VSD) who are symptomatic despite intensive medical therapy require surgical intervention. Choice of treatment depends upon the cumulative mortality and morbidity rates of the two-stage approach of initial pulmonary artery banding followed by debanding and VSD closure as compared to the risk of primary intracardiac repair in infancy. Sixteen infants underwent pulmonary artery banding at Columbia-Presbyterian Medical Center between 1967 and 1976, with one operative death but with a significant incidence of morbidity and late death. Forty patients underwent pulmonary artery debanding and closure of VSD with three operative deaths. This second-stage procedure was frequently complicated by repair of acquired lesions. During the same 10 year period 37 infants underwent primary closure of VSD with eight operative deaths. The morbidity related to this procedure is low. With the use of profound hypothermia and circulatory arrest, results have significantly improved and the risk of early correction now compares favorably with the cumulative mortality rate of the two-stage approach. Primary intracardiac repair is the procedure of choice.

Agenesis of the left lung and total anomalous pulmonary venous connection. Hemodynamic studies before and after complete surgical correction.

A female infant with unilateral pulmonary agenesis developed congestive heart failure dominated by symptoms of obstructive disease of the airways at 3 1/2 months of age. Cardiac catheterization revealed total anomalous pulmonary venous connection to the right atrium. Despite a massive left-to-right shunt with one pulmonary artery receiving the entire right ventricular output since birth, the patient's resting pulmonary vascular resistance was normal. Open heart surgery to repair the cardiac lesion was performed when the infant was four months of age. Subsequent studies revealed an excellent anatomic and functional repair, with normal pulmonary arterial pressures. One year following surgery, the child is asymptomatic and has normal growth and development.

Pulmonary atresia with intact ventricular septum. Sixteen-year experience.

Infants with pulmonary atresia and intact ventricular septum (PA-IVS) usually require urgent surgical intervention. Thirty patients with this anomaly, seen at the Columbia-Presbyterian Medical Center between 1962 and 1978, had palliative operations, 26 within the first 3 days of life. Six underwent a closed pulmonary valvotomy alone, with no survivors; six had only a systemic--pulmonary artery shunt, with three early survivors. Because of this experience, 17 had a combined procedure of valvotomy and shunt, with 14 early survivors. One patient recently underwent a definitive right ventricular outflow patch procedure with cardiopulmonary bypass. Eight patients subsequently have had corrective open-heart procedures, with five patients surviving from 2 to 10 years. A unicusp aortic homograft was used for repair in five and a Hancock valved conduit in three. Four patients are presently awaiting operation. We conclude that the initial surgical management of these critically ill infants must not only increase pulmonary blood flow but in addition provide an opportunity for right ventricular growth. Thus we continue to advocate the combined procedure of a valvotomy plus a shunt to provide adequate palliation. Repeat catheterization should be performed within a year to confirm the adequacy of the valvotomy, since this is essential to maximal right ventricular enlargement and to allow for definitive correction at a later date.

Hypoplastic left heart syndrome: valuing the survival.

OBJECTIVE: To examine the survival, developmental status, quality of life, and direct medical costs of children with hypoplastic left heart syndrome who have undergone stage I, II, and III reconstructive surgery. METHODS: A total of 106 children underwent staged repair for classic hypoplastic left heart syndrome between February 1990 and March 1999 (stage I: 106; stage II: 49; stage III: 25; 4 converted to heart transplantation). Survival was analyzed by the Kaplan-Meier method. In a cross-sectional study, parents assessed quality of life by completing the Infant/Toddler Child Health Questionnaire or Child Health Questionnaire Parent Format-28; they assessed developmental progress by completing the Ages and Stages Questionnaire. The ratio-of-costs-to-charges method was used to derive hospital costs, and payments were used to capture physician time and wholesale pricing for outpatient medications. RESULTS: Institutional 1-year and 5-year actuarial survivals were 58% and 54%. Birth weight, the need for preoperative inotropic drugs, and surgical experience were predictors of survival. Norwood I patients achieved fewer developmental benchmarks than those who survived to subsequent stages. Child Health Questionnaire Parent Format-28 mean summary scores for physical and psychosocial health were 48.5 +/- 6.3 and 42.8 +/- 9.9. The median inpatient costs for stage I, II, and III repairs were $51,000, $33,892, and $52,183, respectively. Monthly outpatient and readmission costs were less than 10% of total costs. CONCLUSION: A prospective, large-scale study of the comprehensive outcomes of staged repair and transplantation is needed. This study will need to address the longer-term developmental and quality-of-life outcomes, as well as the long-term cost effectiveness of these procedures.

An olefin cross-metathesis approach to vinylphosphonate-linked nucleic acids.

[reaction: see text]. The synthesis of vinylphosphonate-linked nucleotide dimers has been achieved using an olefin cross-metathesis (CM) reaction as a key step. The 1,3-dimesityl-4,5-dihydroimidazol-2-ylidine-containing catalyst 5 (Grubbs' second-generation catalyst) was found to be the superior catalyst for this transformation. Both metathesis partners were readily available using known methodology, and the vinylphosphonate-linked dimer was produced with high levels of (E)-selectivity (>20:1) in 58% yield (70% based on recovered starting material).

Commercially available 5'-DMT phosphoramidites as reagents for the synthesis of vinylphosphonate-linked oligonucleic acids.

[reaction: see text]. Commercially available cyanoethyl phosphoramidites derived from T, d(C), d(A), and d(G) were hydrolyzed (1H-tetrazole, MeCN/H2O) to give the corresponding H-phosphonates in excellent yields. Palladium(0)-catalyzed cross-coupling of each of these with the thymidine-derived vinylbromide 2 afforded the corresponding vinylphosphonate-linked dimers TT, d(C)T, d(A)T, and d(G)T in modest to good yields. The TT dimer was further elaborated to give a 5'-DMT-TT-3'-CEP building block, and this was used in the automated synthesis of the TpTTpT tetramer.

A convenient method for 3-pyrroline synthesis.

[reaction: see text]. The synthesis of a range of 3-pyrrolines has been achieved from primary amine starting materials using a two-step alkylation/alkylidene carbene CH-insertion reaction sequence. We have shown that insertion into a range of CH-bond types is possible, and the formation of nitrogen-bearing quaternary stereocenters is a relatively facile process. The insertion reaction occurs with >95% retention of stereochemistry, but the presence of protecting groups on nitrogen is generally deleterious to the cyclization process.

Open-heart experience in infants using normothermia and deep hypothermia.

During the 9-year period from 1967 through 1975, 124 open-heart operations were performed on infants less than 1 year of age with 35 operative deaths (28%). Ninety-seven of these procedures used continuous cardiopulmonary bypass with normothermia or mild hypothermia, and 27 were done under deep hypothermia and circulatory arrest. Mortality and morbidity were similar regardless of the operative technique, although deep hypothermia facilitated the repair of complex lesions. The highest mortality occurred in infants less than 3 months of age. Respiratory insufficiency, usually requiring prolonged ventilatory support, occurred only among infants who had pulmonary overcirculation or congestion prior to operation. Adequacy of intraoperative repair and postoperative care were the major determinants of survival.

The utility and benefits of clinical neuropsychology in Asia.

Neuropsychological evaluation is the clinical practice of identifying and measuring impairments in mental functions in the context of a patient's mental strengths and preserved abilities for the purposes of diagnosis, rehabilitation planning, and long-term care. Best practice approaches to the medical management of neurodegenerative, neurological and psychiatric illness have lead to increasing demand for neuropsychological services. The simultaneous challenges of Asias' increasing adult and rapidly ageing population underscore the need for consideration of the role of neuropsychological services in day-to-day clinical practice. Here, we outline the clinical utility of neuropsychological assessment and indications for its use in general psychiatric practice.