Incidence of milk leakage after dry-off in European dairy herds, related risk factors, and its role in new intramammary infections.

The incidence of milk leakage (ML) after dry-off (DO) and related risk factors was studied in 1,175 dairy cows from 41 commercial herds in 8 European countries: Belgium, Czech Republic, Denmark, France, Germany, Italy, the Netherlands, and Spain. Milk leakage was assessed twice for 30 s each during 3 visits at 20 to 24 h, 30 to 34 h, and 48 to 52 h after DO. Information related to dry-cow management and udder health was collected at herd and cow level, including individual somatic cell count (ISCC) from test-day controls and occurrence of clinical mastitis cases from DO until 30 d in lactation. Mixed-effect logistic regression analyses were used to identify possible risk factors for ML and to study the association between ML and new intramammary infections. Intramammary infections were defined as clinical mastitis cases during the dry period and in the first 30 d in lactation or a rise in ISCC from before to after the dry period (threshold: 200,000 cells/mL) or both. Milk leakage was observed in 24.5% of the cows between 20 and 52 h after DO, where the herd incidence varied between 0.0 and 77.8%. The reduction in number of milkings in the weeks before DO had statistically significant effect on the ML incidence. When the milking frequency was reduced from 3 times/d to 2 or maintained at twice a day, cows had 11 (95% CI = 3.43-35.46) or 9 (95% CI = 1.85-48.22) times higher odds of leaking milk, respectively, compared with cows where the milking frequency was reduced from twice to once a day. Also, the milk production 24 h before DO was associated with ML incidence. Hence, cows with a milk production between 13 and 21 L or above 21 L had 2.3 (95% CI = 1.48-3.53) and 3.1 (95% CI = 1.79-5.3) times higher odds of leaking milk, respectively, compared with cows with a milk production below 13 L. A higher ML incidence was present in the group of cows with an average ISCC in the last 3 mo before DO ≥200,000 cells/mL (odds ratio = 1.7; 95% CI = 1.13-2.41) compared with cows with an average ISCC <100,000 cells/mL. Quarters with ML tended to have 2.0 times higher odds of developing clinical mastitis compared with quarters not leaking milk. Cows with ML tended to have 1.5 times higher odds of intramammary infections (i.e., an increase of ISCC or clinical mastitis) compared with cows without ML.

Patency and Clinical Outcome After Stent Placement for Chronic Obstruction of the Inferior Vena Cava.

OBJECTIVE/BACKGROUND: The objective was to assess the technical success, patency, and clinical outcome after stent placement for chronic obstruction of the inferior vena cava (IVC). METHODS: A retrospective analysis was carried out of patients with chronic IVC obstruction verified with computed tomography and/or magnetic resonance venography, accepted for stent placement at the Norwegian National Unit for Reconstructive Deep Venous Surgery from March 2010 to September 2015. Clinical status was categorized according to the CEAP classification and symptom severity was assessed using venous clinical severity score (VCSS). Stent patency was evaluated by colour duplex ultrasound. Large -diameter Wallstents were placed in the IVC and concurrent iliac and femoral obstructions via right internal jugular and femoral vein access. Sixteen patients presented with symptoms of chronic venous disease. Four patients had symptoms assumed to be related to a reduced cardiac preload. Twelve patients had IVC occlusion and eight had stenosis. Median follow-up was 25 months (range 3-70 months). RESULTS: Stent placement in the IVC was successful in 19 of 20 patients. Primary patency after 24 months was 67% and secondary patency 83%. Fifteen of 19 patients had open stents at final follow-up. Re-interventions were performed in four patients and included catheter directed thrombolysis in all and adjunctive stenting in three. Thirteen of 19 patients (68%) reported a sustained and significant clinical improvement. Mean VCSS improved from 8.5 (range 3-25) at baseline to 7 (range 2-23) at final follow-up (p = .007). There were no peri-procedural or long-term complications. CONCLUSION: The endovascular approach with stent placement for chronic IVC obstruction is a safe treatment option that should be offered to patients who otherwise have little opportunity for sustained clinical improvement.

Moving towards a standardized definition of antimicrobial resistance: a comparison of the antimicrobial susceptibility profile of difficult-to-treat resistance (DTR) versus multidrug-resistant (MDR) Pseudomonas aeruginosa clinical isolates (CANWARD, 2016-2021).

Pseudomonas aeruginosa clinical isolates demonstrating difficult-to-treat resistance (DTR) and multidrug-resistant (MDR) phenotypes were evaluated by broth microdilution. Susceptibility was lower for all antimicrobials versus DTR relative to MDR isolates. Ceftazidime-avibactam, ceftolozane-tazobactam, and imipenem-relebactam susceptibility was 35.9%, 64.5%, and 47.0% for DTR isolates and 60.5%, 80.6%, and 71.5% for MDR isolates.

Treatment with autologous bone marrow mononuclear cells in patients with critical lower limb ischaemia. A pilot study.

BACKGROUND AND AIMS: Treatment with autologous, bone marrow mononuclear stem cells has shown effects in patients with chronic limb ischaemia in one randomized clinical study. The aim of the study was to test the potential effect of stem cell treatment in a strict defined group of patients with stable critical limb ischaemia (CLI). DESIGN: A prospective, combined-centre pilot study. MATERIAL: Eight patients with CLI of the lower extremities, and without any other treatment options. METHODS: Bone marrow cells were harvested from the patient's iliac crest and, after separation, injected into the calf muscles of the affected leg. Outcome was evaluated by digital subtraction angiography (DSA), visual analogue scale (VAS) and several non-invasive circulatory physiological tests. RESULTS: There were no complications from the procedures. Two patients were amputated two months after cell injection. Five patients reported pain relief after four months. Five patients could be evaluated at eight months. According to VAS and physiological tests, they were all either stable or showed improvement. CONCLUSION: This method seems to be a safe option for treating patients with CLI. Inclusion of patients took a long time, mainly because many patients with CLI are offered endovascular treatment in our institution. While symptomatic improvement was found in individual patients, larger trials are required to investigate efficacy. This will probably require multi-centre participation.

Dispersion statistics and sample size estimates for house fly (Diptera: Muscidae) larvae and Macrocheles muscaedomesticae (Acari: Macrochelidae) in poultry manure.

The precision of the density estimate for a given population depends upon the population's density and degree of clumping and upon sampling characteristics, such as the number and surface area of the quadrats. The parameters k of the negative binomial distribution and b of Taylor's power law (s2 = a mean b) were determined for third instars of the muscaedomesticae (Scopoli), which were sampled by random quadrats at two shallow-pit, caged-layer poultry houses. Most calculated values of k were < 1, but agreement with the negative binomial distribution was found only in 4, 18, and 14 of the 27 weekly samples for house fly larvae, female mites, and male mites, respectively. Taylor's power law provided the best fit for the distribution (P < 0.01 for all regression coefficients) with s2 = 9.08 mean 1.83 (r2 = 0.97) for third-instar house flies and s2 = 4.65 mean 1.76 (r2 = 0.97) for both sexes of M. muscaedomesticae. Two ecological processes, social clustering and environmental heterogeneity, were hypothesized as the mechanisms determining aggregation of house fly larvae and the macrochelid mites. Regardless of the biological model influencing their distributions, Taylor's power law provided a reliable index for measuring their degree of aggregation. Reliability defined by the coefficient of variability and Taylor's regression coefficients was used to calculate optimum sample size-density estimates for each species with coefficients of variability of 10, 15, 20, and 25%.

GnRH antagonist inhibition of luteinizing hormone secretion and ovulation in the pig.

A GnRH antagonist, Ac-D-p-Cl-Phe1,2, D-Trp3, D-Arg6, D-Ala10 GnRHb (Organon), was utilized to determine the effective dosage and duration to inhibit LH secretion in the pig. In a preliminary trial, barrows received either 10, 50, or 250 micrograms/kg BW of the GnRH antagonist. Secretion of LH was inhibited within 30 min for a duration of 12 h with the 100 micrograms/kg dose but persisted for greater than 48 h with the 250 micrograms/kg treatment. A second study determined effectiveness of the antagonist for inhibiting ovulation in cyclic gilts. At first detection of standing estrus, cyclic gilts were treated with either saline (control), 100, or 200 micrograms/kg BW of the GnRH antagonist (GnRH1). A second group of GnRH antagonist gilts received 200 micrograms/kg BW of the GnRH antagonist approximately 8 h prior to standing estrus (GnRH2). The GnRH1-treatment failed to inhibit or delay ovulation. Ovulation was inhibited and estrous cycles lengthened in GnRH2-treated gilts. These preliminary results suggest that ovulation in the gilt can be inhibited if the GnRH antagonist is administered prior to the LH surge.

Femoropopliteal bypass; factors influencing long term patency.

One hundred and thirty-six patients operated on with femoropopliteal bypass for arterial occlusive disease are retrospectively examined. In 58% of the cases the reversed saphenous vein was used, while 42% had a Dardick Biograft (umbilical vein graft). Patency rate for all grafts was 62.2% at four years. The most important factor for long term patency in our material is the type of graft used. In the saphenous vein group the four years patency rate was 74%, while in the Dardick group 45%. There was no significant difference in patency rate for patients operated on for claudication and those for limb salvage. We found a significantly lower patency rate when the distal anastomosis was placed below the knee. Patients with good arteriographic runoff had better long term patency. The difference was, however, not significant for the prosthetic group. The perioperative mortality was 1.4%. Early graft failure was 4.8% in the autologous vein group and 33% in the umbilical vein group. The majority of amputations occurred in patients with early failure of umbilical vein grafts.

Meningococcal disease in Norway 1980--83.

The development in the epidemiological patterns of meningococcal disease in Norway after 1979 is briefly described for the general and military population. With the high incidence levels which have lasted for about nine years, the situation may be described as Norway having experienced a shift in 1974 to a new endemic level. The predicted incidence for 1983 is higher than for any year since 1941.

Percutaneous drainage of intrasplenic pancreatic pseudocyst. Case report.

The intrasplenic pancreatic pseudocyst is very rare and surgical treatment has been recommended. We report on a patient with this condition who was successfully treated with percutaneous drainage. Special considerations apply when the drainage catheter is inserted intercostally.

Experimental colonic inflammation and ulceration. Permeation of a water-soluble contrast medium as a measure of 'disease' activity.

The aim of this study was to investigate the permeation of an isosmolar water-soluble X-ray contrast medium (CM) from the unperforated colon after experimental induction of inflammation and ulceration. One hundred and sixty-five male rats were included. In 110 rats 0.25 ml of 40% ethanol + 15 mg or 30 mg trinitrobenzene (TNB) was instilled into the colon, 7-9 cm proximal to the anus, inducing different degrees of inflammation. Fifty-five rats served as controls and had 0.25 ml saline instilled with the same procedure. At 7, 14, 21, and 28 days 3 ml of the non-ionic CM iodixanol was applied as an enema, and subsequently all urine was collected for the next 4 h. High-performance liquid chromatography analyses of the urine showed a positive relation between the severity of inflammation/ulceration in the colonic wall as assessed by a macroscopic damage score and the amount of CM excreted in the urine. Water-soluble contrast media may have prospects of combining functional tests of intestinal membrane dysfunction with segmental exposure control.

Factors predicting the outcome of intraarterial thrombolysis in peripheral arterial and graft occlusions.

PURPOSE: To determine the association between successful intraarterial thrombolysis and the following factors: sex, age, symptoms, duration of symptoms, length of occlusion, conduit type, runoff, and catheter localization. MATERIAL AND METHODS: Forty-six patients with acute or subacute occlusions of peripheral native arteries and grafts were treated with continuous intraarterial infusion of streptokinase or urokinase. A univariate chi-square test and logistic regression analysis were used. RESULTS: Successful lysis was achieved in 27 of 46 patients (59%). The logistic regression analysis revealed a significant association between successful thrombolysis and good runoff (p < 0.01). A catheter position above the occlusion resulted in lysis in only one of 11 patients. The variables rest pain and claudication were slightly significant (p = 0.07). None of the other variables were significant, but a trend toward a separate effect of duration of occlusion was found. CONCLUSION: Good runoff and intrathrombotic infusion are virtual necessities in obtaining a positive immediate outcome in peripheral arterial and graft occlusions. In our study, other factors were less important.

[Intra-arterial thrombolysis in peripheral bypass and arterial occlusions. Results and predictive factors for thrombolysis]. / Intraarteriell trombolyse ved perifere bypass- og arterieokklusjoner. Resultater og prediktive faktorer for trombolyse.

The purpose of the study was to reveal the association between successful intra-arterial thrombolysis in peripheral arterial and graft occlusions and the following factors: sex, age, symptoms, duration of symptoms, length of occlusion, conduit type, runoff and catheter localisation. Forty-six patients were treated with continuous intra-arterial infusion of streptokinase. Twelve patients were given tissue plaminogen activator (tPA). In the streptokinase-group successful lysis was achieved in 27 of 46 patients (59%). A significant association was found between successful thrombolysis and good runoff (p < 0.01). Catheter position above the occlusion resulted in lysis in only 1 of 11 patients. Lysis was achieved in nine of 12 patients (75%) treated with tPA. In this study, good runoff and intrathrombotic infusion were almost prerequisites for obtaining a positive immediate outcome. Other factors were less important.

Diagnosis of acute left-sided colonic diverticulitis by three radiological modalities.

PURPOSE: To compare the findings at US, CT and contrast enema (CE) with the clinical, biochemical, and surgical findings in patients with suspected acute left-sided colonic diverticulitis (ALCD). MATERIAL AND METHODS: The study comprised 32 consecutive patients hospitalized with clinically diagnosed ALCD. During the first 3 days of hospitalization, they were examined by US and CT of the pelvis and abdomen, and CE. RESULTS: Of the 32 patients, 21 had ALCD according to the combined radiological, clinical, biochemical and surgical findings. Findings compatible with ALCD were verified by radiological examination alone in 12 patients (4 patients at US, 10 at CT, and 6 at CE). In 9 patients, only diverticula or tethering was found at either CE or CT, and the diagnoses were then supported by clinical and biochemical findings and clinical follow-up. The most common clinical symptoms and signs associated with ALCD were left lower quadrant pain, left-sided tenderness, and fever. Most patients showed elevations of the white blood-cell count, erythrocyte sedimentation rate, and C-reactive protein, but there was no statistical difference in the stages of severity of ALCD, or between ALCD and other abdominal disorders. CONCLUSION: Radiological examination is valuable in confirming the diagnosis of ALCD. CT was the radiological modality that best demonstrated ALCD and revealed complications (e.g. pericolic abscesses) during the course of the illness.

Subintimal angioplasty in the treatment of patients with intermittent claudication: long term results.

OBJECTIVES: Reporting the long-term results of subintimal angioplasty (SA) in patients with intermittent claudication (IC). DESIGN: A prospective study. PATIENTS: One hundred and sixteen SA procedures were performed in 104 patients, from February 1997 to January 2000. METHODS: This is a prospective study of patients treated for IC with infrainguinal SA. Primary assisted patency rates were calculated, also on intention to treat basis. Univariate and multivariate Cox regression tests were used to assess whether patency was correlated with co-morbidities, run-off or occlusion length. RESULTS: There was no early mortality. Technical success was achieved in 101 cases (87%). Primary assisted patency rates on intention to treat basis (116 cases) at 6, 12, 36 and 60 months were 69, 62, 57 and 54%, respectively. For successfully recanalized patients (101 cases) these respective numbers are 79, 70, 66 and 64%. Length of occlusion, age and male gender were independent risk factors for reocclusion. CONCLUSIONS: The satisfactory results obtained in the present study are probably due to two main factors. First, the three participating radiologist are highly skilled and experienced. Secondly, a conscientious surveillance was adhered to, so that restenoses could be diagnosed and treated early. SA is a relevant alternative to bypass surgery in patients with disabling IC due to long femoro-popliteal occlusions. It is far less traumatic than conventional vascular reconstructions, complications are few and not serious. Very importantly, SA never interfered with later successful vascular surgery. Therefore, we have adopted SA as the primary treatment for patients with IC when medical treatment alone has not been satisfactory.

Outcome after catheter-directed thrombolysis of occluded prosthetic femoropopliteal bypasses. A prospective study.

PURPOSE: To evaluate the outcome after catheter-directed thrombolysis of occluded femoropopliteal prosthetic bypasses with the distal anastomosis above the knee. MATERIAL AND METHODS: Twenty-one patients were included in this prospective study. End-hole catheters, a bolus dose and continuous infusion of recombinant tissue-plasminogen activator (rt-PA) were used, with a median total dose of 10 mg (range 7-20 mg). RESULTS: With an intra-thrombotic position of the catheter, total or subtotal lysis was obtained in 19 of 21 patients (90%). No serious complications occurred. In 9 patients, the stenoses were successfully treated with balloon angioplasty (PTA, n=5), local thrombectomy/extension of bypass (n=3), or with a new bypass (n=1). After a median observation time of 18 months (6-24), 5 patients had open bypass. Re-occlusion occurred in all (6/6) bypasses in which no flow-limiting lesion was discovered, in all (4/4) bypasses treated twice with thrombolysis, as well as in all bypasses in which stenoses had not been adequately treated (3/3). One bypass re-occluded immediately due to poor runoff. CONCLUSION: In the present study, 19/21 infra-inguinal prosthetic bypasses were successfully treated with catheter-directed thrombolysis. However, re-occlusion often took place, especially in bypasses without flow-limiting lesions. If re-occlusion occurs in a bypass in which no stenoses were revealed during the primary thrombolysis procedure, a second catheter-directed thrombolytic treatment does not seem to be warranted. Our results confirm that treatment of flow-limiting lesions is a prerequisite for maintaining patency.

Late sequelae after meningococcal disease as related to anamnestic and clinical factors recorded during the acute illness.

In 71 males who survived acute meningococcal disease 3 to 15 years ago at an age of about 20, associations between acute clinical conditions (including a few pre- and post-admission variables) and late sequelae have been studied. There was a higher rate of sequelae symptoms (mainly light neurological and mental disturbances) among survivors from meningitis (76%) than among those who had had both meningitis and septicemia (58%) or pure septicemia (50%). Twenty percent of control persons experienced such symptoms. "Changed Life" because of serious educational and working problems followed in 29% of the meningitis cases and 70% of the septicemia cases. Most of the clinical and laboratory factors separately examined were not significantly correlated to the sequelae rates. However, less than 2.5 mmol/l glucose in the cerebrospinal fluid (CSF) on admission (p less than 0.01), more than 1000 X 10(6) white blood cells per 1 in the cerebrospinal fluid (p less than 0.05), fever for more than 8 days (p less than 0.05), and probable cerebral symptoms the first week (p less than 0.05), were all positively correlated to a high rate of late sequelae. Well documented early sequelae correlated with serious late sequelae (p = 0.05). No conspicuous associations between acute antibiotic treatment and late sequelae were found. A combination of CSF glucose, blood thrombocytes, and cells in CSF on admission yielded a multiple regression score which seems to be a moderately reliable predictor of sequelae (R = 0.46). Hospital treatment should both aim at avoiding death and escaping residual effects. Because many prognostic factors for sequelae on admission are different from those for lethality, scoring for sequelae may be helpful in such secondary prevention of sequelae. Early standardized registration of sequelae may also be of value in tertiary prevention.