Thermal manipulation during late embryogenesis: Effect on body weight and temperature, thyroid hormones, and differential white blood cell counts in broiler chickens.

The effects of thermal manipulation (TM) at 38.5°C and 40°C for 6 h at embryonic day (ED) 16, 9 h at ED 17, and 12 h at ED 18 on body weight (BW) and cloacal body temperature (Tb) during the first wk and later at post-hatch d 10, 14, 21, 28, and 42 were evaluated. Furthermore, chicks' ability to cope with a thermal challenge (TC; 41°C for 6 h) at post-hatch d 14 and 42 was also evaluated. A chick's response to TC was measured by determining the cloacal body temperature; the plasma thyroid hormones (thyroxin (T4) and triiodothyronine (T3)); the packed cell volume (PCV); the heterophil (H), lymphocyte (L), monocyte, basophil, and eosinophil percentages; and the heterophil-to-lymphocyte ratios (H/L). Thermal manipulation did not affect the hatchability. However, the body weight of TM chicken was higher compared with controls at marketing age (post-hatch d 42). At post-hatch d 14 and 42, no significant changes in Tb were observed among the different treatment groups. However, during TC at d 14 and 42, the Tb of TM chicks was lower compared with the controls. During TC, a significant increase in plasma T4 and a significant decrease in plasma T3 of TM chicks compared with controls were reported. Furthermore, during TC, a significant increase in the PCV and heterophil, monocyte, and H/L ratios, and a reduction in the lymphocyte percentages also were observed in TM chicks compared with the controls. Results of this study showed that chicks subjected to heat manipulation during late embryogenesis respond better to heat stress later in the growth and development period.

Geriatric hip fracture management: keys to providing a successful program.

BACKGROUND: Hip fractures are a common event in older adults and are associated with significant morbidity, mortality and costs. This review examines the necessary elements required to implement a successful geriatric fracture program and identifies some of the barriers faced when implementing a successful program. INTERVENTION: The Geriatric Fracture Center (GFC) is a treatment model that standardizes the approach to the geriatric fracture patient. It is based on five principles: surgical fracture management; early operative intervention; medical co-management with geriatricians; patient-centered, standard order sets to employ best practices; and early discharge planning with a focus on early functional rehabilitation. Implementing a geriatric fracture program begins with an assessment of the hospital's data on hip fractures and standard care metrics such as length of stay, complications, time to surgery, readmission rates and costs. Business planning is essential along with the medical planning process. CONCLUSION: To successfully develop and implement such a program, strong physician leadership is necessary to articulate both a short- and long-term plan for implementation. Good communication is essential-those organizing a geriatric fracture program must be able to implement standardized plans of care working with all members of the healthcare team and must also be able to foster relationships both within the hospital and with other institutions in the community. Finally, a program of continual quality improvement must be undertaken to ensure that performance outcomes are improving patient care.

Incidence and clinical significance of iliac vein compression.

OBJECTIVES: To determine the frequency of left common iliac vein (CIV) compression by the right common iliac artery (CIA) based on CT scan images. METHODS: CT scan images were reviewed and the diameter of CIV was measured at the area of minimal diameter and compared to the distal adjacent segment and the contralateral CIV at the same level. Medical records were reviewed for symptoms, deep vein thrombosis (DVT) and risk factors that might be associated with DVT. Data were analyzed with SPSS program using both Chi square and t test. A p < 0.05 was considered statistically significant. Linear regression (R2) was used to evaluate correlation. RESULTS: A total of 300 complete records were reviewed. The mean age was 51.89 years, with 126 (42%) males. Comparison between the two groups (>70% vs <70%) showed similar clinical factors such as history of DVT, surgery, immobilization, malignancy, limb trauma, pregnancy, obesity, CHF, and smoking. There were more females with CIV compression of 70% or more than males (19.5% vs 11.1% P < .049). CONCLUSION: Diameter stenosis more than 70% was present in 30.6% of cases with higher incidence in females. The presence of stenosis was not associated with the presence of clinical symptoms.

Celiac artery compression syndrome: a radiological finding without clinical symptoms?

The aim of the paper is to determine the incidence of celiac artery compression (CAC) based on computed tomography (CT) scan and correlate the findings to the clinical presentation of patients presenting for CT scan in a hospital. Abdominal CT scans of patients were reviewed between September 2010 and November 2010. CAC was diagnosed if the celiac axis appeared to have a hook or U-shaped appearance with stenosis. The medical records of the patients were reviewed for gastrointestinal symptoms (abdominal pain, nausea, vomiting, constipation, diarrhea), as well as food fear and weight loss. Patients with CAC had lower incidence of symptoms compared with those without CAC (42.1 versus 65.3%, P = 0.042). A total of 450 patients were evaluated. In the end, 284 had both complete medical records and CT scans. The mean age for all patients was 51.3 ± 1.2 years. There were 124 men (42.6%) and 160 (57.4%) women. Nineteen (6.7%) patients had radiological evidence of CAC. CAC is not an uncommon CT finding in patients presenting for CT scan.

Stent fracture in the brachiocephalic trunk.

Stents are commonly used as a tool for revascularization of different vascular beds in the body. However, many pitfalls have been reported with their use, such as thrombosis, migration, restenosis or fractures. The latter have been strongly correlated to in-stent restenosis with long-term follow-up. We report a rare case of an early stent fracture in the brachiocephalic trunk with in-stent restenosis and recurrence of symptoms. To our knowledge there has been only one case report of a delayed brachiocephalic stent fracture in the English literature. We believe that our case is the first report of an early stent fracture in the brachiocephalic trunk.

[Use of neurostimulation in a patient with an implantable cardioverter defibrillator (ICD)]. / Neurostimulation bei einer Patientin mit implantiertem Cardioverter-Defibrillator (ICD).

HISTORY AND ADMISSION FINDINGS: A 76-year old woman presented with a medically refractory chronic pain syndrome of her feet. The patient had a known stable peripheral arterial occlusive disease (PAOD, stage II according to Fontaine Classification). Walk and vessel training according to guidelines did not significantly improve her symptoms. The patient had a one-vessel coronary artery disease with previous myocardial infarction and intervention in the LAD in 2004. Due to the progression of the disease subsequent operative myocardial revascularization in a minimal-invasive LIMA-to-LAD followed 6 years earlier. Since that time, the patient reported an increasingly decrease in exercise capacity and dyspnea at low level of physical stress. CLINICAL INVESTIGATIONS: The patient was in a good general condition. The status after the operative myocardial revascularization showed no evidence for the progression of coronary heart disease. However, the electrocardiographic findings were currently impaired compared to preoperative findings. The left ventricular ejection function was severly restricted with diffuse hypokinesia of all segements of the left ventricle and enlargement of all cardiac chambers. A paradoxical septal motion emerged after surgery. Doppler and color Doppler examinations showed a mitral valve insufficiency I and tricuspid valve insufficiency I. TREATMENT AND COURSE: The medical treatment was intensified by additional treatment with torsemide 10 mg 2 × 1. The given diagnostic findings indicate the implantation of a defibrillator for primary prevention of sudden and arrhytmogenic cardiac death. Furthermore, a spinal cord stimulation (SCS) had a positive influence. Subsequently, a neurostimulator was successfully placed. No interaction could be detected after implantation or follow-up examinations after month 1 and 4. CONCLUSION: A therapeutic combination of an ICD and a neurostimulator to reduce pain is possible. Interferences may arise during the later follow-up.

Field evaluation of maternal antibody transfer to a group of pathogens in meat-type chickens.

This study was conducted to evaluate the rate of antibody transfer on a flock basis from hens to their day-old chicks in meat-type chickens raised in a commercial setting. Fifteen randomly selected hens from a commercial broiler-breeder flock were bled at 37, 40, and 45 wk of age. At day of bleeding, the collected eggs were identified and tracked through hatching where 30 hatchlings were randomly sampled and bled from the jugular vein. Antibodies against 10 different pathogens were quantified from the collected serum samples, and the percentage of maternal antibodies transfer was calculated from the chick antibody titer divided by the hen antibody titer. The results showed a significant variation in the rate of antibody transfer among the pathogens tested for. The transfer percentages were 4.3, 19.5, 25.5, 38.6, 73.6, 6.9, 32.4, 22.4, 29.2, and 32.8 for avian encephalomyelitis virus, avian influenza virus, chicken anemia virus, infectious bronchitis virus, infectious bursal disease virus, laryngotracheitis virus, Mycoplasma gallisepticum, Mycoplasma synoviae, Newcastle disease virus, and reovirus, respectively. The results of this work may be used in commercial farms to predict the antibody titer in day-old chicks as a function of their dams' antibody titers.

Interference between mild and pathogenic strains of infectious bursal disease virus in chickens.

Infectious bursal disease virus is a contagious, immunosuppressive disease of young chickens that is controlled by vaccination. Cross-protection occurs between different strains of the virus as a result of shared neutralizing epitopes. However, interactions between two antigenically similar strains (a mild and a pathogenic) coinfecting the same host have not been investigated. Groups of specific-pathogen-free chickens were inoculated with a mild strain followed by a pathogenic strain at 0, 16, 24, or 48 hr postinoculation (PI) with a mild strain. Virus persistence and the predominant strain of the virus were determined by reverse transcriptase-polymerase chain reaction and restriction fragment length polymorphism analysis, respectively, in bursas at 2, 4, 8, 14, and 21 days PI with the pathogenic strain. Severity of infection was assessed by the bursa/body weight ratios and histopathologic lesion scores. The mild virus interfered with replication of the pathogenic virus. The greatest interference was observed when the pathogenic strain was inoculated 24 hr PI with the mild strain. The interference phenomenon observed might be due to competition for host receptor sites or production of cytokine(s). This interference phenomenon could have practical implications for vaccine usage and protection.

Early colonoscopy in patients with acute diverticulitis: results of a prospective pilot study.

BACKGROUND AND STUDY AIMS: Outcomes following early colonoscopy in patients with acute diverticulitis have not previously been studied. The present study describes the effects of early colonoscopy in patients with acute diverticulitis. PATIENTS AND METHODS: Consecutive patients hospitalized for acute diverticulitis were included in the study. In the first phase, patients with adjacent peridiverticular air or fluid on computed tomography (CT) were excluded. In the second phase of the study, only patients with free intraperitoneal air were excluded. RESULTS: The study population consisted of 107 patients. During the first phase of the study, 49 patients were included; 10 were excluded because of peridiverticular air or fluid. The remaining 39 patients underwent uneventful colonoscopy. During the second phase of the study, 58 patients were included; four were excluded because of free air in the peritoneum. The remaining 54 patients underwent colonoscopy, and perforation of the sigmoid colon occurred in one patient with peridiverticular air. Complete colonoscopy to the cecum or to the obstructing tumor was achieved in 76 patients (81.7 %). A second colonoscopy performed 6 weeks later in 16 of the remaining 17 patients was successfully completed. Findings during the first colonoscopy were polyps in nine cases, polyp with infiltrating adenocarcinoma in one, obstructing adenocarcinoma in one, and a bone trapped in a diverticulum in another one. The latter two patients had a more protracted course and were clearly the ones who benefited most from the colonoscopy. CONCLUSIONS: Early colonoscopy in patients with acute diverticulitis may alter the working diagnosis and be of therapeutic value. The rate of cecal intubation is lower and the perforation rate appears to be higher. A clear-cut indication therefore has to be evident clinically.

Preperitoneal bupivacaine attenuates pain following laparoscopic inguinal hernia repair.

BACKGROUND: Laparoscopic preperitoneal inguinal hernia repair is associated with a short hospital stay and an early return to normal activity. Therefore, early postoperative pain control is important. The aim of this study was to evaluate the effect of preperitoneal Bupivacaine instilled into the preperitoneal cavity on pain following laparoscopic mesh repair of inguinal hernia. METHODS: After institutional review board approval, 44 patients undergoing elective laparoscopic inguinal hernia repair were prospectively randomized into two groups. Upon completion of the Prolene mesh repair, group A received 80 mg of Bupivacaine in 25 cc of saline installed into the preperitoneal space, whereas group B received normal saline installed into the preperitoneal space. Pain was assessed using a visual analog scale at fixed time intervals; the amount of analgesics required was also recorded. RESULTS: Twenty-two patients were included in each group. The demographic characteristics and type of surgery (unilateral vs bilateral) did not significantly differ between the two groups. The average pain levels were significantly attenuated in group A compared to group B at 1 (4.0 vs 5.0, respectively; p = 0.0038), 2 (4.0 vs 5.9, respectively; p = 0.0015), and 4 (4.3 vs 5.8, respectively; p = 0.0038) h after surgery. Furthermore, the analgesic intake was significantly decreased in group A compared to group B. CONCLUSION: Preperitoneal Bupivacaine attenuates pain following laparoscopic inguinal hernia repair and should be considered in these cases.

Effect of diffferent levels of maternally derived antibodies on protection against infectious bursal disease virus.

Fertile eggs were obtained from three different broiler breeder flocks with different levels of virus neutralizing antibodies to infectious bursal disease virus. Egg yolk from these flocks was tested for antibody titers by the virus neutralization test. Flock I eggs had no antibodies, flock II had medium level antibodies (1:200-1600; geometric mean = 1:975), and flock III had a high level of antibodies (1:1600-6400; geometric mean = 1:3365). Chicks from the above flocks were challenged each with 10(2) 50% embryo infective dose of the IN serotype 1 variant virus at 1, 2, and 4 wk of age and examined at 5 and 11 days postchallenge. The average organ/body weight ratios were calculated and statistically analyzed. Chicks with no maternal antibodies were not protected at any age. Chicks with medium levels of maternal antibodies were protected when challenged at 1 and 2 wk of age. Chicks with high levels of maternally derived antibodies were protected when challenged at all the ages tested. The above results were statistically significant (P < 0.05).

The impact of a resident's seniority on operative time and length of hospital stay for laparoscopic appendectomy: outcomes used to measure the resident's laparoscopic skills.

BACKGROUND: Laparoscopic appendectomy (LA) frequently is performed by residents during calls. This study aimed at evaluating residents' surgical skills using parameters of operating time, length of hospital stay (LOS), and conversion rate in correlation with the operating team's level of seniority. In addition, this study compared the operating time for LA with that for open appendectomy performed by the same teams, and identified deterministic factors that have an impact on such parameters. METHODS: All records of patients undergoing appendectomy performed by residents alone during a 32-month period were reviewed retrospectively. Eight residents were assigned to two levels of seniority: juniors 3 years (S). Operating time and LOS were compared between the three surgical teams, namely, J/J, J/S, and S/J as operating and assistant surgeons, respectively. Operating time, conversion rates, and LOS were compared for the same team combinations. RESULTS: Residents alone performed 341 (151 laparoscopic and 190 open) appendectomies during on-call hours. Four of the residents had been 3 years or less in residency (J), and four had been in residency more than 3 years (S). The overall mean operating time was 1.33 +/- 0.48 h for LA and 1.2 +/- 0.5 h for open appendectomy (p = 0.016). The operating time correlated with the level of training for both LA (J/J, 1.6 +/- 0.38 h; J/S, 1.41 +/- 0.37 h; S/J, 1. 25 +/- 0.4 h; p = 0.03, ANOVA) and open appendectomy (J/J, 1.53 +/- 0.89 h; J/S, 1.4 +/- 0.63 h; S/J, 0.86 +/- 0.45 h; p = 0.023, ANOVA). The mean LOS was 2.9 +/- 3.1 days for open appendectomy and 2.1 +/- 2.8 days for LA (p = 0.065), and was not different after operation by any of the teams (J/J, J/S, S/J) for either the open or the laparoscopic procedure. CONCLUSIONS: There is a distinct difference in the surgical skills of residents according to level of seniority, as primarily reflected by operating time. Laparoscopic appendectomy requires longer time to perform in a teaching setting, but the most deterministic factor that dictates operating time is the composition of the surgical team rather than the laparoscopic approach.

Pathogenicity, attenuation, and immunogenicity of infectious bursal disease virus.

An investigation was conducted in specific-pathogen-free chickens on the pathogenicity of bursa-derived and tissue culture-attenuated classic (STC) and variant (IN) serotype 1 strains of infectious bursal disease virus. The IN bursa-derived virus caused bursal inflammation, necrosis, and atrophy earlier than the bursa-derived STC virus. Both viruses lost their pathogenicity after four passages in BGM-70 cells. A statistically significant level (P < 0.05) of protection was observed in SPF chickens vaccinated with the attenuated IN virus used as a live or inactivated vaccine followed by homologous (IN) and heterologous (STC) challenge with bursa-derived viruses.

Traumatic pericarditis in an Awassi lamb.

A case of traumatic pericarditis in a 4-month-old Awassi lamb is reported. A 6 cm long metallic wire was found penetrating the pericardium and the left ventricle through to the other side of the ventricle wall. Fibrinous pericarditis, thickening of the pericardium, fusion of the pericardium and epicardium, and epicarditis were evident. The heart was enlarged with oedematous myocarditis and focal necrotic endocarditis involving the two ventricles. The liver and spleen were also enlarged with scattered 3 mm diameter granulomas.