Use of rotational periosteal flaps in primary repair of sinofacial fractures in seven horses.

Case history: Medical records were reviewed of horses (n = 7) undergoing surgery for fracture of one or more facial bones extending into the paranasal sinuses that was repaired primarily within 24 hours of the time of injury using a rotational periosteal flap, between April 2009 and May 2017. A kick from another horse was the cause of the injury of three horses, and one horse was injured when it collided with a tree. The cause of the injury of three horses was unknown.Clinical findings and treatment: Fractures were of the right maxillary bone in two horses, the left maxillary bone in two horses, the left frontal and left nasal bones in two horses, and the right frontal bones in one horse. The fracture of all but one horse was accompanied by an open wound. The fracture of all seven horses was reduced, stabilised, and covered with a rotational, periosteal flap. Surgery was carried out while standing in six horses, and while anesthetised in one horse. All horses had a deficit in the fractured facial bones after the fracture was reduced. Four horses had complications following surgery, but all horses were reported to have excellent cosmetic outcomes and had retuned to their previous level of activity, as reported by their owners.Clinical relevance: Covering a primarily repaired sinofacial fracture of a horse with a rotational periosteal flap resulted in good cosmetic outcomes, and may be especially beneficial if the fracture is accompanied by loss of bone.

Groin pain and soccer players: male versus female occurrence.

AIM: Groin pain is common in soccer players. Comparison of results from different studies, especially between genders, is difficult as studies use different definitions and data collection procedures. Therefore we conducted a study of both male and female soccer players enabling direct gender comparison. METHODS: The study enrolled 479 male soccer players aged 25 years (17-43) (mean with range) and 144 female soccer players aged 23 years (16-47), who answered a mailed questionnaire that included specific questions on groin pain and sports history. Data are presented as proportions (%) or as mean with 95% confidence intervals (95% CI). RESULTS: Groin pain was experienced by 55% of male soccer players and 28% of female soccer players, resulting in an odds ratio (OR) of 2.9 (95% CI 1.9, 4.5). Groin pain occurred more often in the preseason, than during the rest of the season in both male and female players (both P<0.001). Playing position in the team or playing league did not seem to influence the risk of suffering groin pain. CONCLUSION: In soccer players, male gender and preseasonal training appear to be risk factors for developing groin pain.

Diabetes and radiocontrast media increase endothelin converting enzyme-1 in the kidney.

Plasma endothelin-1 levels rise in diabetes and after exposure to contrast media suggesting a role in progressive diabetic and acute radiocontrast nephropathies. Here we studied individual and combined effects of streptozotocin-induced diabetes and contrast media on renal endothelin converting enzyme-1 levels in the rat. In vivo, medullary (but not cortical) endothelin converting enzyme protein gradually increased 4 to 5-fold following the induction of diabetes or after the administration of contrast media but rose 15-fold when diabetic rats were given contrast media. Changes in mRNA expression paralleled those of the protein. Immunohistochemistry confirmed that increased tubular and endothelial cell endothelin converting enzyme-1 were most pronounced in the medulla. In vitro, endothelin-1 levels increased 3-fold following incubation of endothelial cells with media high in glucose or with contrast and 4-fold with their combination. Endothelin converting enzyme-1 protein and mRNA expression changed in a similar pattern while prepro endothelin-1 mRNA increased with each insult but not in an additive way. Our study shows that diabetes and contrast media up-regulate renal medullary endothelin converting enzyme-1 expression and synthesis.

Agreement among three different equine venipuncture sites with regard to measurement of packed cell volume and total solids.

The primary objective of this study was to determine the agreement between the packed cell volume (PCV) and total solids (TS) values in blood collected from the jugular vein (JV) in comparison with the cephalic vein (CV) and the transverse facial venous sinus (TFVS) in healthy adult horses. A total of 72 samples were taken from 24 horses. We found high agreement that reflects no clinically relevant differences between the PCV and TS values obtained from the CV or the TFVS in comparison with the JV in standing healthy adult horses.

Foscarnet induction therapy for cytomegalovirus retinitis in AIDS: comparison of twice-daily and three-times-daily regimens.

We have evaluated the effects of induction therapy with foscarnet 100 mg/kg b.i.d. via i.v. infusion in 60 AIDS patients with cytomegalovirus (CMV) retinitis and compared the findings with those in 37 such patients receiving a foscarnet induction regimen of 60 mg/kg t.i.d. via i.v. infusion. Induction therapy was given for at least 3 weeks, with the treatment period being extended in cases of slow resolution of retinitis. There was no significant difference between response rates in the two groups, with ophthalmologic response being observed in 52 (96%) of 54 evaluable b.i.d. patients and 33 (97%) of 34 evaluable t.i.d. patients over mean durations of therapy of 26 and 27 days, respectively; complete and partial responses were observed in 91 and 6%, respectively, of b.i.d. patients and 85 and 12%, respectively, of t.i.d. patients. Foscarnet was discontinued because of adverse events in 3 (3%) of 97 patients, with treatment being stopped in 2 patients because of renal insufficiency and in 1 patient because of an acute neurologic disorder. Serum creatinine concentrations increased significantly in both the b.i.d. group (from 82 to 98 mumol/L, p less than 0.01) and the t.i.d. group (from 73 to 122 mumol/L, p less than 0.001), with the difference between increases not being statistically significant. Serum creatinine concentrations greater than 200 mumol/L were observed in two b.i.d. patients and four t.i.d. patients; in four cases, concomitant medications or conditions contributed to renal impairment. Hypocalcemia of less than 1.75 mmol/L occurred in 18% of b.i.d. patients and 28% of t.i.d. patients during treatment (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro and in vivo effects produced by the immunomodulating agent RU 41740 on human polymorphonuclear leukocytes in the elderly.

The activity of RU 41740, a glycoprotein extract from Klebsiella pneumoniae has been investigated on some polymorphonuclear (PMN) functions. Chemotaxis, random migration and oxidative metabolism (assessed by chemiluminescence, O2 consumption and O2- generation) were studied in parallel. PMN were collected from adult and aged human volunteers. Experiments were performed either in vitro or in vivo in a double blind placebo assay. In both PMN populations RU 41740 enhanced oxidative metabolism either in in vivo or in vitro experiments. However, a higher and dose-related activity was observed on PMN collected from the younger subjects whereas maximal effective concentration was reached earlier with PMN collected from aged subjects. RU 41740 did not modify random migration but inhibited chemotaxis of PMN collected from the younger population in a dose-related manner. These data corroborated previous results observed on PMN collected from various animal species and suggested an interaction of RU 41740 on PMN membrane. Moreover drug-induced macrophage and lymphocyte stimulation might also explain, at least in part, the in vivo effects described in this study. Thus RU 41740 could partly account for the protective effects exerted against bacterial and fungal infections through its activity on PMN functions.

Clinical trials with C 1740, an immunomodulator compound proposed for prevention of acute infectious exacerbations in chronic bronchitis.

C 1740 is an immunmodulating agent of biological origin proposed for the prevention of infectious exacerbations in chronic bronchopathy. The first placebo-controlled double-blind randomized clinical trials have led to opposite conclusions regarding the utility of C 1740. The rate of infectious exacerbations in the placebo group and a large Type II error could explain the "negative clinical trials". However, two out of four "positive clinical trials" were associated with high risk of falsely positive results. The activity of C 1740 is discussed here.

[Long-term clinical tolerance of antihypertensive treatment during the HOT study. Groupe français de l'etude HOT]. / Tolérance clinique à long terme du traitement antihypertenseur au cours de l'étude HOT. Groupe français de l'etude HOT.

The objective of the HOT study, an international, prospective, randomised study is to determine the optimal level of the blood pressure under treatment, in linked with the lowest cardiovascular mortality and morbidity. The target diastolic blood pressure of 80, 85 and 90 mmHg was determined at the randomisation. In order to reach the target blood pressure, a strategy of treatment was determined: the 1st step was felodipine (a long acting dihydropyridine) and the next steps (if the blood pressure reduction is not enough) propose the addition of different therapeutic classes and/or the increase of each drug doses. The available data after 2 years of the patients follow-up allow us to evaluate the incidence of the reported side effects according to the target blood pressure assigned by randomisation and the number of hypertension drugs used to reach these targets. The percentage of patients with at least one side effect at 12 and 24 months of follow-up are respectively: for the target group DBP < or = 90 mmHg: 9.2% versus 6%; for the target group DBP < or = 85 mmHg: 8% versus 4.4%; for the target group DBP < or = 80 mmHg: 7.9% versus 4.9%. The overall tolerability is not influenced by the target diastolic blood pressure but depends on the number of hypertension drugs used. At 24 months, 2.8% of patients are under monotherapy; 7% under bitherapy and 9.8% under tritherapy. The incidence of the side effects decreases after the 1st year, but slower than between the third months and the first year. There is an influence of the region on the incidence of the side effects, the south European countries describing more side effects than France or the north European countries. This seems to be linked with a perception of the side effects more than with a higher rate. In conclusion, these results confirm the possibility to reach a targeted blood pressure using a predetermined strategy without increasing dramatically the incidence of the side effects.

[HOT study: quality of the blood pressure control after 2 years follow-up. Pour le Groupe français de l'étude HOT]. / Etude HOT: qualité du contrôle tensionnel après 2 ans de suivi des patients. Pour le Groupe français de l'étude HOT.

UNLABELLED: The objective of the HOT study, an international, prospective, randomised study was to determine the optimal level of the blood pressure under treatment, linked with the lowest cardiovascular mortality and morbidity. The target diastolic blood pressure of 80, 85 and 90 mmHg was determined at the randomisation. In order to reach the target blood pressure, a strategy of treatment was predefined: the 1st step was felodipine (a long acting dihydropyridine) and the next steps (if the blood pressure reduction was not enough) proposed the addition of different therapeutic classes and/or the increase of the doses of each drug. The blood pressure measurements were made, using the oscillometric method (automatic blood pressure measuring device, Hestia). The quality of the blood pressure control observed in the HOT study was verified after 6 months of follow-up ("Quality of the blood pressure control in the clinical practice and in the HOT study", for the French research group of the HOT study. French hypertension meeting, Paris, December 1994). The aim of this second evaluation was to see if the quality of this control was still effective in France and for all countries after 2 years of follow-up. At the inclusion, the mean diastolic blood pressure was 106 +/- 4 mmHg in France (n = 1.574) and 105 +/- 4 mmHg for all countries (n = 18.790). The results at 24 months were the following, according to the target groups: 79.9 for the < or = 80 mmHg target group; 82.1 for the < or = 85 mmHg target and 83.6 for the < or = 90 mmHg target group. The percentages of patients who reached the target blood pressure were respectively 74; 80; 89% for the 3 target groups. The number of antihypertensive treatments needed to reach this blood pressure control slightly increased in the 3 target groups between the first and the second year with a lower rate of monotherapy and a higher rate of bi and tritherapy. But in the 80 mmHg target group (the most strict), the monotherapy was used in more than half of the patients. In comparison with all countries, France had lower number of bi and tritherapies (i.e. in the 85 mmHg target group: 38.4% of bitherapy in France versus 45.6% in all countries). CONCLUSION: after 2 years of follow-up, the quality of the blood pressure control is still good. There is a trend toward a slight increase in the number of antihypertensive drugs after the first year in the 3 target groups.

A single blind normal volunteer bioavailability study of a new microencapsulated potassium chloride tablet compared with two reference potassium formulations.

A single blind placebo controlled, cross-over study comparing a new microencapsulated potassium chloride tablet (MET) with two reference formulations of oral potassium, potassium chloride solution (PS) and potassium chloride wax-matrix tablets (WMT), was performed in 12 normal healthy volunteers. Urinary potassium excretion was the main criterion of comparison. Results showed that all three formulations have excellent bioavailability. This indicates that potassium absorption in the stomach is similar to that in more distant portions of the gut. The slow-release characteristics of both MET and WMT were confirmed. Clinical and pharmacological tolerance was excellent and no side-effects were reported with any of the potassium formulations studied.

[Pre-clinical and clinical electrophysiological studies for the prediction of iatrogenic proarrhythmic effect (torsade de pointes)]. / Etudes électrophysiologiques pré-cliniques et cliniques en vue de la prédiction d'un effet proarythmique (torsade de pointes) iatrogène.

The risk of drug-induced torsade de pointes, a potentially lethal ventricular arrhythmia, raises the problem of the early detection of the effects of any new chemical entity (NCE) on ventricular repolarization since prolongation of myocardial repolarization is a major trigger among others (hypokalaemia, bradycardia, congenital abnormalities in cellular ionic channels) for this arrhythmia. During pre-clinical studies, the effects of a range of concentrations (10(-9) M to 10(-4) M) of NCE on the duration of the action potential of Purkinje and left ventricular myocardial cells (guinea-pig and rabbit) have to be measured. If these effects are present, the duration of QT interval on ECG recorded in animal studies (dogs) has to be carefully measured and correlated with plasma concentrations of NCE and/or its metabolite(s). During clinical trials, additional studies have to be performed in order to document QT interval-plasma concentration relationships and the influence of heart rate on QT interval duration. Ambulatory ECG recordings will attest to the safety of the NCE and precautions for use of the drug will be established according to our knowledge of predisposing factors for a proarrhythmic effect. Should there be a notification of a case of torsade de points after a new drug has been launched, urgent consultations with the drug file will be necessary in order to assess which pre-clinical and clinical studies may be needed for a better evaluation of the benefit/risk ratio of the new drug.

[Evaluation of unexpected and toxic effects of omeprazole (Mopral) reported to the regional centers of pharmacovigilance during the first 22 postmarketing months]. / Bilan des effets inattendus et toxiques de l'oméprazole (Mopral) rapportés aux centres régionaux de pharmacovigilance, au cours des 22 premiers mois de commercialisation.

Omeprazole has been marketed in France since 1989, for the healing of peptic ulcers, erosive reflux esophagitis and the Zollinger Ellison syndrome. It is a proton pump inhibitor which inhibits the acid secretion in the stomach. In the majority of the clinical trials, omeprazole has been found to be well tolerated: headache, dizziness, skin rash, constipation have just been noted. Since September 1989, 143 adverse reactions have been reported to pharmacovigilance centres and Astra France: 37 neurological and psychiatric side effects, especially confusion in patients with hepatic diseases and/or advanced age; 35 cutaneous reactions, generally rash and urticaria; 22 hematological effects: leucopenia and agranulocytosis have been reported but the relation with omeprazole is very uncertain; 10 gastrointestinal effects, generally diarrhoea, nausea, vomiting and abdominal pain; 8 hepatic disorders, especially moderate elevation of aminotransferases. This study confirms the safety of this drug, during short treatment; the frequency of notified adverse effects is about 1/12 200 treatments of 4 weeks. The ministry of health, has decided, in november 1991, to inform the prescribers of this potential toxicity of omeprazole, particularly, of the risk of confusion, hepatotoxicity and leucopenia.

[Choice of a statistical test in a clinical or therapeutic study]. / Le choix du test statistique lors d'une étude clinique ou thérapeutique.

The results of clinical trials are only valid if the right statistical test for the type of study performed is applied. The authors suggest a method, accessible to all physicians, that should facilitate the choice between various tests and enable the readers of clinical trial papers to detect errors in the presentation of the results. Starting from an answer to four questions (what kind of data is investigated, how many samples are studied and are they independent, and what is the purpose of the study?) the mental process is developed in the form of a flow chart, each terminal branch of which leads to the correct statistical test or tests.

[Surgical treatment of Basedow's disease. I--Traditions and new methods in preparation for thyroidectomy: use of dexamethasone]. / Traitement chirurgical de la maladie de Basedow. I--Traditions et nouveautés dans la préparation à la thyroïdectomie: utilisation de la dexaméthasone.

The combination of dexamethasone (2 mg every 6 hours) carbimazole (15 mg every 8 hours) and potassium iodide (XV drops every 8 hours) has been proposed in the preparation of 21 patients with hyperthyroid Graves' disease for surgery. The combination was administered for 6 days and the subtotal thyroidectomy was performed on day 7. All patients had normal serum Triiodothyronine levels after 4 days of such treatment. This combined drug therapy appears to be a rapid, sage and effective preparation for thyroid surgery in patients with Graves' disease and should replace conventional preparation with carbimazole and potassium iodide and beta-blocker preparation in all cases where there are no contra-indications to the use of corticosteroids.